Association between Labour Outcomes and Level of Healthcare System at Which Initial Delivery Assessment is done before Referral in South Western Uganda

Background: In 2013, an estimated 289,000 women died due to complications in pregnancy and childbirth, (WHO 2014). In the same year, almost 1 million newborns died on the day they were born (UNICEF, 2014).Access to appropriate maternity care including prompt referrals for emergency obstetric care (EmOC) services and skilled birth attendance could significantly reduce both perinatal and maternal mortality and/or morbidity (C. Ronsmans et al., 2006, A. Paxton et al 2005).Objective: To determine the association between labour outcomes and the level of healthcare system at which delivery is first attempted before referral to Mbarara hospital (MRRH).Methods: Retrospective review of 644 records was done over a period of five months for referrals that delivered at MRRH. The data was analyzed using SPSS and cross tabulations were done and frequencies, percentages and Pearson Chi-square statistics obtained. Bivariate and multivariate logistic regression models were used to test association. Significance level was set at p value < or = 0.05.Results: First attempt of delivery from a hospital was protective against poor fetal and maternal outcomes OR= 0.43 [0.27-0.69, 95%CI] p<0.001, and OR= 0.49, [0.27-0.92, 95%CI],p=0.024  respectively. A distance of more than 5km from the health facility was associated with poor maternal outcomes OR= 2.38, [1.16-4.86, 95%CI] p=0.015 and urban residence was protective against poor fetal outcomes OR= 0.29, [0.18-0.46,95%CI], p<0.001.Conclusion/Recommendations: Initial labour assessment and management in lower health facilities is associated with poor delivery outcomes. Lower health facilities should be support supervised and mentored as pertains management of mothers in labour. Keywords: Referral, delivery, outcomes, attempt

Factors associated with poor delivery outcomes among women delivering by breech in South Western Uganda: Unmatched case control study

Background: It is globally observed that breech delivery through vaginal route is associated with more adverse neonatal outcomes compared to caesarian section including low 5 minute Apgar score and perinatal mortality increased. The ideal mode of delivery in breech presentation remains an area of intense controversy worldwide coupled with paucity of studies to high light factors associated with poor outcomes among breech deliveries. Objective: This study set out to determine the neonatal delivery outcomes in women delivering by breech at Mbarara University teaching hospital, South Western Uganda and factors associated with poor neonatal outcomes among breech deliveries. Methods: This was an unmatched case control study of 208 breech births between January to December 2014. Relevant socio-demographic and obstetrical variables were abstracted from patients’ records. The data was analyzed using SPSS and cross tabulations were done and frequencies, percentages and Pearson Chi-square statistics obtained. Bivariate and multivariate logistic regression models were used to test association. Significance level was set at p value < or = 0.05 Results: Among the 206 deliveries that were analyzed, 120 babies delivered by caesarean section (C/S) and 86 by assisted vaginal breech delivery. In the C/S group, 4 (3.3%) were fresh still births (FSB) and 116 (96.7%) were live births while in the assisted vaginal breech group, 25 (29.1%) were FSB and 61 (70.1%) were live births. Babies born by C/S had better Apgar scores at 5 minutes with 5 (4.1%) of babies born through C/S scored 0-6 while 115 (95.8%) scored between 7-10 whereas 31 (36%) of babies born by assisted vaginal breech delivery scored between 0-6 while 55 (64%) scored between 7-10. The factors associated with low Apgar scores at five minutes and fresh still births were vaginal mode of delivery, birth weight of less than 3 kilograms and multi-parity. Conclusion: Safe caesarian section and birth weight >2.5kg is associated with better perinatal outcome among breech deliveries Keywords: Breech delivery, mode of delivery, birth weight, Apgar score, perinatal outcome

A Use Intention Model for Location-Based Mobile Advertising

The use of location-based mobile advertising to deliver context specific information from businesses to clients has the potential to help them increase revenues, personalize offerings and reduce marketing costs. However, there is a lack of adoption of this emergent mode of advertising among micro-enterprises. This study examined the underlying reasons for this lack of adoption using an exploratory factor analytic study based on an adaptation of the Technology Acceptance Model with the choice of technology as an additional factor. Data was collected in a survey involving 304 micro-enterprises by means of structured questionnaires and interview schedules. A majority of micro-enterprises sampled in the study were not aware of location-based mobile advertising. The study findings validate the technology acceptance model and also reveal that the choice of technology is an important factor influencing the intention to use location-based mobile advertising by micro-enterprises

