Perinatal care and its association with perinatal death among women attending care in three district hospitals of western Uganda.

BACKGROUND: Provision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda. METHODS: A cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death. RESULTS: The mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1-35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1-0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period. CONCLUSION: Women did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.

Perinatal care in Western Uganda: Prevalence and factors associated with appropriate care among women attending three district hospitals.

BACKGROUND: Perinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes. METHODS: A cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was administered to capture the participants' demographics and data on care received was extracted from their antenatal, labour, delivery, and postpartum records using a pre-tested structured tool. The care received by women was assessed against the standard protocol established by World Health Organization (WHO). Poisson regression with robust standard errors was used to assess factors associated with appropriate postpartum care. RESULTS: A total of 872 mothers receiving care at the participating hospitals between March and June 2020 were enrolled in the study. The mean age of the mothers was 25 years (SD = 5.95). None of the mothers received appropriate antenatal or intrapartum care, and only 3.8% of the participants received appropriate postpartum care. Factors significantly associated with appropriate postpartum care included mothers being >35 years of age (adjusted prevalence ratio [aPR] = 11.9, 95% confidence interval [CI] 2.8-51.4) and parity, with low parity (2-3) and multiparous (>3) mothers less likely to receive appropriate care than prime gravidas (aPR = 0.3, 95% CI 0.1-0.9 and aPR = 0.3, 95% CI 0.1-0.8 respectively). CONCLUSIONS: Antenatal, intrapartum, and postpartum care received by mothers in this region remains below the standard recommended by WHO, and innovative strategies across the continuum of perinatal care need to be devised to prevent mortality among the mothers. The quality of care also needs to be balanced for all mothers irrespective of the age and parity.

Infection patterns of Nile tilapia (Oreochromis niloticus L.) by two helminth species with contrasting life styles.

The larval stages of Bolbophorus sp. (digenean) and Amirthalingamia macracantha (cestode) are frequently reported in Oreochromis niloticus in Uganda. Little, however, is known about their infection patterns. This study examined the influence of habitat type, host size, and sex and weather patterns on the parasite populations in Uganda. A total of 650 fish were collected between January and November 2008 from a reservoir, cages, fishponds and a stream. The prevalence and intensity of A. macracantha and the prevalence of Bolbophorus sp. differed across the water bodies reflecting the effect of habitat characteristics on parasite transmission. Host sex did not significantly influence the infection patterns, although female fish were slightly more parasitized than male and sexually undifferentiated individuals. The fish size was positively correlated with helminth infections demonstrating accumulation and prolonged exposure of larger (older) fish to the parasites. The metacercariae population did not vary significantly across months, while monthly A. macracantha infection fluctuated markedly. With regard to rain seasons, higher prevalence and intensity of A. macracantha were recorded in wet season. For Bolbophorus sp., only the prevalence varied with seasons, with higher prevalence recorded in the dry season than in wet season. Generally, Bolbophorus sp. responded weakly to changes in water body, host sex and size and weather patterns. Rainfall appears to be an essential cue for coracidia hatching.

Parasite fauna of farmed Nile tilapia (Oreochromis niloticus) and African catfish (Clarias gariepinus) in Uganda.

An intensive parasite survey was conducted in 2008 to better understand the parasite fauna occurrence, distribution and diversity in the commercial aquaculture fish species in Uganda. A total of 265 fish collected from hatcheries and grow-out systems were examined for parasites using routine parasitological techniques. The survey yielded 17 parasite species: 11 from Oreochromis niloticus and ten from Clarias gariepinus. Four parasites-Amirthalingamia macracantha, Monobothrioides sp., Zoogonoides sp. and a member of the family Amphilinidae-were recorded for the first time in the country. The parasite diversity was similar between hosts; however, O. niloticus was dominated by free-living stage-transmitted parasites in lower numbers, whereas both trophically and free-living stage-transmitted parasites were equally represented in C. gariepinus in relatively high intensities. The patterns in parasite numbers and composition in the two hosts reflect differences in fish habitat use and diet. A shift in parasite composition from monoxenous species-dominated communities in small-sized fish to heteroxenous in large fishes was recorded in both hosts. This was linked to ontogenetic feeding changes and prolonged exposure to parasites. Polyculture systems showed no effect on parasite intensity and composition. The gills were highly parasitized, mainly by protozoans and monogeneans. Generally, the occurrence and diversity of parasites in these fish species highlight the likelihood of disease outbreak in the proposed intensive aquaculture systems. This calls for raising awareness in fish health management among potential farmers, service providers and researchers.