Introduction: Major abdominal surgery is still a great contributor to postoperative morbidity and mortality in developing countries. Major abdominal surgery, through tissue manipulation and the physiological stress it causes, leads to hypoperfusion. Hypoperfusion has an impact on postoperative morbidity and mortality warranting the need for its early recognition. Lactate, an anion capable of being used to detect hypoperfusion, is under utilized in Uganda. As a result its capacity of being a prognostic tool in patients following abdominal surgery is unknown. Objective: To investigate the association between elevated serum lactate and outcomes (in-hospital mortality, SSI and length of hospital stay) in patients following major abdominal surgery at MNRH. Methodology: A prospective observational cohort study. A total of 246 eligible patients with a diagnosis leading to major abdominal surgery were recruited. Stratified sampling with consecutive sampling in the sub groups was done till desired sample size was achieved. Demographic and perioperative data were collected serum lactate levels were measured at induction and immediately after surgery with serial measurements being done after 12, 24 hours post operatively. Participants were followed up to assess outcomes i.e in-hospital mortality, Surgical Site Infections (SSI) and length of hospital stay. Data analysis was done using STATA version 14.0. Results: A total of 130 patients (52.8%) had elevated serum lactate levels. Elevated serum lactate predicted in-hospital mortality and surgical site infection. The accuracy of elevated serum lactate to predict mortality with AUROC of 0.7898 was exhibited by the 24 hour lactate values. Elevated serum lactate predicted surgical site infection accurately with AUROC 0.6432. Length of hospital stay is strongly associated with elevated serum lactate with p-value of 0.043. Patients with elevated serum lactate on average have a longer length of hospital stay at 5.34±0.69. Conclusion: Elevated serum lactate was associated with in-hospital mortality, surgical site infection and longer length of hospital stay. Serum lactate levels done at 24 hours were most predictive mortality and surgical site infection compared to the other perioperative serum lactate levels. Through intravenous fluid administration, lowering of serum lactate levels was associated with improved outcomes.

At Birunga Dairy Industry, due to less attention given to inventory management, there are usually cases of solid waste accumulation mainly the used boxes, packaging material, used bottles and others. Therefore a solid waste audit was conducted to identify what are the major solid wastes, how are they accumulated and which expense they cause to the dairy. A number of steps were followed in audit conduction to full capture the required information According to the research, the major solid wastes identified were the boxes and the packaging materials plus metal losses. The monetary value of the wasted solid wastes was in a range of 5-8 millions /year considering an even production. However, the rate of loss is dependent of the number of productions, machine stability and store management practices. A number of recommendations were brought to the tale in order to bring down the losses and the wastage through proper inventory management and recycle of boxes.

Background: According to World Health Organization (WHO), Traumatic Brain Injury (TBI) is a leading cause of sudden death and disability amongst young people. About 28% of children managed from Mulago national Referral Hospital (MNRH) report some form of disability 1 year post injury. While studies elsewhere have demonstrated deficits in the psychosocial outcomes in children with TBI, there is limited work to this effect in Mulago. We aimed to establish the psychosocial outcomes, especially school performance, emotional and social outcomes of children following TBI, and hence provide insight into the rehabilitative needs of these children. Objective: To determine the psychosocial outcomes and associated factors in children managed for TBI in MNRH Methods: This was a cross sectional study carried out in the Neurosurgical unit of MNRH, Uganda. Following ethical approval from the Makerere School of Medicine Research Ethics Committee, caretakers of children of 6 years to 17 completed years of age previously managed for TBI in MNRH between 2017 to 2018 were contacted and invited to be part of the study. A PedsQL questionnaire parent-proxy was administered to them. Data collected were analyzed using STATA version 14.0. Linear regression was used to determine factors associated with psychosocial outcomes. P values less than 0.05 were used. .Results: A total of 116 children were included in the study. The overall mean psychosocial outcome of this sample was 82 (SD = 22.74). Using one SD below the mean score as the cut-off standard for at risk status for poor psychosocial function, 85.7% of the children had good psychosocial function, while 14.3% had poor psychosocial function. Longer time of two years post TBI (adjusted β = 1.36, p=0.012) and absence of concurrent injuries ( adjusted β= 0.30, p=0.025)were positively associated with psychosocial function, while TBI severity was negatively associated with psychosocial function TBI (adjustedβ= -0.36, p=0.041). Conclusion: Children managed for TBI in MNRH continue to have psychosocial sequelae 1 -2 years following injury. Care from child psychologists, behavioral therapy, and rehabilitative services may be beneficial to children with severe deficits, so as to improve their quality of life. Key words: traumatic Brain Injury, Psychosocial outcome.

