162 research outputs found
Postpartum infection at Mbarara Regional Referral Hospital, South Western Uganda : epidemiology, microbiology and control
No full textAbstract: This PhD thesis entitled \u201cPostpartum Infection at Mbarara Regional Referral Hospital, South Western Uganda - Epidemiology, Microbiology and Control\u201d assessed the burden, causes and risk factors for maternal deaths at Mbarara Regional Referral Hospital (MRRH) in south-Western Uganda. With puerperal sepsis as the leading cause of maternal deaths at MRRH and the drivers of mortality being late referrals, non-attendance of antenatal care, un-education and HIV sero-positivity, further work was done to describe the microbiology and epidemiology of sepsis. We described the incidence of postpartum infection among women with postpartum fever or hypothermia presenting for delivery or postpartum care, compared clinical outcomes and examined the risk factors associated with incident fever/hypothermia. A composite infection outcome sepsis among mothers delivering at MRRH was done. Cesarean section was independently associated with in-hospital postpartum infection while antenatal clinic attendance was associated with reduced odds of postpartum infection. With Cesarean section being the commonest operation done on the Maternity ward at MRRH, there\u2019s need to explore factors contributing to the high Cesarean section rates at MRRH and other factors that contribute to the occurrence of post-operative infection before delivery, during delivery and post-operatively. We further looked at whether vaginal colonization with GBS, E. coli, or Enterococcus was associated with increased morbidity among women with obstructed labor and determined the risk factors for colonization. There was no difference in maternal or neonatal morbidity between women with vaginal colonization with E. coli, GBS, and Enterococcus and those who were not colonized. Assessment of microbiology of infections is challenging especially in cases where the numbers are few. There are however contributors to infection and colonization such as poor hygiene and also nosocomial infections. Duration of labor was associated with increased risk of vaginal colonization in women with obstructed labor. This would mean that there are other factors that drive poor clinical maternal and neonatal outcomes in women who are colonized with potential pathogens and not necessarily the long labor duration. An intervention of the WHO Surgical Safety Checklist and pre-operative antibiotics for Cesarean section was introduced there was an increase of 77.6% and 69% in the use of WHO checklist and pre-operative antibiotics for Cesarean respectively. There was also a drop in surgical site infection by 6.9%
Predictors and Patterns of HIV Status Disclosure among HIV Positive Pregnant Women at Mbarara Regional Referral Hospital, South-Western Uganda
No full textOUP accepted manuscript
No full textThis is the accepted manuscript version of the work published in its final form as Dolatshahi, S., Butler, A. L., Siedner, M. J., Ngonzi, J., Edlow, A. G., Adong, J., Jennewein, M. F., Atyeo, C., Ingrid V Bassett., Roberts, D. J., Douglas A Lauffenburger., Alter, G., & Bebell, L. M. (2022). Altered Maternal Antibody Profiles in Women With Human Immunodeficiency Virus Drive Changes in Transplacental Antibody Transfer. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciac156
Deposited by shareyourpaper.org and openaccessbutton.org. We've taken reasonable steps to ensure this content doesn't violate copyright. However, if you think it does you can request a takedown by emailing [email protected]
Research: Proposal and Practice - A Manual for Beginners
No full textThis paper is a product of a persistent need of a simplified reference manual for learners beginning a research component of their required accomplishments for their respective degree programs at a University. The author draws from a constantly witnessed struggle the students go through when developing research proposals for their dissertations, in the end finding themselves falling trap of recycling past works with trivial adaptations. The author-cum examiner experiences show that students have problems at all levels of a dissertation project, from the identification of the agenda for research to final reporting, let alone the conducting of research itself.In that context, the intention of this brief paper is to help the novice students for a better beginning of their dissertation assignments. The draft guidance in the paper intends to shift the students’ attitude from viewing research as a torturous examination exercise, to an enjoyable and beneficial academic exercise for development of an inquisitive mind n a person. The paper takes a pragmatic instructional approach in a very simplified language so as to minimize the demand for assistance. Keywords: Research manual, research proposal, literature review, research design DOI: 10.7176/JEP/14-28-01 Publication date:October 31st 202
Antenatal couples’ counselling in Uganda (ACCU): study protocol for a randomised controlled feasibility trial
