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.

Chronicity of self-harming behaviors among adolescent teenage girls living in refugee settlements in Northern Uganda.

BACKGROUND: Self-harming ideations demand targeted research due to their persistent nature, especially among female adolescents within refugee populations who face unique challenges that can exacerbate self-harming tendencies. This study aimed to assess the factors associated with self-harming ideations chronicity among female teenagers living in refugee settlement in Northern Uganda. METHOD: This cross-sectional study used a pretested questionnaire to assess self-harming ideations and other demographic characteristics. Ordinal logistic regression was used to determine factors associated with chronicity of self-harm ideations. RESULTS: Of 385 participants, the prevalence of self-harming ideations was 4.2% (n = 16) for acute, 8% (n = 31) for subacute, and 3.1% (n = 12) for chronic. The likelihood of having more chronic self-harming ideations increased with having ever been pregnant (adjusted odds ratio [aOR] = 3.78, 95% Confidence Interval [CI] = 1.57-9.08). However, having a spouse as the family head reduced the likelihood of having more chronic self-harming ideations (aOR = 0.19, 95% CI = 0.04-0.95). CONCLUSIONS: The persistence of self-harming thoughts among female teenagers in Northern Ugandan refugee settlements varies. Pregnancy history is associated with a higher chance of prolonged self-harming thoughts while having a spouse as the family's head is linked with a lower likelihood. Examining different demographic and familial elements when addressing the mental well-being of female teenage refugees is vital. It stresses the necessity for customized interventions and support networks targeting the reduction of self-harm behaviors among this vulnerable group.

Depression and suicidal ideation among adolescent girls in refugee settlements in northern Uganda.

Depression is a leading cause of disability, morbidity, and mortality among adolescent girls in Africa, with varying prevalence across different populations. However, there is paucity of data on the burden of depression among priority groups in unique settings like adolescent girls living in refugee settlements, where access to mental health services including psychosocial support and psychiatric consultation is scarce. We conducted a cross-sectional, descriptive, observational study among adolescent girls from 4 selected refugee settlements in Obongi and Yumbe districts, Uganda. A multi-stage sampling, and cluster sampling techniques, where each settlement represented 1 cluster was done. Prevalence of depression was assessed using the patient health questionnaire-9 modified for adolescents, followed by the P4 screener assessment tool for suicidal risks. We performed modified Poisson regression analysis to establish predictors of depression. P < .05 was considered statistically significant. We included 385 participants with a mean age of 17 (IQR: 15-18) years. The prevalence of depression was 15.1% (n = 58, 95% confidence interval [CI]: 11.6-19.0). Overall, 8.6% (n = 33) participants had recent suicidal thoughts (within 1 month) and 2.3% (n = 9) attempted suicide. Participants who experienced pregnancy (adjusted prevalence ratio [aPR]: 2.4, 95% CI: 1.00-5.94, P = .049), sexual abuse (aPR: 2.1, 95% CI: 1.19-3.76, P = .011), and physical abuse (aPR: 1.7, 95% CI: 1.01-2.74, P = .044) were independently associated with depression. In this study, we found about one in every 6 adolescents living in refugee settlements of northern Uganda to suffer from depression, particularly among those who experienced adolescent pregnancy and various forms of abuses. Incorporating mental health care in the existing health and social structures within the refugee settlements, exploring legal options against perpetrators of sexual abuse and encouraging education is recommended in this vulnerable population.

Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University teaching hospitals in northern Uganda.

BACKGROUND: Undernutrition has deleterious consequences to both the mother and the unborn child, significantly contributing to maternal and neonatal morbidity and mortality. We assessed dietary diversity, the prevalence, and predictors of undernutrition among pregnant adolescents and young women (PAYW) attending antenatal clinic (ANC) at two large teaching hospitals in northern Uganda. METHODS: Between 12th June 2023 to 27th October 2023, we conducted a facility-based, cross-sectional study at Gulu Regional Referral Hospital (GRRH) and St Mary's Hospital Lacor (SMHL), both in Gulu district, Uganda. We recruited PAYW aged 15-24 years attending ANCs. Sociodemographic and clinical characteristics of the study participants were collected using a pre-tested, semi-structured questionnaire. Undernutrition was defined as a mid-upper arm circumference (MUAC) of < 23 cm. Modified Poisson regression analysis was performed to determine factors independently associated with undernutrition. Data analyses was performed using STATA version 17.0. A p<0.05 was considered statistically significant. RESULTS: A total of 324 participants, with a mean age of 21.2±2.2 years were enrolled. About 62.0% (n = 201) of the participants dewormed during pregnancy. The prevalence of undernutrition was 12.7% [n = 41]. Prevalence was higher among participants who maintained pre-pregnancy diet (adjusted prevalence ratio [aPR] = 2.27, 95% Confidence Interval [CI]: 1.26-4.05, p = 0.006), those who did not receive nutritional education (aPR = 2.25, 95% CI: 1.21-4.20, p = 0.011) and consumption of non-green leafy vegetables (aPR = 4.62 95% CI: 1.64-13.01, p = 0.004). The prevalence of undernutrition was lower among participants who consumed milk and milk products (aPR = 0.44 95% CI: 0.24-0.81, p = 0.009) and among those who consumed fish and seafood compared to those who did not (aPR = 0.45 95% CI: 0.20-1.00, p = 0.050). CONCLUSIONS: About 1 in 8 of PAYW attending GRRH or SMHL had undernutrition, particularly those who lacked education about feeding habits during pregnancy and limited access to milk and milk products, fish and seafoods. We recommend health workers to offer timely education of pregnant adolescent and young women mothers about good feeding habits during pregnancy, appropriate monitoring of weight gain and physiological changes during pregnancy.

