Investigation of risk factors for severe maternal morbidity and progression to mortality: a case control and follow up study in Mulago Hospital Complex Uganda

Maternal morbidity is physical ill health related to pregnancy and childbirth or any maternal complication during pregnancy, labour and puerperium. Severe maternal morbidity is a life-threatening obstetric complication. The importance of severe maternal morbidity is that it precedes maternal mortality and is therefore critical in the understanding of the factors that influence maternal mortality. The overall aim of the study was to investigate risk factors associated with severe maternal morbidity and progression to maternal mortality in Mulago hospital, Kampala, Uganda. The study had two stages: Stage 1 was an unmatched case-control study of severe maternal morbidity and Stage 2 was a follow-up of all cases from Stage 1 to discharge or death. A total of 499 cases of severe maternal morbidity and 500 controls (women with normal deliveries and no severe maternal morbidity) were studied. Both the cases and controls were interviewed to obtain information on socio demographic factors, previous obstetric outcomes and present obstetric performance. Information on obstetric management was extracted from clinical notes. All cases and controls were tested for HIV, syphilis and haemoglobin level. A total of 39 of the 499 severe maternal morbidity cases died. The causes of SMM were severe pre eclampsia (25%), severe dystocia (31%) Post partum haemorrhage (19%), ante partum haemorrhage (14%) puerperal sepsis (5%) and medical diseases (6%). The main risk factors for severe maternal morbidity were low socio economic class, long distance from home to Mulago hospital, having specific medical conditions, having to request permission to attend health unit, having a long interval since the last birth, HIV positive status and poor quality of care during antenatal and delivery. Further details, plus separate analyses of specific causes of SMM (eclampsia, post partum haemorrhage, severe dystocia and ante partum haemorrhage) are presented. Determinants of progression to maternal death included low socio economic class, factors associated with management of labour, and HIV/AIDS. The main conclusion from this work is that improvements in the social and economic status of women, the level of HIV in the community, and the quality of care offered 2 during pregnancy will reduce the burden of severe maternal morbidity and mortality in Kampala, Uganda. It is likely that these results can be generalised to other areas of sub-Saharan Africa and usefully integrated into Safe-Motherhood Programs there

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

Incidence and risk factors for postpartum hemorrhage in Uganda.

BACKGROUND: Globally, postpartum haemorrhage (PPH) remains a leading cause of maternal deaths. However in many low and middle income countries, there is scarcity of information on magnitude of and risk factors for PPH (blood loss of 500 ml or more). It is important to understand the relative contributions of different risk factors for PPH. We assessed the incidence of, and risk factors for postpartum hemorrhage among rural women in Uganda. METHODS: Between March 2013 and March 2014, a prospective cohort study was conducted at six health facilities in Uganda. Women were administered a questionnaire to ascertain risk factors for postpartum hemorrhage, defined as a blood loss of 500 mls or more, and assessed using a calibrated under-buttocks drape at childbirth. We constructed two separate multivariable logistic regression models for the variables associated with PPH. Model 1 included all deliveries (vaginal and cesarean sections). Model 2 analysis was restricted to vaginal deliveries. In both models, we adjusted for clustering at facility level. RESULTS: Among the 1188 women, the overall incidence of postpartum hemorrhage was 9.0%, (95% confidence interval [CI]: 7.5-10.6%) and of severe postpartum hemorrhage (1000 mls or more) was 1.2%, (95% CI 0.6-2.0%). Most (1157 [97.4%]) women received a uterotonic after childbirth for postpartum hemorrhage prophylaxis. Risk factors for postpartum hemorrhage among all deliveries (model 1) were: cesarean section delivery (adjusted odds ratio [aOR] 7.54; 95% CI 4.11-13.81); multiple pregnancy (aOR 2.26; 95% CI 0.58-8.79); foetal macrosomia ≥4000 g (aOR 2.18; 95% CI 1.11-4.29); and HIV positive sero-status (aOR 1.93; 95% CI 1.06-3.50). Risk factors among vaginal deliveries only, were similar in direction and magnitude as in model 1, namely: multiple pregnancy, (aOR 7.66; 95% CI 1.81-32.34); macrosomia, (aOR 2.14; 95% CI1.02-4.47); and HIV positive sero-status (aOR 2.26; 95% CI 1.20-4.25). CONCLUSION: The incidence of postpartum hemorrhage was high in our setting despite use of uterotonics. The risk factors identified could be addressed by extra vigilance during labour and preparedness for PPH management in all women giving birth

