To see the other types of publications on this topic, follow the link: Mothers – Mortality – Uganda.
Journal articles on the topic 'Mothers – Mortality – Uganda'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Mothers – Mortality – Uganda.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
McMURRAY, CHRISTINE. "MEASURING EXCESS RISK OF CHILD MORTALITY: AN EXPLORATION OF DHS I FOR BURUNDI, UGANDA AND ZIMBABWE." Journal of Biosocial Science 29, no. 1 (January 1997): 73–91. http://dx.doi.org/10.1017/s0021932097000734.
Full textAbstract:
This paper proposes a new method of measuring excess risk of child mortality in cross-sectional surveys, which is applied to DHS I data for Burundi, Uganda and Zimbabwe. The expected child mortality experience is estimated for each mother on the basis of child's age, mother's age at child's birth and her parity, and compared with her observed experience. Mothers who exceed their expected child mortality experience and also had more than one child die are considered to have excess child mortality. Zimbabwe had the greatest concentration of child deaths as measured by a simple ratio of mothers to deaths, but when observed experience was compared with expected it had less than half as many excess deaths as Uganda and Burundi. In all three countries mother's education had a strong negative association with the risk of excess child mortality, and in Zimbabwe and Burundi there were significant regional differences.
2
Kaberuka, Will, Alex Mugarura, Javan Tindyebwa, and Debra S. Bishop. "Factors determining child mortality in Uganda." International Journal of Social Economics 44, no. 5 (May 8, 2017): 633–42. http://dx.doi.org/10.1108/ijse-08-2015-0201.
Full textAbstract:
Purpose The purpose of this paper is to establish socio-economic factors and maternal practices that determine child mortality in Uganda. Design/methodology/approach The paper examines the role of sex, birth weight, birth order and duration of breastfeeding of a child; age, marital status and education of the mother; and household wealth in determining child mortality. The study employs a logistic regression model to establish which of the factors significantly impacts child mortality in Uganda. Findings The study established that education level, age and marital status of the mother as well as household wealth significantly impact child mortality. Also important are the sex, birth weight, birth order and breastfeeding duration. Research limitations/implications Policies aimed at promoting breastfeeding and education of female children can make a significant contribution to the reduction of child mortality in Uganda. Practical implications Health care intervention programs should focus on single, poor and uneducated mothers as their children are at great risk due to poor and inadequate health care utilization. Originality/value This paper could be the first effort in examining child mortality status in Uganda using a logistic regression model.
3
Edwards, Grace. "From policy to practice: the challenges facing Uganda in reducing maternal mortality." International Journal of Health Governance 23, no. 3 (September 3, 2018): 226–32. http://dx.doi.org/10.1108/ijhg-06-2017-0031.
Full textAbstract:
Purpose The purpose of this paper is to describe the challenges faced by health professionals in meeting Millennium Goal 5 and reducing maternal mortality in Uganda. Design/methodology/approach Uganda is a low income land locked country with some major challenges around maternal health. There are many comprehensive and visionary plans produced by the Ugandan Government, however, there is a disconnect between policy and practice and there are many barriers to be addressed in order to reduce maternal mortality in Uganda. Findings Despite making considerable progress in reducing maternal mortality, Millenium Development Goal (MDG) 5 was not achieved and every day 300 children and 20 mothers die in Uganda. Major barriers include lack of resources, both human and equipment, disparities in access to care, lack of clinical skills and knowledge and financial constraints. The Millennium goals are now behind us and focus has shifted to the sustainable development goals (SDGs). The Ugandan Government must focus on using these goals as part of developing the maternal and child health strategy by prioritising the human resource and health financial issues and continuing to work towards reducing maternal and perinatal mortality. Originality/value This paper gives a succinct review of the progress of Uganda towards meeting the Millennium Goal 5 and makes key recommendations for addressing SDG 3.
4
Ahn, Namkee, and Abusaleh Shariff. "Determinants of Child Height in Uganda: A Consideration of the Selection Bias Caused by Child Mortality." Food and Nutrition Bulletin 16, no. 1 (March 1995): 1–12. http://dx.doi.org/10.1177/156482659501600109.
Full textAbstract:
This paper reports a methodology for analysis and presents the determinants of child height in Uganda. A two-stage estimation method that evaluated the effects of covariates on child height for age after controlling for the selection bias caused by child mortality was necessary. Important determinants of child health in Uganda are the child's and some maternal characteristics. Some environmental factors (at the levels of both community aggregate and household) have significance. The effects of mothers’ characteristics were relatively more sensitive to correction of the selection bias. In particular, mother's secondary education almost doubled its effect and became significant in determining the height of children. Overall results suggest that Uganda is facing a phase of health transition in which the effect of socio-economic variables (at both individual and community levels) are beginning to show up significantly. Although an all-round developmental effort is essential, selective interventions aiming to improve female education and, where that is difficult, extension of appropriate information through radio are likely to improve the survival and health of children.
5
Orach, Christopher Garimoi. "Maternal Mortality Estimated Using the Sisterhood Method in Gulu District, Uganda." Tropical Doctor 30, no. 2 (April 2000): 72–74. http://dx.doi.org/10.1177/004947550003000205.
Full textAbstract:
A community-based retrospective maternal mortality study using the Sisterhood method was conducted in Gulu district between February and March 1996. The objectives were to estimate the magnitude of and identify factors associated with maternal mortality in the district. Atotal of 5522 adult respondents, randomly selected from 27 parishes, of the five counties in the district were interviewed. Between 1960–1996 324 maternal deaths occurred in the sisterhood sample. The maternal mortality rate (MMR) was estimated to be 662 per 100 000 deliveries [95% confidence interval (CI) 421–839 per 100 deliveries]. The leading causes of maternal death were: haemorrhage 45.1%; obstructed labour 26.2%; puerperal sepsis 9.6%; anaemia 2.2%; AIDS 2.2%; and gunshot wounds (GSW) 1.0%. Factors associated with maternal mortality included: age − 31.8% of the mothers who died were below 20 years; education − 57.1% had no formal education; 65% of the mothers had delivered at home, 50.6% had been attended to by untrained traditional birth attendants (TBAs), while 37.8% were attended to by relatives. The MMR was found to be 1.3 times higher than the estimated national MMR of 500 per 100 000 deliveries. Most maternal deaths (80.9%) were due to preventable causes, being related to low socioeconomic status and low-level education of women in the district. The intractable civil war in the district was a major underlying and contributory factor to the high maternal mortality in the area. A multifaceted approach to reduce maternal mortality in the district should target improving the socioeconomic conditions in the district with special emphasis on encouraging and supporting female education. Intensive education on maternal healthcare in antenatal clinics be conducted targeting husbands/spouses and relatives who care for the prenatal/pregnant and postnatal mothers. There is need for more trained TBAs per village who should be given effective support supervision. Ambulance transport services, motor and bicycle be made available at the district and community levels. At a national level the security situation should be improved in the district.
6
Dey, Teesta, Sam Ononge, Andrew Weeks, and Lenka Benova. "Immediate postnatal care following childbirth in Ugandan health facilities: an analysis of Demographic and Health Surveys between 2001 and 2016." BMJ Global Health 6, no. 4 (April 2021): e004230. http://dx.doi.org/10.1136/bmjgh-2020-004230.
Full textAbstract:
IntroductionProgress in reducing maternal and neonatal mortality, particularly in sub-Saharan Africa, is insufficient to achieve the Sustainable Developmental Goals by 2030. The first 24 hours following childbirth (immediate postnatal period), where the majority of morbidity and mortality occurs, is critical for mothers and babies. In Uganda,<50% of women reported receiving such care. This paper describes the coverage, changes over time and determinants of immediate postnatal care in Uganda after facility births between 2001 and 2016.MethodsWe analysed the 2006, 2011 and 2016 Ugandan Demographic and Health Surveys, including women 15–49 years with most recent live birth in a healthcare facility during the survey 5-year recall period. Immediate postnatal care coverage and changes over time were presented descriptively. Multivariable logistic regression was used to examine determinants of immediate postnatal care.ResultsData from 12 872 mothers were analysed. Between 2006 and 2016, births in healthcare facilities increased from 44.6% (95% CI: 41.9% to 47.3%) to 75.2% (95% CI: 73.4% to 77.0%) and coverage of immediate maternal postnatal care from 35.7% (95% CI 33.4% to 38.1%) to 65.0% (95% CI: 63.2% to 66.7%). The majority of first checks occurred between 1 and 4 hours post partum; the median time reduced from 4 hours to 1 hour. The most important factor associated with receipt of immediate postnatal care was women having a caesarean section birth adjusted OR (aOR) 2.93 (95% CI: 2.28 to 3.75). Other significant factors included exposure to mass media aOR 1.38 (95% CI: 1.15 to 1.65), baby being weighed at birth aOR 1.84 (95% CI: 1.58 to 2.14) and receipt of antenatal care with 4+Antenatal visits aOR 2.34 (95% CI: 1.50 to 3.64).ConclusionIn Uganda, a large gap in coverage remains and universal immediate postnatal care has not materialised through increasing facility-based births or longer length of stay. To ensure universal coverage of high-quality care during this critical time, we recommend that maternal and newborn services should be integrated and actively involve mothers and their partners.
7
Kananura, Rornald Muhumuza. "Mediation role of low birth weight on the factors associated with newborn mortality and the moderation role of institutional delivery in the association of low birth weight with newborn mortality in a resource-poor setting." BMJ Open 11, no. 5 (May 2021): e046322. http://dx.doi.org/10.1136/bmjopen-2020-046322.
Full textAbstract:
ObjectivesTo assess low birth weight’s (LBW) mediation role on the factors associated with newborn mortality (NM), including stillbirth and the role of institutional delivery in the association between LBW and NM.Design and participantsI used the 2011–2015 event histories health demographic data collected by Iganga-Mayuge Health Demographic and Surveillance Site (HDSS). The dataset consisted of 10 758 registered women whose birth occurred at least 22 weeks of the gestation period and records of newborns’ living status 28 days after delivery.SettingThe Iganga-Mayuge HDSS is in Eastern Uganda, which routinely collects health and demographic data from a registered population of at least 100 000 people.Outcome measureThe study’s key outcomes or endogenous factors were perinatal mortality (PM), late NM and LBW (mediating factor).ResultsThe factors that were directly associated with PM were LBW (OR=2.55, 95% CI 1.15 to 5.67)), maternal age of 30+ years (OR=1.68, 95% CI 1.21 to 2.33), rural residence (OR=1.38, 95% CI 1.02 to 1.85), mothers with previous experience of NM (OR=3.95, 95% CI 2.86 to 5.46) and mothers with no education level (OR=1.63, 95% CI 1.21 to 2.18). Multiple births and mother’s prior experience of NM were positively associated with NM at a later age. Institutional delivery had a modest inverse role in the association of LBW with PM. LBW mediated the association of PM with residence status, mothers’ previous NM experience, multiple births, adolescent mothers and mothers’ marital status. Of the total effect attributable to each of these factors, LBW mediated +25%, +22%, +100%, 25% and −38% of rural resident mothers, mothers with previous experience of newborn or pregnancy loss, multiple births, adolescent mothers and mothers with partners, respectively.ConclusionLBW mediated multiple factors in the NM pathways, and the effect of institutional delivery in reducing mortality among LBW newborns was insignificant. The findings demonstrate the need for a holistic life course approach that gears the health systems to tackle NM.