Efficacy of the Gulu University Reproductive Health Simulation Training for final year medical students and interns: a before-and-after study.

Background: Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country. Objectives: The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda. Design: A before-and-after study. Methods: A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample t-tests was used to test the difference in pre- and post-test scores. Independent sample t-tests compared median post-test results between interns and students, with a p-value <0.05 considered significant. Results: A total of 153 participants were enrolled, the majority being males (78.4%, n = 120) and medical students (73.9%, n = 113). Among the 40 interns, 55% (n = 22) were doctors, 30% (n = 12) were midwives, and 15% (n = 6) were nurses. The study participants showed an increase in knowledge, with median post-test scores higher than pre-test scores for all participants [63% (interquartile ranges, IQR: 57-71%) versus 49% (42-54%), with a median difference of 14% (8-23%), p < 0.001]. Conclusion: The SBT effectively imparts key knowledge competencies to the interns and fifth-year medical students. We recommend that SBT be included as part of the course units that students should take and for continuous medical education for qualified healthcare workers in resource-limited settings.

Willingness to start insulin therapy among insulin-naïve persons with type 2 diabetes mellitus at Gulu Regional Referral Hospital, Gulu City, Uganda.

Background: Most patients with type 2 diabetes mellitus (DM2) will require insulin for glycemic control during their disease. Objectives: We evaluated the willingness to start insulin therapy among insulin-naïve persons with DM2 in urban Northern Uganda. Design: A facility-based, quantitative, cross-sectional study was conducted between June and August 2023 recruiting insulin-naïve type 2 diabetes mellitus patients attending routine health care at Gulu Regional Referral Hospital, Gulu, Uganda. Methods: We gauged participants' willingness to use insulin by asking, 'If your doctor prescribed insulin for you, would you accept to use it?' with responses categorized as either 'Yes' or 'No'. Poisson regression analysis was performed to assess the factors associated with willingness to start insulin therapy. p < 0.05 were considered statistically significant. Results: We enrolled 190 participants, with a mean age of 55 ± 12.72 years. Most participants were female (63.7%, n = 121), attained a primary level of education (70.0%, n = 133), and were unemployed (84.2%, n = 160). Overall, 73.4% (n = 138) of the participants were willing to receive insulin therapy if indicated. Participants recently advised on insulin showed a 34% higher willingness [adjusted prevalence ratio (aPR): 1.34, 95% confidence interval (CI): 1.06-1.72, p = 0.007], whereas those with a disease duration of 6 years or more were 43% less willing (aPR: 0.57, 95% CI: 0.39-0.81, p = 0.002) and those concerns about coping with insulin therapy were 55% less willing to commence insulin therapy (aPR: 0.57, 95% CI: 0.39-0.81, p = 0.002). Conclusion: About three in every four participants with DM were willing to receive insulin if indicated. However, healthcare providers should consider personalized counseling strategies to alleviate concerns and enhance informed decision-making regarding insulin initiation. Future interventions should focus on addressing specific barriers associated with prolonged disease duration and apprehensions related to insulin therapy to optimize glycemic control in this population.

Exploring readiness for insulin treatment in people with type 2 diabetes at Gulu Regional Referral Hospital, Uganda In this study, we investigated the willingness to start insulin therapy among individuals with type 2 Diabetes Mellitus (DM2) in urban Northern Uganda. Understanding the importance of insulin for glycemic control in DM2, we surveyed 190 participants at Gulu Regional Referral Hospital. We found that more than three-quarters of the participants expressed a willingness to receive insulin therapy if recommended. Factors influencing this willingness included recent advice on insulin, which was associated with a 34% higher likelihood of acceptance. Conversely, individuals with a disease duration of 6 years or more were 43% less willing, and those concerned about coping with insulin therapy were 55% less willing to commence treatment. These findings underscore the need for healthcare providers to offer personalized counseling strategies, addressing specific concerns, to facilitate informed decision-making regarding insulin initiation. Looking ahead, interventions should prioritize overcoming barriers related to prolonged disease duration and apprehensions about insulin therapy to optimize glycemic control and improve the well-being of individuals with DM2 in this population.

Partnering to Improve Mentorship Capacity for Ugandan Reproductive Health Researchers: Program Description and Evaluation.

