“The Influence of Lifestyle on Adoption of Breast Cancer Prevention Modalities among Women.” A Case Study of Kyaddondo County in Uganda

Background: In Uganda, breast cancer is the third most frequent cancer of women that is preventable through change in life style habits such as reduction in alcohol uptake, obesity, none use of tobacco products, use of hormonal pills and increase in physical activities thereby reducing the risk of women acquiring breast cancer. The objectives of this study are to establish the influence of lifestyle on the adoption of breast cancer prevention modalities among women in Kyaddondo County. Methodology: A household survey of women in Kyaddondo County using a self-administered questionnaire was undertaken to establish the influence of lifestyle on breast cancer prevention modalities. A sample of 414 females with at least 1 female per household was randomly selected. Results: The results using chi-square to establish an association to adoption of breast cancer prevention modalities showed that the significant determinants of the adoption of breast cancer prevention modalities were: taking alcohol, a woman gives birth, children ever born, breast feeding, frequency of breast feeding and a woman doing exercises. There was no significant relationship between frequency of alcohol intake, tobacco usage, frequency use of tobacco, use of family planning, type of family planning method used(orals pills and injectables), length of use of family planning, type of work done for a living and frequency of exercises in relation to adoption of breast cancer prevention modalities. Logistic regression analysis revealed that the lifestyle key determinants of adoption of breast cancer prevention modalities are limiting alcohol consumption (OR 2.084 95% CI: 1.260-3.449), family planning uptake (OR 3.479 95% CI: 1.331-9.095) and exercising (OR 2.524 95% CI: 1.613-3.949). Conclusions: This study inculcates participation of women and their communities’ evidence based lifestyle educational programs to help improve the health of women but also their level of knowledge so as to increase the adoption of breast cancer prevention modalitie

Maternal health-seeking behaviour of peri-urban women living with disability in Busiro South Health sub District, Wakiso district, Uganda: a community-based study

Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda. Methods: This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and logistic regression to determine factors associated with maternal health-seeking behaviour at a 5% level of significance. Content analysis was used to analyse qualitative data. Results: A total of 182 women with disabilities were enrolled. Overall, 150 (82.3%) of the disabled women had attended ANC and 147 (80.8%) had delivered their babies at a health facility. The participants' mean age was 31.9±7.8years (range: 17-49 years). ANC attendance among disabled women was influenced by maternal age 18-30 years (p = 0.010), number of times a disabled woman was pregnant (p = 0.003), parity (p = 0.018), a normal delivery (p = 0.048), receiving financial support from friends of partners (p < 0.001), distance of less than 5KM to the health facility (p = 0.024), friendliness of the health care providers (p=0.030) and availability of health providers (p < 0.001). Conclusion: There is an urgent need for a multi-sectoral approach to better healthcare-seeking behaviour. Keywords: Peri-urban; maternal health-seeking behaviour; disabled women; Uganda

