Caesarean section rates in a tertiary teaching hospital in northern Uganda: a retrospective analysis using the robson ten group classification system.

BACKGROUND: The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS. METHODS: We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1-10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS. RESULTS: We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58). CONCLUSION: Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group-specific interventions through CS auditing to lower group-specific CS rates.

Prehospital Emergency Care: A Cross-Sectional Survey of First-Aid Preparedness Among Layperson First Responders in Northern Uganda.

Background: Uganda has a high incidence of road traffic accidents and high mortality rates, yet lacks a mature prehospital emergency care system. Our study addresses this gap by assessing the experiences, training, and confidence in providing first aid (FA) among diverse layperson first responders in Northern Uganda, expanding beyond previous research, which was limited to Central Uganda and specific occupational groups. Methods: We conducted a cross-sectional survey among layperson first responders of various occupations in Gulu City, Acholi sub-region, Uganda. Data on socio-demographics, training, experiences, knowledge, and confidence in FA were collected. Results: We included 396 participants, of whom 81.6% (n=323) were male, 47.0.6% (n=186) were aged 21-30 years, 59.3% (n=235) had obtained a secondary level of education, 23.7% (n=94) were commercial motorcyclists, and 45.7% (n=181) had work experience of >5 years. The majority (85.4%, n=338) had witnessed acute illness/trauma. Accidents/bleeding were the most commonly witnessed cases (68.6%, n=232), followed by burn injuries (10.1%, n=34). Most participants (52.3%, n=207) had attended FA training. Only 20.5% (n=81) had obtained an above-average score (≥70%). The majority (67.9%, n=269) were confident in providing FA. Lack of knowledge and skills (61.4%, n=78), fear of taking health risks (18.9%, n=24), and legal implications (7.1%, n=9) were the major reasons for not being willing to confidently give FA. Factors associated with above-average knowledge were tertiary education and being confident in providing FA, while training in FA and prior experience in giving FA were associated with confidence in giving FA. Conclusion: In this study, laypeople in Northern Uganda exhibited a high level of FA training. However, low confidence in providing FA is attributed to inadequate knowledge, fear of health risks, and legal concerns. Therefore, future efforts should focus on assessing FA practices in diverse regions and promoting formal FA training.

Can reproductive health services be used to screen for sexual and gender-based violence in post-conflict Northern Uganda? - a pilot study.

Background: Sexual and gender-based violence (SGBV), including rape and child sexual abuse, remains a significant challenge in post-conflict northern Uganda. Many victims have never sought help. Consequently, the scale of the problem is not known, and SGBV victims' injuries, both psychological and physical, remain hidden and unresolved. Objectives: We aimed to explore whether health workers in rural Reproductive Health Services (RHS), following specific training, could provide a valuable resource for SGBV screening and subsequent referral to targeted services. Methods: Our project had three elements. First, RHS workers were trained to use a questionnaire to screen subjects for past SGBV Second, the screening questionnaire was used by RHS workers over a 3-month period, and the data collected were analysed to explore whether the screening approach was an effective one in this setting, and to record the scale and nature of the problem. Third, victims detected were offered referral as appropriate to hospital services or to a dedicated SGBV ActionAid shelter. Results: Of 1656 women screened, 778 (47%) had suffered SGBV: 123 rape, and 505 non-sexual violence. 1,254 (76%) had been directly or indirectly affected by conflict experiences; 1066 had lived in internally displaced persons camps. 145 (9%) requested referral to Gulu SGBV Shelter; 25 attended the shelter and received assistance, and 20 others received telephone counselling. Conclusion: Undetected SGBV remains a significant problem in post-conflict northern Uganda. RHS workers, following specific training, can effectively screen for and identify otherwise unrecognised survivors of SGBV. This matters because without ongoing detection, survivors have no opportunity for resolution, healing or help.

Utilization of modern contraceptives among female health care workers at Gulu university teaching hospitals in Northern Uganda.

BACKGROUND: The global high rate of unintended pregnancy is a direct result of underutilization of contraceptives methods. Healthcare workers (HCWs) play a pivotal role in promoting and facilitating access to modern family planning services. By examining the extent to which healthcare providers practice what they preach, this research aimed to shed light on the prevalence and factors associated with modern contraceptive use among female HCW at two university teaching hospitals in northern Uganda. METHODS: A cross-sectional survey was conducted among qualified female healthcare workers (FHCWs) at Gulu Regional Referral Hospital (GRRH) and St. Mary's Hospital-Lacor in Gulu, Uganda. Convenient consecutive sampling was used to enroll study participants. Linear regression analysis was employed to determine factors independently associated with modern contraceptive use. P < 0.005 was considered statistically significant. RESULTS: We enrolled 201 female HCWs, with a median age 31 (interquartile range: 27-38) years. Overall, 15 (7.5%, 95% Confidence Interval [CI]: 4.4 -11.1) participants utilized modern methods of family planning in the last 3 months while lifetime use was at 73.6% (n = 148, 95%CI: 67.3 - 79.4%). Most common method utilized was intra-uterine devices [IUDs] (51%, n = 76), followed by sub-dermal implants (15.4%, n = 23). Eighty-five (42.3%, n = 85) participants had desire to get pregnant. Factors independently associated with utilization of modern methods contraceptives were working at GRRH (adjusted odds ratio (aOR): 5.0, 95% CI: 1.59 - 10.0, p = 0.003), and being single (aOR: 3.3, 9%CI: 1.02 -10.57, p = 0.046). CONCLUSIONS: Utilization of modern methods of contraceptive among female HCWs in this study is lower than the Uganda national estimates for the general female population. Most utilized method is IUDs followed by sub-dermal implants. More studies are recommended to see if this finding is similar among FHCWs in other regions of Uganda and the rest of Africa while also considering Male Healthcare Workers.

Assessment of hospital-based adult triage at emergency receiving areas in hospitals in Northern Uganda.

BACKGROUND: Limited health service resources must be used in a manner which does "the most for the most". This is partly achieved through the use of a triage system. Whereas efforts have been made to introduce paediatric triage in Uganda such as Emergency Triage Assessment and Treatment Plus (ETAT+), it is not clear if hospitals have local protocols for adult triage being used in each setting. OBJECTIVES: To determine the presence of existing hospital triage systems, the cadre of staff undertaking triage and barriers to development/improvement of formal triage systems. METHODOLOGY: This was a descriptive cross-sectional study. Acholi sub-region was randomly selected for the study among the three sub-regions in Northern Uganda. The study was conducted in 6 of the 7 hospitals in the region. It was a written self-administered questionnaire. RESULTS: Thirty-three participants from 6 hospitals consented and participated in the study. Only one hospital (16.7%) of the 6 hospitals surveyed had a formal hospital-based adult triage protocol in place. Only 2 (33.3%) hospitals had an allocated emergency department, the rest receive emergency patients/perform triage from OPD and wards. Lack of training, variation of triage protocols from hospital to another, shortage of staff on duty, absence of national guidelines on triage and poor administrative support were the major barriers to improvement/development of formal triage in all these hospitals. CONCLUSION: Formal adult hospital-based triage is widely lacking in Northern Uganda and staff do perform subjective "eyeball" judgments to make triage decisions.