Introduction: Adolescent pregnancies are high risk pregnancies and pose severe obstetric risks to the mother and her baby. Repeat adolescent pregnancies present an extension of the obstetric risks, both in the short and long term. Despite the associated public health concerns about repeat adolescent pregnancy, they remain a common occurrence and so does the associated comorbidities. Family planning provision is aimed at reducing the occurrence of repeat pregnancies especially in this age group. The study sought to determine the uptake and associated factors of postpartum family planning among adolescent mothers at Kasangati Health Center IV. Methods: We conducted a cross-sectional study among adolescent mothers who were within their first two years of the postpartum period between February and March, 2020. Enrolment sites included the postnatal clinic, young child and immunisation clinic, exposed infant clinic and the outpatient department. We used an interviewer administered questionnaire to capture data on participant social and clinical characteristics. All data were entered into Epi Data and exported to STATA for analysis. Uptake was expressed as a percentage. Bivariate analysis was done using Chi squares to identify factors associated with uptake of postpartum family planning. Multivariate logistic regression was done to establish the factors independently associated with uptake of postpartum family planning. Findings: A total of 230 mothers were enrolled. Postpartum family planning uptake was found to be 52.6% (95%CI=50.0-55.2) and the CPR was 57% (95%CI=54.5-62.1). Significant associated factors included: Cohabiting or married at delivery (AOR=0.05, 95% CI=0.01-0.27), lack of antenatal and postnatal family planning counselling (AOR=0.15, 95% CI=0.05-0.48) and (AOR=0.03, 95% CI=0.01-0.06), respectively, and also no history of family planning use in sexual debut (AOR=0.32, 95% CI=0.19-0.53). These reduced the odds of postpartum family planning uptake. Conclusion and Recommendation: Although the uptake of postpartum family planning was moderately high, majority of users were inconsistent or only utilized for less than 12 months continuously. Thus, the protection was not optimum in the two years postpartum to prevent repeat adolescent pregnancy. Antenatal and postnatal family planning counselling could improve on the uptake, consistency and continuous utilization of postpartum family planning especially among those adolescents in well-established unions.

Background: Traumatic brain injury (TBI) is a growing public health concern which is associated with an acute stress response mediated by the sympathoadrenomedullary axis, this can be assessed by measuring blood glucose level. Hyperglycemia worsens underlying brain damage by causing free radical injury, apoptosis and tissue lactic acidosis. Hyperglycemia after severe traumatic brain injury (TBI) occurs frequently and is associated with increased mortality. Objective: To determine the prevalence of hyperglycemia in severe Traumatic brain injury patients and its association with 30day mortality in Mulago National Referral Hospital. Methods: The study design was a prospective cohort study. A total of 99 patients with severe TBI were recruited using consecutive sampling method. The serum glucose levels measured at admission and after 24hours. The study variables included; mechanism of injury, CT findings, location and size of hematoma, and social demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia to those without. Data were analysed using proportions or percentages for categorical variable and mean and standard deviation for continuous variable, for bivariate and multivariate analysis, Logistic regression was used. At bivariate, only variables with p-values ≤ 0.2 were considered for multivariate analysis. Odds ratio were used as measure of association. Findings of the study will form a basis for establishing management guidelines for Hyperglycemia in TBI. Findings; A total of 99 newly admitted patients with severe Traumatic brain injury in Mulago National Referral Hospital were enrolled in the study and followed up for one month. Most patients (35.5%) were between 18-30 years of age. Men accounted for the large part of the study (92.9%). Road Traffic Accidents were the most common cause of TBI (64.7%) followed by assault 17.1% and falls8.1%. Nearly 1in 6patients was admitted with hyperglycemia. The mortality rate in severe TBI patients as a result of admission hyperglycemia was 68.8% (O.R, 1.43; P=0.063) compared to 43.7% (N = 83) in those without hyperglycemia. Presence of convulsions was a significant predictor of mortality. (OR, 5. 64; P=0.009) Conclusions; Early Hyperglycemia following severe TBI does occur (16.7%) and there was no statistically significant association with mortality, but shows a tendency towards a high mortality rate (68.8%).