8
Babughirana, Geoffrey, Sanne Gerards, Alex Mokori, Benon Musasizi, Nathan Isabirye, Isaac Charles Baigereza, Grace Rukanda, Emmanuel Bussaja, Stef Kremers, and Jessica Gubbels. "Effects of Implementing the Timed and Targeted Counselling Model on Pregnancy Outcomes and Newborn Survival in Rural Uganda: Protocol for a Quasi-Experimental Study." Methods and Protocols 3, no. 4 (October 29, 2020): 73. http://dx.doi.org/10.3390/mps3040073.
Full textAbstract:
Background: Although mortality rates have declined in Uganda over the last decade, maternal mortality is still high at 336 deaths per 100,000 live births, as is infant mortality at 43 deaths per 1000 live births. One in every 19 babies born in Uganda does not live to celebrate their first birthday. Many of these deaths occur within the first 28 days of life, forming the single largest category of death. Promising effects for preventing death are expected from timed and targeted counselling (ttC), an intervention package of key messages and actions that address integrated health and nutrition needs of the mothers and children, barriers and negotiation agreement, to cause sustainable behavioural change at specific timelines in the first 1000 days. Methods: The study has a quasi-experimental design in order to evaluate the implementation and effectiveness of the ttC intervention. Participants are pregnant women who have been registered by village health team (VHT) members and who live in Hoima (intervention region) or Masindi (control region) districts, who will be monitored throughout their pregnancy up to at least six weeks after delivery. A multi-stage sampling technique will be employed to select participants, the study sites being purposively chosen. Sample size is determined using the pregnancy rate from the population estimates, resulting in a total required sample of 1218 (609 each in the intervention and control group). Study instruments that will be used include the Ugandan VHT household register (in which all mothers to be studied will be registered), the ttC register (an additional tool for the study area), and a study questionnaire, to collect data at outcome level. Univariate, bivariate and multivariate analyses will be performed using SPSS to evaluate intervention effects on outcomes (e.g., relationship between pregnancy outcomes and antenatal attendance). In addition, quantitative findings will be triangulated with qualitative data, and collected through interviews and focus group discussions with participants and implementers. Discussion: The proposed study will examine the effectiveness of implementing ttC to improve maternal and child outcomes in Uganda. If ttC is effective, broader implementation of appropriate antenatal services can be advised as essential newborn care improvements. Trial registration: PACTR, PACTR202002812123868. Registered on 25 February 2020.
9
Ogbo, Felix A., John Eastwood, Andrew Page, Oniovo Efe-Aluta, Chukwudi Anago-Amanze, Eshioramhe A. Kadiri, Ifegwu K. Ifegwu, Sue Woolfenden, and Kingsley E. Agho. "The impact of sociodemographic and health-service factors on breast-feeding in sub-Saharan African countries with high diarrhoea mortality." Public Health Nutrition 20, no. 17 (October 5, 2017): 3109–19. http://dx.doi.org/10.1017/s1368980017002567.
Full textAbstract:
AbstractObjectiveThe current study aimed to examine the impact of sociodemographic and health-service factors on breast-feeding in sub-Saharan African (SSA) countries with high diarrhoea mortality.DesignThe study used the most recent and pooled Demographic and Health Survey data sets collected in nine SSA countries with high diarrhoea mortality. Multivariate logistic regression models that adjusted for cluster and sampling weights were used to investigate the association between sociodemographic and health-service factors and breast-feeding in SSA countries.SettingSub-Saharan Africa with high diarrhoea mortality.SubjectsChildren (n 50 975) under 24 months old (Burkina Faso (2010, N 5710); Demographic Republic of Congo (2013, N 6797); Ethiopia (2013, N 4193); Kenya (2014, N 7024); Mali (2013, N 3802); Niger (2013, N 4930); Nigeria (2013, N 11 712); Tanzania (2015, N 3894); and Uganda (2010, N 2913)).ResultsOverall prevalence of exclusive breast-feeding (EBF) and early initiation of breast-feeding (EIBF) was 35 and 44 %, respectively. Uganda, Ethiopia and Tanzania had higher EBF prevalence compared with Nigeria and Niger. Prevalence of EIBF was highest in Mali and lowest in Kenya. Higher educational attainment and frequent health-service visits of mothers (i.e. antenatal care, postnatal care and delivery at a health facility) were associated with EBF and EIBF.ConclusionsBreast-feeding practices in SSA countries with high diarrhoea mortality varied across geographical regions. To improve breast-feeding behaviours among mothers in SSA countries with high diarrhoea mortality, breast-feeding initiatives and policies should be context-specific, measurable and culturally appropriate, and should focus on all women, particularly mothers from low socio-economic groups with limited health-service access.
10
Delzer, Mackenzie E., Anthony Kkonde, and Ryan M. McAdams. "Viewpoints of pregnant mothers and community health workers on antenatal care in Lweza village, Uganda." PLOS ONE 16, no. 2 (February 16, 2021): e0246926. http://dx.doi.org/10.1371/journal.pone.0246926.
Full textAbstract:
Background Uganda is a low-income country with high fertility, adolescent birth, and maternal mortality rates. How Ugandan Ministry of Health antenatal education guidelines have been implemented into standardized health education and how pregnant women utilize health facilities remains unclear. Objective We aimed to determine how women obtain education during pregnancy, what guidelines health educators follow, and what barriers exist to receiving antenatal care in Lweza Village, Uganda. Methods Household surveys were conducted with women in Lweza who were or had previously been pregnant. Focus group discussions were conducted with community members and Lweza Primary School teachers. Interviews were conducted with key informants, including midwives, a traditional birth attendant, a community leader, and a Village Health Team member. Data collection was done in English along with a Luganda translator. Results Of the 100 household surveys conducted, 86% of women did not meet the WHO recommendation of 8 antenatal appointments during their pregnancies. Reasons cited for inadequate visits included facing long wait times (>7 h) at health facilities, getting education from family or traditional healers, or being told to delay antenatal care until 6 months pregnant. Informant interviews revealed that no standardized antenatal education program exists. Respondents felt least educated on family planning and postpartum depression, despite 37% of them reporting symptoms consistent with postpartum depression. Education was also lacking on the use of traditional herbs, although most women (60%) reported using them during pregnancy. Conclusions Most women in Lweza do not receive 8 antenatal appointments during their pregnancies or any standardized antenatal education. Educational opportunities on family planning, postpartum depression, and the safety of traditional herbs during pregnancy exist. Future studies should focus on ways to overcome barriers to antenatal care, which could include implementing community-based education programs to improve health outcomes for women in Lweza Village.
11
Fedurek, Pawel, Patrick Tkaczynski, Caroline Asiimwe, Catherine Hobaiter, Liran Samuni, Adriana E. Lowe, Appolinaire Gnahe Dijrian, Klaus Zuberbühler, Roman M. Wittig, and Catherine Crockford. "Maternal cannibalism in two populations of wild chimpanzees." Primates 61, no. 2 (October 5, 2019): 181–87. http://dx.doi.org/10.1007/s10329-019-00765-6.
Full textAbstract:
Abstract Maternal cannibalism has been reported in several animal taxa, prompting speculations that the behavior may be part of an evolved strategy. In chimpanzees, however, maternal cannibalism has been conspicuously absent, despite high levels of infant mortality and reports of non-maternal cannibalism. The typical response of chimpanzee mothers is to abandon their deceased infant, sometimes after prolonged periods of carrying and grooming the corpse. Here, we report two anomalous observations of maternal cannibalism in communities of wild chimpanzees in Uganda and Ivory Coast and discuss the evolutionary implications. Both infants likely died under different circumstances; one apparently as a result of premature birth, the other possibly as a result of infanticide. In both cases, the mothers consumed parts of the corpse and participated in meat sharing with other group members. Neither female presented any apparent signs of ill health before or after the events. We concluded that, in both cases, cannibalizing the infant was unlikely due to health-related issues by the mothers. We discuss these observations against a background of chimpanzee mothers consistently refraining from maternal cannibalism, despite ample opportunities and nutritional advantages. We conclude that maternal cannibalism is extremely rare in this primate, likely due to early and strong mother–offspring bond formation, which may have been profoundly disrupted in the current cases.
12
Brahmbhatt, Heena, Godfrey Kigozi, Fred Wabwire-Mangen, David Serwadda, Tom Lutalo, Fred Nalugoda, Nelson Sewankambo, Mohamed Kiduggavu, Maria Wawer, and Ronald Gray. "Mortality in HIV-Infected and Uninfected Children of HIV-Infected and Uninfected Mothers in Rural Uganda." JAIDS Journal of Acquired Immune Deficiency Syndromes 41, no. 4 (April 2006): 504–8. http://dx.doi.org/10.1097/01.qai.0000188122.15493.0a.
Full text
13
Ackers, Louise, Hannah Webster, Richard Mugahi, and Rachel Namiiro. "What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda." International Journal of Health Governance 23, no. 1 (March 5, 2018): 46–59. http://dx.doi.org/10.1108/ijhg-11-2017-0061.
Full textAbstract:
Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.
14
Agho, Kingsley E., Osita K. Ezeh, Akhi J. Ferdous, Irene Mbugua, and Joseph K. Kamara. "Factors associated with under-5 mortality in three disadvantaged East African districts." International Health 12, no. 5 (January 13, 2020): 417–28. http://dx.doi.org/10.1093/inthealth/ihz103.
