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

Distribution of Pregnancy Complications by Gestational Age at Mbarara Regional Referral Hospital, Southwestern Uganda

Background: During pregnancy; both the woman and her developing foetus face various health risks. Pregnancy complications can range from mild discomfort, to severe, sometimes life threatening illnesses. Our objective was to determine the pregnancy complications and the associated gestation ages at Mbarara regional referral hospital. Methods: It was a cross sectional study. The Primary outcome was any pregnancy complications. The sample size was 1016. Pearson Chi-square was used to determine association between categorical variables.  Odds ratio was used to determine statistical significance. Results: The complications included abortion 6.2%, preterm labour 6.0%, and preeclampsia, premature rupture labour, preterm premature rupture of membranes, urinary tract infections 2.4%, malaria, intrauterine feotal death 1.5%, antepartum haemorrhage 1.5% and anaemia. The complications started rising from 29 weeks to 36 weeks and started declining thereafter but rose again after 42 weeks. Majority of complications occurred between 29 and 36 weeks. At bivariate analysis the following were found to be significantly associated with complications in pregnancy, age 35 years and above (OR 2.247(1.376-3.670), 95% CI), being single was negatively associated with absence of pregnancy complications(OR 0.435(0.219-0.863,95% CI), a gestational age bracket of 29-36 was negatively associated with absence of pregnancy complications (OR 0.169(0.123-0.233,95% CI), Conclusion: Though pregnancy complications can occur at any gestational age, there are three peaks at which complications are most common, early pregnancy between 5-16 weeks, 29–36 weeks and after 44weeks of gestation. Pregnancy complication drastically dropped towards term i.e. from 37-42 weeks and an increasing trend thereafter. A maternal age of 35 years and above, being single and a gestational age bracket of 29-36 are associated with pregnancy complications. Recommendations: Pregnant women who are 35 years and above and those who are single need to be monitored as high risk pregnancies. Investigations should be carried out for all women between 29-36 weeks when they come for antenatal care to rule out the potential risks. Pregnancies beyond 42 weeks should be induced. First antenatal care attendance should be as early as five weeks and efforts should be made to encourage preconception care in our setting since complications of pregnancy are high in the first few weeks of gestation

Knowledge and Perceptions of Severe Pre-Eclampsia among Postnatal Women at Mbarara Regional Referral Hospital

Background: Preeclampsia is associated with acute and long-term morbidities. Knowledge of obstetric danger signs and birth preparedness are important strategies at enhancing utilization of skilled care in low income countries. It is generally believed that in light of a looming disaster, those who promote and regulate health and safety need to understand how people think about and respond to risk. We undertook this study because we wanted to know how women in Mbarara perceive vulnerability or risk of death due to severe preeclampsia and how their perceptions influence their response. Methods: This was a cross sectional study that recruited mothers on the postnatal ward. These women were expected to have gained knowledge about pregnancy danger signs during their antenatal period. Women were classified to have either high knowledge perceptions or low knowledge perceptions based on their perceived knowledge of symptoms, complications, right decision and perceived dangers. Knowledge about the above areas of assessment was analyzed and classified as high and low knowledge perceptions. Results: Eighty three percent (83.0%) did not know any symptom of severe preeclampsia, 99.1% knew less than three symptoms of severe preeclampsia, and 36.6% did not know any complication of severe preeclampsia. Conclusion: The knowledge concerning pre eclampsia and its symptoms are still low among women at Mbarara Regional Referral Hospital. Many post natal mothers have misconceptions about severe pre eclampsia and its symptoms. “When I get headache i eat some food or drink water” --- it is a sign of hunger or dehydration’’ are some of the responses we received from the respondents. Recommendations: There is need for the antenatal care service providers to emphasize to the mothers about danger symptoms and signs in pregnancy. Health education during antenatal clinics should be given in a language and methods easily understood by women

Prevalence and Factors Associated With Genital Chlamydial Infections among Women Attending the Gynaecology Clinic At Mbarara Regional Referral Hospital

