Immediate maternal complications associated with thrombocytopenia among women delivering at a tertiary hospital in Southwestern Uganda

Background: Thrombocytopenia is a serious threat both to the mother and the fetus world over. We established the prevalence and associated immediate maternal complications of thrombocytopenia among women delivering at Kampala International University Teaching Hospital (KIUTH) so as to help us draw a platform for provision of appropriate interventions.Methods: A prospective cross-sectional study involving 386 women was conducted in the months of May 2019 to August 2019. Questionnaires and laboratory result forms were used to obtain the data. Data analyses were conducted using STATA version 14.2.Results: The prevalence of thrombocytopenia was 15.8%. Significant immediate maternal outcomes were placenta abruption which was higher among women with thrombocytopenia (44.3%) than those with no thrombocytopenia (2.2%; p<0.001) and postpartum haemorrhage which was higher among those with thrombocytopenia (45.9%) than those with no thrombocytopenia (6.8%; p<0.001).Conclusions: Thrombocytopenia is a serious obstetric issue worth paying extra attention at this facility

Validity of Verbal Autopsy Procedures for Determining Malaria Deaths in Different Epidemiological Settings in Uganda

BACKGROUND: Verbal autopsy (VA) procedures can be used to estimate cause of death in settings with inadequate vital registries. However, the sensitivity of VA for determining malaria-specific mortality may be low, and may vary with transmission intensity. We assessed the diagnostic accuracy of VA procedures as compared to hospital medical records for determining cause of death in children under five in three different malaria transmission settings in Uganda, including Tororo (high), Kampala (medium), and Kisoro (low). METHODS AND FINDINGS: Caretakers of children who died in participating hospitals were interviewed using a standardized World Health Organization questionnaire. Medical records from the child's hospitalization were also reviewed. Causes of death based on the VA questionnaires and the medical records were assigned independently by physician reviewers and then compared. A total of 719 cases were included in the final analysis, 67 in Tororo, 600 in Kampala, and 52 in Kisoro. Malaria was classified as the underlying or contributory cause of death by review of medical records in 33 deaths in Tororo, 60 in Kampala, and 0 in Kisoro. The sensitivity of VA procedures for determining malaria deaths in Tororo was 61% (95% CI 44-78%) and 50% in Kampala (95% CI 37-63%). Specificity for determining malaria deaths in Tororo and Kampala was high (>88%), but positive predictive value varied widely, from 83% in Tororo to 34% in Kampala (difference 49%, 95% CI 31-67, p<0.001). The difference between the cause-specific mortality fraction for malaria as determined by VA procedures and medical records was -11% in Tororo, +5% in Kampala, and +14% in Kisoro. CONCLUSIONS: Our results suggest that these VA methods have an acceptable level of diagnostic accuracy for determining malaria deaths at the population level in high and medium transmission areas, but not in low transmission areas

Predictors of Premature Rupture of Membranes among Pregnant Women in Rural Uganda: A Cross-Sectional Study at a Tertiary Teaching Hospital

Background. Premature rupture of membranes (PROM) is a common condition in developed and developing countries and poses a serious threat to the maternal and fetal well-being if not properly managed. This study delineated the prevalence and predictors of PROM in the western part of Uganda so as to guide specific preventive measures. Methods. A cross-sectional study design was conducted in the months of September 2019 to November 2019. A total of 334 pregnant women above 28 weeks of gestation admitted at the maternity ward of KIU-TH were consecutively enrolled. Interviewer-administered questionnaires were used to obtain the data. Descriptive statistics followed by binary logistic regression were conducted. All data analyses were conducted using STATA 14.2. Results. Of the 334 pregnant women enrolled, the prevalence of PROM was found to be 13.8%. The significant independent predictors associated with lower odds of PROM were no history of urinary tract infection (UTI) in the month preceding enrollment into the study (aOR=0.5, 95% CI: 0.22-0.69, p=0.038) and gestational age of 37 weeks or more (aOR=0.3, 95% CI: 0.14-0.71, p=0.01) while history of 3 or more abortions (aOR=13.1, 95% CI: 1.12-153.62, p=0.05) was associated with higher likelihood of PROM. Conclusions. Majorly urinary tract infections, low gestational age, and abortions influence premature rupture of membranes among women. There is a great need for continuous screening and prompt treatment of pregnant women for UTI especially those with history of 3 or more abortions at less than 34 weeks of gestation

Accuracy of verbal autopsy procedures for determining malaria deaths as compared to medical records at three sites.

<p>*CI  =  Confidence interval; † PPV  =  Positive predictive value.</p>‡<p>CSMF_VA  =  Cause-specific mortality fraction as determined by verbal autopsy procedures.</p>§<p>CSMF_MR  =  Cause-specific mortality fraction as determined from medical records.</p

Misclassification of malaria deaths, as the underlying cause of death, by verbal autopsy procedures.

<p>*<b>False positive</b>: Cause of death determined by VA procedures was inaccurately classified as malaria. The values represent the number and proportion of diagnoses that were incorrectly classified as malaria.</p>†<p><b>False negative</b>: Cause of death determined by VA procedures was inaccurately classified as an illness other than malaria. The values represent the number and proportion of true malaria cases that were incorrectly classified as other illnesses.</p

Cause-specific mortality fraction as established by verbal autopsy and medical records, by site.

<p>Cause-specific mortality fraction as established by verbal autopsy and medical records, by site.</p

Study profile.

<p>Study profile.</p

Accuracy of verbal autopsy procedures for determining cause of death as compared to medical records at three sites.

<p>*Malaria classified as the underlying cause of death.</p>†<p>PPV  =  Positive predictive value.</p>‡<p>CSMF_VA  = Cause-specific mortality fraction as determined by verbal autopsy procedures.</p>§<p>CSMF_MR  = Cause-specific mortality fraction as determined from medical records.</p