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Purpose: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide. TBIs are increasing in Uganda, but little is known about outcomes and their predictors in post-ICU patients. This study assessed outcomes and their predictors in post-ICU patients admitted with TBI at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda. Methodology: Retrospective study was used to review hospital records of patients admitted to the Intensive Care Unit (ICU) for MRRH with TBI. Data were entered into Excel, cleaned and exported to Stata version for analysis and presented as mean (standard deviation), median (interquartile range) and number (percent), while using the chi-square test and multinomial logistic regression as predictors for Post-ICU outcomes were used Findings: In the study, males dominated at 73%, while 81% were of working age (15-64 years). Road traffic accidents (83%) were the most common injury mechanism, followed by physical injury at 11%. Length of stay in the Intensive Care Unit was 9 (IQR = 4–8) days, mean GCS at ICU admission and discharge was 7.7 (±2.65) and 10 (±3.27), respectively. Fifty-seven patients (63%) were discharged home; with 73% good recovery Glasgow coma Outcome Scale of hospital discharges. Post-ICU outcomes were associated with GCS at ICU discharge ( . Having moderate Glasgow Coma Scale on ICU discharge was 3.59 times higher of being discharged home than dying compared to severe GCS on ICU discharge (OR=3.59; 95%CI, 1.11 to 11.63). This study established GCS as a statistical predictor of patient outcomes at ICU discharge. Unique Contribution to Theory, Practice and Policy: Based on the findings of this study, prevention of TBI is critical in order to reduce incidence of TBI related mortality. Policy makers to put rules that continuously teach and enforce road safety and traffic rules to all road users.

Joseph Atukwatse,1 Vallence Niyonzima,2 Cliff Asher Aliga,1 Jalia Nakandi Serwadda,3 Rosemary Nankunda,1 Catherine Nakiganda,3 Peninah Komugabe,4 Hanifah Nantongo2 1School of Nursing and Midwifery, Aga Khan University Uganda, Kampala, Uganda; 2Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda; 3Department of Surgery and Specialized Areas, Mulago National Referral Hospital, Kampala, Uganda; 4Department of Nursing, Uganda Heart Institute, Kampala, UgandaCorrespondence: Vallence Niyonzima, Tel +256777842830, Email vniyonzima@must.ac.ugBackground: The safety attitudes questionnaire (SAQ) short form (2006) is important for assessing patient safety culture in clinical environments. However, little is known about its validity and applicability in Uganda. This study validated the SAQ short form (2006) for use in assessing patient safety culture in critical care settings of hospitals in the Ugandan context.Methods: Using a sequential exploratory mixed-methods research design, the face, content and construct validity for the SAQ short form (2006) was assessed in a multi-phased approach. A panel of eight (8) purposively selected experts assessed the face and content validity in rounds 1 and 2, respectively, while construct validity was assessed in round 3 using data from a cross-sectional survey of 256 frontline health workers in critical care settings of the selected hospitals. Analysis of survey data followed confirmatory factor analysis. Cronbach’s alpha examined internal reliability.Results: Of the 36 items in the tool’s original version, 33 were rated clear, with a score of 100% on face validity. The use of contextual vocabulary and formatting issues arose as concerns. The S-CVI/Ave was 100%, and S-CVI/UA was 86.1%. Four new items added on effective communication as another dimension of patient safety culture. The survey had KMO=0.8605, the a priori-based model had a scale Cronbach’s alpha=0.8881, with unsatisfactory goodness of fit (RMSEA=0.051, 90% CI: 0.044– 0.057, pclose=0.427; chi-square=694.28, p < 0.001; CFI=0.884, TLI=0.871). The modified final model had a scale Cronbach’s alpha =0.8967 and satisfactory goodness of fit (RMSEA=0.030, 90% CI: 0.019– 0.039, pclose=1.000; chi-square=424.98, p=0.002; CFI=0.966, TLI=0.960).Conclusion: In the tool’s original form, the face validity was lacking despite satisfactory scores on item clarity. Content validity was adequate, while construct validity required modifications in construct specifications. Reliability was adequate before and after specification modifications. The modified version has adequate psychometric properties for Uganda.Keywords: patient safety culture, SAQ, tool validation, validity, Ugandan context

