Maternal and newborn health priority setting partnership in rural Uganda in association with the James Lind Alliance: a study protocol.

BackgroundMaternal and newborn deaths and ill health are relatively common in low income countries, but can adequately be addressed through locally, collaboratively designed, and responsive research. This has the potential to enable the affected women, their families and health workers themselves to explore 'why maternal and newborn adverse outcomes continue to occur. The objectives of the study include; To work with seldom heard groups of mothers, their families, and health workers to identify unanswered research questions for maternal and newborn health in villages and health facilities in rural UgandaTo establish locally responsive research questions for maternal and newborn health that could be prioritised together with the public in UgandaTo support the case for locally responsive research in maternal and newborn health by the ministry of health, academic researchers and funding bodies in Uganda.MethodsThe present study will follow the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology. The project was initiated by an academic research group and will be managed by a research team at the Sanyu Africa Research Institute on a day to day basis. A steering group with a separate lay mothers' group and partners' group (individuals or organisations with interest in maternal and newborn health) will be recruited. The PSP will be initiated by launch meetings, then a face-to-face initial survey for the collection of raw unanswered questions; followed by data collation. A face-to-face interim prioritisation survey will then be performed to choose questions before the three separate final prioritisation workshops.The PSP will involve many participants from an illiterate, non-internet population in rural eastern Uganda, but all with an interest in strategies to avert maternal and newborn deaths or morbidities in rural eastern Uganda. This includes local rural women, their families, health and social workers, and relevant local groups or organisations.We will generate a top 10 list of maternal and newborn health research priorities from a group with no prior experience in setting a research agenda in rural eastern Uganda.DiscussionThe current protocol elaborates the JLA methods for application with a new topic and in a new setting translating the JLA principles not just into the local language, but into a rural, vulnerable, illiterate, and non-internet population in Uganda. The face-to-face human interaction is powerful in eliciting what exactly matters to individuals in this particular context as opposed to online surveys.This will be the first time that mothers and lay public with current or previous experience of maternal or neonatal adverse outcomes will have the opportunity to identify and prioritise research questions that matter to them in Uganda. We will be able to compare how the public would prioritise maternal health research questions over newborn health in this setting

Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial

Introduction Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. Objective To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. Methods We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (≥37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. Intervention A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Outcome measures Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. Results The median maternal venous lactate was 6.4 (IQR 3.3–12.3) in the intervention and 7.5 (IQR 4.0–15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40–0.51) implying very little if any effect at all. Conclusion The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels.publishedVersio

Outcomes of interventions in neonatal sepsis:A systematic review of qualitative research

BackgroundWhile a systematic review exists detailing neonatal sepsis outcomes from clinical trials, there remains an absence of a qualitative systematic review capturing the perspectives of key stakeholders.ObjectivesOur aim is to identify outcomes from qualitative research on any intervention to prevent or improve the outcomes of neonatal sepsis that are important to parents, other family members, healthcare providers, policymakers, and researchers as a part of the development of a core outcome set (COS) for neonatal sepsis.Search StrategyA literature search was carried out using MEDLINE, EMBASE, CINAHL, and PsycInfo databases.Selection CriteriaPublications describing qualitative data relating to neonatal sepsis outcomes were included.Data Collection and AnalysisDrawing on the concepts of thematic synthesis, texts related to outcomes were coded and grouped. These outcomes were then mapped to the domain headings of an existing model.Main ResultsOut of 6777 records screened, six studies were included. Overall, 19 outcomes were extracted from the included studies. The most frequently reported outcomes were those in the domains related to parents, healthcare workers and individual organ systemas such as gastrointestinal system. The remaining outcomes were classified under the headings of general outcomes, miscellaneous outcomes, survival, and infection.ConclusionsThe outcomes identified in this review are different from those reported in neonatal sepsis clinical trials, thus highlighting the importance of incorporating qualitative studies into COS development to encapsulate all relevant stakeholders' perspectives.This study reviews outcomes considered important in neonatal sepsis by stakeholders such as parents and healthcare providers, aiding in developing a core outcome set (COS)

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The Road to Genocide: Identity Politics within Former State Institutions, the case of Caisse Sociale du Rwanda

