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Prevalence of and factors associated with post-partum hemorrhage following cesarean section among mothers delivering at Kawempe National Referral Hospital, Uganda
No full textBackground: Postpartum hemorrhage is one of the leading causes of severe maternal morbidity
and mortality; accounting for 27.1% of maternal deaths worldwide, ranging from 8% in developed
countries to 32% in Northern Africa. In Uganda, postpartum hemorrhage accounts for 34% of the
maternal deaths. Despite being a treatable and preventable condition, the high number of maternal
deaths resulting from postpartum hemorrhage has remained a significant worldwide concern. This
study aimed to establish the prevalence and factors associated with PPH following cesarean section
among mothers delivered from Kawempe National Referral hospital.
Methods: This was a cross sectional study conducted at Kawempe National Referral Hospital. A
total of 247 participants (women of reproductive age group 15-49 years) were recruited using
systematic sampling and following attainment of informed consent. Study period from 1
st
December 2023-30th January 2024. PPH was defined as blood loss of >1000mls during or after
cesarean delivery or any amount of bleeding that led to hemodynamic instability characterized by
shock index > 0.7 or hemorrhage that necessitated blood transfusion, hemostatic sutures (O’Leary,
Cho and B lynch) or hysterectomy.
Data was collected using a pretested interviewer-administered questionnaire, entered in EpiData
version 7.1.2, cleaned, and exported to Stata v15 for analysis.
Results: Among the 247 mothers that were recruited into the study, the average age was 27.98
(±5.64). Majority were Baganda (46.6%), 93.1% were married and 49.0% had attained secondary
education. The prevalence of PPH among post caesarean section mothers was found to be 18.2%
with Atony accounting for 73.3%, coagulation disorders (17.8%), trauma (13.3%) and retained
tissue (8.8%). PPH following C/section was found to be significantly associated with anaemia
during pregnancy (aOR=5.212, 95% CI 1.713 - 15.855, P-Value 0.004), history of pre-eclampsia
(aOR=3.803, 95% CI 1.403 - 10.311, P-value 0.009) and increase in shock index > 0.7
(aOR=75.506, 95% CI 10.424 - 546.937, P-Value <0.001).
Conclusion: Mothers with anemia and hypertensive disorders should be identified during
antenatal and optimized to minimize intrapartum complications. In the event of pre or intra
operative diagnosis, management should be tailored to account for the risk of massive
intraoperative bleeding and a multidisciplinary team alerted and prepared to minimize morbidity and/or mortalit
An evaluation of antibiotic prescribing practices based on the WHO AWaRe classification and associated factors at a private hospital in Kampala
No full textBackground: Irrational antibiotic prescribing practices are a key driver for increasing antimicrobial resistance. Moreover, antibiotic use according to the World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification in Ugandan private hospitals is not known. This study measured antibiotic use, evaluated the associated factors and assessed the extent of preparedness for antibiotic stewardship practices at Case Hospital.
Methods: A cross-sectional study design was utilized. Stratified random sampling with proportionate to size allocation between the out-patient and in-patient departments was used. The prevalence of non-Access category antibiotic use and associated factors were analyzed using modified Poisson regression. Preparedness to implement Antimicrobial stewardship (AMS) practices was analyzed by scoring the hospital’s performance against a set of standardized AMS practice indicators.
Results: Overall antibiotic use prevalence was 45% (190/422). Non-Access category antibiotic use prevalence was 79.5% (151/190) with Azithromycin (Watch category) being the most frequently prescribed antibiotic at 13.6% (40/294). More than half of Azithromycin prescriptions with a documented diagnosis (52.9%) were for Respiratory tract infections.
After adjusting for age and sex, patients prescribed ≥ 2 antibiotics were 33% significantly more likely to have received Non-Access antibiotics compared to those prescribed one (aPR: 1.33, 95% CI 1.16 – 1.54, p < 0.001). The hospital’s extent of preparedness for AMS practices as measured against a standardized AMS audit tool was low (41.2%).
