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ItemPrevalence and associated factors of post traumatic stress disorder among ambulance personnel, Kampala, Uganda.(Makerere University, 2025)Background: Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can result from exposure to traumatic incidents, particularly among Emergency Medical Services (EMS) personnel. These individuals, especially ambulance workers, face high risk due to repeated exposure to traumatic events such as road traffic accidents, violence, and mass casualties. While international studies have documented PTSD prevalence in EMS workers, there is limited empirical data specific to Uganda, despite the country’s growing trauma burden. Objective: This study aimed to determine the prevalence of PTSD and associated risk factors among ambulance personnel in Kampala, Uganda. Methods: A cross-sectional study was conducted among ambulance workers operating in Kampala. Data were collected using a structured questionnaire incorporating the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics, bi-variate analysis, and multivariate logistic regression were used to identify factors associated with PTSD. Results: Among the 121 ambulance personnel studied, 27 (22.3%) were found to have post traumatic stress disorder (PTSD), based on PCL-5 scores ≥33. Key factors significantly associated with PTSD included profession and family history of mental illness. Emergency medical technicians/paramedics had 85% lower odds of PTSD compared to ambulance drivers (AOR = 0.15, 95% CI: 0.03–0.68, p = 0.040). Personnel with a family history of psychiatric illness had a 5.3-fold higher odds of PTSD (AOR = 5.33, 95% CI: 1.14–24.86, p = 0.033). Conclusion: PTSD is prevalent among ambulance personnel in Kampala and is driven by occupational, personal, and organizational factors. These findings highlight the urgent need for structured mental health support, policy-level interventions, and workforce protections tailored to the Ugandan EMS context.
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ItemResection rates and predictors of resectability of pancreatic tumors at mulago hospital, a retrospective cross sectional study(Makerere University, 2025)Abstract Background: Pancreatic tumors are highly lethal, ranking 12th in global incidence and seventh in cancer-related mortality. Surgical resection remains the only potential cure, improving 5- year survival from 9–17.5%. However, in low-income countries, most patients present with advanced disease, limiting surgical eligibility. Accurate preoperative assessment using clinical, biochemical, and radiological factors is essential for identifying candidates likely to benefit from surgery. This study evaluated predictors of resectability of pancreatic tumors at Mulago National Referral Hospital, MNRH. Methodology: A retrospective cross-sectional review of 100 patients admitted with pancreatic tumors at MNRH between January 2021 and December 2024 was conducted. Data included clinical symptoms such as jaundice, abdominal pain, and weight loss, biochemical markers including CA 19-9, CEA, hemoglobin, and bilirubin, and radiological findings such as tumor location, size, lymph node involvement, metastases, and vascular invasion. Preoperative resectability and operative outcomes were documented. Associations between predictors and resectability were analyzed using chi-square and multivariate logistic regression, with significance set at p < 0.05. Results: The overall resection rate was 21%. While 55% were deemed resectable on imaging, 61.8% were found intraoperatively to be unresectable, largely due to vascular invasion and distant metastases. Most tumors arose in the pancreatic head, 92%, and 51% of patients presented with late-stage disease. On univariate analysis, tumor size greater than 4 cm, lymph node involvement, and metastasis were associated with irresectability. In multivariate analysis, only tumor size greater than 4 cm remained an independent predictor with an adjusted odds ratio of 0.054, 95% confidence interval 0.015–0.193, and p < 0.001. Other factors, including CA 19-9, CEA, hemoglobin, and tumor location, were not significant. Conclusions: The majority of pancreatic tumors at MNRH were unresectable at surgery despite favorable preoperative imaging. Tumor size less than 4 cm was the only independent predictor of resectability. Enhanced imaging and incorporation of tumor size into preoperative evaluation may improve surgical decision-making and outcomes.
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ItemPrevalence and factors associated with treatment delay among colorectal cancer patients at MNRH and UCI- a cross sectional study(Makerere University, 2025)Background: Colorectal cancer (CRC) is an important cause of morbidity and mortality in Uganda. Timely treatment initiation is critical for outcomes, yet delays are common. This study assessed treatment delays and associated factors among CRC patients at Mulago National Referral Hospital (MNRH) and the Uganda Cancer Institute (UCI). Objective: To determine the diagnosis to treatment interval (DTI), prevalence of treatment delay, and the associated patient and clinicopathologic factors among CRC patients. Methods: A hospital-based cross-sectional study was conducted among 67 patients with histologically confirmed CRC between December 2024 and May 2025. Treatment delay was defined as >31 days between histological diagnosis and first oncologic treatment. Data were collected through interviews and record review. Descriptive statistics summarized demographics and clinical characteristics. Bivariate Poisson regression with robust variance estimation identified factors associated with delay; variables with p<0.20 entered a multivariable model. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were reported. IRB approval was obtained (Ref: Mak-SOMREC-2024-1048). Results: The mean age was 50.5 years (SD: 15.1); 55.2% were female, and 71.6% (n=48) had advanced-stage disease (Stage III/IV). The median DTI was 53 days (IQR: 25–95), with 70.1% (n=47) experiencing delays. Median DTI by treatment: chemotherapy 53 days, radiotherapy 79 days, surgery 14 days. While late-stage disease, comorbidities, and long travel distances showed trends toward delay, only socioeconomic status (SES) was significant. Patients with high SES vulnerability (score ≥4) had 34% higher prevalence of delay (PR=1.34, 95% CI: 1.01–1.78, p=0.042). Conclusion: Most CRC patients experienced treatment delays which were widespread and occurred across all categories; regardless of distance to the treatment facility, clinical status, or disease severity. Socioeconomic disadvantage was the only independent predictor, underscoring the role of structural and financial barriers in timely care. Targeted, context specific interventions are urgently needed to reduce delays and improve outcomes.
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ItemProfile and associated factors of challenging behaviour in Children with developmental disabilities in Mulago national referral hospital.(Makerere University, 2025-12-17)Introduction: Approximately half of individuals with developmental disabilities (DD) exhibit some form of challenging behaviour (CB), with 5–10% displaying very severe behaviour. This behaviour is often associated with age, severity of the disability, and comorbid medical or developmental conditions. However, there is limited research on challenging behaviour among children with developmental disabilities in low-resource settings.Study aim: To profile and assess factors associated with challenging behaviour in children with developmental disabilities attending Mulago National Referral Hospital.Methods: A cross-sectional study was conducted among children aged nine years and below with DD and their primary caregivers in fourteen weeks. Data collected included sociodemographic characteristics (socio-demographics’ questionnaire), types of CB(ABC), clinical features (medical records), primary caregiver coping strategies (Brief-COPE), and perceived social support (MSPSS). Data were analysed using SPSS version 26.0, Excel, and STATA version 16.0. Sample characteristics were described using frequencies, percentages, means and standard deviations. Associations between dependent and independent variables were examined using Chi-square tests at the bivariate level and structural equation modelling at the multivariate level.Results: 295 children and their primary caregivers were enrolled. Most children were male (64.1%), aged more than 5 years (36.3%), not attending school (70.5%), and from Uganda’s central region (56.6%). Over half (57.6%) exhibited challenging behaviour. Three categories of challenging behaviour were identified: (1) hyperactivity, inattention, and disruptive behaviour; (2) social withdrawal and isolation; and (3) self-injurious behaviour. Challenging behaviour was significantly associated with the child’s age (p = 0.007), number of developmental disabilities (p = 0.019), primary caregiver’s education level (p < 0.001) and coping strategies (p = 0.005).Conclusion: Challenging behaviour is common among children with DD and is associated with their age, number of DD, primary caregiver education and coping strategies. Routine screening for CB among children with DD and appropriate management strategies are recommended for better outcomes.