Full textAbstract:
Abstract Background The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children <5 y of age in three disadvantaged East African districts. Methods Pooled cross-sectional data on 9270 live singleton births from rural districts in Rwanda (Gicumbi), Uganda (Kitgum) and Tanzania (Kilindi) were analysed using logistic regression generalized linear latent and mixed models to adjust for clustering and sampling weights. Mortality outcomes were neonatal (0–30 d), post-neonatal (1–11 months), infant (0–11 months), child (1–4 y) and under-5 y (0–4 y). Results The odds of post-neonatal and infant mortality were lower among children delivered by a health professional (adjusted odds ratio [AOR] 0.62 [95% confidence interval {CI} 0.47–0.81] for post-neonatal; AOR 0.60 [95% CI 0.46–0.79] for infant), mothers who had four or more antenatal care (ANC) visits during pregnancy (AOR 0.66 [95% CI 0.51–0.85]) and mothers who initiated breastfeeding within 1 h after birth (AOR 0.60 [95% CI 0.47–0.78]). Neonates not exclusively breastfed had higher mortality (AOR 3.88 [95% CI 1.58–9.52]). Children who lived >6 h away from the nearest health centre (6–23 h: AOR 1.66 [95% CI 1.4–2.0] and ≥24 h: AOR 1.43 [95% CI 1.26–1.72]) reported higher mortality rates in children <5 y of age. Conclusions Interventions for reducing deaths in children ≤5 y of age in disadvantaged East African communities should be strengthened to target communities >6 h away from health centres and mothers who received inadequate ANC visits during pregnancy.
15
Mukuru, Moses, Suzanne N. Kiwanuka, Linda Gibson, and Freddie Ssengooba. "Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviours of frontline health workers in Uganda." Health Policy and Planning 36, no. 3 (January 30, 2021): 260–72. http://dx.doi.org/10.1093/heapol/czab001.
Full textAbstract:
Abstract Uganda is among the sub-Saharan African Countries which continue to experience high preventable maternal mortality due to obstetric emergencies. Several Emergency Obstetric Care (EmOC) policies rolled out have never achieved their intended targets to date. To explore why upstream policy expectations were not achieved at the frontline during the MDG period, we examined the implementation of EmOC policies in Uganda by; exploring the barriers frontline implementers of EmOC policies faced, their coping behaviours and the consequences for maternal health. We conducted a retrospective exploratory qualitative study between March and June 2019 in Luwero, Iganga and Masindi districts selected based on differences in maternal mortality. Data were collected using 8 in-depth interviews with doctors and 17 midwives who provided EmOC services in Uganda’s public health facilities during the MDG period. We reviewed two national maternal health policy documents and interviewed two Ministry of Health Officials on referral by participants. Data analysis was guided by the theory of Street-Level Bureaucracy (SLB). Implementation of EmOC was affected by the incompatibility of policies with implementation systems. Street-level bureaucrats were expected to offer to their continuously increasing clients, sometimes presenting late, ideal EmOC services using an incomplete and unreliable package of inputs, supplies, inadequate workforce size and skills mix. To continue performing their duties and prevent services from total collapse, frontline implementers’ coping behaviours oftentimes involved improvization leading to delivery of incomplete and inconsistent EmOC service packages. This resulted in unresponsive EmOC services with mothers receiving inadequate interventions sometimes after major delays across different levels of care. We suggest that SLB theory can be enriched by reflecting on the consequences of the coping behaviours of street-level bureaucrats. Future reforms should align policies to implementation contexts and resources for optimal results.
16
Egami, Hiroyuki, and Tomoya Matsumoto. "Mobile Money Use and Healthcare Utilization: Evidence from Rural Uganda." Sustainability 12, no. 9 (May 5, 2020): 3741. http://dx.doi.org/10.3390/su12093741.
Full textAbstract:
Lack of cash on hand is a significant obstacle in accessing healthcare services in developing countries. Many expectant mothers in the least developed countries do not receive sufficient care during pregnancy due to financial constraints. If such hurdles in accessing healthcare can be overcome, it will contribute to reduction in maternal and newborn mortality, which is a key target of Sustainable Development Goal 3. This study reports the first assessment of the impact of mobile money services on maternal care utilization. We hypothesize that mobile money adoption would motivate rural Ugandan women to receive antenatal care and to deliver their children at health facilities or with skilled birth attendants. By receiving remittances utilizing mobile money, poor rural households may obtain more cash in hand, which might change women’s health-seeking behavior. We apply community- and mother-fixed effects models with heterogeneity analysis to longitudinal panel data (the RePEAT [Research on Poverty, Environment, and Agricultural Technology] survey) of three waves (2009, 2012, and 2015). The analysis uses pregnancy reports of 2007–2015 from 586 rural Ugandan households. We find suggestive evidence that mobile money adoption positively affects the take-up of antenatal care. Heterogeneity analysis indicates that mobile money brings a larger benefit to geographically challenged households by easing their liquidity constraint as they face higher cost of traveling to distant health facilities. The models failed to reject the null hypothesis of no mobile money effect on the delivery-related outcome variables. This study suggests that promoting financial inclusion by means of mobile money motivates women in rural and remote areas to make antenatal care visits while the evidence of such effect is not found for take-up of facility delivery or delivery with skilled birth attendants.
17
Waniala, Isaac, Sandra Nakiseka, Winnie Nambi, Isaac Naminya, Margret Osuban Ajeni, Jacob Iramiot, Rebecca Nekaka, and Julius Nteziyaremye. "Prevalence, Indications, and Community Perceptions of Caesarean Section Delivery in Ngora District, Eastern Uganda: Mixed Method Study." Obstetrics and Gynecology International 2020 (July 20, 2020): 1–11. http://dx.doi.org/10.1155/2020/5036260.
Full textAbstract:
Background. Uganda has a high maternal mortality ratio (MMR) of 336/100,000 live births. Caesarean section is fundamental in achieving equity and equality in emergency obstetric care services. Despite it being a lifesaving intervention, it is associated with risks. There has been a surge in caesarean section rates in some areas, yet others remain underserved. Studies have shown that rates exceeding 15% do not improve maternal and neonatal morbidity and mortality. Our study aimed at determining the prevalence, indications, and community perceptions of caesarean section delivery in Eastern Uganda. Methods and Materials. It was both health facility and commuity based cross-sectional descriptive study in Ngora district, Eastern Uganda. Mixed methods of data collection were employed in which quantitative data were collected by retrospectively reviewing all charts of all the mothers that had delivered at the two comprehensive emergency obstetric care service facilities between April 2018 and March 2019. Qualitative data were collected by focus group discussions till point of saturation. Data were entered into EpiData (version 3.1) and analyzed using SPSS software (version 24). Qualitative data analysis was done by transcribing and translating into English verbatim and then analyzed into themes and subthemes with the help of NVIVO 12. Results. Of the total 2573 deliveries, 14% (357/2573) were by CS. The major single indications were obstructed labour 17.9%, fetal distress 15.3%, big baby 11.6%, and cephalopelvic disproportion (CPD) 11%. Although appreciated as lifesaving for young mothers, those with diseases and recurrent intrauterine fetal demise, others considered CS a curse, marriage-breaker, misfortune, money-maker and a sign of incompetent health workers, and being for the lazy women and the rich civil servants. The rise was also attributed to intramuscular injections and contraceptive use. Overall, vaginal delivery was the preferred route. Conclusion. Several misconceptions that could hinder access to CS were found which calls for more counseling and male involvement. Although facility based, the rate is higher than the desired 5–15%. It is higher than the projected increase of 36% by 2021. It highlights the need for male involvement during counseling and consent for CS and concerted efforts to demystify community misconceptions about women that undergo CS. These misconceptions may be a hindrance to access to CS.
18
Chemutai, Violet, Julius Nteziyaremye, and Gabriel Julius Wandabwa. "Lived Experiences of Adolescent Mothers Attending Mbale Regional Referral Hospital: A Phenomenological Study." Obstetrics and Gynecology International 2020 (November 23, 2020): 1–11. http://dx.doi.org/10.1155/2020/8897709.
Full textAbstract:
Background. Adolescence is a period of transition from childhood to adulthood, and is a critical stage in ones’ development. It is characterized by immense opportunities and risks. By 2016, 16% of the world’s population was of adolescents, with 82% residing in developing countries. About 12 million births were in 15–19 year olds. Sub-Saharan Africa, particularly East Africa, has high adolescent pregnancy rates, as high as 35.8% in eastern Uganda. Maternal mortality ratio (MMR) attributable to 15–19 years olds is significant with 17.1% of Uganda’s MMR 336/100.000 live births being in this age group. Whereas research is awash with contributing factors to such pregnancies, little is known about lived experiences during early motherhood. This study reports the lived experiences of adolescent mothers attending Mbale Hospital. Materials and Methods. A phenomenological study design was used in which adolescent mothers that were attending Young Child Clinic were identified from the register and simple random sampling was used to select participants. We called these mothers by way of phone numbers and asked them to come for focus group discussions that were limited to 9 mothers per group and lasting about 45 minutes–1 hour. Ethical approval was sought and informed written consent obtained from participants. At every focus group discussion, the data which had largely been taken in local languages was transcribed and translated verbatim into English. Results. The research revealed that adolescent mothers go through hard times especially with the changes of pregnancy and fear of unknown during intrapartum and immediate postpartum period and are largely treated negatively by family and other community members in addition to experiencing extreme hardships during parenting. However, these early mothers’ stress is alleviated by the joy of seeing their own babies. Conclusion. Adolescent motherhood presents a high risk group and efforts to support them during antenatal care with special adolescent ANC clinics and continuous counseling together with their household should be emphasized to optimize outcome not only during pregnancy but also thereafter. Involving these mothers in technical courses to equip them with skills that can foster self-employment and providing support to enable them pursue further education should be explored.
19
Whitworth, Elizabeth, Barbara A. Anderson, Sandra T. Buffington, and Jennifer Braun. "Prevention of Neonatal Hypothermia: A Skin-to-Skin Practices Education Project in Rural Uganda." International Journal of Childbirth 4, no. 1 (2014): 17–24. http://dx.doi.org/10.1891/2156-5287.4.1.17.
Full textAbstract:
PURPOSE: In low resource areas, neonatal hypothermia is an important source of neonatal morbidity. Separating newborns from their mothers at birth puts neonates at risk for hypothermia. The Teso Safe Motherhood Project (TSMP) in Soroti, Uganda provides birth center care for women in conflict areas of Northern Uganda. After conducting a needs assessment at TSMP, a continuing education project was developed to facilitate change in clinical practice to enhance prevention and recognition of neonatal hypothermia, including implementation of skin-to-skin practices at birth.STUDY DESIGN: This education project employed multiple learning strategies including pretest and posttest questionnaires, group discussion of cultural beliefs and practices, didactic education, participation in creative informational art, and demonstration, supervision, and return demonstration of skills.MAJOR FINDINGS: At the completion of the program, 100% of participants demonstrated a statistically significant increase in both knowledge and skills in the prevention and management of neonatal hypothermia (p = .011).MAIN CONCLUSION: The participants reported that this continuing education project enhanced their skills in neonatal hypothermia prevention and management. The cost-effective strategies employed in this project can be replicated in low resource settings, contributing to decreased mortality and morbidity from newborn hypothermia.