Background: Chlamydia trachomatis is responsible for the most common bacterial sexually transmitted bacterial infection. The largest burden is in low income countries. These organisms are not screened for in Mbarara, and information about the burden of disease is no available. This study aimed at establishing the prevalence and factors associated with genital Chlamydia infection among women of reproductive age attending the gynecology clinic at Mbarara Regional Referral Hospital. Methods: In a cross-sectional study done at Mbarara Regional Referral Hospital, 324 women aged 15-49years were consented and interviewed. Data on socio-demographics, maternal medical conditions, obstetric and gynaecological factors and endocervical swabs were collected consecutively from November 2015 to January 2016 from women attending gynaecology clinic at Mbarara Regional Referral Hospital. Samples were analysed using a using CTK biotech Chlamydia kit, which is a rapid immunoassay test for the detection of genital chlamydial antigen in urogenital samples. Results were analysed using STATA 13, Logistic regression models were used to estimate level of significance, the odds ratios (OR) and 95 % CI of the association between the factors and genital infections. Significance was set at a p value of <0.05. Results: Of the 324 samples collected,86 were positive for C. trachomatis antigen giving a prevalence rate of 26.5%. Of all the associated factors examined, only type of residence was significantly associated with C. trachomatis infection (p= 0.0413) with those living in peri-urban areas at greater risk of infection ( aOR 2.4  95%CI (1.22-4.82). Other social demographic ,medical obstetric and gynecological factors were not associated with C. trachomatis infection. No symptom or clinical sign was significant for the infection. Conclusion and recommendation: The prevalence of genital C. trachomatis infection among women attending gynecology clinic is high. Genital Chlamydia infection has no predictive signs and symptoms in our setting. Screening of women in reproductive age should be encouraged. Keywords; Genital Chlamydia trachomatis, endocervical swabs, gynaecology clinic.

Risks of adverse perinatal and maternal outcomes among women with hypertensive disorders of pregnancy in southwestern Uganda.

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are a leading cause of global perinatal (fetal and neonatal) and maternal morbidity and mortality. We sought to describe HDP and determine the magnitude and risk factors for adverse perinatal and maternal outcomes among women with HDP in southwestern Uganda. METHODS: We prospectively enrolled pregnant women admitted for delivery and diagnosed with HDP at a tertiary referral hospital in southwestern Uganda from January 2019 to November 2019, excluding women with pre-existing hypertension. The participants were observed and adverse perinatal and maternal outcomes were documented. We used multivariable logistic regression models to determine independent risk factors associated with adverse perinatal and maternal outcomes. RESULTS: A total of 103 pregnant women with a new-onset HDP were enrolled. Almost all women, 93.2% (n = 96) had either pre-eclampsia with severe features or eclampsia. The majority, 58% (n = 60) of the participants had an adverse perinatal outcome (36.9% admitted to the neonatal intensive care unit (ICU), 20.3% stillbirths, and 1.1% neonatal deaths). Fewer participants, 19.4% (n = 20) had an adverse maternal outcome HELLP syndrome (7.8%), ICU admission (3%), and postpartum hemorrhage (3%). In adjusted analyses, gestational age of < 34 weeks at delivery and birth weight <2.5kg were independent risk factors for adverse perinatal outcomes while referral from another health facility and eclampsia were independent risk factors for adverse maternal outcomes. CONCLUSION: Among women with HDP at our institution, majority had preeclampsia with severe symptoms or eclampsia and an unacceptably high rate of adverse perinatal and maternal outcomes; over a fifth of the mothers experiencing stillbirth. This calls for improved antenatal surveillance of women with HDP and in particular improved neonatal and maternal critical care expertise at delivering facilities. Earlier detection and referral, as well as improvement in initial management at lower level health units and on arrival at the referral site is imperative

Cervical Cancer at Mbarara Regional Referral Hospital: Magnitude, Trends, Stages at Presentation, Impact of Acetic Acid Screening and the Need for Radiotherapy Services

Background: Globally, cervical cancer the fourth most common cause of cancer death accountable for approximately 266,000 deaths of women, with sub-Saharan Africa and East Africa having the highest burden. In Uganda about 2,275 new cervical cancer deaths occur annually. The main objective of the study was to describe the magnitude, trends, clinical stage on presentation and show the importance of cervical cancer prevention and radiotherapy services at Mbarara Regional Referral Hospital. Methods: This was a descriptive cross-sectional study. In the first phase of the study, leading cancers at Mbarara Regional Referral Hospital were determined.  In the second phase of the study, the burden of cervical cancer on the gynecological ward was determined. In the third part of the study the trends of cervical cancer over a ten year period was determined. In the fourth phase of the study the effects of acetic acid screening on the trends of cervical cancer was determined. Results: With a proportion of 25.2%, cervical cancer is the single leading cancer in the hospital. Cervical cancer contributes 10.1% of all diseases on the gynecological ward and 73.9% of all gynecological cancers.  The frequency of cervical cancer more than doubled between 2006 and 2014) with 60.3% of presenting with late stage. The number of cases of early cervical cancer detected had shown a small but steady increase since 2009. There was a decline in clinic cervical cancer incidence rate from 3.2% in 2009, 0.9% in 2013. Conclusion: Cervical cancer is the leading cancer and also the leading gynecological cancer at Mbarara Regional Referral Hospital. Women with cervical cancer are diagnosed late. Screening increases the rate of early detection. Acetic acid screening is effective in reversing the trends of cervical cancer. Expanding cervical cancer preventive services is capable of reducing the burden of cervical. Recommendations: There is need for expansion of HPV vaccination. There is need for expansion of acetic acid cervical cancer screening in southwestern Uganda. There is need for making radiotherapy services more accessible in developing countries. Keywords: Cervical Cancer, Magnitude, Trends, Stages, Impact, Acetic Acid, Screening, Radiotherapy

