Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala.

BACKGROUND: Pre-pregnancy weight and weight gained during pregnancy significantly influence maternal and infant health. Little information is available regarding optimal gestational weight gain (GWG) in relation to pre-pregnancy body mass index (BMI) in Uganda. The study aimed at determining gestational weight gain (GWG) in women pregnant for the first and second time. METHODS: The study was prospective cohort study which included 221 HIV negative women pregnant for the first or second time. It was conducted in the antenatal clinic of the directorate of gynecology and obstetrics, Mulago hospital and women were recruited at ≤18 weeks of gestation by dates. Follow up measurements were done at 26 and 36 weeks gestation. Measured maternal height and reported pre-pregnancy weight were used to calculate BMI. Depending on BMI category, GWG was categorized as inadequate, adequate and excessive based on the Uganda Ministry of Health guidelines. RESULTS: The participants' mean ± standard deviation (Sd) age was 20.9 ± 2.7 years and mean ± Sd BMI was 21.40 ± 2.73 kg/m2. None of the participants was obese and 68.8% (n = 132) were pregnant for the first time. The mean ± Sd GWG at time of delivery was 10.58 ± 2.44 kg. Inadequate GWG was recorded in 62.5% (n = 120/192) while only 3.1% (n = 6/192) of the participants gained excessive weight during pregnancy. CONCLUSION: About 62% of pregnant women in Kampala did not gain adequate weight during their first/second pregnancy. We recommend that studies be carried out to assess whether the Uganda Ministry of Health recommendations for weight gain during are appropriate for preventing adverse pregnancy outcomes across populations in Uganda.

Rate and associated factors of non-retention of mother-baby pairs in HIV care in the elimination of mother-to-child transmission programme, Gulu-Uganda: a cohort study.

BACKGROUND: Poor retention in HIV care of mother-baby pairs remains a public health challenge in the elimination of mother-to-child transmission (eMTCT) of HIV. We determined the rate of non-retention and time to non-retention of mother-baby pairs and associated factors in Gulu district, Northern Uganda. METHODS: Mother-baby pairs enrolled into the eMTCT programme at Gulu Regional Referral Hospital (GRRH) and Lacor Hospital (LH) were retrospectively followed for 18 months. The primary outcomes were the rate of non-retention and time to non-retention of mother-baby pairs in HIV care. Data were abstracted from the antiretroviral treatment and early infant diagnosis (EID) registers, and mother/baby appointment books at the health facilities. Additional data on possible reasons for non-retention were obtained from cross-sectional interviews of mothers. Time to non-retention was calculated as the duration between enrolment of mother-baby pair into care and the date when the mother and/or baby missed a scheduled visit and did not return within 30 days. Factors associated with time to non-retention were assessed using Cox proportional hazards regression analysis. The measures of association were expressed as hazards ratio (HR) with 95% confidence intervals. Alpha was set at 0.05. The adjusted analysis includes variables with p <0.2 in the bivariable analysis or considered potential confounders. The Analysis used Stata version 12. RESULTS: A total of 410 mother-baby pairs were enrolled in this study. Overall, non-retention by 18 month was 30.5%; higher at GRRH (34.7%) than LH (25.8%), p = 0.049. Non-retention was higher among pairs where the infant had no EID, adjusted (adj) HR = 5.81; 95% CI (2.55, 13.24), non-disclosure of mother's HIV status, adj.HR = 1.86; 95% CI (1.22, 2.85), and lack of privacy during counselling session, adj.HR = 1.86; 95% CI (1.26, 2.85). Non-retention was about 60% lower [adj.HR = 0.43; 95% CI (0.20, 0.92)] among pairs where the mothers understood and appreciated the importance of adhering to all clinic appointments together with the baby. CONCLUSION: Nearly a third of mother-baby pairs are not retained in HIV care. Lack of EID services, poor quality service, non-disclosure of mother's HIV status, and understanding the importance of adhering to all appointments together with the baby, were associated with time to non-retention.

Prevalence of anaemia and associated risk factors among pregnant women attending antenatal care in Gulu and Hoima Regional Hospitals in Uganda: A cross sectional study.

BACKGROUND: Anaemia is a public health problem affecting over 1.62 billion people globally. It affects all age groups of people and is particularly more prevalent in pregnant women. Africa carries a high burden of anaemia; in Uganda 24 % of women of child bearing age have anaemia. Pregnant women living in poverty are at greater risk of developing iron deficiency anaemia. The objective of this study was to determine the prevalence of anaemia and the associated risk factors in pregnant women attending antenatal care at Gulu and Hoima Regional Hospitals in Northern and Western Uganda respectively. METHODS: We conducted a cross sectional study in Gulu and Hoima Regional Hospitals from July to October 2012. Our study participants were pregnant women attending antenatal care. Socio-demographic data were collected using structured questionnaires and blood samples were collected for haemoglobin estimation. Haemoglobin concentration was determined using an automated analyzer closed mode of blood sampling. Data were analysed using Stata version 12. Odds ratio was used as a measure of association, with 95% confidence interval; and independent risk factors for anaemia were investigated using logistic regression analyses. Ethical approval was obtained from Gulu University Research Ethics Committee and written informed consent was obtained from each study participant. RESULTS: The overall prevalence of anaemia was 22.1%; higher in Gulu (32.9%) than in Hoima (12.1%), p < 0.001. In Gulu, the prevalence of mild anaemia was 23%, moderate anaemia was 9%, and severe anaemia was 0.8%, while in Hoima, the prevalence of mild anaemia was 9%, moderate anaemia was 2.5%, and severe anaemia was 0.5%. Independent risk factors for anaemia were: being a housewife [Adjusted Odds Ratio (AOR) = 1.7, 95% CI: 1.05-2.68]; and being a resident in Gulu (AOR = 3.6, 95% CI: 2.41-5.58). CONCLUSION: The prevalence of anaemia in pregnant women in Gulu is higher than in Hoima. Amongst pregnancy women, being a housewife is an independent risk factor for anaemia. Greater efforts are required to encourage early antenatal attendance from women in these at risk groups. This would allow iron and folic acid supplementation during pregnancy, which would potentially reduce the prevalence of anaemia.

