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Article: Knowledge, Attitudes and Practices Regarding Use of Local Anaesthetics Among Non-Anaesthesia Healthcare Professionals at Mulago National Referral Hospital.

Abdi, Intisar Ahmed / Kasumba, John Mark / Wabule, Agnes / Nabukenya, Mary T / Kayongo, Joseph / Kyoheirwe, Bernadette / Sheikdon, Abdirizak Abdullahi / Osman, Kamaludin D

Local and regional anesthesia

2024 Volume 17, Page(s) 29–37

Abstract: Introduction: Local anaesthetics (LA) are commonly used in dental and surgical emergency wards by both anaesthesia professionals and non-anaesthesia professionals. Anecdotal evidence shows that non-anaesthesia health-care professionals do not monitor ... ...

Abstract	Introduction: Local anaesthetics (LA) are commonly used in dental and surgical emergency wards by both anaesthesia professionals and non-anaesthesia professionals. Anecdotal evidence shows that non-anaesthesia health-care professionals do not monitor vital signs during the use of local anaesthesia, and there are no standard hospital guidelines on the use of LA and management of LA toxicity by non-anaesthesia professionals. Purpose: This study sought to assess the knowledge, attitudes and practices regarding local anaesthetic use among non-anaesthesia health-care professionals at Mulago National Referral Hospital. Patients and methods: This was a cross-sectional study that utilized a quantitative research approach. The sample size of the study was 43 non-anaesthesia healthcare professionals from the casualty and surgical outpatient wards and Mulago dental ward. Data was collected using a questionnaire and analyzed using STATA 15. Results: Overall, 66.67% of the Specialist, 76.47% of the senior house officers, 100% of medical officers, and 80% of the clinical orthopedic house officers had unsatisfactory levels of knowledge in Mulago casualty and surgical outpatient wards. 20% of the specialist and 16.67% of the senior house officers had unsatisfactory levels of knowledge in Mulago dental ward. 87.5% of the non-anaesthesia health-care professionals do not give a test dose on a routine basis in Mulago casualty and surgical outpatient wards. A total of 63.64% of the non-anaesthesia healthcare professionals in Mulago dental ward do not sterilize the site of injection. Conclusion: Non-anaesthesia health-care professionals had unsatisfactory levels of knowledge, somewhat good practices, and negative attitudes toward LA use.
Language	English
Publishing date	2024-03-08
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520725-8
ISSN	1178-7112
ISSN	1178-7112
DOI	10.2147/LRA.S428661
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Article ; Online: A Cross-Sectional Survey of Anesthetic Airway Equipment and Airway Management Practices in Uganda.

Bulamba, Fred / Connelly, Stephanie / Richards, Sara / Lipnick, Michael S / Gelb, Adrian W / Igaga, Elizabeth N / Nabukenya, Mary T / Wabule, Agnes / Hewitt-Smith, Adam

Anesthesia and analgesia

2023 Volume 137, Issue 1, Page(s) 191–199

Abstract: Background: Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant ... ...

