Browsing by Author "Engebretsen, Marie S. Ingunn"

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    Acceptability of minimal invasive tissue sampling (MITS) for stillbirths in Eastern Uganda
    (PLOS One, 2025) Chebet, Martin; Burgoine, Kathy; Rujumba, Joseph; Okalany, Regina Akwi Noela; Olupot-Olupot, Peter; Tylleskär, Thorkild; Weeks, D. Andrew; Napyo, Agnes; Mukunya, David; Engebretsen, Marie S. Ingunn
    Background In sub-Saharan Africa, stillbirth rates remain high. To design effective interventions to reduce stillbirths, accurate determination of their aetiology is important. Conventional autopsy for accurate confirmation of cause is not acceptable or feasible in several societies in sub-Saharan Africa; minimal invasive tissue sampling (MITS), is a recently developed, less invasive alternative. In this study, we explored the acceptability of MITS in the community and among healthcare workers in Uganda to guide the future implementation. Methods A qualitative study was done among community members and healthcare workers in Mbale in Eastern Uganda. We undertook in-depth interviews and focus group discussions in English or local languages. Interviews were audio-recorded, transcribed as necessary prior to formal content analysis. The themes were organised using NVivo software and presented according to Sekhon’s theoretical framework. Results Overall, participants preferred the idea of MITS to conventional autopsy because of the perception that it was fast, maintained the facial appearance and kept the body intact. It was thought that the procedure would improve the detection of the cause of stillbirths, which in turn would help to prevent future stillbirths. It would also resolve conflicts in the community between community members or the women and the healthcare workers about the cause of a stillbirth. It was suggested that some community members may not approve of MITS because of their religious beliefs; the fear that the body parts may be extracted and stolen for witchcraft or organ donation; and a lack of trust in the healthcare system. To implement the procedure, it was suggested that extensive community sensitization should be done, space limitations in healthcare facilities overcome, healthcare workers should be trained and limited human resource should be addressed. Conclusion The implementation of MITS in Mbale, Eastern Uganda, is likely to be acceptable given sufficient training and sensitisation.
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    Congenital cytomegalovirus in eastern Uganda : prevalence and outcomes.
    (BMC Pediatrics, 2025) Okalany, Regina Akwi Noela; Engebretsen, Marie S. Ingunn; Mukunya, David; Chebet, Martin; Okello, Francis; Weeks, D. Andrew; Mwanda, Edrin; Muhindo, Rita; Bisso, Fred; Tylleskär, Thorkild; Olupot-Olupot, Peter; Burgoine, Kathy
    Background: Cytomegalovirus (CMV) infection poses risks to both maternal and neonatal health, however there are limited comprehensive data on congenital CMV in low-resource settings where the virus is widespread, particularly among women of reproductive age. Our research in eastern Uganda aimed to assess the prevalence of congenital CMV and outcomes among infants to inform public health policies and interventions in similar settings, addressing a significant gap in current knowledge. Methods: We conducted a descriptive study, nested within the BabyGel Trial, across Mbale and Budaka districts in eastern Uganda, between May 2023 and January 2024. Infants underwent saliva sampling within the first week of life, which was validated through urine polymerase chain reaction testing within the first 21 days of life. At three months of age, a cranial ultrasound examination, neurological examination, developmental evaluation, and audiological assessment were conducted for all infants diagnosed with congenital CMV infection. Statistical analyses were performed using Stata 17.0. Results: Congenital CMV infection was found in 5 out of 1,265 newborns tested, indicating a prevalence of 0.4% (95% CI: 0.16 to 0.96). Of these 5 infected infants, two experienced febrile illness at birth and required hospitalisation within the first week of life, and three had findings on ultrasound examination consistent with congenital cytomegalovirus during the neonatal period. Audiologic follow-up until three months of age revealed that three infants had failed unilateral and bilateral hearing screening. Neurodevelopment assessments using the Malawi Development Assessment Tool fell within optimal ranges for all 5 infants; however, when evaluated using the Hammersmith Infant Neurological Examination, four infants scored below optimal levels. Conclusion: Our community-based study revealed a low prevalence of congenital CMV infection. Further longitudinal multi-site research is needed to assess the generalisability of these findings. Also, long-term follow-up of children is crucial to understanding the outcomes and sequelae of infected infants to inform prevention strategies, targeted interventions and scalable screening frameworks in resource-limited settings. Keywords: Cytomegalovirus, Congenital, Prevalence, Neurodevelopment, Hearing, Low-resource setting, Uganda
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    ‘The grave must not be seen by anyone!’: beliefs and practices about stillbirths in Eastern Uganda.
    (BMC, 2025) Chebet, Martin; Rujumba, Joseph; Burgoine, Kathy; Mukunya, David; Okalany, Regina Akwi Noela; Olupot‑Olupot, Peter; Tylleskär, Thorkild; Weeks, D. Andrew; Napyo, Agnes; Engebretsen, Marie S. Ingunn
    Background: Nearly half of all stillbirths occur in sub-Saharan Africa and accurate registration could inform reduction efforts. We explored the beliefs and practices surrounding stillbirths in Eastern Uganda, revealing cultural factors that could influence the accurate counting of stillbirths. Methods: We conducted a qualitative study among women with a history of stillbirths, and men, women and community leaders with an experience of childbirth in Eastern Uganda. The study also included healthcare workers from three health facilities. We conducted 30 in-depth interviews and six focus group discussions to explore the beliefs and practices about stillbirths. All discussions and interviews were audio recorded and transcribed into English. Thematic analysis was done using NVivo R1 (2020) software for coding. Results: We enrolled a total of 74 participants: 44 in six focus group discussions and 30 in in-depth interviews. Four themes emerged: first, the community believed that stillborn babies can be used for witchcraft or as a source of curses therefore stillbirths were hidden from the public. Second, women were useful in marriage only when they bore live children and were despised when they had a stillbirth leading to discord in marriage and stigma. Third, stillborn babies were not considered human and therefore, the baby was not named or buried in a coffin. Fourth, the spirit of the stillborn baby was considered harmful to the next siblings, and their parents sought the services of traditional healers and witch doctors to protect these siblings. Conclusion The immediate tragedy of a stillbirth has long-term personal and societal effects on the mother, resulting in stigma, marital breakup and isolation. The secrecy about stillbirths may also contribute to underreporting of stillbirths. Efforts to improve documentation of stillbirths and support for families who have had stillbirths need to incorporate culturally sensitive interventions. Keywords Stillbirths, Beliefs, Practices, Eastern Uganda, Culture, Hidden, Stigma