Disclosure, Contraceptive Practices, Reproductive Desires and Outcomes of Abortion, at Mbarara Regional Referral Hospital

Background: Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion constitutes an important part of safe motherhood initiatives. Methods: This was a cross sectional study. The study period was from August to December 2015. Women with missed abortion and threatened abortion were excluded. The outcome variables included treatment outcomes, contraceptive practices, reproductive desires and disclosure. Results: There were a total of 40 respondents. Prevalence of knowledge of contraceptives was 87.5%, though 95% lacked knowledge of ECs.  The ended pregnancy was unintended in majority of respondents (62.5%). Half of the abortions 50% were induced. Of the eight induced abortions (62.5%) were done by health workers, (25%) by a traditional healer, and 12.5% by a relative. The methods used to induce the abortion included medical methods (25%) =5, surgical (60%) n=12, mechanical local (5%) n=1, herbal (10%) n=2.  Complications of abortion occurred in 20%. Women who had intended pregnancy were more willing to get more children as compared to women who had had unintended pregnancy, 60 % and 54 % respectively. More complications occurred among induced abortions as compared to spontaneous abortion37.5% and 9.7% respectively. Eight women (20%) volunteered to have induced abortion. Conclusion: There is low knowledge of ECs among women undergoing PAC at MRRH with majority having unintended pregnancy. Half of the abortions are induced. Providers of abortion include health workers, a traditional healer, and a relative. The methods used included medical method, mechanical local and, herbal   Complications of abortion occurred in 20%. , and these included septic abortion, perforated viscera and anaemia. Women who had intended pregnancy were more willing to get more children as compared to women who had had unintended pregnancy. More complications occurred among induced abortions as compared to spontaneous abortion. Voluntary disclosure was in 40% of all women who had induced abortion. Recommendations: There is need for expansion of contraceptive services in order to reduce the burden of unintended pregnancies. Emergency contraception should be made more available. All abortions should regard and managed as induced abortion as the rate of voluntary disclosure is low (40%). Keywords: Contraceptive, Practice, Desires, Abortion

Factors Associated with Short Births Intervals among Women Delivering at Mbarara Hospital

Background; Birth interval is the time between two consecutive births. World Health Organization recommends a minimum birth to pregnancy interval of 24months after live birth and 6months after abortion. Short birth interval is associated with adverse perinatal and maternal outcomes. Few studies have described factors associated with birth intervals. Knowing these factors will enable stake holders and care providers to modify practice to address them thus improving neonatal infant and maternal health.Methods: This was a case-control study. We enrolled 56cases and 162 controls that consented to the study and interviewed them. Statistical analysis was done using SPSS statistical software, version 20 (SPSS, Chicago, IL, USA). Cross tabulations was conducted to obtain descriptive statistics. Bivariable and multivariable logistic regression models were used to test the association.Results: The age of participants ranged from 17 to 42years, the modal birth interval as 36months. Age below 30years P=0.015 (OR 2.3 CI 1.17-4.67), low education level P= 0.005, lack of contraceptive use P=0.000 and lack of contraceptive P=0.000. A previous good fetal birth outcome and having live child was protective P=0.000, P=0.000 respectively.Conclusion and recommendation: Contraceptive knowledge and use programs targeting mothers below 30years should be strengthened especially in the postnatal period. Universal secondary school education program should be strengthened. Programs to improve neonatal and child survival should be strengthened as they directly affect child spacing thereby indirectly affecting maternal health. Keywords: Birth interval, Deliver

Factors Associated With Adverse Perinatal Outcomes Among Women Referred In Labour to Mbarara Regional Referral Hospital.