Factors Associated with Stillbirths at Mbarara Regional Referral Hospital

Background: Still births contribute more than half 39(65%) to perinatal deaths but can be minimized if pregnancy is adequately monitored during antenatal care and adequate intrapartum care is given. Perinatal mortality is a key outcome indicator for obstetric care, preventable through EMOC and routine antenatal care of a pregnant woman that allows early detection, prompt diagnosis and early treatment of any pregnancy related conditions that improve perinatal outcome. Thus the objective of this study was to determine factors associated with still births among women at Mbarara Regional Referral Hospital in Mbarara District.Methods: An unmatched case control study was adopted. A total of 300 mothers who delivered at or above 28 weeks between august and December 2013 were interviewed using administered questionnaires. Data was analyzed using STATA.Results: We found that 102(34%) mothers had stillbirths and 198(66%) had live births. The mean age (in complete years) of mothers that had live births (25.1±5.45) and those that experienced a stillbirth (25.8±5.89). Mothers in the 30-45 age bracket experienced high 32(31.7%) stillbirth frequency, contrary to younger mothers in the 25-29 age bracket that had the lowest 19(18.8%) stillbirth frequency Therefore, the key determinants of stillbirths at Mbarara Regional Referral Hospital were: obstetric and health systems factors that include (cOR, 95%) inadequate antenatal care: ≤ 3 visits (2.10, 1.12-4.0, P= 0.0312) cord prolapsed (5.8, 1.50-4.28, P=0.012), referral status (3.4, 1.74-6.74, P=0.000), lack of partogram use (6.44, 2.3-7.90, P=0.000) and antenatal booking health facility II (3.9, 1.36-11.26 P=0.000) and anemia (2.75 1.60-6.50 P=0.0213 was the medical factor found to be associated with stillbirth.Conclusions: To significantly lower stillbirth rates at MRRH, there is need to strengthen goal oriented antenatal care so as to identify and address the aforementioned factors during antenatal visits and delivery. Key words: Stillbirth, Case, Control, Fresh stillbirth (intrapartum stillbirth), Macerated stillbirth (ante partum stillbirth) and Perinatal

Assessing the Influence of Social Networking Material on Adolescents’ Sexual Behavior in Kampala

Background: Social media has been used to promote risky sexual behavior in form of unsolicited photos, videos and text from peers and strangers that is not regulated by parents or guardians. Therefore, it’s important to investigate the influence of social networking material on adolescents‘ sexual behavior in Ugandan in order to close the knowledge gap. Adolescents in Uganda may be at risk of indulging in risky sexual behavior if usage of social networking sites remains unrestricted. Methods: A cross sectional study was conducted among 280 randomly selected adolescents in Kampala between August and October 2016. Results: Majority (68.9%) of the respondents thought that messages, photos, videos with sexual content shared/posted on social networking sites, changed their sexual behavior. Variables that were found to significantly explain the effect of exposure of social network  content on adolescent sexual behavior, among adolescents included: Gender (male) (OR 2.646, 95% CI 1.088-6.434, use of social networking sites during holidays (OR 2.581, 95% CI .836-7.965) and social sites being used for leisure activities (OR 4.516, 95% CI 1.232-16.548). Conclusion: Parents may need to restrict access and use sexual content especially pictures and videos available on social networking site among the adolescents. Key words: Adolescent, social networking sites, change, sexual behavio

Predictors of Length of Hospital Stay among Burns Patients in Mulago National Referral Hospital, Kampala- Uganda

Background: According to WHO (2014), burn injuries are a major problem to health care worldwide. Ninety five per cent of all burn cases occur in LMICs leading to prolonged and expensive hospital stays (WHO, 2009). In Uganda, burn injuries account for 11% of all childhood injuries (Nakitto & Lett, 2010). Burns Unit at Mulago National Referral Hospital is the only specialized burns care unit in the country. However, it was observed that patients in this unit spends unusually longer time in admission than the WHO (2015) recommended time. Thus the objective of this study was to determine the predictors of length of hospital stay among burn patients in Mulago National Referral Hospital Kampala, Burns Care Unit from July, 2014 to June, 2015.Methods: A retrospective study design was used by reviewing medical records of patients discharged from the Burns Care Unit from July, 2014 to June, 2015. Results: More than half (57.1%) of the patients in the study were male with children 5 years and below constituting 55.2%. The majority of patients (86.2%) got burnt at home. The average length of stay for patients was 24.3 days (±22.1 days). The degree/ depth of burns (OR=44.22, 95% CI =10.86-180.08, P=0.000) was the single most significant predictor of length of stay of patients with burns at multivariate analysis level. Keywords: Burns, length of stay, predictor

Assessment of the Readiness and Availability of Palliative Care Services in Hospitals in Kampala, Uganda

