An exploratory study of men's companionship, perceptions and experiences during pregnancy and delivery in Uganda.

BACKGROUND: Globally, low involvement of men in maternal health care services remains a problem to health care providers and policy makers. Men's support is essential for making women's world better. There are increasing debates among policymakers and researchers on the role of men in maternal health programs, which is a challenge in patriarchal societies like Uganda. The aim of the study was to assess companionship during delivery; men's perception and experiences during pregnancy and delivery. METHODS: This was a descriptive exploratory study using a qualitative approach. This study involved 16 male participants who were present in the labor room during the delivery of their child. In-depth interviews (IDIs) were the main data collection methods used in the study. Purposive sampling was used to select participants who share particular characteristics with the potential of providing rich, relevant, and diverse data. The interviews were tape-recorded with the permission of the participants; in addition, the interviewer took notes. Each interview lasted between 30 and 45 min. The transcripts were entered into ATLAS.ti for analysis. Manifest content analysis was used. RESULTS: The major themes were; feelings about attending child birth, responsibilities during child birth, positive experiences and negative experiences about child birth. Men are willing to participate in child birth and should be encouraged as many are the decision makers in the family. Admission of men into the delivery room, improves family togetherness. The women felt loved and treasured. The men reported bondage to their partners and new born. CONCLUSIONS: Men's involvement in the child birth process was associated with a more perceived bondage with the partner and the newborn. Their presence helped to promote a calm and successful child birth process. Hospitals should work on measures encouraging male involvement.

Use of wind-up fetal Doppler versus Pinard for fetal heart rate intermittent monitoring in labour: a randomised clinical trial.

OBJECTIVES: In resource-poor settings, the standard of care to inform labour management is the partograph plus Pinard stethoscope for intermittent fetal heart rate (FHR) monitoring. We compared FHR monitoring in labour using a novel, robust wind-up handheld Doppler with the Pinard as a primary screening tool for abnormal FHR on perinatal outcomes. DESIGN: Prospective equally randomised clinical trial. SETTING: The labour and delivery unit of a teaching hospital in Kampala, Uganda. PARTICIPANTS: Of the 2042 eligible antenatal women, 1971 women in active term labour, following uncomplicated pregnancies, were randomised to either the standard of care or not. INTERVENTION: Intermittent FHR monitoring using Doppler. PRIMARY OUTCOME MEASURES: Incidence of FHR abnormality detection, intrapartum stillbirth and neonatal mortality prior to discharge. RESULTS: Age, parity, gestational age, mode of delivery and newborn weight were similar between study groups. In the Doppler group, there was a significantly higher rate of FHR abnormalities detected (incidence rate ratio (IRR)=1.61, 95% CI 1.13 to 2.30). However, in this group, there were also higher though not statistically significant rates of intrapartum stillbirths (IRR=3.94, 0.44 to 35.24) and neonatal deaths (IRR=1.38, 0.44 to 4.34). CONCLUSIONS: Routine monitoring with a handheld Doppler increased the identification of FHR abnormalities in labour; however, our trial did not find evidence that this leads to a decrease in the incidence of intrapartum stillbirth or neonatal death. TRIAL REGISTRATION NUMBER: Clinical Trails.gov (1000031587).

A rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum.

A 6-year-old girl was referred to the ENT (Ear nose and throat) unit at Mulago National Referral Hospital with a foreign body in the esophagus diagnosed by routine chest radiograph. The child's parents recall she had ingested a round object (galvanised iron umbrella cap of a roofing nail) two years prior to this, but they thought that the child had passed it out in stool since she had continued eating and swallowing normally. On arrival at the National referral hospital, the child had two esophagoscopies done but the foreign body was not seen, not until a barium swallow was done was it confirmed that the FB(foreign body) had perforated the esophagus and entered the mediastinum. The cardiothoracic surgeons were consulted, and they removed the foreign body via a thoracotomy. The child recovered well and was discharged from hospital on day 55.

Perinatal death audits in a peri-urban hospital in Kampala, Uganda.