The purpose of this study was to assess the factors contributing to the low uptake of insurance services a case study of market vendors of Rubaga division. The need for insurance services is important for low-income groups as they are more vulnerable to ill-health or death, unexpected expenses, and natural disasters. Consequently, there is need to reach to this group and mitigate their level of risk since when it occurs, it is bound to drive them to deeper level of poverty. To bridge this need, insurance firms have developed products that target this section of the market The study adopted use of primary data, which was collected using Questionnaire approach, data was put in excel for cleaning and imported to Stata 15 .0 for analysis. Findings of the study show that Individual’s level of Startup capital is the crucial factor facilitating uptake of insurance among this cohort. Other individual demographic, economic and social characteristics to include Age, Gender, Marital status, Business ownership and Source of Business startup capital were found to have an insignificant relationship with Uptake of insurance given the data used. The study also established that respondents that had contracts had concerns of them paying continuously their premiums and not having any claim situation something they call a waste of money. The study recommends that further study should be carried out on a large sample cohort of the same kind, this time segmenting it to provide insights on insurance needs of these groups. Microinsurance with appropriate flexible distribution channels is a recommended opportunity to reach the unserved and underserved groups majorly within the informal sector.

Wetlands commonly called swamps in Uganda are estimated to cover about 13% of the total land surface (about 30,000km2) of the country and represent a considerable ecological, social and economic value. However, this coverage is gradually dropping as a result pressure from anthropogenic activities. A case study of Gitundwe wetland in Kisoro district south western Uganda was carried out. The major objectives of this study were to compare the extent of wetland cover for 20years (1999,2009 and 2019), assess community awareness about the impacts of their activities taking place in Gitundwe wetland and their attitudes towards wetland conservation. Landsatmages of 1999, 2009 and 2019 covering Gitundwe wetland were downloaded from United States Geological/Earth explorer. The images revealed that there was a progressive reduction in the wetland size which covered an area of 7.84km2before encroachment at around 1930’s. In 1999, the wetland vegetation had reduced to 5.46km2 (70%), in 2009 it reduced to 4.34km2(55%) and to 3.25km2 (42%) in 2019 and the reasons for the reduction were due to agriculture which increased from 13% in 1999 to 35% in 2019, built up areas from 5% in 1999 to 8% in 2019 and woodlots from 12% to 16% in 2019. Information about wetland use and people’s attitudes towards wetland conservation was collected from people in the five villages sorrounding the wetland and these are Butuga, Gasaro, Buhayo, Mukozi and Kiraro where a total of 86 respondents were interviewed using questionaires and data collected was analysed usings SPSS and Microsoft Excel Packages.The results revealed that activities taking place in the wetland include crop cultivation with 93%, Papyrus harvesting 33%, Brick making 14%, fire wood collection 17%and tourism 13%. The study revealed that the wetland users are aware of the impacts of the activities taking place in the wetland however they look at Gitundwe wetland as their only source of livelihood to the increasing population of the area thus continued wetland encroachment. People’s attitude towards wetland conservation was positive where by 47%of the respondents strongly agreed that there should be conservation education programs to people using Gitundwe wetland, 38% agreed, 14% neutral, 1% disagreed and none strongly disagreed.

