A randomised controlled trial of early initiation of oral feeding after Caesarean delivery in Mulago Hospital

Background: The concept of early initiation of oral feeding after caesarean delivery is well tolerated by patients, yet not routinely practiced in Mulago Hospital. An effective postoperative dietary management schedule could have major implications on the management of maternal post-caesarean section mothers. Objectives: To compare the effect of time initiation of oral feeding on acceptability, benefits and gastrointestinal functions in women who had undergone caesarean section in Mulago Hospital. Design: A randomised controlled study. Setting: Mulago Hospital. Subjects: One hundred and ninety two women admitted on the postnatal ward after emergency or elective caesarean section for various indications and who satisfied the eligibility criteria were recruited and randomized into the study. Assignment to the early feeding group or routine feeding group was done randomly using a computer generated numbers. The early feeding group were encouraged to take sips of water within six to eight hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post operative under supervision. The routine group were managed by restricting oral intake for twenty four hours and administration of orals sips of water 24 to 48 hours post operative. The outcome measures were rate of ileus symptoms, post operative presence of bowel sounds, maternal pyrexia and acceptability and benefits of early feeding. Results: The mean age, parity and gravidity were similar in the two groups. The study shows that women of the early feeding group had more rapid return of their bowel function with significant more shorter mean post operative time intervals to bowels sounds (24.2 hours versus 34.2 hours), passage of flatus (51.6 hours versus 62.1 hours) and bowel movement (67.8 hours versus 75.8 hours). The women who fed early, made more rapid recovery and expressed their interest in earlier hospital discharge. The findings significantly indicated that women in the early feeding group got out of bed (patient mobilisation) earlier (p = 0.001) than their control group (15.1 hours versus 17.8 hours). This could probably have been because of the adequate rehydration and improved early energy intake. In comparison those who were fed early required less number of bottles of intravenous fluids (5.0 bottles versus 7.0 bottles). The average hospital stay was similar and not statistically significant in both groups (5.5 days versus 6.0 days). Conclusion: Early initiation of oral feeding after caesarean delivery is safe and well tolerated and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus. East African Medical Journal Vol.80(7) 2003: 345-35

Using rapid research to develop a national strategy to assist families affected by AIDS in Tanzania

Although information on African family adaptation to the AIDS epidemic is critical to planning and managing government, donor and NGO programs of assistance, current knowledge is limited to a small number of research studies. An AIDS prevention project in Tanzania undertook a rapid national assessment to identify the major problems for families in Tanzania in adapting to the epidemic. The methodology used for the work was distinct from prior studies: the research covered a wide cross-section of Tanzanian population groups to gauge the extent of ethnic, urban–rural and regional variation; it was rapid and qualitative, to gather data on broad trends in a short time; and it was designed in co-operation with policymakers so they could understand the approach being used and were receptive to the findings. The study identified common problems in AIDS care, counselling and survivor assistance. Many of the problems for families with AIDS have their origin in poverty and changes in African family structures over the past 20 years, which African demographers are just beginning to describe. Stresses arising from these changes are now being aggravated by AIDS, but families with sufficient resources, whether female or male-headed, are coping better than those without

Risk factors for severe pre-eclampsia and eclamsia in Mulago Hospital, Kampala, Uganda

Objective: To determine the risk factors for severe pre-eclampsia and eclampsia in Mulago Hospital, Kampala, Uganda.Design: A case control study.Setting: Mulago Hospital labour wardSubject: One hundread and fourty three women with severe pre-eclampsia/ eclampsia and 500 women with normal delivery.Results: The predictors of severe pre-eclampsia/eclampsia were: low socio - economic status (OR 7.6, 95%CI 3.9 - 26.9), chronic hypertension (OR 26.9,95% CI 4.3-170.4), family history of hypertension (OR 1.9, 95% CI 1.2-2.9), nulliparity (OR 2.2, 95% CI 1.2-4.3) and delivery of male babies (OR 1.5, 95% CI 1.0 to 2.3).Conclusion: Severe pre - eclampsia is one of the main causes of maternal morbidity and mortality in Mulago hospital. The predictors of severe pre - eclampsia were chronic hypertension, family history of hypertension, low socio - economic status, nulliparity and delivering male babies. Health workers need to identify women at risk and offer them counseling and, those who develop pre - eclampsia be referred and managed inhospitals with expertise and facilities. Those who develop severe pre-eclampsia should be delivered immediately so as to reduce the morbidity and mortality associated with this condition

Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

BACKGROUND: Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda. METHODS: This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care. RESULTS: Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1). CONCLUSION: The predictors of progression from severe maternal morbidity to mortality were: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community

Risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda

Objective: To determine the risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda. Design: A case control study. Setting: Mulago hospital labour suite Participants: Between 15th November 2001 and 30th November 2002 we identified and recruited thirty six parturients with placenta previa who developed severe bleeding and 180 women with normal delivery. The risk factors were studied. Variables of interest: Socio demographic characteristics, social and family history, gynaecological operations, blood transfusion, medical conditions, past and present obstetric performance and HIV status. Results: Significant predictors for severe bleeding in parturients with placenta praevia were: previous history of evacuation of the uterus or dilation and curettage (O.R. 3.6, CI: 1.1-12.5), delivery by caesarean section in previous pregnancy (O.R. 19.9, CI: 6.4-61.7), residing more than ten kilometres from Mulago hospital (O.R. 2.4, CI: 1.0-5.7) and recurrent vaginal bleeding during the current pregnancy (O.R. 7.3, CI 2.4-63.7). Conclusion: Severe bleeding in placenta praevia is associated with high maternal morbidity and mortality. The determinants of severe bleeding in placenta praevia can be used in the antenatal period to identify mothers at risk. These, with prompt interventions to deliver the women can be used to reduce the maternal morbidity associated with this condition. African Health Science Vol. 8 (1) 2008: pp. 44-4

Risk factor for severe post partum haemorrhage in Mulago hospital, Kampala, Uganda

No Abstract. East African Medical Journal Vol. 85 (2) 2008 pp. 64-7

A RANDOMISED CONTROLLED TRIAL OF EARLY INITIATION OF ORAL FEEDING AFTER CAESAREAN DELIVERY IN MULAGO HOSPITAL

ABSTRACTBackground: The concept of early initiation of oral feeding after caesarean delivery is welltolerated by patients, yet not routinely practiced in Mulago Hospital. An effective postoperativedietary management schedule could have major implications on the management of maternalpost-caesarean section mothers.Objectives: To compare the effect of time initiation of oral feeding on acceptability, benefitsand gastrointestinal functions in women who had undergone caesarean section in MulagoHospital.Design: A randomised controlled study.Setting: Mulago Hospital.Subjects: One hundred and ninety two women admitted on the postnatal ward afteremergency or elective caesarean section for various indications and who satisfied theeligibility criteria were recruited and randomized into the study. Assignment to the earlyfeeding group or routine feeding group was done randomly using a computer generatednumbers. The early feeding group were encouraged to take sips of water within six to eighthours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours postoperative under supervision. The routine group were managed by restricting oral intake fortwenty four hours and administration of orals sips of water 24 to 48 hours post operative. Theoutcome measures were rate of ileus symptoms, post operative presence of bowel sounds,maternal pyrexia and acceptability and benefits of early feeding.Results: The mean age, parity and gravidity were similar in the two groups. The study showsthat women of the early feeding group had more rapid return of their bowel function withsignificant more shorter mean post operative time intervals to bowels sounds (24.2 hoursversus 34.2 hours), passage of flatus (51.6 hours versus 62.1 hours) and bowel movement (67.8hours versus 75.8 hours). The women who fed early, made more rapid recovery andexpressed their interest in earlier hospital discharge. The findings significantly indicated thatwomen in the early feeding group got out of bed (patient mobilisation) earlier (p = 0.001) thantheir control group (15.1 hours versus 17.8 hours). This could probably have been becauseof the adequate rehydration and improved early energy intake. In comparison those whowere fed early required less number of bottles of intravenous fluids (5.0 bottles versus 7.0bottles). The average hospital stay was similar and not statistically significant in both groups(5.5 days versus 6.0 days).Conclusion: Early initiation of oral feeding after caesarean delivery is safe and well toleratedand can be implemented without an increase in gastrointestinal symptoms or paralytic ileus

RISK FACTORS FOR SEVERE POST PARTUM HAEMORRHAGE IN MULAGO HOSPITAL, KAMPALA, UGANDA

Objective: To determine the risk factors for severe postpartum haemorrhage.Design: A case control study.Setting: Mulago hospital labour wards, Kampala, Uganda.Subjects: One hundred and six mothers with severe postpartum haemorrhage were recruited between 15th November 2001 and 30th November 2002 and were compared with 500 women who had normal delivery.Results: The predictors for postpartum haemorrhage were co-existing hypertension (O.R 9.3, 95%CI: 1.7-51.7), chronic anaemia (OR 17.3,95% CI: 9.5-31.7), low socio economic background (OR 5.3,95% CI:3.0,9.2), past history of postpartum haemorrhage(OR 3.6,95% CI:1.1-11.8), previous delivery by Caesarean section(OR 7.5,95% CI:3.5-14.3), long birth interval of more than sixty months (OR 5.2,95% CI:2.1- 13.0), prolonged third stage (OR 49.1,95% CI:8.8-342.8)and non use of oxytocics (OR 4.3%, 95%CI:1.2-15.3).Conclusion: Severe postpartum haemorrhage is common in our environment and is associated with a high maternal morbidity and mortality. The determinants of postpartum haemorrhage are useful in identifying mothers at risk and together with the services of a skilled birth attendant at delivery will prevent postpartum haemorrhage and reduce the maternal morbidity and mortality associated with this condition. In our study, the following risk factors were identified: pre-existing hypertension, chronicanaemia, low socio-economic background, history of postpartum haemorrhage, previous delivery by Caesarean section, long birth interval of more than sixty months, prolonged third stage and non use of oxytocics were found to be significant

Risk factors for ruptured uterus in Mulago hospital Kampala, Uganda

No Abstract. East African Medical Journal Vol. 85 (2) 2008 pp. 56-6