BACKGROUND: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya Hospital. METHODS: This was a retrospective descriptive study conducted from March - November 2008. An interdisciplinary hospital team conducted weekly perinatal death reviews. Each case was summarized and discussed, identifying gaps and cause of death. Local solutions were implemented according to the gaps identified from the audit process. RESULTS: Of the 350 perinatal deaths which occurred, 120 perinatal deaths were audited. 34.2% were macerated still births, 31.7% fresh still births and 34.2% early neonatal deaths. Avoidable factors included: poor neonatal resuscitation skills, incorrect use of the partographs and delay in performing caesarean sections. Activities implemented included: three skills sessions of neonatal resuscitation, introduction of Continuous positive airway pressure (CPAP) for babies with respiratory distress, updates on use of partographs. Perinatal mortality rate was 47.9 deaths per 1000 total births in 2008 after introduction of the audits compared to 52.8 per 1,000 total births in 2007. CONCLUSION: Conducting routine perinatal audits is feasible and contributes to reduction of facility perinatal mortality rate.

Loss to follow up from isoniazid preventive therapy among adults attending HIV voluntary counseling and testing sites in Uganda.

Among HIV-infected adults attending non-governmental organization voluntary counseling and testing (VCT) sites in Uganda that provide a nine-month course of isoniazid preventive treatment (IPT), we report on loss to follow-up (LTFU) and its associated risk factors. The design was a retrospective cohort study of program data spanning a three year period (2006-2008). A total of 586 IPT patients were enrolled of whom 335 (57.1%) were females with a mean age of 34 years. Of those starting IPT, 341 (58.1%) were lost to follow-up, 197 (33.6%) completed IPT, 29 (4.9%) were discontinued and 19 (3.2%) died. The return rates at one, three, five and seven months were 78.0% (457), 62.1% (364), 52.9% (310) and 33.6% (197) respectively. Being less than 30 years of age, widowed, separated, or divorced were found to be associated with a higher risk of loss to follow-up. Sudden improvement in retention on IPT was observed between the years 2006 and 2007, although causes of the improvement are poorly understood hence the need for more research. At non-governmental VCT sites in Uganda, six out of ten individuals enrolled on IPT are lost to follow-up and efforts to reduce this attrition including systems strengthening might play a critical role in the success of IPT programs.

Risk of seropositivity to multiple oncogenic human papillomavirus types among human immunodeficiency virus-positive and -negative Ugandan women.

To understand the prospects for human papillomavirus (HPV) mass vaccination in the setting of a developing country, we studied the co-occurrence of seropositivity to multiple high-risk (hr) HPV types among HIV-positive and HIV-negative Ugandan women. Our seroepidemiological study was conducted among 2053 women attending antenatal clinics. Sera were analysed for antibodies to eight hrHPV types of the α-7 (18/45) and α-9 (16/31/33/35/52/58) species of HPV by using a multiplex serology assay. Our results show that seropositivity for greater than one hrHPV type was as common (18 %) as for a single type (18 %). HIV-positive women had higher HPV16, HPV18 and HPV45 seroprevalences than HIV-negative women. In multivariate logistic regression analysis, age (>30 years) and level of education (secondary school and above) reduced the risk, whereas parity (>5) and HIV-positivity increased the risk for multiple hrHPV seropositivity. However, in stepwise logistic regression analyses, HIV-status remained the only independent, stand-alone risk factor [odds ratio (OR) 1.7, 95 % confidence interval (CI) 1.0-2.8). On the other hand, the risk of HPV16 or HPV18 seropositive women, as compared to HPV16 or HPV18 seronegative women, for being seropositive to other hrHPV types was not significantly different when they were grouped by HIV-status (ORHPV16/HIV+ 12, 95 % CI 4.5-32 versus ORHPV16/HIV- 22, 95 % CI 15-31 and ORHPV18/HIV+ 58, 95 % CI 14-242 versus ORHPV18/HIV- 45, 95 % CI 31-65). In conclusion, seropositivity to HPV16, HPV18 and to non-vaccine hrHPV types is common in Ugandan women, suggesting that there is little natural cross-protective immunity between the types. HIV-positivity was an independent, stand-alone, albeit moderate risk factor for multiple hrHPV seropositivity. HPV mass vaccination may be the most appropriate method in the fight against cervical cancer in the Ugandan population.

