Browsing by Author "Ezati, Daniel"

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    Factors affecting mortality after traumatic brain injury in a resource-poor setting
    (BJS Open, 2019) Okidi, Ronald; Ogwang, Martin David; Okello, Tom Richard; Ezati, Daniel; Kyegombe, W.; Nyeko, D.; Scolding, N. J.
    Background: Traumatic brain injury (TBI) is a major cause of long-term disability and economic loss to society. The aim of this study was to assess the factors affecting mortality after TBI in a resource-poor setting. Methods: Chart review was performed for randomly selected patients who presented with TBI between 2013 and 2017 at St Mary’s Hospital, Lacor, northern Uganda. Data collected included demographic details, time from injury to presentation, and vital signs on arrival. In-hospital management and mortality were recorded. Severe head injury was dened as a Glasgow Coma Scale score below 9. Results: A total of 194 patient charts were reviewed. Median age at time of injury was 27 (i.q.r. 2–68) years. The majority of patients were male (M : F ratio 4⋅9 : 1). Some 30⋅9 per cent of patients had severe head injury, and an associated skull fracture was observed in 8⋅8 per cent. Treatment was mainly conservative in 94⋅8 per cent of patients; three patients (1⋅5 per cent) had burr-holes, four (2⋅1 per cent) had a craniotomy, and three (1⋅5 per cent) had skull fracture elevation. The mortality rate was 33⋅0per cent; 46 (72 per cent) of the 64 patients who died had severe head injury. Of the ten surgically treated patients, seven died, including all three patients who had a burr-hole. In multivariable analysis, factors associated with mortality were mean arterial pressure (P = 0⋅012), referral status (P = 0⋅001), respiratory distress (P = 0⋅040), severe head injury (P = 0⋅011) and pupil reactivity (P = 0⋅011). Conclusion: TBI in a resource-poor setting remains a major challenge and affects mainly young males. Decisions concerning surgical intervention are compromised by the lack of both CT and intracranial pressure monitoring, with consequent poor outcomes
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    Major limb loss (MLL): An overview of etiology, outcomes, experiences and challenges faced by amputees and service providers in the post-conflict period in Northern Uganda
    (Journal of Global Health Reports, 2019) Okello, Tom Richard; Magada, Samuel M; Atim, Pamela; Ezati, Daniel; Campion, Alice; Moro, Emmanuel B; Huck, Jonathon; Byrne, Ged; Redmond, Anthony; Nirmalan, Mahesh
    Background Trauma is a leading cause for major limb loss (MLL) during war. As societies transition into peace other factors become important. The voluntary sector plays a diminishing role in service delivery as countries transition towards peace. Methods We undertook a retrospective review of 141 inpatient case notes at two hospitals in Northern Uganda to study the etiology of MLL. Focus group discussions, a literature search and key informant interviews were undertaken to ascertain patients’ experience and the state of current services. Results The most common indication for amputation was malignancy (36%), followed by gangrene and complications from diabetes. Trauma was the 5th most common cause. The mean (standard deviation, SD) age of this cohort was 43 (22.2) years and the mean (SD) distance from their homes to the closest rehabilitation service unit was 91 (75) km. Less than 1% of patients were formally referred to rehabilitation services. Patients described experiences of stigma and marginalization impacting relationship and/or employability. Rehabilitation services were limited/ unaffordable and inaccessible. Unpreparedness of government agencies in taking over rehabilitation services was evident. Conclusions Non-communicable diseases account for the majority of MLL in this region now. These new cohorts of patients join an existing large pool of war-related amputees. Chronic dependence on the voluntary sector has rendered a state of unpreparedness amongst the local health providers.