Time Interval between Onset of Symptoms of Severe Preeclampsia to Delivery: Effect on Pregnancy Outcomes at Mbarara Regional Referral Hospital, South Western Uganda

Background: Hypertensive disorders of pregnancy (HDP) account for nearly 18% of all maternal deaths worldwide. Preeclampsia is a leading cause of direct maternal mortality worldwide, and the second in Uganda contributing about 9.1% of total maternal death. Expectant management of severe pre-eclampsia at 30–34 weeks is associated with good perinatal outcome and risk reduction for the motherMethods: This was a retrospective cohort study done by reviewing maternal medical records from September 2009 to September 2011 and all mothers who had delivered at Mbarara Hospital with a diagnosis of severe pre-eclampsia (SPE) during study period were included in the study. Results: Primigravida accounted for about 42.6% of the cases of severe pre-eclampsia studied and majority (66.7%) of the women were aged between 20-30 years. The overall good fetal outcome rate in this study was 47.5% and 68.3% of the women studied were more than 28 weeks of amenorrhoea and 31.2% had still births. The most common symptom was headache (47%) and over 35% of these women presented for delivery more than 72hours from onset of symptoms. Delivery between 0-18 hours was protective OR 0.43, CI=0.29-0.52), p-value 0.013Conclusions: The complication rate associated with severe preeclampsia is high and worsens with longer duration of symptoms before delivery. Delivery within 18 hours of onset of symptoms is associated with good fetal outcomes and this stresses the importance of early presentation for care by the mothers and timely decision making by the clinicians.

Prevalence, Morphological Types and Factors Associated With Anemia among Mothers Attending Antenatal Clinic at Mbarara Regional Referral Hospital, South Western Uganda

Background: Anemia in pregnancy is defined as reduction in hemoglobin concentration of below 11.0g/dl in the first and third trimester, or hemoglobin below 10.5g/dl in the second trimester. Globally 50% of pregnant women have anemia, the prevalence is even higher in Uganda where 64% of pregnant women have anemia, and the factors that are associated with anemia in pregnancy include social demographic, nutritional and medical factors. Objective: To determine the prevalence, morphological types, and factors associated with anemia in pregnancy among mothers attending antenatal clinic at Mbarara Regional Referral Hospital (MRRH). Materials and methods: A total of 355 mothers were recruited in a cross-sectional study at MRRH, social demographic, obstetric and medical factors were collected. Samples of blood, urine and stool were examined for malaria parasitaemia, hemoglobin (Hb) estimate, features of urinary tract infection (UTI), hookworm infestation and fecal occult blood. Thin film was done for those with low Hb. The dependant variable was anemia. A univariate and multivariate analysis was done to determine factors associated with anemia in pregnancy. A p-value of 0.05 was considered significant. Results: The prevalence of anemia among pregnant women attending antenatal clinic was 62.82%. Factors significantly associated with anemia were UTI (p=0.038), malaria parasitaemia (p=0.007), fecal occult blood (p=0.002) and use of hematinics (p=0.031). The common morphological type of anemia was found to be microcytic hypochromic anemia (76.68%). Conclusion: Microcytic hypochromic anemia was the most common morphological type of anemia. There is need to strengthen policies on screening for anemia during pregnancy, hematinics supplementation and use of IPT (Intermittent Preventive Treatment) together with proper treatment of Malaria and UTIs. Key words; Anemia, Pregnancy, Prevalence, factors, morphology, antenatal car

Prevalence of and Factors Associated with Vulva Intraepithelial Neoplasia (VIN) among HIV Positive Women at Mbarara Regional Referral Hospital, Uganda

