IntroductionMortality from trauma remains a major challenge despite recent substantial improvements in acute trauma care. In trauma care patient resuscitation to correct hypotension from volume loss still majorly relies on use of physiological parameters such as blood pressure, pulse rate, respiratory rate, urine output and oxygen saturation. In resource limited settings these methods may not be sufficient to detect occult tissue hypoxia and the accompanying metabolic derangements.MethodsA prospective observational study carried out at a level I urban Trauma centre; Accident and Emergency unit. Major trauma patients were consecutively recruited into the study. Venous blood samples were drawn for analysis of serum electrolytes, serum PH and anion gap. The venous blood gas findings were correlated with patients’ clinical outcome at two weeks. Ethical approval was obtained.ResultsNinety three major trauma patients were recruited, patients’ age ranged from 12 months to 50 years. Forty nine patients (53%) were acidotic (PH less than 7.32), 39 patients (42%) had low bicarbonate (bicarbonate level less than 21 mmol), 54 patients (58%) had high corrected anion gap (anion gap corrected of 16 or more). Fourteen patients (15%) developed secondary organ failure and 32 (34%) patients died.ConclusionMetabolic acidosis is common among major trauma patients, its severity may be related to delay in initiating care. Acid base derangements were predictors of mortality among major trauma patients in this resource limited setting.

Urinary incontinence (UI) is highly prevalent amongst women around the world. In this review article we explore UI, its consequences and treatment in sub-Saharan Africa, providing specific examples from Uganda and Malawi. In sub-Saharan Africa the prevalence of UI is difficult to assess because of the wide variation in reporting resulting from patients hiding their condition due to the associated stigma in many communities. Whilst much of the literature from low-or lowmiddle-income countries focuses on UI from pelvic floor fistula, recent evidence demonstrates that non-fistulous stress, urgency and mixed UI are highly prevalent in sub-Saharan Africa. Incontinence secondary to vesico-vaginal fistula can be related to obstetric causes, mainly obstructed labour. The risk factors for non-fistulous incontinence are similar to those identified in high-income countries, including high parity, vaginal and assisted delivery, gestational age, constipation, obesity, chronic cough and ageing. Urinary incontinence has significant social and emotional consequences, with a high proportion of women in African countries reporting relationship problems, depression and suicidal ideation. There is poor understanding of the perceived aetiology of incontinence in sub-Saharan Africa, which may, in part, act as a barrier for women to seek medical advice. Innovative solutions have been found to manage the large number of obstetric fistulas that are prevalent across Africa, but a lack of capacity in specialists trained to treat women with UI means that more doctors, medical officers and better resource prioritization will be required to help the, as yet unquantified, number of women with non-fistulous leakage. Better patient peri-natal education may reduce the incidence of fistula still further, especially if the stigma felt by women with incontinence is overcome and they are encouraged to seek treatment.

Aims: To assess the duration of leaking urine and patient perceived reasons for delay to seek repair among genitourinary fistula mothers who presented in fistula camps from June-2017 to July-2018 at Mubende and Hoima fistula treatment centers. Methods: This was a retrospective study in which qualitative and quantitative data was collected from standardized patient records of patient chats and registers filled by fistula surgeons. Results: We had a total of 125 mothers from 19 districts and of age between 16 to 72 years with genital urinary fistula operated. The majority (47.4%) of the clients were 25 years or less, of low parity with 41% (para 1+0) and without formal employment. Only 59.5% of the clients presented within one year from the time they developed the fistula. Perception was that fistulas are only treated during camps; ill health results from difficult labour; and lack of awareness that the bladder can be repaired. Conclusions: With the low turn up of mothers seeking repair, there is need to reduce leaking time and lessen suffering of obstetric fistula patients by creating more awareness, promoting routine repairs and continued financial support to care for fistula clients.