Browsing by Author "Tumuhamye, Josephine"

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    Incidence and risk factors for clinical omphalitis among neonates in Eastern Uganda using chlorhexidine gel for cord care : a community-cohort study.
    (BMC, 2025) Wogabaga, John; Burgoine, Kathy; Kakuru, Abel; Nambozo, Brendah; Chebet, Martin; Tumuhamye, Josephine; Wanume, Benon; Oguttu, Faith; Musaba, W. Milton; Napyo, Agnes; Wani, Solomon; Olupot-Olupot, Peter; Weeks, D. Andrew; Tylleskär, Thorkild; Mukunya, David
    Background: Omphalitis is a bacterial infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period. Whereas it is known to be a major route of localized and often systemic infection, studies describing incidence and risk factors remain scanty, especially in resource limited settings where the condition is thought to be common. We assessed the incidence and risk factors for omphalitis among neonates born to women who received a birth kit containing chlorhexidine for umbilical cord care after birth in Eastern Uganda. Trial registration for the parent study: The BabyGel trial was registered in the Pan African Clinical Trial Registry-(PACTR202004705649428 Registered 1 April 2020, https://pactr.samrc.ac.za/). Methods: We conducted a community-based cohort study between January 2021 and June 2023. This study was nested within the BabyGel trial. Our outcome of interest was clinical omphalitis, defined as purulent discharge from the umbilical cord stump within the first twenty-eight days of life as witnessed by a study midwife. Data were analyzed using Stata version 17.0. Bivariable and multivariable analyses were conducted using Cox proportional hazard regression models to estimate hazard ratios (HR) of selected exposures and time to omphalitis. Results: A total of 2052 neonates were enrolled; half of which were female (51.1%). The incidence of omphalitis was 3.0% (62/2052; 95% confidence interval (CI): 1.9%, 4.4%). The incidence rate of omphalitis was 1.6 cases per 1000 person days (95% CI: 1.1, 2.3). Neonates born at home were twice as likely to develop omphalitis as those born in a health facility (adjusted hazards ratio (AHR) 1.99; 95% CI: 1.01, 3.9). Conclusion: The incidence of omphalitis among neonates in Eastern Uganda was low. Home births carried twice the risk for omphalitis. Use of chlorhexidine coupled with close follow-up of neonates in the community by health workers and community health workers might have reduced the risk of omphalitis. Keywords: Omphalitis, Neonate, Chlorhexidine, BabyGel, Neonatal sepsis, Newborn, Low-resource setting
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    Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda :
    (BMC, 2021) Tumuhamye, Josephine; Steinsland, Hans; Bwanga, Freddie; Tumwine, James K.; Ndeezi, Grace; Mukunya, David; Namugga, Olive; Kasede, Agnes Napyo; Sommerfelt, Halvor; Nankabirwa, Victoria
    Background: According to WHO (CISMAC. Centre for Intervention Science in Maternal and Child Health), the antimicrobial-resistant bacteria considered to be clinically most important for human health and earmarked for surveillance include extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant bacteria, methicillin-resistant (MRSA) and, macrolide-lincosamide-streptogramin B -resistant vancomycin-resistant (VRSA) Staphylococcus aureus and vancomycin-resistant Enterococcus (VRE). If these bacteria are carried in the female genital tract, they may be transmitted to the neonate causing local or systemic neonatal infections that can be difficult to treat with conventionally available antimicrobials. In order to develop effective treatment strategies, there is a need for updated information about the prevalence of colonization with important antimicrobial-resistant pathogens. Objective: We sought to estimate the prevalence of vaginal colonization with potentially pathogenic and clinically important AMR bacteria among women in labour in Uganda and to identify factors associated with colonization. Methods: We conducted a cross-sectional study among HIV-1 and HIV-2-negative women in labour at three primary healthcare facilities in Uganda. Drug susceptibility testing was done using the disk diffusion method on bacterial isolates cultured from vaginal swabs. We calculated the prevalence of colonization with potentially pathogenic and clinically important AMR bacteria, in addition to multidrug-resistant (MDR) bacteria, defined as bacteria resistant to antibiotics from ≥3 antibiotic classes. Results: We found that 57 of the 1472 enrolled women (3.9% prevalence; 95% Confidence interval [CI] 3.0%, 5.1%) were colonized with ESBL-producing Enterobacteriaceace, 27 (1.8%; 95% CI 1.2%, 2.6%) were colonized with carbapenem-resistant Enterobacteriaceae, and 85 (5.8%; 95% CI 4.6%, 7.1%) were colonized with MRSA. The prevalence of colonization with MDR bacteria was high (750/1472; 50.9%; 95% CI 48.4%, 53.5%). Women who were ≥30 years of age had higher odds of being colonized with MDR bacteria compared to women aged 20–24 years (OR 1.6; 95% CI 1.1, 2.2). Conclusion: Most of the women included in our study were vaginally colonized with potentially pathogenic MDR and other clinically important AMR bacteria. The high prevalence of colonization with these bacteria is likely to further increase the incidence of difficult-to-treat neonatal sepsis. Keywords: Antimicrobial resistance, Multidrug resistance, MDR, ESBL, MRSA, MLSB, Carbapenem-resistant bacteria, Vaginal colonization