Background: Vulva intraepithelial neoplasia (VIN) is a noninvasive potential precursor of squamous cell carcinoma of the vulva. VIN is more prevalent in HIV-positive than HIV-negative women and if not identified and treated early, there is a high risk of progression to invasive cancer. Despite a large number of HIV-positive women getting care from Immunesuppression (ISS) clinic at Mbarara Regional Referral Hospital (MRRH), the local burden of VIN remains unknown in this group. Objective: To determine the prevalence and factors associated with vulva intraepithelial neoplasia (VIN) among HIV-positive women attending HIV care clinic at Mbarara Regional Referral Hospital (MRRH). Methods: This cross sectional study consisted of 225 HIV-positive women who attended the HIV care clinic at MRRH in a period of three months. Simple random sampling was used in the recruitment of study participants until the sample size was achieved. All participants underwent vulvoscopy. Any lesion detected was biopsied. Demographic and medical data were collected. The dependent variable was histologically confirmed VIN. Logistic regression analysis to assess association of factors with VIN was done. Results were presented in charts, graphs and tables.  Results: Two hundred and twenty five HIV-positive women were enrolled. Their median age was 33 years.  14 (6.22%) had VIN; of these, 9 had VIN-1, 4 had VIN-2 and 1 had VIN-3. All the study participants with VIN had Human papilloma virus (HPV) infection and were on antiretroviral therapy (ART). The symptoms of VIN included vulvar itching (43%), vulvar burning sensation (29%), and superficial dyspareunia (14%). Age, multiple sexual partners, age of sexual debut, menarche and genital warts were not significantly associated with VIN Conclusion: The prevalence of VIN among HIV-positive women attending HIV care clinic at MRRH is low. All participants with VIN had the following in common, HPV infection; vulva itching, vulva burning sensation and superficial dyspareunia. Recommendations: Since all cases of VIN had HPV infection we recommend that HPV vaccination should be included in HIV care to prevent VIN and consequently vulva cancer. We also recommend that all women with vulva itching, vulva burning and superficial dyspareunia should be screened for VIN. Key words: Vulva Intraepithelial Neoplasia (VIN), Human Immunodeficiency Virus (HIV

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

Association between Contraceptive Awareness and Use, and Teenage Pregnancy among Prime Gravidas Delivering at Mbarara Hospital Regional Referral, Uganda

Introduction: The promotion of family planning, so that women can avoid unwanted pregnancy, is central to the World Health Organisation work on improving maternal health. This requires that women have access to safe and effective methods of fertility control. It is estimated that 90% of abortion-related and 20% of pregnancy-related morbidity and mortality, along with 32% of maternal deaths, could be prevented by use of effective contraception. In sub-Saharan Africa, it is estimated that 14 million unintended pregnancies occur every year, with almost half occurring among women aged 15–24 years. The objective of this study was to determine the impact of contraceptive awareness and use on teenage pregnancy among primigravidas at Mbarara Regional Referral Hospital, Southwestern Uganda. Methods: The study was conducted on postnatal ward at Mbarara Regional Referral Hospital between October and December 2015 using case control design by consecutively sampling 100 primiparas who delivered during the study period at gestation age ≥28 WOA Results: The total number of respondents was 100 where by 30 mothers were below 20 years and 70 above 20 years. The age range was 15- 35 years and the most frequent age was 20 years.  Majority of teenage mothers were either married or cohabiting (85%), unemployed (57%), never used contraceptive (93%), lacked knowledge of long term contraception (71%) and emergency contraception (84%). Lack of Knowledge of contraceptives, long term contraception and Emergency contraception was found to be strongly associated with likelihood of teenage pregnancy [OR (95%CI) and p values: 7.992(2.533- 25.222) <0.0001, 6.838(1.891-24.730) 0.001, 0.105(0.013-0.837) 0.012] respectively. Other factors associated with teenage pregnancy included rural residence [OR (95%CI) 2.382 (1.022-5.556) p value 0.043], Education Below secondary level [OR (95%CI): 5.167(2.116-12.617) p value<0.0001] and being unemployed [OR (95%CI): 9.374(2.595-33.859) p value <0.000]. Conclusion: Majority of teenage mothers delivering at Mbarara Regional Referral Hospital lack knowledge about contraception, long term contraceptives and emergency contraception. This knowledge gap is associated with low use of contraception and hence of teenage pregnancy. Key Words: teenage mothers, Contraception, Knowledge, Primigravida