Conclusion: Non-Access category antibiotic use prevalence was about twice the WHO recommended limit of 40%. Additionally, the extent of preparedness to implement AMS practices at the facility was low. As such, there is need to strengthen and support effective functioning of the hospital’s Medicines and Therapeutics committee
Prevalence and associated factors of amblyopia among children seeking eye services at Mulago Hospital
No full textIntroduction: Amblyopia is the leading cause of visual impairment in children, with a worldwide prevalence ranging between 0.13% and 12.9%. The burden of amblyopia among children in Uganda is not well documented, and the consequences of amblyopia, which include poor stereovision, reductions in visual acuity, pattern recognition, contrast sensitivity, low sensitivity to motion, and consequently blindness, remain a challenge to society, hence this study.
Study objectives: This study aimed to determine the prevalence and associated factors of amblyopia among children 17 years of age and below who attended the eye clinic of MNRH from March to May 2024. Specifically, the study determined the prevalence and the factors associated with amblyopia among children 17 years and below attending the eye clinic of MNRH from March to May 2024.
Methods: This study was a cross-sectional study conducted among children below 17 years old attending the eye clinic at Mulago National Referral Hospital. Logistic regression was done to determine the factors associated with Amblyopia at a 5% significance level.
Results: The average age of the children was 11.7 years (SD=3.6 years). Amblyopia was diagnosed in 8.7% (25 out of 288) of the children, with anisometropic amblyopia accounting for 52.0% (13 out of 25) and ametropic amblyopia accounting for 28.0% (7 out of 25) of cases. Children whose next of kin (NOK) were their fathers were 3.01 times more likely [AOR=3.01, CI=1.09-8.29, P=0.03] to be diagnosed with amblyopia compared to those whose NOK were mothers at a 95% confidence interval. Mothers who never consumed alcohol during pregnancy [AOR=0.38, CI=0.22-0.97, P<0.001] were 62% less likely to have their children diagnosed with amblyopia compared to those who consumed alcohol during pregnancy. Additionally, children with first-degree family members using spectacles [AOR=2.75, CI=1.97-7.41, P=0.02] were 2.75 times more likely to be diagnosed with amblyopia than those without. Furthermore, children who presented with photophobia [AOR=4.98, CI=1.38-9.94, P=0.014] were 4.98 times more likely to be diagnosed with amblyopia compared to those without.
Conclusion: Amblyopia prevalence was high, with Anisometropic amblyopia being the most common type of amblyopia diagnosed among children. Amblyopia was associated with having photophobia, a family history of spectacle use, alcohol consumption during the child’s pregnancy, and having the next of kin as the father. Interventions to reduce the public health burden of amblyopia among children in the study area should deliberately address these factors
The impact of compensation delays on water supply projects: case study of construction supervision of Kapchorwa Town Water Supply and Sanitation System
No full textA Project report submitted to the Department of Construction Economics and Management in partial fulfilment of the requirements for the Award of a Master of Science in Construction Management of Makerere University.Compensation of Project Affected Persons on water supply and sanitation projects can sometimes be unfair and delayed hence leading to protests from the affected persons and delays in the project completion. The study was intended to investigate the impact of delayed compensation of project affected persons (PAPS) on construction of water supply projects with a major focus on
Kapchorwa water supply and sanitation project in Kapchorwa district. The research focused on the causes of delayed
compensation of PAPs in relation to the different stakeholders. The research gave recommendations on how delayed compensation can be minimized. Water supply project is very essential to the community especially in Kapchorwa where they face
a very big challenge in accessing safe and adequate water for consumption. The Ministry of Water and Environment aims at providing sustainable and safe water for human consumption by generating a system that provides consistent water for all. However, during the construction of this project, there were many people that were affected especially in places where the pipeline route was passing and also where some structures like break pressure tanks were located along the pipeline. Many trees were cut, crops destroyed which called for compensation of the affected people in the community and acquisition of land where these sites like booster station, Reservoir tanks and the treatment plant were to be located. This research focused on understanding how delay in compensating of the project affected persons has impacted the successful completion of the Kapchorwa water supply and sanitation project in Kapchorwa District. The study strived to understand the possible strategies that have been implemented to address the concerns of these people
Kidney function impairment among older people living with and without HIV at the Infectious Diseases Institute Clinic-Mulago, Kampala , Uganda
No full textThe use of antiretroviral therapy (ART) has averted at least 20 million human immunodeficiency virus (HIV)-related deaths over the last two decades allowing people living with HIV (PLWH) to age. However, HIV-associated chronic inflammation and long life use of ART increases risk of non-communicable diseases (NCDs) including chronic kidney disease (CKD). Moreover, aging-related nephron senescence leads to kidney function decline. Consequently, older PLWH may experience a higher burden of kidney function impairment than older people without HIV. Among PLWH, CKD has been associated with an increased hazard of death. Despite this, there is limited data on the kidney health of older PLWH in Uganda and other low-income regions in sub-Saharan Africa, leading to potential gaps in routine kidney function monitoring.We aimed to compare the burden of kidney function impairment and associated factors between older people aged ≥60 years living with and without HIV at the Infectious Diseases Institute (IDI) clinic-Mulago, Kampala.
Methods: We conducted a cross-sectional study between April and August 2023 among older people aged ≥60 years living with and without HIV at IDI clinic, Mulago. We collected data using an interviewer-administered questionnaire and obtained blood and urine samples from each participant for creatinine and urine protein measurements, respectively. We compared the burden of kidney function impairment between PLWH and people without HIV using the chi-square statistic. We constructed multivariable log binomial models to study factors associated with kidney function impairment.
Results: Among 278 old people aged ≥60 years, median age 66 years, 50% were PLWH, 51.8% were female and 23.0% (95% CI:18.1-28.0) had kidney function impairment. Among Older PLWH 32.4% (95%confidence interval: 25.1%-40.6%) had kidney function impairment compared to 12.9% (95%confidence interval: 8.3%-19.7%) among older people without HIV, p-value<0.01. Proteinuria was present among 43.9% (95%confidence interval: 35.8%-52.3%) older PLWH versus 19.4% (95%confidence interval: 13.6%-26.9%) in older people without HIV, p-value<0.01. Older age (PR=1.1, (95% CI: 1.06-1.20), p-value<0.01), being female (PR=1.6, (95% CI: 1.05-2.37), p-value=0.03) and living with HIV (PR=2.72, (95% CI: 1.71-4.34), p<0.01) were associated with kidney function impairment.
Conclusion: Our findings highlight the higher burden of kidney impairment among older PLWH, driven by age, HIV status, and gender. There is urgent need for targeted interventions to detect and prevent CKD and its progression in older PLWH in Uganda and similar settings.European Union grant agreement number TMA2017GSF-1936
Determinants of access to learning during COVID-19 lockdown among primary school going children in refugee-hosting districts of Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of the degree of Master of Statistics of Makerere UniversityThe main objective of this research was to identify the determinants of access to learning during covid-19 lockdown among primary school going children in refugee hosting districts of Uganda. This study utilized data from the Education Response Plan COVID-19 Survey which was conducted from 10th to 28th March 2022. A total of 2,984 learners across all levels (pre-primary to A-level) in the sampled districts were interviewed. A total sample of 2,797 primary learners were included for analysis and a total of 1,767 learners had access to learning during lockdown while 1,030 did not have access to learning. The study employed logistic regression on the following factors: sex, age, learner’s education level, location (settlement), wealth index, access to self-study materials, learner’s perception on the importance of self-study learning materials, learner’s experience of child abuse during schools’ closure and learner’s disability status. The determinants of access to learning during COVID-19 lock down among school going children in the refugee hosting districts in Uganda were household’s wealth index, access to self-study learning materials and learner’s perception about the importance of self-study learning materials. It was found out that learners from rich households were 1.5 times more likely to access learning during COVID-19 lockdown as compared to those from poor households (OR=1.520, P=0.001). Learners who had received self-study materials were four times more likely to access learning during COVID-19 lockdown as compared to those that had not received self-study materials (OR=3.565, P=0.000). Learners who perceived self-study materials to be helpful were two times more likely to access learning during COVID-19 lockdown compared to those who perceived them as unnecessary materials (OR=2.424, P=0.000). In order to increase access to learning during pandemics, government and refugee supporting partners should; invest and provide learners with offline learning assets like radios and Televisions, formulate programmes aimed at sensitizing and changing the mindset for learners in refugee hosting districts about the importance of self-study learning materials. Future studies should focus on identifying data sources in Uganda that would allow analyzing the confounding factors that were not included in this study and elucidate how they contributed to the observed access to learning during COVID-19 lockdown in refugee hosting districts of Uganda
Prevalence and associated factors of acute kidney injury among preterm neonates admitted at the special care unit of Kawempe National Referral Hospital