No full textBACKGROUND: Common avoidable factors leading to maternal, perinatal and neonatal deaths include lack of birth planning (and delivery in an inappropriate place) and unmet need for contraception. Progress has been slow because routine antenatal care has focused only on women. Yet, in Uganda, many women first want the approval of their husbands. The World Health Organization recommends postpartum family planning (PPFP) as a critical component of health care. The aim of this trial is to test the feasibility of recruiting and retaining participants in a trial of a complex community-based intervention to provide counselling to antenatal couples in Uganda. METHODS: This is a two-group, non-blinded cluster-randomised controlled feasibility trial of a complex intervention. Primary health centres in Uganda will be randomised to receive the intervention or usual care provided by the Ministry of Health. The intervention consists of training village health teams to provide basic counselling to couples at home, encouraging men to accompany their wives to an antenatal clinic, and secondly of training health workers to provide information and counselling to couples at antenatal clinics, to facilitate shared decision-making on the most appropriate place of delivery, and postpartum contraception. We aim to recruit 2 health centres in each arm, each with 10 village health teams, each of whom will aim to recruit 35 pregnant women (a total of 700 women per arm). The village health teams will follow up and collect data on pregnant women in the community up to 12 months after delivery and will directly enter the data using the COSMOS software on a smartphone. DISCUSSION: This intervention addresses two key avoidable factors in maternal, perinatal and neonatal deaths (lack of family planning and inappropriate place of delivery). Determining the acceptability and feasibility of antenatal couples’ counselling in this study will inform the design of a fully randomised controlled clinical trial. If this trial demonstrates the feasibility of recruitment and delivery, we will seek funding to conduct a fully powered trial of the complex intervention for improving uptake of birth planning and postpartum family planning in Uganda. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR202102794681952. Approved on 10 February 2021. ISRCTN Registry ISRCTN97229911. Registered on 23 September 2021 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40814-022-01049-5
Improving the quality of maternity services in Uganda through accelerated implementation of essential interventions by healthcare professional associations
No full textOBJECTIVE: To assess whether the implementation of a package of activities through the joint action of the three international healthcare professionals associations (HCPAs) increased the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda. METHODS: A non-controlled before-and-after study was undertaken to evaluate the effect of a package of activities designed to change practice relating to nine EIs among providers. Coverage of the EIs was measured in a 3-month pre-implementation period and a 3-month post-implementation period in 2014. Data were obtained for women older than 18 years who delivered vaginally or by cesarean. RESULTS: Overall, 4816 women were included. Level of use remained high for EIs used widely at baseline. Some EIs that had low use at baseline did not show improvement after the implementation. Promotion of breastfeeding showed a significant improvement in the Kampala hospital, from 8.5% (8/94) to 25.6% (30/117; P=0.001), whereas promotion of hygiene in cord care improved at the Mbarara hospital, from 0.1% (2/1592) to 46.0% (622/1351; P<0.001). CONCLUSION: These exploratory results show that a package delivered through the joint work of the three HCPAs was feasible to implement along with rigorous data collection. Although the data show disparities, trends suggest that improvement could be achieved.Fil: Spira, Cintia. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Kwizera, Amata. International Federation of Gynecology and Obstetrics; Reino UnidoFil: Jacob, Sue. International Confederation of Midwives; Países BajosFil: Amongin, Dinah. Busitema University; UgandaFil: Ngonzi, Joseph. Mbarara University of Science and Technology. Department of Obstetrics and Technology; Uganda. Association of Obstetricians and Gynecologists; UgandaFil: Namisi, Charles P.. Makerere University. College of Health Sciences School of Public Health. Infectious Disease Institute; Uganda. St. Francis Hospital Nsambya; UgandaFil: Byaruhanga, Romano. St. Francis Hospital Nsambya; UgandaFil: Rushwan, Hamid. International Federation of Gynecology and Obstetrics; Reino UnidoFil: Cooper, Peter. University of the Witwatersrand; SudáfricaFil: Day Stirk, Frances. International Confederation of Midwives; Países BajosFil: Berrueta, Amanda Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin
A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda
No full textA Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda
No full textBACKGROUND: Enhanced recovery after surgery (ERAS) expedites return to patient baseline
and functional status by reducing surgical trauma, stress, and organ dysfunction. Despite the
potential benefits of enhanced recovery protocols, limited research has been done in lowresource
settings, where 95% of cesarean deliveries are emergent and could possibly benefit
from the application of ERAS protocols.
