Update and Trend in Episiotomy Practice

Episiotomy is one of the most commonly practiced obstetric procedures done to enlarge the diameter of the vulval outlet to facilitate the passage for the fetal head and prevent an uncontrolled tear of the perineal tissues in the second stage of labor. Historically, the procedure was indicated to prevent third- or fourth-degree perineal tears as well as for prolonged second stage, macrosomia, non-reassuring fetal heart rate, instrumental delivery, occiput posterior position, and shoulder dystocia. Routine episiotomy is now considered to be obstetrics violence, rates of not exceeding 10% have been recommended by World Health Organization (WHO). Despite this recommendation, episiotomy is still practiced routinely in many settings

Dynamics of the Twenty-First-Century Midwifery Practice

Globally, midwifery is the safest, most cost-effective, and most satisfying method of birth assistance. This age-old profession embraces the most non-interventionist philosophy that childbirth is a natural and normal process in which the attendant merely assists in the healthy routine progression. Midwifery is commonly assumed to be all about assisting labor and childbirth, but there is more to it than that. This noble profession entails skilled, knowledgeable, and compassionate care for childbearing women, newborn infants, and families across the continuum throughout pre-pregnancy, and pre, intra, and postpartum periods. Over decades, midwifery has evolved from being informal and invisible to independent professional practice with major shifts in the scope of practice, gender, economic, and career dynamics concerning the profession. With maternal and child health being at the center of most important developments, the midwife stands out in his/her role as a primary care provider, advocate, and teacher

Invasive Fungal Diseases in Africa: A Critical Literature Review

Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy

Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report

Abstract Background Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2 + 1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the significance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. Case presentation A 25 year African black female, para 2 + 1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The postoperative course was uneventful, with initial concerns about inadequate breast milk flow which resolved after placental removal during the second exploratory laparotomy. Conclusion This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings

Episiotomy related morbidities measured using redness, edema, ecchymosis, discharge and apposition scale and numerical pain scale among primiparous women in Mulago National Referral Hospital, Kampala, Uganda

Introduction: episiotomy induced inflammatory signs like redness, edema, ecchymosis and pain may remain beyond the period of hospitalization and can be objectively measured using redness, edema, ecchymosis, discharge and apposition (REEDA) scale. Pain in the postpartum period is a common problem and can be measured using the numerical pain scale (NPS). Episiotomy is normally poorly executed and poorly repaired with little attention to the subtle pain-free scar. Postpartum perineal pain has been found to affect more people with episiotomy compared to spontaneous perineal tears or contusion in the first two weeks. This study was aimed at comparing NPS and REEDA scores in the first two weeks of postpartum among primiparous parturients with or without episiotomy in Mulago National Referral Hospital. Methods: a prospective cohort study conducted by recruiting primiparous women systematically on the first postnatal day and categorizing them into episiotomy and no episiotomy group. NPS and REEDA scale were taken at baseline and 2 weeks postpartum. Results: the mean total REEDA score for primiparous women among the episiotomy group was significantly higher both on day 1 and day 14 with p-values <0.0001 and <0.0001 respectively as well as the day 14 mean NPS p-value 0.001. Conclusion: episiotomy, a traumatic obstetric procedure, that heals slowly and with persistent perineal pain compare to spontaneous perineal contusion or tears

Dual contraceptive use and associated factors among female sex workers in Gulu City, Uganda in 2023

Abstract Background Dual contraception is an essential approach to mitigating the heightened risks of unintended pregnancies and sexually transmitted infections faced by female sex workers (FSWs). We determined the prevalence and factors associated with dual contraceptive use among FSWs in Northern Uganda. Methods A cross-sectional study was conducted in Gulu city, Uganda between February, and March 2023. Purposively selected FSWs aged 18 years or older who provided verbal informed consent were enrolled in the study. A sample size of 374 was estimated. Data on sociodemographic and reproductive health characteristics were collected using an interviewer-administered semi-structured questionnaire. Current dual contraception was defined the as concurrent use of a barrier and any other modern contraceptive methods within the last 3 months. Continuous variables were summarized using mean and standard deviation and categorical variables were summarized using frequencies and percentages. Modified Poisson regression analysis was used to determine factors associated with dual contraceptive use. Results We enrolled 314 FSWs, with a mean age of 28.8 ± 6.4 years. About 13.8% (n = 41) were living with HIV. In total, 66.2% (95%CI 60.8–71.3) of the participants (n = 208) reported current dual contraceptive use. The most common modern contraceptive method used was the implants (52.4%, n = 109), followed by injectable contraceptives (22.6.0%, n = 47), and bilateral tubal ligation (0.5%, n = 1) was the least utilized. Having had at least one previous pregnancy was positively associated with dual contraceptive use (adjusted PR: 1.87, 95%CI 1.40–2.51, p < 0.001). Conclusions A high proportion of FSWs in Gulu city were currently using dual contraceptives. Interventions are needed to facilitate the use of dual contraception, particularly among FSWs without a history of previous pregnancies