Background: In-hospital cardiac arrest (IHCA) is often the end result of a progressive deterioration in respiratory and circulatory functions in critically ill patients. Cardiopulmonary resuscitation (CPR) is a lifesaving procedure required to bring back the heart function at the time of cardiac arrest. The outcomes of IHCA at Muhimbili National Hospital (MNH) has not been studied despite of Paediatric Advanced Life Support (PALS) training. Objectives: This study sought to determine the outcomes and factors associated with survival at 24 hours after in-hospital paediatric CA in the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH) in Tanzania. Methodology: A retrospective cohort study was conducted at the EMD-MNH. Patients ages 1 month to 18 years who underwent cardiopulmonary resuscitation between January 2016 to December 2019 were enrolled. Data was retrieved retrospectively from Emergency Medicine Department Electronic Medical Records System (EMD-EMR) and reported using the Utstein-style guidelines, entered into Epidata V.3.1 and analyzed in Stata version 14.1. Bivariate and Multivariate logistic regression analyses were performed to assess factors that are associated with survival at 24 hours among patients who had IHCA. Results: A total 136 patients with IHCA were evaluated, majority 108 (79.4%) of whom were children aged ≤ 5 years. After initial CPR, the sustained return of spontaneous circulation was achieved in 70 (51.5%) patients, survival at 24 hours was attained in 43 (31.3%) of patients, and only 7 patients (5.2%) survived to hospital discharge. In the multivariate analysis, the factors associated with survival at 24 hours were; CPR event during the day/evening (AOR = 5.02, 95% CI: 1.12-22.4, p=0.035), duration of CPR ≤ 20 minutes (AOR = 9.09, 95% CI: 1.49-55.3, p=0.017), epinephrine ≤2 doses (AOR = 4.8, 95% CI: 1.01-22.93, p=0.049), reversible causes of cardiac arrest identified (AOR = 12.38, 95% CI: 3.26-58.5, p=0.001), being monitored (AOR = 45.63, 95% CI: 1.08-193.15, p=0.046), and having assisted/mechanical ventilation after CPR (AOR = 15.95, 95% CI: 3.26-78.05, p=0.001). Conclusions and Recommendations: One in every three paediatric patients who had IHCA survived at 24 hours. Although half of the paediatric patients with IHCA had sustained ROSC, only one in ten of those who had initial survival, survived to hospital discharge. The overall survival to hospital discharge after in-hospital paediatric CA at the EMD is unacceptably poor.

This study was conducted to establish the pedestrian behavior in relation to roads with pedestrian’s facilities in Kampala city, cases in study being Makerere hill road and Bombo road. The research aimed at identifying the available pedestrian facilities to support walking along these roads, how pedestrians behave while walking along these roads and what factors influence their behavior. This research was carried out by cross sectional survey, and data was collected using questionnaires and interview responses from respondents selected through random sampling techniques. The data was represented and analyzed using both qualitative and quantitative techniques which was then represented by using graphs and explanations This research work contains the views of the technical team especially the Physical Planner, the division engineer for Kawempe division and traffic officers in charge of the roads in study. It also contains different views pedestrians walking along these roads, the people working along adjacent to these roads, other road users and the scholars that wrote about the areas of concern of the research topic in the section of literature view. The research established that the available pedestrian facilities were generally in good condition and the pedestrian behaviors varied while using different pedestrian facilities. The study also revealed the various factors that influence the pedestrian behaviors among which was the behavior of other road users, the placement of the road facilities, the size and nature of facilities and the design of facilities and most especially their perception of these facilities. Therefore the researcher then drew conclusion from the study and suggested possible and implementable solutions to improve walkability within Kampala city among which was to ensure clear significance of the pedestrian facilities, sensitizing the public on the importance of walking and the functionality of the pedestrian facilities.