Influence of Climatic Factors on Malaria Epidemic in Gulu District, Northern Uganda: A 10-Year Retrospective Study.

BACKGROUND: Globally, 15 countries, mainly in Sub-Saharan Africa, account for 80% of malaria cases and 78% of malaria related deaths. In Uganda, malaria is endemic and the mortality and morbidity due to malaria cause significant negative impact on the economy. In Gulu district, malaria is the leading killer disease among children <5 years. In 2015, the high intensity of malaria infection in Northern Uganda revealed a possible link between malaria and rainfall. However, available information on the influence of climatic factors on malaria are scarce, conflicting, and highly contextualized and therefore one cannot reference such information to malaria control policy in Northern Uganda, thus the need for this study. METHODS AND RESULTS: During the 10 year's retrospective study period a total of 2,304,537 people suffered from malaria in Gulu district. Malaria infection was generally stable with biannual peaks during the months of June-July and September-October but showed a declining trend after introduction of indoor residual spraying. Analysis of the departure of mean monthly malaria cases from the long-term mean monthly malaria cases revealed biannual seasonal outbreaks before and during the first year of introduction of indoor residual spraying. However, there were two major malaria epidemics in 2015 following discontinuation of indoor residual spraying in the late 2014. Children <5 years of age were disproportionally affected by malaria and accounted for 47.6% of the total malaria cases. Both rainfall (P=0.04) and relative humidity (P=0.003) had significant positive correlations with malaria. Meanwhile, maximum temperature had significant negative correlation with malaria (P=0.02) but minimum temperature had no correlation with malaria (P=0.29). CONCLUSION: Malaria in Gulu disproportionately affects children under 5 years and shows seasonality with a generally stable trend influenced by rainfall and relative humidity. However, indoor residual spraying is a very promising method to achieve a sustained malaria control in this population.

Effect of maternal Helicobacter Pylori infection on gestational weight gain in an urban community of Uganda.

INTRODUCTION: Maternal Helicobacter pylori (H. pylori) infection has been associated with undesirable effects during pregnancy such as; hyperemesis gravidarum, anemia, intrauterine fetal growth restriction and miscarriage. Our aim was to document the effect of H. pylori infection on gestational weight gain (GWG) in a low-income urban setting in Uganda. METHODS: This was a prospective cohort study conducted in Kampala between May 2012 and May 2013. The participants were HIV negative, H. pylori positive and H. pylori negative primigravidae and secundigravidae. Recruitment was at gestation age of eighteen or less weeks and follow up assessments were carried out at 26 and 36 weeks gestation age. H. pylori infection was determined using H. pylori stool antigen test. Maternal weight and height were measured, and body mass index (BMI) and rates of GWG were calculated. RESULTS: The participants' mean±standard deviation (sd) age was 20.9±2.7 years. Primigravidae were 68.8% (n = 132) and 57.3% (n = 110) of the participants were positive for H. pylori infection. Low pre-women pregnancy BMI (< 18.5 kg/m2) was recorded in 14.6% (n = 28). The mean±sd rate of GWG during second and third trimesters was 300.5±79.7 grams/week. The mean±sd weight gained by 36 weeks of gestation was 9.6±2.2 kg while gestation age at delivery was 39.4±1.0 weeks. Factors independently associated with the rates of GWG during the second and third trimesters were parity (P=0.023), H. pylori infection (P = 0.006), pre-pregnancy BMI (P = 0.037), height (P = 0.022) and household income (P = 0.003). CONCLUSION: H. pylori infection is associated with low rates of GWG among primigravidae and secundigravidae.

The State of Ambient Air Quality in Two Ugandan Cities: A Pilot Cross-Sectional Spatial Assessment.

Air pollution is one of the leading global public health risks but its magnitude in many developing countries' cities is not known. We aimed to measure the concentration of particulate matter with aerodynamic diameter <2.5 µm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) pollutants in two Ugandan cities (Kampala and Jinja). PM2.5, O3, temperature and humidity were measured with real-time monitors, while NO2 and SO2 were measured with diffusion tubes. We found that the mean concentrations of the air pollutants PM2.5, NO2, SO2 and O3 were 132.1 µg/m3, 24.9 µg/m3, 3.7 µg/m3 and 11.4 µg/m3, respectively. The mean PM2.5 concentration is 5.3 times the World Health Organization (WHO) cut-off limits while the NO2, SO2 and O3 concentrations are below WHO cut-off limits. PM2.5 levels were higher in Kampala than in Jinja (138.6 µg/m3 vs. 99.3 µg/m3) and at industrial than residential sites (152.6 µg/m3 vs. 120.5 µg/m3) but residential sites with unpaved roads also had high PM2.5 concentrations (152.6 µg/m3). In conclusion, air pollutant concentrations in Kampala and Jinja in Uganda are dangerously high. Long-term studies are needed to characterize air pollution levels during all seasons, to assess related public health impacts, and explore mitigation approaches.