Background: In Uganda, there are approximately 350,000 patients with illnesses needing palliative care (Merriman, Mwebesa & Katabira, 2012) and among whom 210,000 persons in painare in urgent need of Palliative care (American Cancer Society, 2014).Further, palliative care was introduced to improve the quality of life of patients and their families who are facing problems associated with life-threatening illness, whether physical, psychosocial or spiritual (Temel, 2010). More still, palliative care reduces unnecessary hospital admissions and the use of health services. However, the use of morphine and other controlled medicines that are essential for palliative careare overly restricted by regulations thereby hindering access to adequate pain relief and palliative care. Furthermore,palliative care has been incorporated into the Uganda’s Health Sector Strategic and Investment Plans but has been hampered by minimal resources and huge shortages of health workers. Further, Uganda has one of the most rapid growth of palliative care in Africa as well as the only country in sub-Saharan Africa graded as having “Stage 4” comprehensive palliative care according to the Global Atlas of Palliative Care (Worldwide Palliative Care Alliance, 2014). Additionally, Uganda was ranked 35th out of 80 countries for the Quality of death Index (Economist Intelligence Unit, 2015). Despite these accolades, hospital based palliative care is not universally available throughout the country. In 2014 the Ministry of Health provided only 103 million Uganda shillings for development of Palliative care in its national budget. This is a small amount to share, and as most hospitals received very little funding for palliative care, it is likely that hospital medical superintendents used discretionary funds to provide the service (O’Brien et al., 2013). Therefore, the objective of this study was to assess the readiness and availability of palliative Care services in hospitals in Kampala, Uganda from April, 2016 to June, 2016. Methods: A cross sectional study design was used. Results: The study found that 7 of the 27 hospitals (26%) were offering palliative care, 6 (22%) had a specialized staff offering palliative care and only 5 (19%) had a staff designated to coordinate palliative care services. Overall, the level of  readiness to provide palliative care was found to be very low with only 3 of the 27 hospitals (11%) demonstrating readiness as per the set criteria (availability of pain medication in stock, availability of morphine in stock and availability of a healthcare worker to provide palliative care). Conclusion: Readiness and availability of palliative care services is very low among hospitals in Kampala. Keywords: Palliative Care, Morphine, Readiness, Availabilit

Missed Opportunity for Neonates to Live: A Cross-Sectional study on Utilization of Peri-Natal Death Audits to address the Causes of Peri-Natal Mortality in District Hospitals of East–Central Uganda.

Aim:  To assess the utilization of PDAs in addressing the avoidable causes of perinatal mortality in the eastern region of Uganda. Methodology:  A cross-section design using a mixed method was conducted between 2014-2015 at Iganga, Bugiri, and Kamuli general hospitals in the East-Central region of Uganda. The interviews involved 115 health workers who included Doctors, Nurses/Midwives, Clinical officers, and Laboratory and Theatre staff. These were drawn from four departments including the Maternity ward, Outpatient department, Theatre, and pediatric ward. Hospital top and departmental managers formed the key informants for this study. Annual reports for the period 2009/10-2012/13 were reviewed. In addition, monthly reports for the calendar year 2013 together with patients’ clinical case notes and patients’ registers were also reviewed to determine the magnitude and causes of perinatal mortality. Factors contributing to perinatal death were assessed and categorized into fetal, maternal, and health facility factors. Results:  Results revealed a high and rising perinatal mortality rate of 70/1,000 live births and a decreasing maternal mortality ratio of 363/100,000 live births. Most perinatal deaths were fresh stillbirths 48/88 which occurred during the intrapartum period and the majority of early neonatal death was due to birth asphyxia. None of the health facilities was conducting perinatal death audits and the quality of data used for perinatal death audits was inadequate and was scored poorly. Challenges hindering utilization of perinatal death audits included lack of staff sensitization and training, work overload, lack of motivation, fear of blame and litigation, political interference, and lack of support from the community. Conclusion:  There was a high prevalence of perinatal deaths in east-central Uganda yet none of the hospitals was conducting perinatal death reviews. Recommendations: Health workers should be trained on perinatal death audit tools and guidelines. Records departments to revitalize with tools and personnel for effective data management

Assessment of Menstrual Hygiene Management Among Karamojong Adolescent Girls in Rupa Sub-County, Moroto District

Background: Menstrual hygiene and management is insufficiently acknowledged since it has not received adequate attention, in most cases because it is considered a private issue that's rarely open to discussion making it difficult for girls to manage their periods. This leaves them at high risk of contracting diseases related to poor menstrual management. Methods: A cross-sectional study involving both quantitative and qualitative data collection techniques was conducted in Rupa Sub-County, Moroto district between August and October 2016 and a total of 133 adolescent girls were interviewed. Descriptive statistics, Chi-square and Odd ratios tests were used for analysis to assess the menstrual hygiene management. Results: Mean age of respondents was 17.03±2.121 years; respondents going to school were 5.9 times more likely to practice safe menstrual hygiene management (p-value 0.000), half (50.4%) of the adolescent girls had no education (p-value 0.000), 38.3 % of the girls did not know what to do during menstruation (p-value 0.000), respondents who agreed that it is ideal to bath at least twice during menstruation were 2.9 times more likely to practice safe menstrual hygiene management (p-vaue-0.024), less than half (28.6%) of the respondents were not sure whether it is hygienic to use material for less than 6 hours during menstruation (p-value 0.000), while slightly three quarters (61.7%) of adolescent girls used old rags during menstruation, 48.1% of the respondents agreed that there are cultural factors attached to menstrual hygiene management (0.000). Conclusion: Menstrual hygiene management is still a very big challenge among adolescent girls in Moroto district; various factors were identified to affect menstrual behaviors most influential being lack of adequate knowledge, Socio-economic status of participants and cultural factors. Keywords: Adolescent, Menarche, Menstruation, Menstrual hygiene, Taboos, Safe menstrual & unsafe menstrual practices

Quality of Life among Obstetric Fistula Patients at Kitovu Mission Hospital: A Health Facility-Based Cross-Sectional Study in Masaka District, Uganda

Background. Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman’s quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda. Method. A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis. Results. Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education (P<0.001), employment status (P<0.001), energy for everyday life (P<0.001), capacity to work (P<0.001), satisfaction with personal relationships (P<0.001), feelings of loneliness (P<0.001), negative feelings (P=0.002), and self-confidence (P<0.001) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019–517.467), formal education (OR = 9.9497; CI = 1.075–92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149–2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447–74.824). Conclusion. A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients

Laboratory assessment of SD Bioline HIV/Syphilis Duo Kit among pregnant women attending antenatal clinic Mayuge Health Center III, East central Uganda

Abstract Objective Efforts to dual eradication of mother-to-child transmission of human immune deficiency virus (HIV) and syphilis have improved in the previous decades. This has however been hindered by limited validation studies. A cross-sectional study was conducted among adult pregnant women attending antenatal care clinic at Mayuge Health Center III. Two milliliters of venous blood were collected into Ethylene di-amine tetra acetic acid vacutainers, and tested for HIV and syphilis using the SD Bioline HIV/Syphilis Duo assay, and the national HIV and syphilis testing algorithm. Sensitivity and specificity were calculated for the Duo Kit against the gold standards within 95% confidence intervals. Results Three hundred and eighty-two (382) participants were enrolled. Their mean age was 25.8 years. The prevalence of HIV was 1.8% (95% confidence interval 1.23–2.41); while that of syphilis was 2.1% (95% confidence interval 1.81–2.54), and the dual infection was 0.52% (95% confidence interval 0.37–0.92). The sensitivity and specificity of the SD Bioline HIV/Syphilis Duo assay were all 100.0% (95% confidence interval 99.5 to 100.0 and 98.6 to 100.0, respectively). The performance of the SD Bioline HIV/Syphilis Duo Kit was optimal, reassuring its aptness for use, and favorable qualities to a limited resource setting