Low birthweight associated with maternal anaemia and Plasmodium falciparum infection during pregnancy, in a peri-urban/urban area of low endemicity in Uganda.

A cross-sectional study of pregnant women was conducted at Nsambya Hospital in Kampala, to investigate the prevalence and effect of Plasmodium falciparum infections during pregnancy, in a peri-urban/urban location. Overall, 544 pregnant women were recruited when they presented at the labour ward for delivery. After giving informed consent, each subject answered a questionnaire and underwent a physical examination, and peripheral-blood samples were obtained. After each uncomplicated delivery, samples of placental and cord blood were obtained from the placenta and infant, respectively, and infant birthweights were recorded. Smears were prepared from the blood samples and checked for parasites. Only 46 and 36 of the 537 women investigated were positive for P. falciparum infection in their peripheral and placental blood, respectively. Plasmodium falciparum was the only parasite encountered. The prevalences of low birthweight and maternal parasitaemia and the intensities of maternal infection were each greater in primigravidae than secundi- or multi-gravidae. Despite the low prevalence of parasitaemia in this population, P. falciparum infection in the primigravidae was a significant contributor to their ill health, leading to low birthweights in their infants.

A randomized controlled trial of low-dose aspirin in women at risk from pre-eclampsia.

OBJECTIVES: To determine whether low-dose aspirin reduces the incidence of pre-eclampsia, reduces perinatal mortality and improves birth weights in pregnant women considered at high risk of developing pre-eclampsia. METHOD: Two-hundred fifty subjects were recruited from the antenatal clinics at Harare Central Hospital with either a previous history of pregnancy-induced hypertension or pre-existing chronic hypertension and were randomized to receive either 75 mg of aspirin (ASA) or placebo (PLA). RESULTS: Two-hundred thirty subjects (ASA, n = 113; PLA, n = 117) completed the trial. The odds of developing pre-eclampsia for those on aspirin was 0.72 times those on placebo (95% CI, 0.34-1.52). The mean birth weight was 2774 g for those on aspirin and 2694 g for those on placebo (P = 0.80). No difference was noted in the perinatal deaths (OR = 0.38; 95% CI, 0.10-1.20). CONCLUSION: Prophylactic use of aspirin was not associated with a significant effect on the major pregnancy outcomes assessed in this study.

HIV-1 risk and vaccine acceptability in the Ugandan military.

Between July and October 1993, 570 19- to 22-year-old volunteers were screened for HIV-1, with a resulting seroprevalence rate of 18.3% (95% CI: 14.0%, 22.6%). A cohort of 249 HIV-1-noninfected military recruits in the Ugandan Peoples' Defense Forces was followed prospectively for up to 18 months to document rates of HIV-1 seroprevalence, seroconversion, and knowledge and attitudes related to vaccine acceptability. The HIV-1 seroincidence rate was 3.56 per 100 person-years (95% CI: 1.49, 5.62) over 309 person-years of observation. At the 3- and 12-month visits, subjects were interviewed on issues of acceptance and knowledge about vaccines, including anti-HIV vaccines in particular. More than 90% believe that HIV vaccines will not cause HIV infection, and if offered, 88% report that they would take the vaccine if they were not already infected. Nonvaccine prevention methods were considered less reliable; monogamy and condom use were considered effective by only 33.5% and 69.3% of the cohort respectively. After completing the vaccine acceptability questionnaire at the 12-month visit, subjects were offered an approved polyvalent meningococcal vaccine as an indicator of general vaccine acceptance. All subjects reported receiving at least one previous vaccination, and 95% willingly accepted the meningococcal vaccination. The Ugandan military is a stable population at substantial risk for HIV-1 infection and may be a suitable population for vaccine efficacy trials.