Catherine Nakiganda, Joseph Atukwatse, Johnan Turyasingura, Vallence Niyonzima Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, UgandaCorrespondence: Vallence Niyonzima, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara City, Uganda, Tel +256 777842830, Email vniyonzima@must.ac.ugBackground: Sepsis is a global pandemic and public health concern. There is a paucity of data relating to its management and outcomes in the developing world. The surviving sepsis campaign (SSC) guidelines have been developed to improve outcomes of patients with sepsis. There are no documented in-hospital protocols on sepsis management for nurses in Uganda. This study evaluated the effect of an educational intervention on nurses’ knowledge of SSC guidelines in management of patients with sepsis at Mulago National Referral Hospital.Methods: We used a quasi-experimental design and recruited 40 nurses from neuro-surgical ward and ICU. Pre- and post-intervention assessments were conducted using a validated self-administered questionnaire between October 2020 to February 2021. The intervention was conducted through sessions of presentations, watching videos, and case studies. Data were entered in excel, cleaned, and exported to Stata version 16. Median and interquartile range were used for continuous variables while frequencies and percentages were used for categorical variables. Mean knowledge scores were computed for pre- and post-test evaluation. A paired t-test was used to compare the pre- and post-test knowledge scores at p ≤ 0.05 and 95% confidence interval.Results: In this study, 57.5% of nurses were from ICU, 67.7% were females and 70% diploma holders. Median age was 32 (IQR= 21.5– 35.5) years. In the post test all nurses were able to score above the preset acceptable score of 50% on the current sepsis guidelines. Mean knowledge score was 3.6 (SD = 1.8) pretest and 8.4 (SD = 1.2) posttest. There was a significant difference in pre and post-intervention mean knowledge scores of 4.9 (SD = 1.90, 95% CI: 4.2– 4.5; t (39) = 16.242, p < 0.001).Conclusion: The educational intervention improved nurses’ knowledge on SSC guidelines. Regular continuous professional nursing education on sepsis could improve nurses’ knowledge and quality of care for patients with sepsis.Keywords: nurses, sepsis, knowledge, surviving sepsis campaign guidelines, management

Background Sexual violence is a public health concern globally and locally, and trauma-informed services are put in place to mitigate its consequences. A few studies have evaluated the quality and uptake of these trauma-informed services for sexual violence. This study aimed at; i) assessing the knowledge of participants about trauma-informed services, ii) exploring the attitudes of females about trauma-informed services, and iii) assessing different factors associated with the utilization of trauma-informed services. Methods This study employed a descriptive cross-sectional qualitative design. The participants were females at Kyangyenyi health center III and Kigarama health center III in Sheema district, southwestern Uganda. We used a purposive sampling procedure for all participants and then a consecutive sampling of females. Data about; knowledge of trauma-informed services for sexual violence, attitudes towards trauma-informed services, and factors influencing the utilization of trauma-informed services were collected using an in-depth interview guide. Data were analyzed using thematic content analysis. Results We interviewed 32 participants. There was a high prevalence of sexual violence, and it was a big concern in the community. Many of the respondents were not sensitized about trauma-informed services. Most of them knew only about HIV treatment. Our study shows that a good section of females did not seek the services after being sexually violated due to the fear of the perpetrator, bribing of the family of the affected and authorities, or even fear of family breakup and stigmatization. There were a lot of bribery, poor road networks, and inadequate health care services. These hindered survivors of sexual violence from utilizing trauma-informed services. Conclusions There was a knowledge gap about trauma-informed services for survivors of sexual violence. There was sexual violence in the community. Sensitization needs to be done among the populations by respective authorities to iron out issues of ignorance about the services and health workers evaluated for competence in offering the trauma-informed services.

