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Background Gastroenterologists of Mulago hospital noted that many patients with gastrointestinal bleeding are transferred to their ward from the emergency ward without adequate resuscitation. They recommended that blood should be ring fenced for patients with gastrointestinal bleeding (GI) on the emergency ward so that urgent resuscitation can be done. There was however no current data on the prevalence of GI bleeding in the emergency ward to provide a guide of how much blood should be ring fenced. This was partly because the medical records are not adequately completed as designed. We thus undertook a study to estimate the prevalence of GI bleeding on the emergency ward by incorporating quality improvement methods in the process of data collection to improve the documentation practice on the Casualty assessment form (CAF).Methods This was a cross sectional study incorporating quality improvement methods in the process of data collection from the CAF for patients attending the emergency ward. Focus group discussions and key informant interviews were conducted to ascertain the root causes of inadequate completion of this form. The health care team was educated on documentation of GI bleeding while being assessed weekly for knowledge and practice of completion of the CAF. The filled CAF were assessed for adequate completion while looking out for a documented diagnosis of GI bleeding and selected predictors of mortality.Results Of the 1881 CAF assessed, 278 had a documented diagnosis of GI bleeding, resulting in a prevalence of 6.8%. Of the patients with GI bleeding, 14.1% of them had age greater than 60 years old, 24.0% had a systolic blood pressure less than 100mmHg and 44.5% had a heart rate greater than 100 beats per minute.Conclusion The prevalence of GI bleeding on the medical emergency ward of Mulago hospital is high, with 1 in every 15 patients having this condition. This calls for strategies for resuscitative management of this potentially life threatening condition. Among the selected predictors of mortality, tachycardia was most frequent followed by hypotension. These should always be assessed in a patient with GI bleeding and resuscitative measures with blood transfusion and intravenous fluids undertaken to correct them.

Background : Hepatitis B virus (HBV) and HIV are endemic in Uganda. Co-infection is common and leads to rapid progression of liver disease. Burden of co-infection is unknown yet most patients are on lamivudine-only ART where resistance is frequent. Most patients are initiated on antiretroviral therapy (ART) without knowing their HBV status. Objectives : To determine burden of co-infection and HBV viral suppression among patients on ART in NorthernUganda. Methods : We recruited HIV infected adult patients on ART in a cross-sectional study. Age, sex, ART regimen and duration were recorded. Hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBcAb) and liver panel were performed. For those HBsAg+, hepatitis B e antigen (HBeAg) and HBV DNA were performed. CD4 cell count was recorded. Results : Three hundred patients were recruited. Twenty (6.7%) were co-infected, while 41% were anti-HBcAb+. Overall 188 (62.7%) were on lamivudine- only HBV active drug. Median ART duration 2 years (IQR 1-5), mean CD4+ cell count 317 cells/microlitre (SD 255-557). Of 20 HIV/HBV co-infected, 11/20 (55%) were on lamivudine-only ART, median duration 1.5 years. Nineteen (95%) had undetectable HBV DNA. Seventeen (85%) were HBeAg negative. Mean CD4+ cell count 327 cells/microlitre (SD 197-482). Conclusion : A large proportion of patients were on lamivudine- only HBV-active ART. Resistance may occur long term thus testing for HBV and correct ART is recommended Key words : HIV, HBV, Co-infection, Treatment

Background: Hepatitis B virus (HBV) is the commonest cause of primary hepatocellular (PHC) carcinoma worldwide. Coinfection with the HIV leads to more rapid progression of liver disease. Objectives: We described prevalence of HBV and HIV among patients with PHC admitted to Mulago Hospital, Kampala, Uganda. Methods: We assessed all patients admitted to the gastrointestinal service of Mulago hospital with a diagnosis of PHC for HBV and HIV infection. Results: From March to June 2008, we recruited 15 patients. Nine (60%) were male; the overall median age was 32 years (IQR 15 -67), with median ages for male and female 33 and 36 years respectively. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and AFP were all elevated with median values of 57.5 IU/L, 222 IU/L, 392 IU/L and 362 ng/ml respectively (IQR 14-145, 49-393, 165-1294 and 7-480). Eight (53%) patients were from North and Northeastern Uganda. The HBsAg was reactive in 13(87%) patients and HIV in 3(20%), all of whom were also co-infected with HBV. Conclusion: There is high prevalence of HBV and HBV/HIV co-infection among patients with PHC in Uganda with high mortality. Reduction in incidence and mortality due to PHC in Uganda will require urgent large scale HBV vaccination. Key Words: Hepatitis B, HIV, Primary Hepatocelular Carcinoma