Background: In 2013, 1 million newborns died on the day they were born, 2 million newborns died within the first seven days after birth, representing 73 per cent of all neonatal deaths. There are also 1.19 million intrapartum related stillbirths (Lawn et al., 2011) yet 280,000 babies die of birth asphyxia soon after birth. Poor fetal outcomes are higher among women who are referred for delivery. Objectives: The aim of the study was to determine factors associated with adverse perinatal outcomes among women referred in labour to Mbarara regional referral hospital (MRRH). Methods: We conducted an unmatched case-control study between October 2015 and February 2016 .A total of 106 cases and 212 controls were enrolled in the study. A case was a mother who delivered a baby with an adverse perinatal outcome (still birth, early neonatal death or need for admission in the neonatal ward) while a control was mother who delivered a baby with no adverse perinatal outcome. Data was collected entered in Epidata version 3.1 and analyzed using STATA Version 2012. Frequencies, percentages and Pearson Chi-square statistics obtained. Bivariate and multivariate logistic regression models were used to test association. Odds ratios with their corresponding 95% confidence intervals (CI) and p-values were recorded.  Significance level was set at p value < or = 0.05. Results: Admission in second stage of labour (aOR 95% CI: 3.7 [ 1.53-9.03], p=0.0001), fetal distress (aOR 95% CI:  7.1 [ 2.92-17.45], p<0.001), cord prolapse (aOR 95% CI: 7.2 [1.13-45.72], p=0.037), gestational age below 37 weeks (aOR 95% CI: 2.74 [1.25-6.00], p<0.0391), preeclampsia (aOR 95% CI:13.3 [ 2.75-63.85], p=0.001), ruptured uterus (aOR 95% CI: 38.7 [4.55-329.00], p=0.001), pre-referral interventions (aOR 95% CI: 2.0 [1.12-3.73], p=0.020), and  stay at the referring facility for less than 6 hours (aOR 95% CI: 4.7 [1.33-16.48], p=0.0221) were independently associated with adverse perinatal outcomes among women referred in labour to MRRH. Socio-demographic factors were not associated with adverse perinatal outcomes. Conclusion: Admission in second stage of labour, fetal distress, gestational age less than 37 weeks, ruptured uterus, cord prolapse, pre-eclampsia, pre-referral interventions and stay at the referring health facility for less than 6 hours were independently associated with adverse perinatal outcomes among referrals in labour at MRRH. There was no association between socio-demographic factors and adverse perinatal outcomes of referrals to MRRH. Early recognition women at risk of adverse perinatal outcomes, timely referral followed by prompt and appropriate management, may reduce the adverse perinatal outcomes among women referred in labour. Keywords: Referral, Adverse perinatal outcomes, Labour

Prevalence and Factors Associated With Histological Chorioamnionitis among Term Women Delivering From Mbarara Regional Referral Hospital

Background: Chorioamninitis (CAM), is an acute inflammation of the membrane and chorion of the placenta which can either be clinical or histological. At Mbarara Regional Referral Hospital the prevalence and factors associated with histological chorioamnionitis are widely unknown. Objective: To assess the prevalence and factors associated with histological chorioamnionitis in term pregnancy among mothers delivering from Mbarara Regional Referral Hospital.   Methods: At inclusion in a cross-section, from December 2015 to February 2016, 136 women at term were interviewed. The placentas were evaluated, and diagnosis was based on histologic examination of the placenta. Placentas with microscopic evidence of inflammation of the membranes (infiltration of polymorphonuclear leukocytes and other immunocytes, such as macrophages and T cells) were considered positive for histological chorioamnionitis (HCA). Placental positive for HCA were scored and categorized as: Grade 1 (mild to moderate chorioamninitis) or Grade 2 (severe chorioamnionitis- three or more chorionic microabscesses). Logistic regression was used to determine factors associated with chorioamnionitis. The significant level of 5% was used. Odds ratios and their corresponding 95% CI were provided at both bivariate and multivariate analysis.   Results: Among the 129 placentas of mothers at term that were examined, histologogical chorioamnionitis was diagnosed (HCA-positive) in 34.1% of women. Duration of labor more than 18 hours was found to be associated with HCA (aOR=4.0, 95%CI:1.30-12.39, p=0.0267). There were 34 cases of HCA grade 1 among cases positive for HCA (81.8%).   Conclusions: In our study, the prevalence of HCA was found to be high and duration of labor more than 18 hours was found to be significantly associated with HCA. The proportion of grade 1 HCA among term women with HCA at MRRH is 81.8%