Background: Diabetes mellitus is a heterogeneous metabolic disorder known to lead to several pathogenic disorders, and has a bidirectional relationship with oral health conditions. This study aimed at estimating the prevalence, treatment needs and correlates of dental carries among adult patients attending a diabetic clinic in Uganda. Methods: This was a cross-sectional study that used questionnaires to collect data on socio-demographic factors, diabetes history, oral health status, dental health care, dietary factors, lifestyle factors, and dental examination guided by the modified World Health Organization (WHO) oral health questionnaire for adults. Results: We enrolled 239 participants, prevalence of dental caries was 71.6%, treatment need was nearly 100%, and mean DMFT was 3.82. Dental caries experience was associated with being female, lower education, being widowed and rural residence. Conclusion: We found a high prevalence of dental caries experience, a large treatment need and a high DMFT among our participants. We recommend integration of oral health care into routine diabetic services in rural sub Saharan Africa.

Humphrey Atwijukiire,1 Hajarah Jemba Nalubega,1 Vicensio Byaruhanga,1 Prossy Atwiine,1 Kennedy Muhame,1 Peninah Mpumwire,1 Eliphaz Bukombi Muhindi,1 Vallence Niyonzima2 1Nursing Department, Bishop Stuart University, Mbarara City, Uganda; 2Nursing Department, Mbarara University of Science and Technology, Mbarara City, UgandaCorrespondence: Vallence Niyonzima, Tel +256777842830, Email vniyonzima@must.ac.ugPurpose: Stigma and discrimination (SAD) remains a major challenge facing HIV/AIDs management in most countries of sub-Saharan Africa. Expert clients can potentially play a role in the fight against SAD. Our study explored the experiences and the role of expert clients in reducing SAD among people living with HIV/AIDs enrolled on care in health facilities in Western Uganda.Participants and Materials: We conducted a phenomenological qualitative study among (12) twelve purposively selected expert clients at four health facilities in Sheema district, Western Uganda. In-depth interviews were conducted using an interview guide. Data were transcribed verbatim, translated to English, manually coded and analysed manually by thematic content.Results: Four themes emerged describing the experiences of expert clients in reducing HIV/AIDs SAD; 1) Feeling of inner satisfaction, 2) Challenging work environment, 3) Acquisition of skills and 4) Disclosure dilemma. The roles of expert clients in reducing HIV-related SAD included 1) Facilitating status disclosure, 2) Identifying and helping clients with stigma/discrimination, 3) Linking patients to the health care system and 4) Promotion of positive living.Conclusion: Expert clients had numerous experiences and play a key role in the fight against SAD. Expert clients should be included as one of the stakeholders in the efforts to reduce or eradicate SAD in the management of HIV/AIDs.Keywords: expert clients, HIV, stigma, discrimination, experiences, roles

Adella Arishaba,1 Wilson Kiduuma,1 Grace Night,2 Innocent Arinaitwe,3 Vallence Niyonzima,1 Vincent Mubangizi1 1Department of Nursing, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda; 2Department of Physiotherapy, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, Uganda; 3Department of Internal Medicine, Faculty of Medicine Mbarara University of Science and Technology, Mbarara City, UgandaCorrespondence: Vallence Niyonzima, Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara city, Uganda, Tel +256777842830, Email vniyonzima@must.ac.ugPurpose: The study intended to establish the proportion of HIV-positive women experiencing IPV and the predictors of counseling-seeking behavior among women living with HIV in Isingiro district.Methods: The study was a cross-sectional quantitative study. We conducted the study in April 2021 among 296 HIV-positive women receiving ART services at Rwekubo and Nyamuyanja Health Centre fours. Data were collected using a researcher-administered questionnaire. Consecutively participants were recruited from the ART clinic. SPSS Version 23.0 was used to analyze data. We computed the prevalence of intimate partner violence among the study participants. Logistic regression was performed to identify the associated factors and predictors of counseling-seeking behavior.Results: Of the 296 participants interviewed, 66.2% of the HIV-positive women had experienced IPV. Only 40.2% of those who had experienced IPV had received counseling, 35.5% of the participants sought help for IPV from family and friends and 27% sought help from other service providers including the police. A majority (67.2%) of the participants had a primary level of education and over a third (45.9%) of the participants were from monogamous families. The factors associated with seeking care for IPV were education level (p = 0.002), type of family (p = 0.04), physical abuse within one last year (p < 0.001), emotional abuse (p < 0.001), awareness about IPV services (p < 0.001) and availability of counselors (p < 0.001). The predictors of care-seeking for IPV included awareness about IPV services (aOR: 295.6, 95% CI: 54.3– 1608.9) and availability of counselors (aOR: 5.3, 95% CI: 1.5– 19.2).Conclusion: The prevalence of IPV is 66.2%, and proportion of HIV-positive women who seek IPV counseling services is low. The predictors of counseling-seeking behavior were awareness about IPV services and availability of counselors. There is a need to improve awareness about IPV services and provide more counselors to offer help to the IPV victims.Keywords: intimate partner violence, HIV-positive women, counseling, Uganda, cross-sectional study