20
Kajjura, Richard B., Frederick J. Veldman, and Susanna M. Kassier. "Effect of Nutrition Education on Knowledge, Complementary Feeding, and Hygiene Practices of Mothers With Moderate Acutely Malnourished Children in Uganda." Food and Nutrition Bulletin 40, no. 2 (May 8, 2019): 221–30. http://dx.doi.org/10.1177/0379572119840214.
Full textAbstract:
Background: Inappropriate infant and young child complementary feeding practices related to a lack of maternal knowledge contributes to an increased risk of malnutrition, morbidity, and mortality. There is a lack of data regarding the effect of nutrition education on maternal knowledge, feeding, and hygiene practices as part of a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition in low-income countries like Uganda. Objective: To determine whether nutrition education improves knowledge, feeding, and hygiene practices of mothers with infants and young children diagnosed with moderate acute malnutrition. Methods: A cross-sequential study using a pretest–posttest design included 204 mother–infant pairs conveniently sampled across 24 randomly selected clusters. Weekly nutrition education sessions were embedded in a supplementary porridge intervention for 3 months. Mean scores and proportions for knowledge, feeding, and hygiene practices were determined at baseline and end line. The difference between mean scores at the 2 time points were calculated with the paired t test analysis, while the proportions between baseline and end line were calculated using a z test analysis. Results: Mean scores for knowledge, dietary diversity, and meal frequency were higher at end line compared to baseline ( P < .001). Handwashing did not improve significantly ( P = .183), while boiling water to enhance water quality improved ( P < .001). Conclusion: Nutrition education in conjunction with a supplementary feeding intervention targeting infants and young children with moderate acute malnutrition improved meal frequency, dietary diversity and water quality.
21
Apili, Felister, Stephen Ochaya, Charles Peter Osingada, Scovia Nalugo Mbalinda, David Mukunya, Grace Ndeezi, and James K. Tumwine. "Hookworm Infection among Pregnant Women at First Antenatal Visit in Lira, Uganda: A Cross-Sectional Study." International Journal of Reproductive Medicine 2020 (June 29, 2020): 1–8. http://dx.doi.org/10.1155/2020/8053939.
Full textAbstract:
Background. Hookworm infection in expectant mothers has adverse health effects on both the mothers and their unborn babies. Foetal effects are known to include intrauterine growth retardation and physical and mental growth retardation, while the mothers may develop anemia which could potentially result in death. Unfortunately, little is known about factors that may predispose a pregnant woman to infection by hookworm. In this study, we strived to determine not only the prevalence of hookworm infection among pregnant women attending their first antenatal visit during the current pregnancy in a local health center in northern Uganda but also factors that might predispose them to hookworm infection. Method. This cross-sectional study was conducted among 346 pregnant women from Ogur Health Center IV located in Lira district, northern Uganda. Stool samples were collected from each study participant and analyzed for hookworms. The independent variables listed in this study (participant’s sociodemographic characteristics, preconception care, and sanitation factors) were obtained using a structured questionnaire. Data analysis, including calculation of adjusted ratios, was performed using STATA software (version 14). Results. Prevalence of hookworm infection among pregnant women who attended their first antenatal visit at Ogur Health Center IV was 11% (n=38). After controlling for confounders, factors found to be significantly associated with this infection among pregnant women here were gardening barefooted (adjusted odds ratio (AOR), 3.4; 95% confidence interval (CI), 1.6 to 7.5; P<0.001) and fetching unsafe water shared with animals for domestic uses (AOR, 2.8; 95% CI, 1.3 to 6.2; P value of 0.002). Conclusion. Hookworm infection among pregnant women at Ogur Health Center IV in Lira district, at 11%, is a public health concern and significantly associated with barefoot gardening and fetching water from unsafe sources shared with animals. We, therefore, recommend that special emphasis during routine prenatal health education be placed on the use of protective footwear during farming and fetching water for domestic use from protected safe sources. Author Summary. Hookworm infection is a parasitic condition that more often goes unnoticed, yet it presents immense detrimental effects, especially to pregnant women and their unborn children. It is a chronic disease with accruing effects of blood depletion resulting in anemia. Anemia is, by far, one of the major causes of maternal morbidity and mortality in Uganda. Pregnant women are more prone to hookworm infection by virtue of their compromised immunity, secondary to the physiological process of pregnancy. We demonstrated here that hookworm infection still exists among pregnant women in Uganda. We also showed that gardening barefooted and fetching water for domestic uses from unsafe sources shared with animals were major factors associated with this helminthic infection. This study provides evidence necessary to influence decision making on prevention of hookworm infection in the study area.
22
He, Zhifei, Ghose Bishwajit, Sanni Yaya, Zhaohui Cheng, Dongsheng Zou, and Yan Zhou. "Prevalence of low birth weight and its association with maternal body weight status in selected countries in Africa: a cross-sectional study." BMJ Open 8, no. 8 (August 2018): e020410. http://dx.doi.org/10.1136/bmjopen-2017-020410.
Full textAbstract:
ObjectivesThe present study aimed to estimate the prevalence of low birth weight (LBW), and to investigate the association between maternal body weight measured in terms of body mass index (BMI) and birth weight in selected countries in Africa.SettingUrban and rural household in Burkina Faso, Ghana, Malawi, Senegal and Uganda.ParticipantsMothers (n=11 418) aged between 15 and 49 years with a history of childbirth in the last 5 years.ResultsThe prevalence of LBW in Burkina Faso, Ghana, Malawi, Senegal and Uganda was, respectively, 13.4%, 10.2%, 12.1%, 15.7% and 10%. Compared with women who are of normal weight, underweight mothers had a higher likelihood of giving birth to LBW babies in all countries except Ghana. However, the association between maternal BMI and birth weight was found to be statistically significant for Senegal only (OR=1.961 (95% CI 1.259 to 3.055)).ConclusionUnderweight mothers in Senegal share a greater risk of having LBW babies compared with their normal-weight counterparts. Programmes targeting to address infant mortality should focus on promoting nutritional status among women of childbearing age. Longitudinal studies are required to better elucidate the causal nature of the relationship between maternal underweight and LBW.
23
Isaac Ocheng V. O., Isaac, Eddy Ika, and Kizito Omona [PhD]. "Factors Influencing Utilization of Maternal Health Services by Adolescent Young Mothers Aged 15-19 Years in Kiryandongo General Hospital." International Journal of Medicine 9, no. 1 (March 28, 2021): 31. http://dx.doi.org/10.14419/ijm.v9i1.31389.
Full textAbstract:
Background: In Uganda, 25 % of adolescents age 15-19 have already begun childbearing, 19 % have already given birth and another 5 % pregnant with their first child. Utilization of maternal health services is, therefore, an effective approach to reducing the risk of maternal morbidity and mortality. Low utilization of Maternal Health Services (MHS) has been registered in many parts of Uganda.Objective: To identify the key factors that influenced the utilization of MHS by adolescent young mothers aged 15-19years in Kiryandongo general HospitalMethods: A Cross Sectional analytical design, both quantitative and qualitative was used. A total of 98 adolescent young mothers were randomly selected. Data was collected using semi-structure questionnaires and analyzed using SPSS version 19.Results: Level of utilization of MHS was 44.9%. The socio-demographic (personal) factors that significantly influenced MHS utilization were; maternal age (COR= 0.29; 95% CI: 0.13-0.67, p = 0.003), husband’s education level (COR= 0.19; 95% CI: 0.08-0.47, p =0.000) and husband’s monthly income (COR= 0.35; 95% CI: 0.15-0.80, p = 0.012). Health System factors that influenced MHS utilization included; Time for travelling to reach health facility (COR=2.39; 95% CI: 1.03-5.52, p = 0.040) and Cost of the health services (COR= 2.68; 95% CI: 1.17-6.15, p =0.019).Conclusion: Strategies in addressing decision-making norms, engaging in massive community dialogue and designing appropriate communication strategies may help improve MHS utilization.
24
Nabudere, Harriet, Delius Asiimwe, and Rhona Mijumbi. "Task shifting in maternal and child health care: An evidence brief for Uganda." International Journal of Technology Assessment in Health Care 27, no. 2 (March 30, 2011): 173–79. http://dx.doi.org/10.1017/s0266462311000055.
Full textAbstract:
The Problem: There is a shortage and maldistribution of medically trained health professionals to deliver cost-effective maternal and child health (MCH) services. Hence, cost-effective MCH services are not available to over half the population of Uganda and progress toward the Millennium Development Goals for MCH is slow. Optimizing the roles of less specialized health workers (“task shifting”) is one strategy to address the shortage and maldistribution of more specialized health professionals.Policy Options: (i) Lay health workers (community health workers) may reduce morbidity and mortality in children under five and neonates; and training for traditional birth attendants may improve perinatal outcomes and appropriate referrals. (ii) Nursing assistants in facilities might increase the time available from nurses, midwives, and doctors to provide care that requires more training. (iii) Nurses and midwives to deliver cost-effective MCH interventions in areas where there is a shortage of doctors. (iv) Drug dispensers to promote and deliver cost-effective MCH interventions and improve the quality of the services they provide. The costs and cost-effectiveness of all four options are uncertain. Given the limitations of the currently available evidence, rigorous evaluation and monitoring of resource use and activities is warranted for all four options.Implementation Strategies: A clear policy on optimizing health worker roles. Community mobilization and reduction of out-of-pocket costs to improve mothers’ knowledge and care-seeking behaviors, continuing education, and incentives to ensure health workers are competent and motivated, and community referral and transport schemes for MCH care are needed.
25
Mbonye, Anthony K. "Prevalence of Childhood Illnesses and Care-Seeking Practices in Rural Uganda." Scientific World JOURNAL 3 (2003): 721–30. http://dx.doi.org/10.1100/tsw.2003.52.