A Framework for Designing Learning Analytics Information Systems

Learning analytics offers new opportunities in higher education, yet the design and development of educational data analytics are facing several challenges. Little guidance is available for researchers and developers when it comes to designing, developing, and implementing learning analytics information systems in higher education. Hence, this study proposes a comprehensive conceptual framework for designing learning analytics information systems incorporating both computational and educational aspects. The framework provides systematic support for learning analytics researchers and designers. It is constructed based on the process and critical dimensions of learning analytics and instructional systems design. By applying the framework to analyze a previously published study, we provide a better understanding of its key qualities. Furthermore, the application of the framework to design a new learning analytics information system provides forward engineering support

TOPICAL EXPRESSIVITY IN SHORT TEXTS

With each passing minute, online data is growing exponentially. A bulk of such data is generated from short text social media platforms such as Twitter. Such platforms are fundamental in social media knowledge-based applications like recommender systems. Twitter, for example, provides rich real-time streaming information. Extracting knowledge from such short texts without automated support is not feasible due to Twitter\u27s platform streaming nature. Therefore, an automated method for comprehending patterns in such text is a need for many knowledge systems. This paper provides solutions to generate topics from Twitter data. We present several techniques related to topical modelling to identify topics of interest in short texts. Topic modelling is inherently problematic in shorter texts with very sparse vocabulary in addition to the informal language used in their dissemination. Such findings are informative in knowledge extraction for social media-based recommender systems as well as in understanding tweeters over time

Follow-back Recommendations for Sports Bettors: A Twitter-based Approach

Social network based recommender systems are powered by a complex web of social discussions and user connections. Short text microblogs e.g. Twitter present powerful frameworks for information consumption, due to their real-time nature in content throughput as well as user connections. Therefore, users on such platforms consume the disseminated content to a greater or lesser extent based on their interests. Quantifying this degree of interest is a difficult task based on the amount of information that such platforms generate at any given time. Thus, the generation of personalized profiles based on the Degree of Interest (DoI) that users have towards certain topics in such short texts presents a research problem. We address this challenge by following a two-step process in generation of personalized sports betting related user profiles in tweets as a case study. We (i) compute the Degree of Interest in Sports Betting (DoiSB) of tweeters and (ii) affirm this DoiSB by correlating it with their friendship network. This is an integral process in the design of a short text based recommender systems for users to follow i.e follow-back recommendations as well as content-based recommendations relying on the interests of users on such platforms. In this paper, we described the DoiSB computation and follow-back recommendation process by building a vector representation model for tweets. We then use this model to profile users interested in sports betting. Experiments using real Twitter dataset geolocated to Kenya shows the effectiveness of our approach in the identification of tweeter\u27s DoiSBs as well as their correlation with their friendship network

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

Factors associated with utilization of quality antenatal care: Asecondary data analysis of Rwandan Demographic Health Survey 2020

Background Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample. Methods We analyzed secondary data of 6,302 women aged 15–49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25. Results Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4–14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6–61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1–48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1–0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09–2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82–9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23–1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10–1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18–1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25–1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66–0.95). Conclusion The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting the use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care

Risk factors for cardiac dysfunction in children on treatment for cancer at Kenyatta National Hospital, Nairobi

Objective: To determine the point prevalence of abnormal cardiac function and to assess the risk factors for cardiac dysfunction in paediatric oncology patients on treatment at Kenyatta National Hospital. Design: Descriptive cross-sectional study with a nested case control. Setting: Kenyatta National Hospital between February and April 2006. Main outcome measures: Left ventricular dysfunction if ejection fraction (EF) 29%. Results: One hundred and eleven patients were enrolled of whom 32 had abnormal cardiac function and were classified as cases while 79 had normal cardiac function. About a third, point prevalence 29% (95% CI 21.2-37.9), had cardiac dysfunction. Cumulative anthracycline dose was a risk factor for cardiac dysfunction in this population. Above 200mg/m2 the attributable risk percentage of cardiac dysfunction was 77%. Conclusions: Serial echocardiography should be performed to identify patients at risk. Alternative treatment protocols should be used when the cumulative anthracycline dose exceeds 200mg/m2 due to the high attributable risk. Studies to further assess the other associated risk factors and long term effects of anthracycline are recommended

Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda.

BACKGROUND: Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. METHODS: This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. RESULTS: Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20-24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02-0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. CONCLUSION: There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications