Maternal HIV status and infant feeding practices among Ugandan women

To describe the infant feeding practices in the general population in Uganda, and to assess the impact of maternal HIV status on these practices, a questionnaire was administered to women attending the follow-up clinics for child vaccination. Among the mothers who were still breastfeeding at the time of interview (N=838), 61.4% of the HIV-infected women had planned to breastfeed for a maximum of 6 months, compared with 12.1% of the HIV-uninfected women (

Obstetric near miss and deaths in public and private hospitals in Indonesia

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Systematic review of the magnitude and case fatality ratio for severe maternal morbidity in sub-Saharan Africa between 1995 and 2010

<p>Abstract</p> <p>Background</p> <p>Analysis of severe maternal morbidity (maternal near misses) provides information on the quality of care. We assessed the prevalence/incidence of maternal near miss, maternal mortality and case fatality ratio through systematic review of studies on severe maternal morbidity in sub-Saharan Africa.</p> <p>Methods</p> <p>We examined studies that reported prevalence/incidence of severe maternal morbidity (maternal near misses) during pregnancy, childbirth and postpartum period between 1996 and 2010. We evaluated the quality of studies (objectives, study design, population studied, setting and context, definition of severe acute obstetric morbidity and data collection instruments). We extracted data, using a pre-defined protocol and criteria, and estimated the prevalence or incidence of maternal near miss. The case-fatality ratios for reported maternal complications were estimated.</p> <p>Results</p> <p>We identified 12 studies: six were cross-sectional, five were prospective and one was a retrospective review of medical records. There was variation in the setting: while some studies were health facility-based (at the national referral hospital, regional hospital or various district hospitals), others were community-based studies. The sample size varied from 557 women to 23,026. Different definitions and terminologies for maternal near miss included acute obstetric complications, severe life threatening obstetric complications and severe obstetric complications. The incidence/prevalence ratio and case-fatality ratio for maternal near misses ranged from 1.1%-10.1% and 3.1%-37.4% respectively. Ruptured uterus, sepsis, obstructed labor and hemorrhage were the commonest morbidities that were analyzed. The incidence/prevalence ratio of hemorrhage ranged from 0.06% to 3.05%, while the case fatality ratio for hemorrhage ranged from 2.8% to 27.3%. The prevalence/incidence ratio for sepsis ranged from 0.03% to 0.7%, while the case fatality ratio ranged from 0.0% to 72.7%.</p> <p>Conclusion</p> <p>The incidence/prevalence ratio and case fatality ratio of maternal near misses are very high in studies from sub-Saharan Africa. Large differences exist between countries on the prevalence/incidence of maternal near misses. This could be due to different contexts/settings, variation in the criteria used to define the maternal near misses morbidity, or rigor used carrying out the study. Future research on maternal near misses should adopt the WHO recommendation on classification of maternal morbidity and mortality.</p

Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

<p>Abstract</p> <p>Background</p> <p>Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.</p> <p>Methods</p> <p>Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.</p> <p>Results</p> <p>The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.</p> <p>Conclusions</p> <p>The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.</p

Accounts of severe acute obstetric complications in Rural Bangladesh

<p>Abstract</p> <p>Background</p> <p>As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh.</p> <p>Methods</p> <p>Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model.</p> <p>Results</p> <p>Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors.</p> <p>Conclusions</p> <p>Strategies to increase timely and appropriate care seeking for severe obstetric complications may consider targeting of non-certified providers for strengthening of referral linkages between patients and certified facility-based providers. Future research may characterize the treatments and appropriateness of emergency care provided by ubiquitous village doctors and other non-certified treatment providers in rural South Asian settings. In addition, future studies may explore the use of mobile phones in decreasing delays to certified medical care during obstetric emergencies.</p

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Perinatal death audits in a peri-urban hospital in Kampala, Uganda

Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya Hospital. Methods: This was a retrospective descriptive study conducted from March – November 2008. An interdisciplinary hospital team conducted weekly perinatal death reviews. Each case was summarized and discussed, identifying gaps and cause of death. Local solutions were implemented according to the gaps identified from the audit process. Results: Of the 350 perinatal deaths which occurred, 120 perinatal deaths were audited. 34.2% were macerated still births, 31.7% fresh still births and 34.2% early neonatal deaths. Avoidable factors included: poor neonatal resuscitation skills, incorrect use of the partographs and delay in performing caesarean sections. Activities implemented included: three skills sessions of neonatal resuscitation, introduction of Continuous positive airway pressure (CPAP) for babies with respiratory distress, updates on use of partographs. Perinatal mortality rate was 47.9 deaths per 1000 total births in 2008 after introduction of the audits compared to 52.8 per 1,000 total births in 2007. Conclusion: Conducting routine perinatal audits is feasible and contributes to reduction of facility perinatal mortality rate

Perinatal death audits in a peri-urban hospital in Kampala, Uganda

BACKGROUND: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya Hospital. METHODS: This was a retrospective descriptive study conducted from March – November 2008. An interdisciplinary hospital team conducted weekly perinatal death reviews. Each case was summarized and discussed, identifying gaps and cause of death. Local solutions were implemented according to the gaps identified from the audit process. RESULTS: Of the 350 perinatal deaths which occurred, 120 perinatal deaths were audited. 34.2% were macerated still births, 31.7% fresh still births and 34.2% early neonatal deaths. Avoidable factors included: poor neonatal resuscitation skills, incorrect use of the partographs and delay in performing caesarean sections. Activities implemented included: three skills sessions of neonatal resuscitation, introduction of Continuous positive airway pressure (CPAP) for babies with respiratory distress, updates on use of partographs. Perinatal mortality rate was 47.9 deaths per 1000 total births in 2008 after introduction of the audits compared to 52.8 per 1,000 total births in 2007. CONCLUSION: Conducting routine perinatal audits is feasible and contributes to reduction of facility perinatal mortality rate