Full textAbstract:
There is a declining trend of child health indicators in Uganda despite intensified program efforts to improve child care. For example, the infant mortality rate increased from 81/1,000 in 1995 to 88/1,000 in the year 2000. This paper presents results of a study that assessed factors responsible for this trend. The objectives were to assess the prevalence of childhood illnesses and care-seeking practices for children with fever, diarrhea, and upper respiratory tract infections (URTI) in the Sembabule district of Central Uganda. A cross-sectional survey, using a WHO 30 cluster-sampling technique, was used to obtain data from 300 women with children aged less than 2 years. Prevalence of childhood illnesses and care-seeking practices were obtained using a structured questionnaire supplemented by in-depth interviews. The results showed that the 300 women interviewed had 323 children of whom 37.9% had an episode of fever 2 weeks before the survey, 40.3% had diarrhea, 37.4% had URTI, and 26.8% were fully immunized. Most of the women, 82.7%, perceived fever as the most serious health problem to their children. URTI, diarrhea, and measles were perceived as serious by a lower proportion of women. Although this study showed high perceptions of childhood diseases, the proportion of mothers seeking care for sick children was low, indicating that there are barriers to accessing care. For example, 44.7% of women sought care when their children had fever, 35.0% when children had URTI, and 31.3% when children had diarrhea. However, most children with fever, diarrhea, and URTI were treated at home and taken to health units only when they developed life-threatening symptoms. This late referral to health units was complicated by high costs of care, long distances to health units, poor attitude of health workers, lack of drugs at health units, and limited involvement of fathers in care of the children.The results of this study showed that although the perceptions of childhood diseases were high, the care-seeking practices were poor. In order to improve child care in this district, there is a need to address barriers to quality of care and to conduct further research to assess the role of cultural factors and male involvement in child care.
26
Chinkhumba, Jobiba, Manuela De Allegri, Stephan Brenner, Adamson Muula, and Bjarne Robberstad. "The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi." BMJ Global Health 5, no. 5 (May 2020): e002260. http://dx.doi.org/10.1136/bmjgh-2019-002260.
Full textAbstract:
IntroductionResults-based financing (RBF) is being promoted to increase coverage and quality of maternal and perinatal healthcare in sub-Saharan Africa (SSA) countries. Evidence on the cost-effectiveness of RBF is limited. We assessed the cost-effectiveness within the context of an RBF intervention, including performance-based financing and conditional cash transfers, in rural Malawi.MethodsWe used a decision tree model to estimate expected costs and effects of RBF compared with status quo care during single pregnancy episodes. RBF effects on maternal case fatality rates were modelled based on data from a maternal and perinatal programme evaluation in Zambia and Uganda. We obtained complementary epidemiological information from the published literature. Service utilisation rates for normal and complicated deliveries and associated costs of care were based on the RBF intervention in Malawi. Costs were estimated from a societal perspective. We estimated incremental cost-effectiveness ratios per disability adjusted life year (DALY) averted, death averted and life-year gained (LYG) and conducted sensitivity analyses to how robust results were to variations in key model parameters.ResultsRelative to status quo, RBF implied incremental costs of US$1122, US$26 220 and US$987 per additional DALY averted, death averted and LYG, respectively. The share of non-RBF facilities that provide quality care, life expectancy of mothers at time of delivery and the share of births in non-RBF facilities strongly influenced cost-effectiveness values. At a willingness to pay of US$1485 (3 times Malawi gross domestic product per capita) per DALY averted, RBF has a 77% probability of being cost-effective.ConclusionsAt high thresholds of wiliness-to-pay, RBF is a cost-effective intervention to improve quality of maternal and perinatal healthcare and outcomes, compared with the non-RBF based approach. More RBF cost-effectiveness analyses are needed in the SSA region to complement the few published studies and narrow the uncertainties surrounding cost-effectiveness estimates.
27
Amongin, Dinah, Anna Kågesten, Özge Tunçalp, A. Nakimuli, Mary Nakafeero, Lynn Atuyambe, Claudia Hanson, and Lenka Benova. "Later life outcomes of women by adolescent birth history: analysis of the 2016 Uganda Demographic and Health Survey." BMJ Open 11, no. 2 (February 2021): e041545. http://dx.doi.org/10.1136/bmjopen-2020-041545.
Full textAbstract:
ObjectivesTo describe the long-term socioeconomic and reproductive health outcomes of women in Uganda by adolescent birth history.DesignCross-sectional study.SettingUganda.ParticipantsWomen aged 40–49 years at the 2016 Uganda Demographic and Health Survey.Outcome measuresWe compared socioeconomic and reproductive outcomes among those with first birth <18 years versus not. Among those with a first birth <18 years, we compared those with and without repeat adolescent births (another birth <20 years). We used two-sample test for proportions, linear regression and Poisson regression.FindingsAmong the 2814 women aged 40–49 years analysed, 36.2% reported a first birth <18 years and 85.9% of these had a repeat adolescent birth. Compared with women with no birth <18 years, those with first birth <18 years were less likely to have completed primary education (16.3% vs 32.2%, p<0.001), more likely to be illiterate (55.0% vs 44.0%, p<0.001), to report challenges seeking healthcare (67.6% vs 61.8%, p=0.002) and had higher mean number of births by age 40 years (6.6 vs 5.3, p<0.001). Among women married at time of survey, those with birth <18 years had older husbands (p<0.001) who also had lower educational attainment (p<0.001). Educational attainment, household wealth score, total number of births and under-5 mortality among women with one adolescent birth were similar, and sometimes better, than among those with no birth <18 years.ConclusionsResults suggest lifelong adverse socioeconomic and reproductive outcomes among women with adolescent birth, primarily in the category with repeat adolescent birth. While our results might be birth-cohort specific, they underscore the need to support adolescent mothers to have the same possibilities to develop their potentials, by supporting school continuation and prevention of further unwanted pregnancies.
28
Vanosdoll, Madison, Natalie Ng, Anthony Ho, Allison Wallingford, Shicheng Xu, Shababa Binte Matin, Neha Verma, et al. "A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study." JMIR mHealth and uHealth 7, no. 8 (August 15, 2019): e14540. http://dx.doi.org/10.2196/14540.
Full textAbstract:
Background While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda.
29
Brenner, Jennifer L., Dismas Matovelo, Boniphace Maendaelo, Wemaeli Mweteni, Nalini Singhal, Alberto Nettel-Aguirre, and Leonard Subi. "65 Mama na Mtoto: Health Outcome Achievements Following Implementation of Comprehensive Maternal Newborn Programming in Rural Tanzania." Paediatrics & Child Health 25, Supplement_2 (August 2020): e27-e27. http://dx.doi.org/10.1093/pch/pxaa068.064.
Full textAbstract:
Abstract Introduction/Background Preventable deaths in pregnant women and newborns remain unacceptably high in East Africa. Limited antenatal, delivery and postnatal care-seeking combined with service delivery gaps at government facilities contribute to high mortality. Between 2016-2019, partners from Tanzania, Uganda, and Canada jointly developed, implemented, and evaluated a comprehensive, district-wide maternal, newborn, and child health (MNCH) ‘package’ in Lake Zone, Tanzania. Known locally as ‘Mama na Mtoto’, the scale-up programming involved training and capacity building for district managers, health facility staff and a network of volunteer community health workers selected by their own communities. Objectives To quantitatively assess changes in MNCH health outcomes following the Mama na Mtoto intervention. Design/Methods MNCH household-level care-seeking outcomes were assessed using a pre/post coverage survey adapted from the Demographic Health Survey. Households and women (15-49 years), selected through cluster sampling (cluster unit=hamlet), were surveyed by local, trained research assistants using tablet-based surveys. MNCH service outcomes were assessed at all government health facilities using a comprehensive pre/post cross-sectional audit tool; key measures included staff, equipment, infrastructure, supplies, and medication availability. Descriptive statistics for antenatal care (ANC), health facility delivery (HFD), and postnatal care (PNC)-related indicators were analyzed pre- and post-intervention using R software. Composite health facility ‘Readiness Scores’ were calculated through tallies of relevant itemized facility-based measures for each core MNCH service area across the district. Absolute percentage differences, confidence intervals and design effect are presented where relevant. Results In total, 1,977 households, 2,438 women, and 45 health facilities were surveyed pre-intervention and 1,835 homes, 2,073 women, and 49 health facilities were surveyed post. Care-seeking indicators with statistically significant changes were ANC 4+ (+11%), ANC <12 weeks (+7%), HFD (+17%), and PNC for mothers (+9%); PNC for babies was not significant. Increases in composite MNCH Service Readiness Scores were as follows: ANC +24%, essential newborn care +42%, newborn resuscitation +37%, and labour and delivery +27%. Conclusion The comprehensive MnM package was associated with important improvements in the demand (care-seeking) and service (facility readiness) health outcomes. Attribution is complicated by an uncontrolled health system and lack of district controls; however, the extensive scope, reach, and positive changes are promising and consistent with sustained Ugandan experiences. Best practice documentation is critical to facilitate scale-up and progress acceleration of MNCH programs in Tanzanian and East African settings.
30
Bbaale, Edward, and Faisal Buyinza. "Micro-analysis of mother's education and child mortality: Evidence from Uganda." Journal of International Development 24 (January 5, 2011): S138—S158. http://dx.doi.org/10.1002/jid.1762.
Full text
31
Ambrose, Emmanuela E., Luke R. Smart, Mwesige Charles, Arielle G. Hernandez, Adolfine Hokororo, Teresa Latham, Medard Beyanga, et al. "Geospatial Mapping of Sickle Cell Disease in Northwest Tanzania: The Tanzania Sickle Surveillance Study (TS3)." Blood 132, Supplement 1 (November 29, 2018): 3662. http://dx.doi.org/10.1182/blood-2018-99-113939.