Scholarly works on the 1994 Genocide against the Tutsi have been too generic with minimal focus on institutional violence. Therefore, this paper addresses this knowledge gap by focusing on the former Caisse Sociale du Rwanda (CSR) as a case study. The research adopted a qualitative approach, with primary data being collected through structured and semi-structured interviews, which were administered to sixty-two (62) participants, and data collection methods were structured and semi-structured interviews, observation method, and secondary sources. Primary data was complemented and reinforced with data from secondary sources. This research study, which is built on ideological and identitarianism discourses, addresses some specific questions to elicit empirical explanations for institutional violence within state institutions, using the former Caisse Sociale du Rwanda as a case study. Specifically, the study sought to determine the level to which institutional violence was engineered within CSR during the genocide as well as assess the relations between Hutu and Tutsi employees before the 1994 war, during the 1994 war, and during the 1994 genocide. The study further delves into how Hutu employees engineered the execution and executed Tutsis within the former institution and the role institutional leaders played in executing the genocide both within and outside the former institution. Additionally, the study explores the weaponry used to commit the killings and how the institution covered up and tried to erase these acts afterward. The findings show the institutionalization of violence through different political periods. The study also highlights the crimes committed against the former Tutsi employees, weapons used in killing the former Tutsi employees, acts of erasing genocide facts, and how the former state institution used workers’ money to implement the genocide in conspiracy with the former genocidal government. As depicted in the empirical findings, institutional ethnic cleavage was a result of ethnopolitical violence against Tutsi employees. The extent and consistency of ethnic institutionalization and violence against Tutsi employees were unprecedented. Equally, legitimizing exclusion in CSR was inseparable from the state’s ethnic divide between the Hutu and Tutsi

Voices of Youth Born of Genocidal Rape in Rwanda: Their Social Exclusion after 26 Years of Genocide

This article explains social exclusion issues of youth born of rape during the 1994 Genocide after 26 years of genocide. Their social exclusion is exclusively related to the circumstances under which they were conceived and born and living with a neglected identity that is associated with Hutu killers. Thus, the research problem centered on their identity issue which leads to their social exclusion. The research approach was qualitative in nature where data was collected through individual interviews with 81 respondents and a review of existing literature. The study used social exclusion theory to contextualize the life experiences of the youth born of rape during the genocide. Findings indicate that children are continuously perceived as ‘children of genocide perpetrators’, ‘children of killers’, ‘children of Hutus’ ‘little killers’, or ‘evil children – so they exist with identity complex and inferiority. Though their identity was not a result of their own making, findings indicate majority are not legally or socially recognized either on the maternal or paternal sides. As a result of these life experiences, they suffer from abuse, internalized stigma, hurt feelings, abandonment, discrimination, and marginalization due to the circumstances they were born as children of Hutu killers. Gradually, they are losing self-esteem; they lack meaningful existence and belongingness due to structural family and societal social exclusion

Voices of Youth Born of Genocidal Rape in Rwanda: Their Social Exclusion after 26 Years of Genocide

This article explains social exclusion issues of youth born of rape during the 1994 Genocide after 26 years of genocide. Their social exclusion is exclusively related to the circumstances under which they were conceived and born and living with a neglected identity that is associated with Hutu killers. Thus, the research problem centered on their identity issue which leads to their social exclusion. The research approach was qualitative in nature where data was collected through individual interviews with 81 respondents and a review of existing literature. The study used social exclusion theory to contextualize the life experiences of the youth born of rape during the genocide. Findings indicate that children are continuously perceived as ‘children of genocide perpetrators’, ‘children of killers’, ‘children of Hutus’ ‘little killers’, or ‘evil children – so they exist with identity complex and inferiority. Though their identity was not a result of their own making, findings indicate majority are not legally or socially recognized either on the maternal or paternal sides. As a result of these life experiences, they suffer from abuse, internalized stigma, hurt feelings, abandonment, discrimination, and marginalization due to the circumstances they were born as children of Hutu killers. Gradually, they are losing self-esteem; they lack meaningful existence and belongingness due to structural family and societal social exclusion

