Chronic Osteomyelitis in Uganda: Mulago Hospital

On behalf of IGOT and UCSF, Christine Stanley, a fourth year medical student from UCSF worked in Kampala, Uganda in 2008. While there, Christine collaborated with orthopaedic surgeons at Mulago Hospital, the national referral hospital of Uganda. The focus of her research was primary chronic osteomyelitis, an illness that continues to affect many children in developing countries despite the existence of appropriate antibiotic treatment. Once in the chronic stage, osteomyelitis requires surgical intervention as well as medical therapy. Given there are 20 orthopaedic surgeons for a population of over 30 million people, appropriate orthopaedic surgical care is not available to most patients in Uganda. In addition, the continuing influx of motor vehicles and motorcycles in Uganda has lead to a huge increase in traumatic orthopaedic injuries. Orthopaedic surgeons are now overwhelmed with caring for acute trauma, leaving little or no time and resources to address chronic conditions such as osteomyelitis.

Christine traveled to 5 hospitals, each located in one of geographical regions of Uganda. Her project had 3 components:

1. Estimate the burden of disease by determining the number of visits for osteomyelitis completed at 5 hospital-based orthopaedic clinics in a one year period.

2. Estimate the surgical burden of osteomyelitis by calculating the number of surgeries for osteomyelitis completed at the 5 hospitals in a one year period.

3. Descriptive study of osteomyelitis focusing on the initial presentation and treatment of the disease, as well as investigating associated risk factors. Over 50 patients and/or their caregivers were interviewed by Christine and a translator. Their x-ray images were also reviewed. The information gathered through Christine’s work will be used to design future research projects to better address this continuing problem. Data can be used by the Uganda Ministry of Health to better target areas in need of more orthopedic care. Designing education initiatives for health care providers is also an important goal of this project.

Continued data analysis of preliminary findings are underway and Christine, along with IGOT have incorporated other medical students interested in orthopedics and international health to continue this projects efforts. Future plans to progress this project include continuing Christine’s research as well as facilitate capacity building within the Mulago hospital.

This project would not be possible without the guidance and support of Dr. Titus Beyeza, director of the Mulago Hospital Dept. of Orthopaedics, Dr. Richard Coughlin, director of IGOT, and Dr. George Rutherford, director of the UCSF Institute of Global Health, UCSF Dean’s Research Fund, Pathways to Careers in Clinical and Translational Research (PACCTR) and NTH Dimensions.