Full textAbstract:
Abstract Tanzania ranks third in Africa for the estimated number of annual births with sickle cell disease, but these estimates are based on sparse data from small studies reported over the past 50 years. A recently completed surveillance study from Uganda documented substantial variation in the prevalence of sickle cell trait and disease across the country. Tanzania lacks a national newborn screening program, and no contemporary multi-regional screening of infants has been undertaken. We designed and conducted a prospective study to determine the prevalence of sickle cell trait and disease by region and district in northwest Tanzania, where the prevalence of sickle cell is thought to be highest. The study used existing public health infrastructure while building local capacity for accurate diagnosis of sickle cell disease. Secondary objectives included characterization of hemoglobin variants and exploration of associations between sickle cell trait, sickle cell disease, malaria, and HIV. The Tanzania Sickle Surveillance Study (TS3) is a prospective cross-sectional study of HIV-exposed infants born in 9 regions across the Lake Zone of northwest Tanzania. In Tanzania, the HIV early infant diagnosis (EID) program collects dried blood spots (DBS) from all children born to HIV-infected mothers. DBS are transported to a central laboratory for prompt detection of HIV vertical transmission. In northwest Tanzania, the DBS are transported to Bugando Medical Centre, a teaching and consultancy hospital in Mwanza, where they are tested for HIV and then stored on-site, and thus available for further testing. Isoelectric focusing (IEF) equipment was donated to Bugando Medical Centre along with reagents and supplies. Two laboratory staff were trained by a board certified hematologist, and then attended a two day seminar by the IEF manufacturer. One pediatrician completed a 2-month observership at Cincinnati Children's Hospital. All DBS samples were tested by IEF using appropriate controls. Completed gels were scored independently by two Tanzanian staff members as normal, disease, trait, variant, or uninterpretable. DBS samples scored as disease or variant were repeated for confirmation and preserved for later genotyping. Regular Skype calls were convened with US-based collaborators to improve quality and interpretation. HIV test results were obtained from the local EID program. Between February 2017 and May 2018, 232 IEF gels were completed by the local staff. After children >24 months of age were excluded to obtain a more accurate newborn prevalence, the median age of children tested was 52 days (IQR 41-93 days), and a total of 17,278 unique DBS samples were scored. The quality of laboratory testing was extremely high with only 20 samples scored as uninterpretable and 54 with missing results, and the primary analysis was performed on the 17,204 remaining samples. The overall prevalence of sickle cell trait and disease in the entire cohort was 20.3% and 1.2%, respectively, with a 0.1% prevalence of hemoglobin variants. This corresponds to an allelic frequency of 0.114 for the sickle gene mutation and demonstrates perfect Hardy-Weinberg equilibrium. No HbC or other common beta-globin variants were identified. Geospatial mapping revealed some variation across regions, with sickle trait ranging from 16.6% to 22.5% and disease ranging from 0.5% to 1.5%. Analysis of individual districts with >100 samples revealed wider geographic variability, with sickle trait ranging from 15.2% to 27.8% and disease ranging from 0.0% to 4.3%. Co-morbidity between HIV and sickle cell disease was analyzed to compare it with the effect on mortality previously observed in Uganda. The prevalence of sickle cell disease was the same among HIV-infected and HIV-negative children (1.2%), suggesting no difference in mortality. The prevalence of sickle cell trait and disease among infants born in northwest Tanzania is very high, exceeding 20% trait and 1.2% disease. All regions in the Lake Zone are affected possibly due to lack of immigration to the area and similar environmental exposures. Targeted newborn screening can be started in high prevalence districts, using existing public health infrastructure with minimal start-up cost and training. Future work will evaluate the correlation between historical malaria prevalence and sickle cell prevalence, and identify hemoglobin variants. Disclosures Ware: Addmedica: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees; Bristol Myers Squibb: Research Funding; Agios: Other: advisory board; Global Blood Therapeutics: Other: advisory board; Biomedomics: Research Funding; Nova Laboratories: Consultancy.
32
Ssentongo, Paddy, Djibril Ba, Claudio Fronterre, Jessica Ericson, Alison Gernand, Ming Wang, Ping Du, Duanping Liao, Vernon Chinchilli, and Steven Schiff. "Micronutrient Supplementation During Pregnancy, Birth Weight and Neonatal Mortality in Uganda: A Causal Mediation Analysis." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 912. http://dx.doi.org/10.1093/cdn/nzaa053_117.
Full textAbstract:
Abstract Objectives Low birth weight (LBW) is a significant risk factor for death in the first 30 days of life. Maternal iron-deficiency anemia during pregnancy increases the risk of LBW. We aimed to explore whether antenatal IFA supplementation reduces neonatal mortality in Uganda and to examine if the association of IFA supplementation with neonatal death is mediated through LBW. Methods We used a retrospective birth cohort from the 2016 population-based Uganda demographic and health survey. We examined information on neonatal survival, sociodemographic and intake of IFA supplementation of 9203 women and 17,202 live-born, term infants ≤ 5 y before the survey. Birth weight was categorized as very low (VLBW, defined as < 1500 g or very small baby as perceived by the mother), low (LBW, birth weight of < 2500 g or baby smaller than average as perceived by the mother), and normal (NBW, ≥ 2500 g or an average and larger baby as perceived by the mother). Causal mediation analysis (CMA) treating the birth weight as a mediator was conducted to measure the direct and indirect effects of IFA on neonatal mortality (death of a live-born infant during the first 30 d of life). Results IFA supplementation was reported in 89% of women. The prevalence of LBW and VLBW was 21% and 7% respectively. 474 (3%) babies died within the 30 d after birth, 320 (66%) died within the first 24 h and 469 (99%) died within the first week of life (early neonatal mortality). IFA supplementation during pregnancy was independently associated with a 56% reduction in neonatal mortality [(hazard ratio (HR): 0.44; 95% CI 0.31, 0.61); P < 0.0001] and 26% reduction in VLBW (Relative risk (RR): 0.74; 95% CI 0.60, 0.92, P = 0.007). There was a linear dose-response relationship between the category of birth weight and increased neonatal mortality (LBW versus NBW: RR: 1.39 95% CI: 1.05–1.81, P = 0.02, VLBW versus NBW: RR; 3.6: 95% CI: 2.83–4.53, P < 0.0001). CMA showed that 6% of the effect of IFA supplement on reducing neonatal mortality was meditated through reducing the risk of VLBW but not through LBW, and 94% of the causal effect was direct. Conclusions The use of antenatal iron/folic acid supplements during pregnancy is an important intervention to reduce neonatal mortality. These findings indicate that the association is weakly mediated through improved birth weight, and other mediators should be identified in future studies. Funding Sources NIH.
33
Burt, Jessica Florence, Joseph Ouma, Lawrence Lubyayi, Alexander Amone, Lorna Aol, Musa Sekikubo, Annettee Nakimuli, et al. "Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda." BMJ Global Health 6, no. 8 (August 2021): e006102. http://dx.doi.org/10.1136/bmjgh-2021-006102.
Full textAbstract:
BackgroundCOVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services.MethodsAn observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020).ResultsBetween 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown.ConclusionThe Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
34
Odorizzi, Pamela M., Prasanna Jagannathan, Tara I. McIntyre, Rachel Budker, Mary Prahl, Ann Auma, Trevor D. Burt, et al. "In utero priming of highly functional effector T cell responses to human malaria." Science Translational Medicine 10, no. 463 (October 17, 2018): eaat6176. http://dx.doi.org/10.1126/scitranslmed.aat6176.
Full textAbstract:
Malaria remains a significant cause of morbidity and mortality worldwide, particularly in infants and children. Some studies have reported that exposure to malaria antigens in utero results in the development of tolerance, which could contribute to poor immunity to malaria in early life. However, the effector T cell response to pathogen-derived antigens encountered in utero, including malaria, has not been well characterized. Here, we assessed the frequency, phenotype, and function of cord blood T cells from Ugandan infants born to mothers with and without placental malaria. We found that infants born to mothers with active placental malaria had elevated frequencies of proliferating effector memory fetal CD4+ T cells and higher frequencies of CD4+ and CD8+ T cells that produced inflammatory cytokines. Fetal CD4+ and CD8+ T cells from placental malaria–exposed infants exhibited greater in vitro proliferation to malaria antigens. Malaria-specific CD4+ T cell proliferation correlated with prospective protection from malaria during childhood. These data demonstrate that placental malaria is associated with the generation of proinflammatory malaria-responsive fetal T cells. These findings add to our current understanding of fetal immunity and indicate that a functional and protective pathogen-specific T cell response can be generated in utero.
35
Carr, Katherine Camacho, and Ruth White. "Focus Group and Health Teaching With Traditional Birth Attendants in Njeru, Uganda." International Journal of Childbirth 2, no. 1 (2012): 12–19. http://dx.doi.org/10.1891/2156-5287.2.1.12.
Full textAbstract:
The Safe Motherhood Initiative identifies the presence of skilled birth attendants at delivery as the single most critical intervention for safe motherhood. This article reports the findings from a focus group with traditional birth attendants (TBAs) conducted at the request of the Namwezi Health Center and the Njeru town council in Uganda as part of a community needs assessment. The purposes of the focus group included the identification of the problems encountered by the TBAs during antenatal, birth, and postpartum care for mother and newborn and how these problems were managed to assess the educational needs of the TBAs and plan for appropriate education and skills training for them. With a high prevalence of HIV, malaria, neonatal tetanus, and maternal morbidity and mortality in this region, TBAs were in need of education to promote hygiene, including hand washing, handling of bodily fluids, and disposal of the placenta; instruction on cord cutting, tying, and care; malaria prevention in pregnancy; and the management of common complications of childbirth and the newborn. “Too much bleeding” was identified as the primary maternal complication, and bleeding from the umbilical cord and preterm delivery were identified as the most common baby problems. Complication narratives from the TBAs indicated a need for continued training in the management of the common complications of childbirth and the neonatal period to improve maternal and newborn survival.
36
Homsy, Jaco, David Moore, Alex Barasa, Willi Were, Celina Likicho, Bernard Waiswa, Robert Downing, Samuel Malamba, Jordan Tappero, and Jonathan Mermin. "Breastfeeding, Mother-to-Child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women on Highly Active Antiretroviral Therapy in Rural Uganda." JAIDS Journal of Acquired Immune Deficiency Syndromes 53, no. 1 (January 2010): 28–35. http://dx.doi.org/10.1097/qai.0b013e3181bdf65a.
Full text
37
Simon Peter, Emurot, Sambo Haruna Aliyu, and Rabiu Salisu Hassan. "Nutrition Assessment and Factors Influencing Malnutrition among Children under Five in Adjumani District Uganda." Journal of Advances in Medicine and Medical Research, March 30, 2019, 1–7. http://dx.doi.org/10.9734/jammr/2019/v29i330074.
Full textAbstract:
Globally and specifically within the sub-Saharan African region, the nutritional status of children under five has remain a public health concern. Deficiency in nutrients has been documented as a cause of morbidity and mortality in children under five in most developing countries. The study was conducted to determine factors influencing malnutrition among children under five in Adjumani district in Uganda. The study design adopted was a descriptive and cross-sectional type. Three hundred children aged under five years together with either their mothers or adult care givers were selected. An interviewer administered structured questionnaire was completed by 200 mothers/caregivers. Nutritional status was assessed by anthropometric measurements while focus group discussions with medical personnel and direct observation were also conducted. The result depicts that Wasting was significantly associated with sex of the children with females more likely to be wasted than males (p=0.023). Age of the studied children was found to be significantly associated with mid upper arm circumference (p<0.001). Also education level of mothers/care givers was significantly associated with malnutrition of children under five. (P value 0.013). Stunting and underweight were identified as the main nutrition problems in Adjumani District. Poor weaning practices, poor sanitation due to inadequate hand washing and poor maintenance of latrine as well as low income for house hold due to few loan/ credit facilities were identified as factors influencing malnutrition.