Abstract	Background: Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant contributor to perioperative morbidity and mortality. While existing data have highlighted the magnitude of airway management complications in LMICs, there are inadequate data to understand their root causes. This study aimed to pilot an airway management capacity tool that evaluates airway management resources, provider practices, and experiences with difficult airways in an attempt to better understand potential contributing factors to airway management challenges. Methods: We developed a novel airway management capacity assessment tool through a nonsystematic review of existing literature on anesthesia and airway management in LMICs, internationally recognized difficult airway algorithms, minimum standards for equipment, the safe practice of anesthesia, and the essential medicines and health supplies list of Uganda. We distributed the survey tool during conferences and workshops, to anesthesia care providers from across the spectrum of surgical care facilities in Uganda. The data were analyzed using descriptive methods. Results: Between May 2017 and May 2018, 89 of 93 surveys were returned (17% of anesthesia providers in the country) from all levels of health facilities that provide surgical services in Uganda. Equipment for routine airway management was available to all anesthesia providers surveyed, but with a limited range of sizes. Pediatric airway equipment was always available 54% of the time. There was limited availability of capnography (15%), video laryngoscopes (4%), cricothyroidotomy kits (6%), and fiber-optic bronchoscopes (7%). Twenty-one percent (18/87) of respondents reported experiencing a "can't intubate, can't ventilate" (CICV) scenario in the 12 months preceding the survey, while 63% (54/86) reported experiencing at least 1 CICV during their career. Eighty-five percent (74/87) of respondents reported witnessing a severe airway management complication during their career, with 21% (19/89) witnessing a death as a result of a CICV scenario. Conclusions: We have developed and implemented an airway management capacity tool that describes airway management practices in Uganda. Using this tool, we have identified significant gaps in access to airway management resources. Gaps identified by the survey, along with advocacy by the Association of Anesthesiologists of Uganda, in partnership with the Ugandan Ministry of Health, have led to some progress in closing these gaps. Expanding the availability of airway management resources further, providing more airway management training, and identifying opportunities to support skilled workforce expansion have the potential to improve perioperative safety in Uganda.
MeSH term(s)	Humans ; Child ; Uganda ; Cross-Sectional Studies ; Airway Management/adverse effects ; Anesthetics ; Anesthesiology
Chemical Substances	Anesthetics
Language	English
Publishing date	2023-04-28
Publishing country	United States
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006278
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Article ; Online: Assessment of the current capacity of intensive care units in Uganda; A descriptive study.

Atumanya, Patience / Sendagire, Cornelius / Wabule, Agnes / Mukisa, John / Ssemogerere, Lameck / Kwizera, Arthur / Agaba, Peter K

Journal of critical care

2019 Volume 55, Page(s) 95–99

Abstract: Purpose: To describe the organizational characteristics of functional ICUs in Uganda.: Methods: A descriptive survey of 12 ICUs in Uganda; ICU organisation, structure, staffing, and support facilities. A functional ICU was defined as one that ... ...

Abstract	Purpose: To describe the organizational characteristics of functional ICUs in Uganda. Methods: A descriptive survey of 12 ICUs in Uganda; ICU organisation, structure, staffing, and support facilities. A functional ICU was defined as one that admitted critically ill patients and had the ability to provide mechanical ventilation. ICUs were selected based on information of their existence. Direct structured interviews were carried out with the ICU directors. Results: Of the fourteen ICUs reviewed, 12 were functional, and a majority were located in the central region. There were 55 ICU beds making up a ratio of 1.3 ICU beds per million population. The ICU beds comprised 1.5 % of the total bed capacity of studied hospitals. Most of the ICUs [11] were mixed (paediatric-adults), anaesthesia-led (nine) and five operated in a closed model. There were 171 ICU nurses, of whom 13 had formal training in critical care nursing. The majority of the ICUs had a nurse to patient ratio ≥ 1.2; nine during the day and seven at night. Conclusions: This study shows limited accessibility to critical care services in Uganda. With a high variability in the ICU operational characteristics, there is a need for standardization of ICU care in the country.
MeSH term(s)	Adult ; Child ; Critical Care/statistics & numerical data ; Critical Care Nursing ; Critical Illness ; Cross-Sectional Studies ; Hospital Bed Capacity/statistics & numerical data ; Hospitals, Urban ; Humans ; Intensive Care Units/statistics & numerical data ; Intensive Care Units/supply & distribution ; Nurses ; Nursing Staff, Hospital/supply & distribution ; Respiration, Artificial ; Surveys and Questionnaires ; Uganda/epidemiology ; Workforce
Language	English
Publishing date	2019-11-04
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2019.10.019
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Article ; Online: Key bottlenecks to the provision of safe obstetric anaesthesia in low- income countries; a cross-sectional survey of 64 hospitals in Uganda.

Epiu, Isabella / Wabule, Agnes / Kambugu, Andrew / Mayanja-Kizza, Harriet / Tindimwebwa, Jossy Verel Bahe / Dubowitz, Gerald

BMC pregnancy and childbirth

2017 Volume 17, Issue 1, Page(s) 387

Abstract: Background: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious ... ...