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ItemAssessment of the quality of perinatal care and development of an improved model to reduce perinatal deaths in Bunyoro Sub-Region, Uganda.(Makerere University, 2025-04-20)Background: Perinatal mortality, a key indicator of healthcare quality, remains high worldwide. To address this, effective antenatal, intrapartum, and postnatal care in facilities is essential. The World Health Organization has established standards and recommendations to enhance care quality. However, sub–Saharan Africa continues to struggle with providing effective care to women. Efforts to close this quality gap are complicated by contextual factors, necessitating the adaptation of individual evidence-based interventions to local context. This study assessed the perinatal care quality, and developed an improved, context specific model to reduce perinatal deaths in public general (district) hospitals. Methods: A convergent parallel mixed-methods study was conducted in Masindi, Kagadi, and Kiryandongo districts, involving early postpartum women at discharge, maternal healthcare providers, facility managers, and district health officers. The study had two phases: the formative phase assessed health facility structures and processes, prevalence and associated factors of inappropriate perinatal care, the relationship between perinatal care and perinatal deaths, and the experiences of women and providers. Findings from this phase informed the development of a context-specific quality of perinatal care model using a modified Delphi technique. Quantitative data were collected using pre-tested questionnaires, observation checklists, and data extraction tool, and analysed using descriptive statistics and Poisson regression, compared against WHO standards. Qualitative data were gathered through in-depth individual interviews and focus group discussions, analysed using inductive thematic analysis. Results: The health care provider to women ratio in antenatal and maternity units was low (1:72 and 1:60 for doctors; 1:29 and 1:7 for midwives). The mean availability of basic equipment in the perinatal units was 76.2%, with the postnatal unit having the least (22.2%). Medicines and supplies were available at 66.7% while amenities were at 81.3%. Bed density was 6.6 beds per 1,000 pregnant women, with no designated waiting space for labouring women or leadership in the obstetrics and gynaecology department. Most staff (98.2%) were supervised during care but refresher trainings occurred only once in a year for 69.2%. Receiving units were not notified about referrals (64.8%), and patient care records were predominantly paper based (98.2%), with 40.7% recorded in exercise books/papers. Documentation of medications and physical assessment findings was also low (46.3% and 55.6% respectively). The majority of women received inappropriate care during the antenatal (99%, CI 0.00-0.00), intrapartum (79.1%, CI 0.00-0.01), and postpartum (91.2%, CI 0.00-0.01). Older women were more likely to receive inappropriate care (adjusted prevalence ratio [aPR] = 11.9, 95% Cl 2.8-51.4, p=0.001), while those with more than three children were less likely to receive it (aPR=0.3, 95% CI 0.1–0.8, p=0.018). There were 19 perinatal deaths, resulting in a perinatal mortality rate of 22/1,000 births (95% CI 8.1–35.5). Perinatal death was significantly lower in women whose fetal status were examined during antenatal (aPR=0.22, 95% CI 0.1–0.6, p=0.01). Three themes emerged from the client provider experiences: good care provision, receiving information about care, and provider and client satisfaction. There were feelings of inadequacy regarding facility structures and differing perspectives on facility processes. To develop a context specific quality of perinatal care model, five structural interventions were identified including financing, staffing, physical infrastructure, leadership, and equipment, supplies, and diagnostic tests. Additionally, four process interventions were identified: continuing professional development system, care transition, coordination, and continuity. Conclusions: The region faces inadequate resources and support for women’s care transitions and continuity which hinders adequate perinatal care provision, resulting in care below the WHO standards during antenatal, intrapartum, and postpartum. Although the perinatal mortality rate was high, it was lower than the national average and reduced among women whose fetal status was examined during antenatal care. Despite receiving inappropriate care, women reported positive experience, contrary to that of health care providers. This study highlights the need to implement targeted structural and process interventions focusing on financing, staffing, leadership, and enhancing continuing professional development and care transitions. We recommend that policy makers allocate the required resources based on the population served, adapt WHO recommendations for perinatal care, and enable hospitals to adopt sustainable strategies for quality improvement. Hospitals should establish clear referral and care documentation systems while empowering women and staff regarding the recommended perinatal care. Health care professionals must enhance their training on the recommended perinatal care and establish strong communication channels for effective referrals and continuity of care. Additionally, further research is needed to assess the effectiveness of these proposed interventions.