SEARCH STRATEGIES | Knowledge, attitudes, and practice of sexual and reproductive health and rights in Uganda: a scoping review of qualitative studies

A comprehensive literature search was conducted by a health sciences informationist (GKR) in May 2022 and updated in May 2023. The eight databases searched were MEDLINE (via Ovid interface), EMBASE (via Embase.com), Scopus, CINAHL (via EBSCOhost), Web of Science Core Collection (via Thomson Reuters), Global Health (via CABI), PsycINFO (via EBSCOhost) and Women's Studies International (via EBSCOhost). Keyword and controlled vocabulary search terms were used to represent concepts related to SRHR in Uganda. Geographic search terms focused search retrieval on articles referencing Uganda at the country level, by district [1] or capital city of Kampala. A revised qualitative/mixed methods search filter was used in all eight database searches [2]. Two unique qualitative/mixed methods search filters were revised for use in Ovid Medline to maximize retrieval of qualitative studies [2,3]. Final search strategies were determined through test searching and search syntax to enhance search retrieval. Search results were limited to articles published from 2002 to 2023. No language limits were applied. The comprehensive literature search was conducted to address overall sexual reproductive health and rights (SRHR) in Uganda as a whole. Due to the breadth and scope of the literature retrieval, this one search was used to inform two scoping reviews on qualitative studies: one to address family planning and comprehensive abortion care in Uganda [4]; and this review which addresses SRHR in Uganda. The study selection for each of the two scoping reviews was differentiated by their use of inclusion and exclusion criteria. _________________________________________________________________________________________ 1. Government of Uganda. (2021, August 19). DISTRICTS - Ministry of Local Government. https://molg.go.ug/districts/ _________________________________________________________________________________________ 2. El Sherif R, Pluye P, Gore G, Granikov V, Hong QN. Performance of a mixed filter to identify relevant studies for mixed studies reviews. J Med Libr Assoc. 2016;104(1):47-51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722642/ _________________________________________________________________________________________ 3. Slater, Linda G. A Comprehensive Filter to Retrieve Qualitative Studies from the OVID MEDLINE Database (based on McKibbon, Eady and Marks (1999) and Evans (2002). John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB. Oct 4, 2017. https://docs.google.com/document/d/1KdReD-h5NL5pX3vdEsOLxK2VtAsRe8ZM_uzuZPWcitQ/edit _________________________________________________________________________________________ 4. Buser, J. et al.(2024). Scoping review of qualitative studies on family planning in Uganda. [Unpublished manuscript].U-M Center for International Reproductive Health Traininghttp://deepblue.lib.umich.edu/bitstream/2027.42/178183/1/05_27_2022 SEARCH STRATEGIES - UGANDA _ ScR of qual studies.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/178183/2/05_12_2023 SEARCH UPDATE _ SEARCH STRATEGIES - UGANDA _ ScR of qual studies .pdf-1Description of 05_27_2022 SEARCH STRATEGIES - UGANDA _ ScR of qual studies.pdf : LITERATURE SEARCH STRATEGIES_27_MAY_2022Description of 05_12_2023 SEARCH UPDATE _ SEARCH STRATEGIES - UGANDA _ ScR of qual studies .pdf : SEARCH UPDATE_LITERATURE SEARCH STRATEGIES_12_MAY_2023SEL

“I Use Strawberry Flavoured Condoms during My Periods”: Safe Sex Practices and STI Screening Behaviours among Female Sex Workers in Gulu City, Uganda

Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging health-risk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility, empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population