The study therefore recommends that nutrition survey for children under five should be done regularly at community level. Sanitation can be improved by availing hand washing facility for each latrine. Female education be encouraged while agriculture to should be modernized in order to boost household income and improve food security.
38
Roed, Marte Bodil, Ingunn Marie Stadskleiv Engebretsen, and Robert Mangeni. "Neonatal care practices in Buikwe District, Uganda: a qualitative study." BMC Pregnancy and Childbirth 21, no. 1 (March 17, 2021). http://dx.doi.org/10.1186/s12884-021-03699-4.
Full textAbstract:
Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.
39
Serbanescu, Florina, Howard I. Goldberg, Isabella Danel, Tadesse Wuhib, Lawrence Marum, Walter Obiero, James McAuley, et al. "Rapid reduction of maternal mortality in Uganda and Zambia through the saving mothers, giving life initiative: results of year 1 evaluation." BMC Pregnancy and Childbirth 17, no. 1 (January 19, 2017). http://dx.doi.org/10.1186/s12884-017-1222-y.
Full text
40
Hanson, Claudia, Susan Atuhairwe, Joyce Lucy Atim, Gaetano Marrone, Jessica L. Morris, and Frank Kaharuza. "Effects of the Helping Mothers Survive Bleeding after Birth training on near miss morbidity and mortality in Uganda: A cluster‐randomized trial." International Journal of Gynecology & Obstetrics, October 20, 2020. http://dx.doi.org/10.1002/ijgo.13395.
Full text
41
"Factors Associated With Severe Maternal Outcomes at a Regional Referral Hospital in South-Western Uganda: A Case-Control Study." International Journal of Women’s Health Care 5, no. 1 (February 13, 2020). http://dx.doi.org/10.33140/ijwhc.05.01.03.
Full textAbstract:
Background: The Sustainable Development Goal target is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. Severe maternal outcome studies offer a panoramic assessment of obstetric care. Objective: The study aimed at determining the factors associated with severe maternal outcomes among women admitted at the obstetrics and gynecology ward of Mbarara Regional Referral Hospital. Methods: In an unmatched case control (1:2) study conducted between February and May 2018, 162 pregnant women admitted on the obstetrics and gynecology ward of Mbarara Regional Referral Hospital, or who had delivered within the past 42 days were recruited. Near miss cases were defined based on the WHO criteria. Near-miss cases and events, maternal deaths and their causes were retrospectively reviewed. Three categories of risk factors (socio-demographic, obstetric and health system) were examined. P-values <0.05 were considered statistically significant. A multivariable logistic regression model was used to identify factors associated with severe maternal outcomes. All analyses were performed using Stata software (Version 12.0, StataCorp, and College Station, TX). Results: In the four-month period there were 2301 live births, there were 45 near miss cases and 9 maternal deaths resulting in a severe maternal outcome ratio of 23.5/1000 live births, maternal near miss ratio of 19.6/1,000 live births, maternal near-miss mortality ratio of 5 and mortality index of 16.7%. Severe obstetric hemorrhage (33%), ruptured uterus (27.8%), sepsis or severe systemic infection (16.7%) and hypertensive disorders in pregnancy (16.7%) were the direct causes of severe maternal outcomes. About seventy-seven percent (77.8%) of the mothers with severe maternal outcomes were referred in from the peripheral health facilities, with a 4-time risk increased risk of a severe maternal outcome (aOR, 4.00; 95 % CI, 1.84-6.66, p-<0.001). Conclusion: Of the severe maternal outcomes, direct causes were the most prevalent and most of which are preventable. Being referred in was significantly associated with severe maternal outcomes. The maternal near miss indicators indicate need for improved quality.
42
"POST CESEREAN WOUND SEPSIS: Recognizable Risks and Causes at a Rural Ugandan Hospital." International Journal of Women’s Health Care 3, no. 2 (July 25, 2018). http://dx.doi.org/10.33140/ijwhc/03/02/00003.
Full textAbstract:
Post cesarean wound sepsis refers to a superficial surgical site infection that occurs within 30 days of the operative procedure and involves only the skin or subcutaneous tissue of the incision, and at least a purulent drainage from the incision or isolation of Organisms on culture or one of the cardinal signs of inflammation. Wound sepsis increases morbidity, mortality and length of hospital stay (Oliver, et al). In Uganda, rates of severe wound infection are as high as 25% [1]. Caesarean section rates at the Bwindi community Hospital are 30% of the total deliveries. Purpose: To determine the factors associated with post cesarean wound sepsis among mothers at Bwindi Community Hospital. Methods: This was a retrospective cross sectional study. Consecutive sampling was used to obtain 50 files of mothers who got post cesarean wound sepsis and a matching equal sample of controls at Bwindi Community Hospital from July 2015 to June 2017. Results: The rate of post caesarean sepsis was 3.5%.Multiple factors were associated with postoperative wound sepsis; Age between 26-30 years(OR 3.46, p0.008), Parity of greater than 5(OR 3.14, p0.010), Duration of labor of 5 -8hrs or greater (OR 10.67, p0.013), delayed time of ambulation greater than 24-72hrs (OR 0.14, p<0.001), intra operative blood loss of 500- 1000mls or greater(OR 8.00, p0.023) and Post-operative administration of ampicillin and metronidazole (OR40.00,p<0.001). Conclusion: Post-operative wound sepsis in caesarean section is a relatively common occurrence in low-resource settings and mitigation of the multiple identified modifiable associated factors will greatly reduce patient morbidity and improve their outcomes.
43
Mukunya, David, Beatrice Odongkara, Thereza Piloya, Victoria Nankabirwa, Vincentina Achora, Charles Batte, James Ditai, et al. "Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross-sectional study." Tropical Medicine and Health 48, no. 1 (November 4, 2020). http://dx.doi.org/10.1186/s41182-020-00275-y.
Full textAbstract:
Abstract Background Neonatal hypoglycemia is the most common endocrine abnormality in children, which is associated with increased morbidity and mortality. The burden and risk factors of neonatal hypoglycemia in rural communities in sub-Saharan Africa are unknown. Objective To determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda. Methods This was a community-based cross-sectional study, nested in a cluster randomized controlled trial designed to promote health facility births and newborn care practices in Lira District, Northern Uganda. This study recruited neonates born to mothers in the parent study. Random blood glucose was measured using an On Call® Plus glucometer (ACON Laboratories, Inc., 10125 Mesa Road, San Diego, CA, USA). We defined hypoglycemia as a blood glucose of < 47 mg/dl. To determine the factors associated with neonatal hypoglycemia, a multivariable linear regression mixed-effects model was used. Results We examined 1416 participants of mean age 3.1 days (standard deviation (SD) 2.1) and mean weight of 3.2 kg (SD 0.5). The mean neonatal blood glucose level was 81.6 mg/dl (SD 16.8). The prevalence of a blood glucose concentration of < 47 mg/dl was 2.2% (31/1416): 95% CI 1.2%, 3.9%. The risk factors for neonatal hypoglycemia were delayed breastfeeding initiation [adjusted mean difference, − 2.6; 95% CI, − 4.4, − 0.79] and child age of 3 days or less [adjusted mean, − 12.2; 95% CI, − 14.0, − 10.4]. Conclusion The incidence of neonatal hypoglycemia was low in this community and was predicted by delay in initiating breastfeeding and a child age of 3 days or less. We therefore suggest targeted screening and management of neonatal hypoglycemia among neonates before 3 days of age and those who are delayed in the onset of breastfeeding.
44
Nionzima, Elizabeth. "Prevalence and Outcome of Obstructed Labour at a Tertiary Institution." International Journal of Multidisciplinary Research and Analysis 04, no. 09 (September 15, 2021). http://dx.doi.org/10.47191/ijmra/v4-i9-11.
Full textAbstract:
Obstructed labour is a common preventable causes of both maternal and perinatal morbidity and mortality in developing countries affecting 3-6% labouring women globally and accounts for an estimated 8% of maternal deaths in Sub-Saharan Africa and South Asia. Objective: To determine the prevalence and outcome of obstructed labour in the Gynaecology and Obstetrics Department at a tertiary hospital in Northern Uganda. Method: This was a retrospective chart review of pregnant women admitted in labour and delivered by caesarean section from 1st January 2016 to 31st December 2017 at a Lira Regional Referral Hospital, a tertiary institution in Lango Sub region. Data was analysed using Statistical Package for Social Sciences version 16.0. Results: A total of 808 medical charts of mothers with obstructed labour were retrieved, evaluated and included in this review out of 12,189 deliveries during the study period, giving a prevalence of 6.6%. Majority (77%; 622/808) mothers admitted with diagnosis of obstructed were referred in from peripheral facilities. Over half (53.4%) of the women were in the age group of 20 to 29 years. Over 53%, were prime gravidae and were twice more likely to undergo C/S due to obstructed labour than multigravidas (OR 1.8; 95% CI 1.5-2.2). Only 49.2% had documented cause of obstructed labour, with Cephalo-pelvic disproportion being most common (17.5%), malposition/mal-presentation (14.6%), and macrosomia (3.6%). Partograph was used in only 46.6% (374) women who had obstructed labour. The commonest maternal complication observed were Sepsis (11%), PPH (5.2%), uterine rupture (4%) and burst abdomen (3%) which led to prolonged hospital stay and loss of fertility to some. Mode of delivery in the 808 reviewed charts was caesarean section, 90.3% of babies were born alive, while 8.5% (69) were born dead, (1.2%) had early neonatal, and 40.2% were referred Paediatric Neonatal Intensive Care Unit (NICU) because of low APGAR score. Conclusion: The prevalence of obstructed labour among women delivered by Caesarean section was high compared to the global average. Majority of the women were referrals from the peripheral health centres and associated with life threatening complications and even death. Young age and prime gravida is associated with obstructed labour and high caesarean section rates. The obstruction in multigravida could be due to secondary cephalo-pelvic disproportion as majority of the babies were in normal range weight. Low use of Partograph to monitor labour was evident among women who had obstructed.
45
Tesema, Getayeneh Antehunegn, Zemenu Tadesse Tessema, Koku Sisay Tamirat, and Achamyeleh Birhanu Teshale. "Complete basic childhood vaccination and associated factors among children aged 12–23 months in East Africa: a multilevel analysis of recent demographic and health surveys." BMC Public Health 20, no. 1 (December 2020). http://dx.doi.org/10.1186/s12889-020-09965-y.