Mentorship is essential to health researchers in achieving their full potential and advancing public health. In most low-resource settings, there is a paucity of training on how to be a successful mentor. The Center for International Reproductive Health Training at the University of Michigan conducted and evaluated a workshop at two universities in Uganda for mentors of new reproductive health research grant awardees. The program aimed to strengthen mentors' mentorship skills and to identify ways to foster institutional support for mentoring. Mentors rated their post-training skills using a 5-point Likert scale (not skilled to extremely skilled) immediately and 3 months after the training. Ten of 19 mentors who participated in the training completed the evaluation. The majority were 41 to 50 years old, male, midcareer faculty. Immediately after the training, mentors rated themselves (mean ± SD) highest in knowledge of research ethics (4.4 ± 0.5), fostering independence in mentees (4.3 ± 0.9), and understanding the benefits of mentoring (3.9 ± 1.1). Mentors felt least confident in fostering institutional change to support mentorship (3.3 ± 0.8), communication (3.5 ± 0.5), and overcoming adversity (3.5 ± 0.8). The two most important things the mentors learned were how to appreciate and manage diversity and how they can benefit from mentorship. Barriers to mentoring that persisted after the program ended included lack of time and institutional resources. Enhancing mentorship training opportunities will foster a generation of scientists who are more supported, skilled, and productive in research, leading to better reproductive and public health outcomes in their communities.

A scoping review of qualitative studies on sexual and reproductive health and rights in Uganda: Exploring factors at multiple levels.

BACKGROUND: Uganda is burdened by high unintended and teen pregnancies, high sexually transmitted infections, and harm caused by unsafe abortion. OBJECTIVES: Explore factors influencing sexual and reproductive health and rights (SRHR) in Uganda by synthesizing evidence from qualitative studies using a scoping review. ELIGIBILITY CRITERIA: Original qualitative peer-reviewed research studies published between 2002 and 2023 in any language exploring factors influencing SRHR in Uganda. SOURCES OF EVIDENCE: Eight databases searched using qualitative/mixed methods search filters and no language limits. CHARTING METHODS: Information extracted included author, article title, publication year, study aims, participant description, data collection type, sample size, main findings, factors at the individual, interpersonal, community, and policy levels, implications for SRHR in Uganda, and study limitations. Quality of the selected articles was assessed using the Critical Appraisal Skills Programme tool. RESULTS: One hundred seventy-three studies met inclusion criteria. At the individual level, knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were identified as critical factors influencing health outcomes. Interpersonal factors included communication with sexual partners and relationships with family, school, and community members. Healthcare organization factors included adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors included gendered norms and male involvement in SRHR. Policy-level factors included the importance of aligning policy and practice. CONCLUSIONS: Multiple factors at individual, interpersonal, community, healthcare, cultural, and policy levels were found to influence SRHR in Uganda. The findings suggest that interventions targeting multiple levels of the socio-ecological system may be necessary to improve SRHR outcomes. This review highlights the need for a holistic approach that considers the broader socio-ecological context. Reducing identified gaps in the literature, particularly between policy and practice related to SRHR, is urgently needed in Uganda. We hope this review will inform the development of policies and interventions to improve SRHR outcomes.

A scoping review of qualitative studies on sexual and reproductive health and rights in UgandaIn Uganda, there are significant challenges regarding sexual and reproductive health and rights (SRHR), including high rates of unintended and teen pregnancies, sexually transmitted infections, and unsafe abortions. To better understand these issues, we conducted a comprehensive review of qualitative studies published between 2002 and 2023. Our analysis identified 173 studies that revealed various factors influencing SRHR in Uganda across different levels. At the individual level, factors such as knowledge and attitudes toward SRHR, risky sexual behavior, and access to maternal SRHR services were found to significantly impact health outcomes. Interpersonal relationships also played a crucial role, with communication with sexual partners and relationships with family, school, and community members being identified as important influences. Furthermore, the organization of healthcare services was found to be vital, particularly regarding adolescent access to education, SRHR services, and HIV prevention. Cultural and social factors, including gender norms and the involvement of males in SRHR, were noted as significant contributors to SRHR outcomes. Additionally, the alignment of policy and practice was emphasized as essential for improving SRHR outcomes in Uganda. Overall, the review concluded that addressing SRHR challenges in Uganda requires interventions that target multiple levels of the socio-ecological system. A holistic approach considering individual, interpersonal, community, healthcare, cultural, and policy factors is necessary. There is an urgent need to bridge gaps between policy and practice related to SRHR. Findings could inform the development of policies and interventions aimed at improving SRHR outcomes in Uganda.

Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda: a community-based cross-sectional study.

Background: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sex workers in Gulu, Uganda. Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3 months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p < 0.05 was considered statistically significant. Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range: 24-32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with; regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11-6.35, p < 0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32-35.77, p = 0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI: 1.49-4.35, p < 0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43-7.74, p = 0.005), and use of postexposure prophylaxis (PEP) in the past 12 months (aPR: 0.31, 95% CI: 0.17-0.59, p < 0.001). Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.

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

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.

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.