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Severe Traumatic brain injury (STBI) is a leading cause of morbidity and mortality among young individuals worldwide with worse outcomes being registered in low-income countries. Brain trauma foundation recommends the management of patients with TBI in the intensive care unit (ICU) to prevent secondary brain injury for improved outcome. However, Uganda being a low-income country, still grapples with the availability of ICU resources and space. Information regarding burden, predictors and short-term outcomes of ICU patients with TBI in Uganda has never been reconnoitered. A multicenter prospective observational cohort was conducted between 2013 to 2015 at four Ugandan ICUs. During the study period, we consecutively enrolled 387 critically ill, adult patients with TBI to determine the burden, predictors and short term outcomes in these patients. . Baseline demographics, clinical and treatment parameters were recorded and followed till discharge from ICU or death. Of 387 patients enrolled in the study, 277 (71.6%) had moderate TBI, while 113 (29.2%) patients had STBI. The highest burden of TBI was recorded among patients assaulted through mob violence, recorded at 17/21 (81.0%), as shown in table 5. The overall mortality was at 34.4% (95/277) among patients with moderate or severe TBI, and 46.9% (53/113) among patients with STBI alone. Mortality was relatively higher among patients brought by the police, and those brought in at night. Multivariate analysis showed patient intubation, lack of antibiotic use, failure to transfuse, tracheostomy tube not inserted, and being involved in RTA or sustaining a fall were significantly associated with mortality among patients with TBI. We found a high burden of TBI and mortality among ICU patients. Despite limited resources in the local setting, inexpensive and locally available measures can reduce on the length of patient’s stay in the ICU and eventually decrease on the mortality. Improvement in prehospital as well as early trauma and airway care, antibiotic use, blood transfusion plus public health safety measures may reduce on the burden of TBI as well as improve outcomes.

Background: Intra-abdominal hypertension (IAH) is sustained increase in intra-abdominal pressure (IAP) ≥12 mm Hg in adults and ≥ 10 mmHg in children. [1] . IAH has been noted to be associated with increased morbidity and mortality among critically ill patients. Measurement of IAP is common among at risk patients in the developed world. However, it has not received due attention in the majority of intensive care units (ICUs) in low-income countries, Uganda being one of these. This is evidenced by paucity of data and lack of protocols from the Ugandan Ministry of Health. This multi-center study was thus conducted to assess the prevalence, incidence and associated factors of IAH among critically ill patients admitted to Ugandan ICUs. Methods: A multi-center prospective cohort study was conducted from September 2017 to February 2018 at three ICUs in Uganda. We consecutively enrolled 126 patients into the study. IAP was measured using the Harrahil manometer technique. Categorical variables were analyzed using the Chi square test and continuous variables analyzed using the t-test and Man Whitney test. The prevalence and incidence were determined using proportions and mortality was determined using survival analysis. Results: The median age was 33 years (26-48.5) for the patients without IAH and 42 years (29-55) for those with IAH. The majority of the patients were male and 9.6% of the patients were below 18 years. The prevalence of IAH was 62.7 (CI 54.1-71.3), whereas the 24 hour and 72 -hour incidence of IAH was 9.3% (CI 1.3-17.2) and 14.3 % ( CI 4.1-24.4), respectively. Mortality was higher in patients with IAH compared to those without (p-value 0.003 and 0.028, mean and maximum IAP, respectively). Conclusion: We found a high prevalence and incidence of IAH among critically ill patients, associated with a high mortality. Routine screening for IAH can preempt management strategies to mitigate this.