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the Award of a Master of Medicine in Paediatrics and Child Health of Makerere University.Background: Acute kidney injury (AKI) is one of the most common conditions among neonates hospitalized in neonatal intensive care units (NICUs) and is known to be associated with short- and long-term complications. Preterm neonates are at greatest risk, however there is paucity of data as regards Acute Kidney Injury occurrence among this population in this study area. This study aimed to investigate the prevalence and associated factors of acute kidney injury among preterm neonates admitted at the special care unit of Kawempe National Referral Hospital, Kampala, Uganda. Methods: This study was a prospective cohort study conducted at the Special Care Unit of Kawempe National Referral Hospital. Data was collected from preterm neonates who met the eligibility criteria. A binary logistic regression analysis was done to identify factors associated with AKI. Variables with a P-value <0.05 were considered as statistically significant in multiple logistic regression analysis. Data analysis was done using STATA 17. Results: A total of 288 participants were enrolled in the study and analysed data of 285. Of these, 23(8.1%), (95%CI=5.4-11.8%) had AKI. Of the 23 that had AKI, 20(87%) neonates had stage 1, 1(4.3%) had stage 2 and 2(8.7%) with stage 3 AKI. Maternal illness (AOR=33.8; 95%CI= (8.89-128.4) and sepsis (AOR=4.3; 95%CI= (1.12-16.49)) were factors significantly associated with AKI among the preterm neonates. Conclusion: This study revealed that 8% of preterm neonates had AKI, hence a common occurrence. Preterm neonates especially those with identified associated factors like sepsis should have their serum creatinine serially checked to aid early recognition of AKI, prompt treatment, monitoring and follow up to avert the known short- and long-term complications. Key words: Acute kidney injury, preterm, neonate, prevalence and associated factors.1.Fogarty International Center of the National Institutes of Health.
2.U.S Department of State’s Office of the U.S Global AIDS Coordinator and Health Diplomacy (S/GAC), and Presidents Emergency Plan for AIDS’ Relief (PEPFAR) under award number 1R25TW011213.
3.Health Professions Education and Training for strengthening the health system and services in Uganda project (HEPI-SHSSU)
Analysis of sustainable growth strategies in the tourism sector: case study of Uganda tourism board.
No full textA research report submitted to the College of Business and Management Sciences in partial fulfillment of the requirements for the award of the degree of Master of Business Administration of Makerere UniversityThis study analyzed the Sustainable Growth Strategies in the tourism sector with a special focus on the Uganda Tourism Board. The objectives of the study were to; identify the existing sustainable growth strategies implemented by Uganda Tourism Board, analyze the lapses related to sustainable growth strategies implemented by Uganda Tourism Board and develop suitable strategies that can be utilized to improve the sustainable growth of tourism sector in Uganda. A cross sectional survey design was adopted, where quantitative data was collected with the aid of the structured self-administered questionnaires from a sample of 70 employees of Uganda Tourism Board using purposive sampling. Of these, 61 were usable which indicates 87% response rate. The data collected was captured and analyzed for descriptive analysis using SPSS. The findings established that Uganda Tourism Board minimizes destruction of environmental resources meant for tourism. Additionally, the Board has encouraged development and implementation of sustainable transport networks in tourism areas, as well as protecting and supporting cultural and historical heritage of people for sustainable tourism. Furthermore, the Board develops and implements sound environmental policies in all areas of tourism. These findings revealed that Uganda Tourism Board is key in implementing sustainable growth strategies. This, they do through minimizing destruction of environmental resources meant for tourism; encouraging development and implementation of sustainable transport networks in tourism areas; protecting and supporting cultural and historical heritage of people for sustainable tourism. However, more effort is needed in ensuring that the Board installs appropriate systems to minimize pollution of tourism developments and the Board should carry out capacity research to develop capacity of destinations of tourists
Prevalence and correlates of preeclampsia in Hoima District- Western Uganda.