METHODS: In a prospective, randomized, single-blind, controlled trial, mothers delivering by
emergency cesarean delivery were randomly assigned to either an ERAS or a standard of care
(SOC) recovery arm. Patients in the ERAS arm were treated with a modified ERAS protocol that
included modified counseling and education, prophylactic antibiotics, antiemetics, normothermia,
restrictive fluid administration, and multimodal analgesia. They also received early initiation
of mobilization, feeding, and urethral catheter removal. The primary end point was length
of hospital stay. The secondary end points were complications and readmission rates. Mean
length of stay in the intervention and control arms were compared using t tests. Statistical
analyses were performed using STATA version 13 (College Station, TX).
RESULTS: A total of 160 patients were enrolled in the study, with 80 randomized to each arm.
There was a statistically significant shorter length of stay for the ERAS arm compared to SOC,
with a difference of −18.5 hours (P < .001, 95% confidence interval [CI], −23.67, −13.34). The
incidence of complications of severe pain and headache was lower in the ERAS arm compared
to SOC (P = .001 for both complications). However, pruritus was more common in the ERAS arm
compared to SOC (P = .023).
CONCLUSIONS: Use of an ERAS protocol for women undergoing emergency cesarean delivery in
a low-income setting is feasible and reduces length of hospital stay without generally increasing
the complication rate. (Anesth Analg 2020;130:769–76)Kabale Universit
Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study
No full textTonny Kyagambiddwa,1,* Timothy Mwanje Kintu,1,* Emmanuel Miiro,1,* Franchesca Nabalamba,1 Gloria Suubi Asiimwe,1 Anne Marion Namutebi,2 Fardous C Abeya,3 Boniface A Lumori,3 Isaac Ijuka,4 Rose K Muhindo,1,3 Andrew Mutekanga,1,3 Richard Musinguzi,5 Francis Natuhwera,6 Joseph Ngonzi,1,7 Edwin Nuwagira3,8 1Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Kabale Regional Referral Hospital, Kabale, Uganda; 3Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 4Mayanja Memorial Hospital, Mbarara, Uganda; 5Masaka Regional Referral Hospital, Masaka, Uganda; 6Fort Portal Regional Referral Hospital, Fort Portal, Uganda; 7Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda; 8Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda*These authors contributed equally to this workCorrespondence: Tonny Kyagambiddwa; Edwin Nuwagira, Mbarara University of Science and Technology, Tel +256782980116 ; +256779096887, Email [email protected]; [email protected]: There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda.Methods: We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation 50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance.Results: Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32– 6.82; p = 0.009) and altered mental state (GCS < 15) (HR: 6.89, 95% CI: 1.48– 32.08, p = 0.014) were significant predictors of 30-day mortality.Conclusion: There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.Keywords: COVID-19, Uganda, mortality, young and middle-aged adult
Group B Streptococcus Colonization among Pregnant Women Attending Antenatal Care at Tertiary Hospital in Rural Southwestern Uganda
No full textObjectives. This study sought to determine the prevalence and factors associated with group B streptococcal anogenital colonization among pregnant women attending antenatal care at Mbarara Regional Referral Hospital, a tertiary hospital. Methods. Crosssectional study where 309 pregnant women ≥ thirty-five weeks of gestation attending antenatal clinic were consecutively recruited between January and March 2015. Anovaginal swabs were collected and tested qualitatively using rapid visual immunoassay GBS test kits for presence of GBS antigens. Data was analyzed using STATA version 12. In univariate analysis, GBS colonized mothers were presented as percentages and numbers, and in multivariate analysis logistic regression analysis was applied to determine the associations of exposure variable and GBS colonization; a value of less than 0.05 was considered significant. Results. Mothers' median age was 25 years, 14.6% mothers being obese. GBS prevalence was 28.8%, 95% CI: 23.7-33.9. Obesity was the only significant factor associated with anogenital GBS colonization with odds ratio of 3.78, 95% CI: 1.78-8.35, a value of 0.001. Maternal ages, educational level, residence, and gravidity were not associated with GBS anogenital colonization. Conclusion. Group B streptococcal anogenital colonization among pregnant women attending antenatal care at tertiary hospital, in Southwestern Uganda, is high
- …