Full textAbstract:
Abstract Background Complete childhood vaccination remains poor in Sub-Saharan Africa, despite major improvement in childhood vaccination coverage worldwide. Globally, an estimated 2.5 million children die annually from vaccine-preventable diseases. While studies are being conducted in different East African countries, there is limited evidence of complete basic childhood vaccinations and associated factors in East Africa among children aged 12–23 months. Therefore, this study aimed to investigate complete basic childhood vaccinations and associated factors among children aged 12–23 months in East Africa. Methods Based on the Demographic and Health Surveys (DHSs) of 12 East African countries (Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Mozambique, Madagascar, Zimbabwe, Kenya, Zambia, and Malawi), secondary data analysis was performed. The study included a total weighted sample of 18,811 children aged 12–23 months. The basic childhood vaccination coverage was presented using a bar graph. Multilevel binary logistic regression analysis was fitted for identifying significantly associated factors because the DHS has a hierarchical nature. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (−2LLR) were used for checking model fitness, and for model comparison. Variable with p-value ≤0.2 in the bi-variable multilevel analysis were considered for the multivariable analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the significance and strength of association with full vaccination. Results Complete basic childhood vaccination in East Africa was 69.21% (95% CI, 69.20, 69.21%). In the multivariable multilevel analysis; Mothers aged 25–34 years (AOR = 1.21, 95% CI: 1.10, 1.32), mothers aged 35 years and above (AOR = 1.50, 95% CI: 1.31, 1.71), maternal primary education (AOR = 1.26, 95% CI: 1.15, 1.38), maternal secondary education and above (AOR = 1.54, 95% CI: 1.36, 1.75), husband primary education (AOR = 1.25, 95% CI: 1.13, 1.39), husband secondary education and above (AOR = 1.24, 95% CI: 1.11, 1.40), media exposure (AOR = 1.23, 95% CI: 1.13, 1.33), birth interval of 24–48 months (AOR = 1.28, 95% CI: 1.15, 1.42), birth interval greater than 48 months (AOR = 1.35, 95% CI: 1.21, 1.50), having 1–3 ANC visit (AOR = 3.24, 95% CI: 2.78, 3.77), four and above ANC visit (AOR = 3.68, 95% CI: 3.17, 4.28), PNC visit (AOR = 1.34, 95% CI: 1.23, 1.47), health facility delivery (AOR = 1.48, 95% CI: 1.35, 1.62), large size at birth 1.09 (AOR = 1.09, 95% CI: 1.01, 1.19), being 4–6 births (AOR = 0.83, 95% CI: 0.75, 0.91), being above the sixth birth (AOR = 0.60, 95% CI: 0.52, 0.70), middle wealth index (AOR = 1.16, 95% CI: 1.06, 1.28), rich wealth index (AOR = 1.20, 95% CI: 1.09, 1.33), community poverty (AOR = 1.21, 95% CI: 1.11, 1.32) and country were significantly associated with complete childhood vaccination. Conclusions In East Africa, full basic childhood vaccine coverage remains a major public health concern with substantial differences across countries. Complete basic childhood vaccination was significantly associated with maternal age, maternal education, husband education, media exposure, preceding birth interval, number of ANC visits, PNC visits, place of delivery, child-size at birth, parity, wealth index, country, and community poverty. Public health interventions should therefore target children born to uneducated mothers and fathers, poor families, and those who have not used maternal health services to enhance full childhood vaccination to reduce the incidence of child mortality from vaccine-preventable diseases.
46
Mirkuzie, Alemnesh H., Solomon Ali, Ebba Abate, Asnake Worku, and Awoke Misganaw. "Progress towards the 2020 fast track HIV/AIDS reduction targets across ages in Ethiopia as compared to neighboring countries using global burden of diseases 2017 data." BMC Public Health 21, no. 1 (February 4, 2021). http://dx.doi.org/10.1186/s12889-021-10269-y.
Full textAbstract:
Abstract Background Sustainable Development Goal (SDG) 3.3, targets to eliminate HIV from being a public health threat by 2030. For better tracking of this target interim Fast Track milestones for 2020 and composite complementary measures have been indicated. This study measured the Fast Track progress in the epidemiology of HIV/AIDS in Ethiopia across ages compared to neighboring countries. Methods The National Data Management Center for health’s research team at the Ethiopian Public Health Institute has analyzed the Global Burden of Disease (GBD) 2017 secondary data for the year 2010 to 2017 for Ethiopia and its neighbors. GBD 2017 data sources were census, demographic and a health survey, prevention of mother-to-child HIV transmission, antiretroviral treatment programs, sentinel surveillance, and UNAIDS reports. Age-standardized and age-specific HIV/AIDS incidence, prevalence, mortality, Disability-Adjusted Life Years (DALYs), incidence:mortality ratio and incidence:prevalence ratio were calculated with corresponding 95% confidence intervals. Results Ethiopia and neighboring countries recorded slow progress in reducing new HIV infection since 2010. Only Uganda would achieve the 75% target by 2020. Ethiopia, Tanzania, and Uganda already achieved the 75% mortality reduction target set for 2020. The incidence: prevalence ratio for Ethiopia, Rwanda, and Uganda were < 0.03, indicating the countries were on track to end HIV by 2030. Ethiopia had an incidence: mortality ratio < 1 due to high mortality; while Kenya, Rwanda, Tanzania and Uganda had a ratio of > 1 due to high incidence. The HIV incidence rate in Ethiopia was dropped by 76% among under 5 children in 2017 compared to 2010 and the country would likely to attain the 2020 national target, but far behind achieving the target among the 15–49 age group. Conclusions Ethiopia and neighboring countries have made remarkable progress towards achieving the 75% HIV/AIDS mortality reduction target by 2020, although they progressed poorly in reducing HIV incidence. By recording an incidence:prevalence ratio benchmark of less than 0.03, Ethiopia, Rwanda, and Uganda are well heading towards epidemic control. Nonetheless, the high HIV/AIDS mortality rate in Ethiopia for its incidence requires innovative strategies to reach out undiagnosed cases and to build institutional capacity for generating strong evidence to ensure sustainable epidemic control.
47
Musaba, Milton W., Grace Ndeezi, Justus K. Barageine, Andrew D. Weeks, Julius N. Wandabwa, David Mukunya, Paul Waako, et al. "Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study." Maternal Health, Neonatology and Perinatology 7, no. 1 (July 15, 2021). http://dx.doi.org/10.1186/s40748-021-00133-7.
Full textAbstract:
Abstract Background In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. Methods Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death. Results Of the 623 women diagnosed with obstructed labour, 584 met the eligibility criteria. There were 24 fresh still births (FSB) and 32 early neonatal deaths (ENND) giving an FSB rate of 43.8 (95% CI 28.3–64.4) deaths per 1000 total births; early neonatal death rate of 58.4 (95% CI 40.3–81.4) deaths per 1000 and an overall perinatal mortality rate of 102.2 (95% CI 79.4–130.6) deaths in the first 7 days of life. A mother being referred in active labour adjusted risk ratio of 2.84 (95% CI: 1.35–5.96) and having high blood lactate levels at recruitment adjusted risk ratio 2.71 (95% CI: 1.26–4.24) were the determinants of perinatal deaths. Conclusions The incidence of perinatal death was four times the regional and national average. Babies to women referred in active labour and those with high maternal blood lactate were more likely to die.
48
Ssemata, Andrew Sentoogo, Robert Opika Opoka, John Mbaziira Ssenkusu, Noeline Nakasujja, Chandy C. John, and Paul Bangirana. "Socio-emotional and adaptive behaviour in children treated for severe anaemia at Lira Regional Referral Hospital, Uganda: a prospective cohort study." Child and Adolescent Psychiatry and Mental Health 14, no. 1 (November 26, 2020). http://dx.doi.org/10.1186/s13034-020-00352-4.
Full textAbstract:
Abstract Background Severe anaemia is a global public health challenge commonly associated with morbidity and mortality among children < 5 years of age in Sub-Saharan Africa. However, less is known about the behavioural performance of children < 5 years surviving severe anaemia in low resource settings. We investigated social-emotional and adaptive behaviour in children < 5 years diagnosed with severe anaemia in Northern Uganda. Methods We conducted a hospital based prospective cohort study among children 6—42 months who were treated for severe anaemia (n = 171) at Lira Regional Referral Hospital, Uganda. Socio-emotional and adaptive behaviour were assessed 14 days post discharge using the Bayley Scales of Infant and Toddler Development, 3rd edition. Age-adjusted z-scores for each domain were calculated using scores from healthy community children (n = 88) from the same environment for each age category. Multiple linear regression was used to compare z-scores in the social-emotional and adaptive behaviour scales between the two groups after adjusting for weight-for-age z-score, social economic status, mother’s education, father’s education and father’s employment on all the scales. Results Compared with healthy community controls, children with severe anaemia had poorer [adjusted mean scores (standard error)], socio-emotional [− 0.29, (0.05) vs. 0.01, (0.08), P = 0.002]; but not overall/ composite adaptive behaviour [− 0.10, (0.05) vs. − 0.01, (0.07), P = 0.343]. Within the adaptive behaviour subscales, children with SA displayed significantly poorer scores on the community use [adjusted mean score (standard error)], [− 0.63, (0.10) vs. − 0.01, (0.13), P < 0.001]; and leisure [− 0.35, (0.07) vs. − 0.02, (0.07), P = 0.036] skills. Conclusion This study suggests that severe anaemia in children < 5 years is associated with poor social-emotional scores in the short-term post clinical recovery in Northern Uganda. We recommend long-term follow-up to determine the course of these problems and appropriate interventions to reduce the behavioural burden among children < 5 years surviving severe anaemia in Uganda.
49
Milln, Jack, Betty Nakabuye, Barnabas Kahiira Natamba, Isaac Sekitoleko, Michael Mubiru, Arthur Araali Namara, Samuel Tumwesigire, et al. "Antenatal management and maternal/fetal outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda; a prospective cohort study." BMC Pregnancy and Childbirth 21, no. 1 (May 19, 2021). http://dx.doi.org/10.1186/s12884-021-03795-5.
Full textAbstract:
Abstract Background Hyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women. Methods A prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Results Two hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM. Conclusion HIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.
50
Medvedev, Melissa M., Victor Tumukunde, Ivan Mambule, Cally J. Tann, Peter Waiswa, Ruth R. Canter, Christian H. Hansen, et al. "Operationalising kangaroo Mother care before stabilisation amongst low birth Weight Neonates in Africa (OMWaNA): protocol for a randomised controlled trial to examine mortality impact in Uganda." Trials 21, no. 1 (January 31, 2020). http://dx.doi.org/10.1186/s13063-019-4044-6.
Full text