Abstract	Background: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries. WFSA; 2014 http://wfsa.newsweaver.com/Newsletter/p8c8ta4ri7a1wsacct9y3u?a=2&p=47730565&t=27996496 ). In spite of this evidence, factors contributing to maternal mortality related to anaesthesia in LMICs and the magnitude of these issues have not been comprehensively studied. We therefore set out to assess regional referral, district, private for profit and private not-for profit hospitals in Uganda. Methods: We conducted a cross-sectional survey at 64 government and private hospitals in Uganda using pre-set questionnaires to the anaesthetists and hospital directors. Access to the minimum requirements for safe obstetric anaesthesia according to WFSA guidelines were also checked using a checklist for operating and recovery rooms. Results: Response rate was 100% following personal interviews of anaesthetists, and hospital directors. Only 3 of the 64 (5%) of the hospitals had all requirements available to meet the WFSA International guidelines for safe anaesthesia. Additionally, 54/64 (84%) did not have a trained physician anaesthetist and 5/64 (8%) had no trained providers for anaesthesia at all. Frequent shortages of drugs were reported for regional/neuroaxial anaesthesia, and other essential drugs were often lacking such as antacids and antihypertensives. We noted that many of the anaesthesia machines present were obsolete models without functional safety alarms and/or mechanical ventilators. Continuous ECG was only available in 3/64 (5%) of hospitals. Conclusion: We conclude that there is a significant lack of essential equipment for the delivery of safe anaesthesia across this region. This is compounded by the shortage of trained providers and inadequate supervision. It is therefore essential to strengthen anaesthesia services by addressing these specific deficiencies. This will include improved training of associate clinicians, training more physician anaesthetists and providing the basic equipment required to provide safe and effective care. These services are key components of comprehensive emergency obstetric care and anaesthetists are crucial in managing critically ill mothers and ensuring good surgical outcomes.
MeSH term(s)	Anesthesia, Obstetrical/mortality ; Anesthesia, Obstetrical/standards ; Checklist ; Cross-Sectional Studies ; Developing Countries ; Female ; Guideline Adherence/statistics & numerical data ; Guidelines as Topic ; Health Care Surveys ; Health Resources/standards ; Health Resources/statistics & numerical data ; Hospitals/standards ; Hospitals/statistics & numerical data ; Humans ; Maternal Mortality ; Poverty ; Pregnancy ; Uganda
Language	English
Publishing date	2017-11-17
Publishing country	England
Document type	Journal Article
ISSN	1471-2393
ISSN (online)	1471-2393
DOI	10.1186/s12884-017-1566-3
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Article: Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation.

Bulamba, Fred / Kintu, Andrew / Ayupo, Nodreen / Kojjo, Charles / Ssemogerere, Lameck / Wabule, Agnes / Kwizera, Arthur

Anesthesiology research and practice

2017 Volume 2017, Page(s) 2032748

Abstract: Background: Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20-30 cmH: Methods: This was a randomized clinical trial. ... ...

Abstract	Background: Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20-30 cmH Methods: This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results: One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant. Conclusion: The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation.
Language	English
Publishing date	2017-12-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2017/2032748
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Article ; Online: Knowledge, attitudes and use of labour analgesia among women at a low-income country antenatal clinic.

Nabukenya, Mary T / Kintu, Andrew / Wabule, Agnes / Muyingo, Mark T / Kwizera, Arthur

BMC anesthesiology

2015 Volume 15, Page(s) 98

Abstract: Background: Childbirth is one of the most painful experiences of a woman's life. Authorities in the fields of obstetrics and anaesthesia encourage use of labour analgesia. Unlike in high-income countries, pain relief in labour in Africa is not a well ... ...