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%

Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda

<p>Abstract</p> <p>Background</p> <p>Obstetric fistula although virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world. It occurs in areas where access to care at childbirth is limited, or of poor quality and where few hospitals offer the necessary corrective surgery.</p> <p>Methods</p> <p>This was a prospective observational study where all women who attended Mbarara Regional Referral Hospital in western Uganda with obstetric fistula during the study period were assessed pre-operatively for social demographics, fistula characteristics, classification and outcomes after surgery. Assessment for fistula closure and stress incontinence after surgery was done using a dye test before discharge</p> <p>Results</p> <p>Of the 77 women who were recruited in this study, 60 (77.9%) had successful closure of their fistulae. Unsuccessful fistula closure was significantly associated with large fistula size (Odds Ratio 6 95% Confidential interval 1.46-24.63), circumferential fistulae (Odds ratio 9.33 95% Confidential interval 2.23-39.12) and moderate to severe vaginal scarring (Odds ratio 12.24 95% Confidential interval 1.52-98.30). Vaginal scarring was the only factor independently associated with unsuccessful fistula repair (Odds ratio 10 95% confidential interval 1.12-100.57). Residual stress incontinence after successful fistula closure was associated with type IIb fistulae (Odds ratio 5.56 95% Confidential interval 1.34-23.02), circumferential fistulae (Odds ratio 10.5 95% Confidential interval 1.39-79.13) and previous unsuccessful fistula repair (Odds ratio 4.8 95% Confidential interval 1.27-18.11). Independent predictors for residual stress incontinence after successful fistula closure were urethral involvement (Odds Ratio 4.024 95% Confidential interval 2.77-5.83) and previous unsuccessful fistula repair (Odds ratio 38.69 95% Confidential interval 2.13-703.88).</p> <p>Conclusions</p> <p>This study demonstrated that large fistula size, circumferential fistulae and marked vaginal scarring are predictors for unsuccessful fistula repair while predictors for residual stress incontinence after successful fistula closure were urethral involvement, circumferential fistulae and previous unsuccessful fistula repair.</p

A modified neo-vagina procedure in a low resource urogynecological unit: a case report of a 21 year old with Mayer-Rokitansky-Küster-Hauser (mrkh) Syndrome operated at Mbarara referral hospital, Southwestern Uganda

Abstract Background Although vaginal agenesis as may occur in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare condition, it is associated with not only anatomical problems but also serious psychological and social problems like painful sexual intercourse, primary amenorrhea and infertility. Surgery, which is aimed at reconstruction of a vagina of adequate length and width to serve the function, is the main method of treatment. Many methods for vaginal reconstruction have been described but each has its complications and limitations. The most commonly preferred procedure for treating this condition is the McIndoe vaginoplasty which involves dissection into the recto-vesical space, inserting two split thickness skin grafts folded over a mold in this newly created space and regular dilatation of the neovagina postoperatively to avoid stenosis. However surgeons with this expertise in this part of the world are rare to find and where they are available, the special molds on which to fold the skin grafts into the neovaginal space are not readily available. Case presentation A 21-year-old female with vaginal agenesis was operated on using a modification of the McIndoe procedure using a cylinder of a 60cm3 syringe as a vaginal mold/form and kept in place. We left a Foley in place for 10 days and we did a dye test after removing the syringe to ensure that there was no leakage resulting from fistula formation. Conclusion The operation was successful and on subsequent monthly reviews of the patient, she has a patent functional vagina of about 9 cm in length at 8 months after the operation with resumption of sexual intercourse