Department of Obstetrics & Gynaecology
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Item Sero-prevalence and factors associated with helicobacter pylori infection in a rural population in eastern Uganda:(Primary Health Care: Open Access, 2021) Nekaka, Rebecca; Oboth, Paul; Nteziyaremye, Julius; Gavamukulya, Yahaya; Ssenyonga, Lydia VN; Iramiot, Jacob StanleyBackground: Globally, 50% or more of the world’s population is infected with Helicobacter pylori making it the most widely spread bacteria across the world. The low developed countries are more overburdened by Helicobacter pylori infection than the developed countries. H. pylori infection is associated with duodenal ulcer, chronic atrophic gastritis (CAG), lymphomas, and adenocarcinoma. This study reports the prevalence of H. pylori and itsassociated factors in Eastern Uganda. Materials and methods: A cross-sectional study involving 275 participants was carried out in eastern Uganda. H. pylori serology was done and face to face interviewer-administered questionnaire were used for data collection. Data were entered in Microsoft Excel and imported to Stata version 14 for analysis and a P value of <0.05 was considered statistically significant. Results: The seroprevalence of H. pylori was 27.3% (75/275) with 28.4% (50/176) of the females being positive compared to 25.3% (25/99) of the males. Consumption of animal products (meat, milk, and eggs) was the only statistically significant factor associated with H. pylori seropositivity (P <0.001, 95% CI =1.934-4.209, AOR=2.85). Conclusion: The H. pylori seroprevalence is high in eastern Uganda. Consumption of animal products was a positive predictor of infectivity. Keywords: Helicobacter pylori • Animal products • Seroprevalence • Kibuku • Eastern UgandaItem Covariates of pica among pregnant women attending antenatal care at Kawempe hospital, Kampala, Uganda: a cross-sectional study(The American Society of Tropical Medicine and Hygiene, 2021) Nakiyemba, Olivia; Obore, Susan; Musaba, Milton; Wandabwa, Julius; Kiondo, PaulPica is the craving and purposive eating of nonfood items. It is common worldwide and presents among vulnerable populations like children and pregnant women. Its etiology and health consequences are not well understood. The aim of this study was to determine the prevalence and covariates of pica among pregnant women attending antenatal clinic at Kawempe hospital in Uganda. We conducted a cross-sectional study from July 2019 to December 2019. Participants in this study were 307 pregnant women who had come to attend antenatal clinic at the hospital. The prevalence of pica was computed. Bivariate and multivariable analysis was done to establish the factors that were independently associated with pica. The prevalence of pica was 57%. The most common type of pica was geophagia (eating clay and sand) followed by pagophagia (eating ice). Of the women who practiced pica, half consumed the nonfood items daily. Factors independently associated with pica were being in the third trimester (adjusted OR [aOR]: 3.60; 95% CI: 1.36–9.48] and having nausea in pregnancy (aOR: 2.11; 95% CI: 1.20–3.70). At Kawempe hospital, pica is common among women who attend the antenatal clinic and is associated with having nausea in pregnancy and being in the third trimester. Health workers need to counsel pregnant women about the dangers of pica so as to reduce helminth infections and micronutrient deficiency associated with it.Item Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial(PLOS One, 2021) Musaba, Milton W.; Wandabwa, Julius N.; Ndeezi, Grace; Weeks, Andrew D.; Mukunya, David; Waako, Paul; Nankabirwa, Victoria; Tulyamuhika Mugabe, Kenneth; Semakula, Daniel; Tumwine, James K.; Barageine, Justus K.Introduction Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. Objective To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. Methods We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (>37 weeks’ gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. Intervention A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Outcome measures Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. Results The median maternal venous lactate was 6.4 (IQR 3.3–12.3) in the intervention and 7.5 (IQR 4.0–15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40–0.51) implying very little if any effect at all. Conclusion The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels.Item Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study(Springer Nature, 2021) Musaba, Milton W.; Ndeezi, Grace; Barageine, Justus K.; Weeks, Andrew D.; Wandabwa, Julius N.; Mukunya, David; Waako, Paul; Odongkara, Beatrice; Arach, Agnes; Tulya-muhika Mugabe, Kenneth; Kasede Napyo, Agnes; Nankabirwa, Victoria; Tumwine, James K.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. Keywords: Obstructed labour, Perinatal death, Determinants, LactateItem Predictors of Intrapartum Stillbirths among Women Delivering at Mulago Hospital, Kampala, Uganda(PubMed, 2021) Kiondo, Paul; Nakimuli, Annettee; Ononge, Samuel; Wandabwa, Julius N.; Musaba, Milton W.Background: Over the last decade, Uganda has registered a significant improvement in the utilization of maternity care services. Unfortunately, this has not resulted in a significant and commensurate improvement in the maternal and child health (MCH) indicators. More than half of all the stillbirths (54 per 1,000 deliveries) occur in the peripartum period. Understanding the predictors of preventable stillbirths (SB) will inform the formulation of strategies to reduce this preventable loss of newborns in the intrapartum period. The objective of this study was to determine the predictors of intrapartum stillbirth among women delivering at Mulago National Referral and Teaching Hospital in Central Uganda. Methods: This was an unmatched case-control study conducted at Mulago Hospital from October 29, 2018 to October 30, 2019. A total of 474 women were included in the analysis: 158 as cases with an intrapartum stillbirth and 316 as controls without an intrapartum stillbirth. Bivariable and multivariable logistic regression was done to determine the predictors of intrapartum stillbirth. Results: The predictors of intrapartum stillbirth were history of being referred from lower health units to Mulago hospital (aOR 2.5, 95% CI:1.5-4.5); maternal age 35 years or more (aOR 2.9, 95% CI:1.01-8.4); antepartum hemorrhage (aOR 8.5, 95% CI:2.4-30.7); malpresentation (aOR 6.29; 95% CI:2.39-16.1); prolonged/obstructed labor (aOR 6.2; 95% CI:2.39-16.1); and cesarean delivery (aOR 7.6; 95% CI:3.2-13.7). Conclusion and Global Health Implications: Referral to hospital, maternal age 35 years and above, obstetric complication during labor, and cesarean delivery were predictors of intrapartum stillbirth in women delivering at Mulago hospital. Timely referral and improving access to quality intrapartum obstetric care have the potential to reduce the incidence of intrapartum SB in our community. Key words: • Stillbirths • Intrapartum • Predictors • Maternal Health • Child Health • Child Death • MCH • Case-Control • Uganda • AfricaItem The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation(MDPI, 2021) Ditai, James; Aisling, Barry; Weeks, Andrew D.; Burgoine, Kathy; Mbonye, Anthony K.; Wandabwa, Julius N.; Watt, PeterThe initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK. Keywords: intact cord; resuscitation; placental circulation; design; BabySaver