Abstract	Background: Childbirth is one of the most painful experiences of a woman's life. Authorities in the fields of obstetrics and anaesthesia encourage use of labour analgesia. Unlike in high-income countries, pain relief in labour in Africa is not a well established service, especially in the low-income countries like Uganda. Little is known about whether parturients would be amenable to labour analgesia. We sought to determine knowledge, attitudes and use of labour analgesia among women attending the antenatal clinic at Mulago National Referral Hospital. Methods: Upon obtaining institutional approval, we conducted a cross-sectional descriptive study. Women were requested to complete the researcher-administered survey following informed consent. The study was conducted in the general antenatal clinic at the Mulago National Referral Hospital. Results: Of 1293 participants interviewed, only 7 % of the participants had knowledge of labour analgesia. Of the multiparous mothers 87.9 % did not have labour analgesia in their previous deliveries, although 79.2 % of them had delivered in a national referral hospital. The commonest reason for refusal of labour analgesia was to experience natural childbirth. 87.7 % of the participants wanted labour analgesia for their next delivery. Conclusion: There is a wide gap between the desire for labour analgesia and its availability. Obstetricians and anaesthesiologists have a role to educate the women, and to provide this much desired service.
MeSH term(s)	Adolescent ; Adult ; Analgesia, Obstetrical/methods ; Analgesics/administration & dosage ; Cross-Sectional Studies ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Kenya ; Labor Pain/drug therapy ; Pregnancy ; Prenatal Care/methods ; Uganda ; Young Adult
Chemical Substances	Analgesics
Language	English
Publishing date	2015-07-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1471-2253
ISSN (online)	1471-2253
DOI	10.1186/s12871-015-0078-9
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Article ; Online: Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: a prospective observational study.

Ocen, Davidson / Kalungi, Sam / Ejoku, Joseph / Luggya, Tonny / Wabule, Agnes / Tumukunde, Janat / Kwizera, Arthur

BMC emergency medicine

2015 Volume 15, Page(s) 23

Abstract: Background: Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known ... ...

Abstract	Background: Research on cardiac arrest and cardiopulmonary resuscitation (CPR) has considerably increased in recent decades, and international guidelines for resuscitation have been implemented and have undergone several changes. Very little is known about the prevalence and management of in-hospital cardiac arrest in low-resource settings. We therefore sought to determine the prevalence, outcomes and associated factors of adult inpatients with cardiac arrest at a tertiary referral hospital in a low-income country. Methods: Upon obtaining institutional approval, we conducted a prospective observational period prevalence study over a 2-month period. We recruited adult inpatients with cardiac arrest in the intensive care unit and emergency wards of Mulago Hospital, Uganda during the study period. We reviewed all files and monitoring charts, and also any postmortem findings. Data were analyzed with Stata 12 and statistical significance was set at p < 0.05. Results: There was a cardiac arrest in 2.3% (190) of 8,131 hospital admissions; 34.5% occurred in the intensive care unit, 4.4% in emergency operating theaters, and 3.0% in emergency wards. A majority (63.2%) was unwitnessed, and only 35 patients (18.4%) received CPR. There was return of spontaneous circulation (ROSC) in 14 (7.4%) cardiac arrest patients. Survival to 24 h occurred in three ROSC patients, which was only 1.6% of all cardiac arrest patients during the study period. Trauma was the most common primary diagnosis and HIV infection was the most common co-morbidity. Conclusion: Our hospital has a high prevalence of cardiac arrest, and low rates of CPR performance, ROSC, and 24-hour survival. Single provider CPR; abnormal temperatures as well as after hours/weekend CAs were associated with lower survival rates.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cardiopulmonary Resuscitation ; Developing Countries ; Female ; Heart Arrest/epidemiology ; Heart Arrest/etiology ; Heart Arrest/therapy ; Hospitalization ; Humans ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Risk Factors ; Tertiary Care Centers ; Treatment Outcome ; Uganda/epidemiology ; Young Adult
Language	English
Publishing date	2015-09-16
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ISSN	1471-227X
ISSN (online)	1471-227X
DOI	10.1186/s12873-015-0047-0
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Article ; Online: Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda.