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of a Master’s Degree in Public Health of Makerere University.Background: Global maternal health indicators remain worrying; a woman dies every two minutes due to obstetric complications, 33% of which occur in pregnancy. Preeclampsia is the single most concerning pregnancy complication since it causes adverse pregnancy outcomes, in addition to multi-organ dysfunction and cardiovascular disease. Of more concern, its treatment once incident is never certain to result into good outcomes; this partly explains why preeclampsia is associated with 50,000 global maternal deaths. It was projected that without effective secondary prevention interventions, hypertensive disorders of pregnancy including preeclampsia may surpass postpartum hemorrhage in being the leading cause of maternal mortality, yet the disease is easily preventable. However, its prevention requires that its magnitude and possible correlates are known, for which Hoima district had no such documentation.
Objective: To determine the prevalence and correlates of preeclampsia among pregnant women in Hoima District - Western Uganda.
Methods: A cross-sectional survey design was adopted, targeting 286 women at five months or more of gestation. Hoima Regional Referral Hospital and the health center IV were purposively sampled. Half of the health center IIIs 12(50%) were sampled using simple random sampling and the pregnant women consecutively sampled. They were engaged in structured interviews and subjected to blood pressure and urinalysis assessments. Data obtained was entered and analyzed in STATA 14 using a binomial logit model, which yielded adjusted odds ratios.
Results: The prevalence of preeclampsia in Hoima district is 1.7%, although Isolated Gestational Proteinuria is five times as high, at 9.1%. No socio demographic, intrapersonal or obstetric characteristics had a statistically significant association with preeclampsia (p>0.05) and hence were not correlated with it.
Conclusion: The prevalence of preeclampsia in Hoima district is low; only about 2 in every 100 of them have the hypertensive disorder in pregnancy. But, 9 in every 100 of them are at a very high risk of developing preeclampsia as they progress through gestation. However, neither socio-demographic, nor intrapersonal nor obstetric characteristics have correlations with preeclampsia in Hoima district. While status quo should be maintained in terms of pre-partum preventive efforts for preeclampsia, there is need for healthcare service providers to screen for proteinuria, identify IGP cases and treat them before progression to preeclampsia
Teacher training, remuneration and academic performance in primary school : a comparison of private and government aided schools in Adjumani district, Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of Master of Arts in Rural Development of Makerere University.This study examined the influence of teacher training and remuneration on academic performance of pupils in private and government aided primary schools in Adjumani District. Pupils’ academic performance is influenced by teacher-related factors such as teachers’ training and remuneration, among others. Academic performance in Primary Leaving Examination (PLE) of government and private schools was considered for years 2015-2019. The study was guided by three specific objectives which included; examine the perceived influence of teacher training on the academic performance of pupils in two categories of schools, determine the perceived impact of teacher remuneration and academic performance, and finally establish other factors that influence academic performance of pupils. I adopted a research design combining qualitative and quantitative approaches, 14 key informants were interviewed, including head teachers, classroom teachers, the district Education Officer, Senior Education Officer and the District School Inspector. Two Focus Group Discussions were conducted with School Management Committee (SMC) members and Parents and Teachers Associations (PTA). The study results showed that private schools perform better than government schools in PLE, and that there exist differences between the two categories of schools in some variables. For instance, the two categories of schools remunerate teachers differently, and this was a possible basis for the differences in performance. Therefore, this study concluded that teacher training and teacher remuneration have a positive impact on pupils’ academic performance. The other factors that influence pupils’ academic performance include teacher supervision, distance traveled to school and school basic inputs, in addition, community participation, teacher work overload, inadequate school inputs, and teachers’ experience played an important role in pupils’ academic performance. The study recommends that training needs assessment should be conducted for teacher training to be effective in both private and government aided schools. More innovative forms of remuneration such as those used in private schools should be adopted by government aided schools