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

Prevalence, Outcome and Associated Factors among Adolescents Delivering at Mbarara Regional Referral Hospital

Globally, almost one in five women aged 20 to 24 (19 %) had a live birth by their 18th birthday. Adolescent pregnancies and deliveries are universally recognized to be associated with many complications. Although many studies have been done on adolescent mothers globally, not much has been documented on the prevalence, outcomes and associated factors especially in Uganda. This study aimed at finding out the prevalence of adolescent deliveries, delivery outcomes and potential factors influencing these outcomes among adolescent mothers at Mbarara Regional Referral Hospital (MRRH), in Southwestern Uganda. We conducted a cross sectional study at MRRH between June and October 2015. We consecutively sampled 786 adolescent mothers within 24 hours postpartum and obtained their characteristics and delivery outcomes. The prevalence of adolescent deliveries at MRRH was 23.4% of all deliveries. Majority of the participants were aged 18-19 years (median 18.5years, standard deviation 0.87).  Majority had only attained primary education and almost all (90.5%) were married. Most had an average of 3 antenatal care visits, delivered by spontaneous vaginal delivery (59.4%). Caesarian section rate was 39.4% with the main indication of contracted pelvis (45.8%).  Majority had good fetal outcome (80.7%) while 50.2% of mothers had poor outcome. The main obstetric complication was perineal tears (32.6%) followed by prolonged labour (23%). Being referred and delivery by vacuum delivery remained significantly associated with poor outcomes while episiotomy and delivery by Caeserian section were protective. The prevalence of adolescent deliveries at MRRH is high with most of adolescent mothers having poor sociodemographic characteristics. Commonest poor maternal outcome was perineal tears followed by prolonged labour. Fetal outcomes were good. Being referred and delivery by vacuum delivery were associated with poor outcomes while episiotomy and delivery by Caeserian section were associated with good fetal outcome. Keywords: adolescent delivery, delivery outcome, maternal outcome, fetal outcome, associated factor

Frequency of HIV status disclosure, associated factors and outcomes among HIV positive pregnant women at Mbarara Regional Referral Hospital, southwestern Uganda

Introduction: positive HIV results disclosure plays a significant role in the successful prevention and care of HIV infected patients. It provides significant social and health benefits to the individual and the community. Non-disclosure is one of the contextual factors driving the HIV epidemic in Uganda. Study objectives: to determine the frequency of HIV disclosure, associated factors and disclosure outcomes among HIV positive pregnant women at Mbarara Hospital, southwestern Uganda. Methods: a cross-sectional study using quantitative and qualitative methods among a group of HIV positive pregnant women attending antenatal clinic was done and consecutive sampling conducted. Results: the total participant recruitment was 103, of which 88 (85.4%) had disclosed their serostatus with 57% disclosure to their partners. About 80% had disclosed within less than 2 months of testing HIV positive. Reasons for disclosure included their partners having disclosed to them (27.3%), caring partners (27.3%) and encouragement by health workers (25.0%). Following disclosure, 74%) were comforted and 6.8% were verbally abused. Reasons for non-disclosure were fear of abandonment (33.3%), being beaten (33.3%) and loss of financial and emotional support (13.3%). The factors associated with disclosure were age 26-35 years (OR 3.9, 95% CI 1.03-15.16), primary education (OR 3.53, 95%CI 1.10-11.307) and urban dwelling (OR 4.22, 95% CI 1.27-14.01). Conclusion: participants disclosed mainly to their partners and were comforted and many of them were encouraged by the health workers. There is need to optimize disclosure merits to enable increased participation in treatment and support programs

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