Background People living with HIV still have challenges in accessing HIV services in low- and middle income countries. In Uganda, the community drug distribution points are interventions to improve access to anti-retroviral medications. However, there is still low enrollment on community drug distribution points among PLHIV in south western Uganda particularly in Bushenyi district. This study explored the barriers and facilitators to utilization of community drugs distribution points among adult HIV patients. Methods This was a descriptive study utilizing a qualitative approach. We purposively recruited 24 adult HIV patients and 6 health workers as key informants. We conducted in depth interviews with adult HIV patients and key informant interviews with health workers using interview guide. The data were transcribed from audios to Runyakore-Rukiga in word document then translated to English. Data were analyzed manually using thematic analysis. Results We found that the main facilitators to utilization of community drug distribution points were positive health workers’ attitude and reduced expenses especially in term of transport cost. The main barriers to utilization of community drug distribution points were lack of infrastructure and privacy. Conclusion and recommendations : Patients’ utilization of community drug distribution points is greatly influenced by the health workers attitude. Stigma is still a limitation to utilization of HIV services. We recommend that interventions to eliminate stigma be put in place and infrastructure be put at the community drug distribution points.

Background HIV-Associated Neurocognitive Disorder (HAND remains a pronounced consequence of HIV/AIDS despite improved life expectancies. This is often associated with several dysfunctions such as decrease of attention, mood alterations and psychomotor disturbances. Many factors, including age, gender, employment status, and psychiatric disorders, have been associated with HAND. Among the associated psychiatric disorders, depression is often more prevalent. It can influence not only quality of life, relationships and employment but also adherence to medical care. We assessed the prevalence of depression and its association with HAND among people living with HIV in rural Southwestern Uganda. Methods This was a cross-sectional study that used Beck Depression Inventory-1 and International HIV Dementia Scale to assess depression and HAND respectively. We defined depression with a score of > 10 and HAND with a cutoff score of ≤10. We conducted data analysis using STATA version 12, and Pearson Chi-square test and logistic regression to determine associations between depression and HAND. The level of statistical significance was set at p ≤ 0.05. Ethical approval and administrative clearance were obtained from relevant bodies. Results Of the 393 participants assessed for depression and HAND, 27% had depression and 58.3% screened positive for HAND. All levels of depression were more prevalent among female participants. We found a significant association between depression and HIV associated neurocognitive disorders (χ2 (3) = 9.0538 p = 0.029). Conclusion Our findings confirmed a high prevalence of depression in individuals with HAND which is a major component of the disease burden.

Background: The world’s population is ageing resulting in a larger number of people living with dementia. Prevalence of dementia for persons aged above 60 years is expected to increase . There is paucity of information regarding formal support available for institutionalised individuals with AD/ADRD, enablers and barriers to its utilisation particularly South Western Uganda. Therefore this study, filling this knowledge gap, sought to assess formal support available for individuals with AD/ADRD, enablers and barriers to its utilisation in rural communities in South Western Uganda Methods: This study was conducted in two nongovernmental community based facilities for the elderly in South Western Uganda employing a qualitative cross sectional study design. Purposive sampling was used to recruit caretakers of individuals with Alzheimer’s disease and related dementias. A total of 28 in depth interviews and 6 key informant interviews were conducted. Results: Three arching themes emerged: 1) Formal support services available, 2) Enablers and 3) Barriers to the utilisation of the formal support services in institutionalised patients with AD/ADRD in rural communities in South Western Uganda. Conclusions: These findings highlight the importance of formal care in the long-term care of individuals with AD/ADRD. There is a dire need to equip caretakers involved in the care of patients with AD/ADRD with the required skill set and include formal support services in the mainstream primary health care to make the services accessible.