Kavuma Mwanje, Arthur / Ejoku, Joseph / Ssemogerere, Lameck / Lubulwa, Clare / Namata, Christine / Kwizera, Arthur / Wabule, Agnes / Okello, Erasmus / Kizito, Samuel / Lubikire, Aggrey / Sendagire, Cornelius / Andia Biraro, Irene

AAS open research

2019 Volume 2, Page(s) 2

Abstract: ... ...

Abstract	Background
Language	English
Publishing date	2019-01-08
Publishing country	England
Document type	Journal Article
ISSN	2515-9321
ISSN (online)	2515-9321
DOI	10.12688/aasopenres.12925.1
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Article ; Online: Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections.

Dlamini, Lomangisi D / Sekikubo, Musa / Tumukunde, Janat / Kojjo, Charles / Ocen, Davidson / Wabule, Agnes / Kwizera, Arthur

BMC pregnancy and childbirth

2015 Volume 15, Page(s) 91

Abstract: Background: Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the ... ...

Abstract	Background: Prophylactic antibiotics are used to prevent postoperative infections after caesarean section. Studies have suggested that the timing of prophylaxis plays an important role. Over the years, the role of the anaesthesiologist in the administration of prophylactic antibiotics has become prominent. Therefore, there is an increasing need for anaesthesia providers to understand the rationale of antibiotic prophylaxis. We therefore sought to compare the effect of antibiotics prophylaxis within 1 hour before skin incision and after skin incision on the incidence of postoperative infections in patients undergoing caesarean section at Mulago Hospital. Methods: We conducted a single-blind randomised clinical trial conducted at Mulago Hospital evaluating 464 patients undergoing emergency caesarean section. Patients were randomly assigned a group number that allocated them to either arm of the study. They received the same prophylactic antibiotic according to their allotment, that is, either within 1 hour before skin incision or after skin incision as per current standards of practice in Mulago Hospital. They were followed up to detect infection up to 10 days postoperatively. The primary outcome was postoperative infection. The data collected were analysed with STATA version 12 using univariate and bivariate analysis. Results: The risk of overall postoperative infection was significantly lower when prophylaxis was given within an hour before incision (RR O.77, 95% CI 0.62-0.97). We also found endometritis to be significantly reduced in the pre-incision group (RR 0.62; 95% CI 0.39-0.99; P value 0.036). Conclusions: Giving prophylactic antibiotics before skin incision reduces risk of postoperative infection, in particular of endometritis. Trial registration: Pan African Clinical Trial Registry PACTR201311000610495. Date of trial registration: 12(th) August 2013.
MeSH term(s)	Adolescent ; Adult ; Anti-Bacterial Agents/administration & dosage ; Antibiotic Prophylaxis/methods ; Ceftriaxone/administration & dosage ; Cesarean Section/methods ; Endometritis/prevention & control ; Female ; Humans ; Pregnancy ; Single-Blind Method ; Surgical Wound Infection/prevention & control ; Time Factors ; Treatment Outcome ; Uganda ; Young Adult
Chemical Substances	Anti-Bacterial Agents ; Ceftriaxone (75J73V1629)
Language	English
Publishing date	2015-04-12
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ISSN	1471-2393
ISSN (online)	1471-2393
DOI	10.1186/s12884-015-0514-3
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Article: Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study.

Kwizera, Arthur / Nakibuuka, Jane / Ssemogerere, Lameck / Sendikadiwa, Charles / Obua, Daniel / Kizito, Samuel / Tumukunde, Janat / Wabule, Agnes / Nakasujja, Noeline

Critical care research and practice

2015 Volume 2015, Page(s) 491780

Abstract: Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU). There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated ... ...

Abstract	Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU). There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU). Comparisons were made using t-test, chi-squares, and Fisher's exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P < 0.05. Results. Of 160 patients, 81 (51%) had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.
Language	English
Publishing date	2015-04-05
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2573849-5
ISSN	2090-1313 ; 2090-1305
ISSN (online)	2090-1313
ISSN	2090-1305
DOI	10.1155/2015/491780
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