An analysis of barriers to public sector innovation in Namibia

This study is about barriers to public sector innovation in Namibia. It is motivated by the fact that while the Government of the Republic of Namibia has adopted a wide range of public policies and programmes, and established institutions to promote the efficiency and effectiveness of its public sector, not much is known as to whether these measures are enhancing innovation in service delivery and public administration. There is a paucity of evidence-based analysis on public sector innovation in Namibia. The study fills the gap and aims to stimulate further academic inquiry into this area. Based on an online survey, face-to-face interviews, and focus group discussions at regional and national workshops, we identified and analysed barriers to public sector innovation in the country. The study recommends a strategic policy framework and whole-ofgovernment institutional configuration to spur on innovation in public service delivery and administration. It suggests further research on the measurement of public sector innovation, and detailed analysis of specific barriers to innovation in public services.http://www.saapam.co.za/joba.htmlam2023School of Public Management and Administration (SPMA

Multiple electrolyte derangements among perioperative women with obstructed labour in eastern Uganda: A cross-sectional study.

There is a dearth of information on the patterns of electrolyte derangements among perioperative women with obstructed labour. We measured the levels and patterns of electrolyte derangements among women with obstructed labour in eastern Uganda. This was a secondary analysis of data for 389 patients with obstructed labour, diagnosed by either an obstetrician or medical officer on duty between July 2018 and June 2019. Five milliliters of venous blood was drawn from the antecubital fossa under an aseptic procedure for electrolytes and complete blood analyses. The primary outcome was the prevalence of electrolyte derangements, defined as values outside the normal ranges: Potassium 3.3-5.1 mmol/L, Sodium 130-148 mmol/L, Chloride 97-109 mmol/L, Magnesium 0.55-1.10 mmol/L, Calcium (Total) 2.05-2.42 mmol/L, and Bicarbonate 20-24 mmol/L. The most prevalent electrolyte derangement was hypobicarbonatemia [85.8% (334/389)], followed by hypocalcaemia [29.1% (113/389)], then hyponatremia [18% (70/389)]. Hyperchloraemia [4.1% (16/389)], hyperbicarbonatemia [3.1% (12/389)], hypercalcaemia [2.8% (11/389)] and hypermagnesemia [2.8% (11/389)] were seen in a minority of the study participants. A total of 209/389 (53.7%) of the participants had multiple electrolyte derangements. Women who used herbal medicines had 1.6 times the odds of having multiple electrolyte derangements as those who did not use herbal medicines [Adjusted Odds Ratio (AOR): 1.6; 95% Confidence Interval (CI): (1.0-2.5)]. Having multiple electrolyte derangements was associated with perinatal death although this estimate was not precise [AOR 2.1; 95% CI: (0.9-4.7)]. Women with obstructed labour in the perioperative period have multiple electrolyte derangements. Use of herbal medicines in labour was associated with having multiple electrolyte derangements. We recommend routine assessment of electrolytes prior to surgery in patients with obstructed labour

Decision to delivery interval for emergency caesarean section in Eastern Uganda: A cross-sectional study.

IntroductionThe decision to delivery interval is a key indicator of the quality of obstetric care. This study assessed the decision to delivery interval for emergency cesarean sections and factors associated with delay.MethodsWe conducted a cross-sectional study between October 2022 and December 2022 in the labor ward at Mbale regional referral hospital. Our primary outcome variable was the decision to delivery interval defined as the time interval in minutes from the decision to perform the emergency caesarean section to delivery of the baby. We used an observer checklist and interviewer administered questionnaire to collect data. Stata version 14.0 (StataCorp; College Station, TX, USA) was used to analyze the data.ResultsWe enrolled 352 participants; the mean age was 25.9 years and standard deviation (SD) ±5.9 years. The median (interquartile range) decision to delivery interval was 110 minutes (80 to 145). Only 7/352 (2.0%) participants had a decision to delivery time interval of ≤30 minutes. More than three quarters 281 /352 (79.8%) had a decision to delivery interval of greater than 75 minutes. Emergency cesarean section done by intern doctors compared to specialists [Adjusted Prevalence Ratio (aPR): 1.26; 95% CI: (1.09-1.45)] was associated with a prolonged decision to delivery interval.ConclusionThe average decision to delivery interval was almost 2 hours. Delays were mostly due to health system challenges. We recommend routine monitoring of decision to delivery interval as an indicator of the quality of obstetric care