Endometriosis among African women

Endometriosis has long been wrongly perceived to be rare among women of African descent. The misconception about the prevalence of endometriosis among African women has significantly contributed to long diagnostic delays, limited access to diagnosis and care, and a scarcity of research on the condition among African women. In this commentary, we highlight the prevalence of endometriosis among African women, the state of endometriosis care in Africa, and the gaps in knowledge that need to be addressed. Based on the available data, the prevalence of endometriosis in Africa is likely higher than previously thought, with varying subtypes. There is a long diagnostic delay of endometriosis among African women. Additionally, endometriosis care in Africa from the general population and health practitioners is poor; this can be attributed to the high diagnostic cost, scarcity of trained specialists, as well as patients’ inability to express their symptoms due to societal taboos surrounding menstrual health. Public sensitization on endometriosis may help improve endometriosis diagnosis and care in Africa. LAY SUMMARY: Endometriosis is a condition in which tissue like the uterine lining is found outside the uterus, causing women to experience pain especially before, during, or after menstruation. Although endometriosis affects an estimated 176 million women worldwide, it has been wrongly reported that endometriosis is a rare condition among African women, mainly due to lack of awareness among healthcare providers and historical bias. In the current commentary, we discuss the prevalence of endometriosis, the diagnostic delays, and the care of endometriosis among black African women living in the African continent. Much of the literature has demonstrated (falsely) that endometriosis is rare in Black women compared to White ethnicity. African women experience a long diagnostic delay and do not receive appropriate care. Public awareness of endometriosis may help improve diagnosis delay and endometriosis care in Africa

Association between Duration of Second Stage of Labour and Perinatal Outcomes among Mothers admitted in Labour at Mbarara Regional Referral Hospital, Uganda

About four million babies die in the first 4 weeks of life annually. Most of the neonatal deaths occur in the first week mainly on the first day after delivery. The objective of our study was to determine the factors associated with poor perinatal   outcomes among low risk mothers admitted in labour at Mbarara Regional Referral Hospital (MRRH). This was a retrospective cohort study of mothers on the postnatal ward of MRRH. The total number of respondents was 140. The duration of second stage was ≤30 minutes in 70.0% of the women.  The number of women with poor feotal outcome was 27(19.3%). The poor outcomes included, birth asphyxia, fresh still birth and early neonatal death. The odds of having a good feotal delivery outcome was inversely proportional to time, with best results registered when delivery occurred within 30minutes OR, 4.9, 95% CI (1.8-13.1), weakening towards duration of ≥60 minutes with OR, 17.7, 95% CI (5.3-52.5). A second stage of labour lasting more than 60 minutes is associated with poor neonatal outcomes.For best perinatal outcomes we recommend if the second stage exceeds 60 minutes, labour should be re-assed and action should be taken to avoid further delay. To avoid poor neonatal outcomes, a second stage of labour lasting more than 60minutes requires continuous feotal monitoring

Incidence and Factors Associated with Postpartum Anemia at Mbarara Regional Referral Hospital

Background: The World Health organization defines postpartum anemia as hemoglobin <11g/dl at 1 week postpartum and <12g/dl at 8 weeks postpartum. Postpartum anemia can also be defined as less than 11.8 g/dl for women aged 12–15 years and less than 12g/dl for women at least age 15 years. In Uganda, 23% of women age 15-49 are anemic, with 18 percent having mild anemia, 5 percent having moderate anemia, and less than 1 percent having severe anemia. Objective: To determine the incidence and factors associated with the new cases of post natal anemia in Mbarara Regional Referral Hospital. Methods:  A prospective cohort study of 271 postpartum mothers without anemia enrolled on discharge after delivery. Participants were followed up to determine development of anemia at 10 weeks postpartum and associated factors on the subsequent postnatal visits. Incidence of postpartum anemia in MRRH was 29.9%, 95% CI (24 - 35). Helminthes infestations AOR95%CI; 12.88(5.25- 31.64, P<0.000), malaria infections AOR95%CI 4.74(1.50-14.94, P=0.008), poor hematinic adherence AOR95%CI, 6.81(3.17-14.62, P<0.000), high parity AOR95%CI, 2.48(1.11- 5.54, P=0.026), and husband unemployment AOR 3.92(1.14 – 13.39, P=0.030) were found to be statistically associated with post-partum anemia. Conclusion: The incidence of postpartum anemia in Mbarara Regional Referral Hospital is very high. Hematinics non adherence, husband unemployment, increased parity; malaria infection and helminthes infestation were found to be associated with post-partum anemia at MRRH