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1.
Int J Reprod Med ; 2020: 8016483, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062664

RESUMO

Background: Contraceptive practices of perinatally HIV-infected adolescents (PHIAs) have implications related to pregnancy prevention, risks of HIV heterosexual transmission, reinfection, and vertical transmission. The study assessed contraceptive use among sexually active PHIAs in Uganda. Methods: Mixed methods consisting of a survey and in-depth interviews were employed among 213 sexually active PHIAs who were attending antiretroviral therapy (ART) clinics. The study was guided by Andersen's Behavioral Model of Health Service Use as a theoretical framework to identify factors that influence contraceptive use. These factors include health care factors, personal characteristics, enabling factors, and needs. The outcome was contraceptive use. Multivariable logistic regression was used to establish determinants of contraceptive use. Qualitative data were analyzed by thematic analysis. Results: Most PHIAs were female (67.6%); the mean (SD) and median (IQR) age was 17.5 (±1.4) and 18 (17-19) years. The mean age of sexual debut and at marriage were 15 (±1.7) and 17 (±1.1), respectively. Condoms were the most known method of family planning (indicated by 55.4%). Only 16.9% of the participants knew about dual protection (condom use for FP as well as HIV/STI prevention). Of the PHIAs, 43.6% had ever used modern contraception and 56.9% of the females had ever been pregnant. The odds of contraceptive ever-use were significantly higher among adolescents aged 17-19 years (OR 5.1, 95% CI: 2.1-13.3) compared to those aged 10-16 years, those in school (OR 1.8, 95% CI: 1.07-3.2) compared to those out of school, and those with perceived need to use FP (OR 2.0, 95% CI: 1.1-3.9) compared to their counterparts. The odds of contraceptive used were lower among females (OR 0.13, 95% CI: 0.06-0.28) compared to males. From the in-depth interviews, the attitude of health workers, availability of health workers, having a friend using family planning, and waiting time were viewed to affect contraceptive use. Conclusion: Contraceptive use among sexually active perinatally HIV-infected adolescents was (43.6%). However, out of those who used family planning majority were using short-term methods. The unmet need for family planning was high (47%) with high reports of pregnancy (56.9%). The factors associated with contraceptive use included education, age, sex (predisposing factors), and perceived need of family planning (need factors). Other factors that could affect contraceptive use from qualitative analysis included attitude of health workers, availability of health workers, having a friend using family planning (predisposing factors), and waiting time (health system factors). HIV care for adolescents should be promoted using SRH approach. There is a need to provide training for all providers to cater for SRH services. We should continue to provide youth-responsive adolescent sexual and reproductive health services across all ART facilities and build a supportive environment and continue to integrate SRH services into HIV care.

2.
BMC Med Ethics ; 20(1): 27, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029121

RESUMO

BACKGROUND: There is unanimous agreement regarding the need to ethically conduct research for improving therapy for patients admitted to hospital with acute conditions, including in emergency obstetric care. We present a conceptual analysis of ethical tensions inherent in the informed consent process for randomized clinical trials for emergency obstetric care and suggest ways in which these could be mitigated. DISCUSSION: A valid consenting process, leading to an informed consent, is a cornerstone of this aspect necessary for preservation and maintenance of respect for autonomy and dignity. In emergency obstetric care research, obtaining informed consent can be problematic, leading to ethical tension between different moral considerations. Potential participants may be vulnerable due to severity of disease, powerlessness or impaired decisional capacity. Time for the consent process is limited, and some interventions have a narrow therapeutic window. These factors create ethical tension in allowing potentially beneficial research while avoiding potential harms and maintaining respect for dignity, human rights, justice and autonomy of the participants. CONCLUSION: Informed consent in emergency obstetric care in low- and middle-income countries poses numerous ethical challenges. Allowing research on vulnerable populations while maintaining respect for participant dignity and autonomy, protecting participants from potential harms and promoting justice underlie the ethical tensions in the research in emergency obstetric and newborn care. Those involved in research conduct or oversight have a duty of fair inclusion, to avoid denying participants the right to participate and to any potential research benefits.


Assuntos
Parto Obstétrico/ética , Países em Desenvolvimento , Serviços Médicos de Emergência/ética , Consentimento Informado por Menores/ética , Consentimento Livre e Esclarecido/ética , Terapia Intensiva Neonatal/ética , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Humanos , Recém-Nascido
3.
Health Res Policy Syst ; 15(1): 33, 2017 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-28431554

RESUMO

BACKGROUND: In the last decade, Makerere University College of Health Sciences (MakCHS) has taken strides in research and training to improve healthcare through collaborative training and research programs. However, there is limited data on the trends of MakCHS faculty contributions to research and on faculty growth to take leading roles in health research. This paper reviews MakCHS faculty research publications over 15.5 years and outlines possible strategies to enhance faculty research outputs. METHODS: We used a mixed methods approach. A systematic review of research publications by faculty at MakCHS (PubMed and Google Scholar from January 1, 2000, to June 30, 2015) to quantify the number of research articles, areas researched, authorship contribution by MakCHS faculty, source of funding, as well as affiliated local and international collaborations. Graphs were used to shown trends in publications and leadership of authorship by faculty. Annual individual faculty research productivity was presented as publication per capita. Qualitative data on high priority needs to improve research outputs was collected through focus group discussions (FGDs) with faculty members, and analysed manually into emerging themes. RESULTS: Of 298 faculty at MakCHS at 2015, 89 (30%) were female and 229 (77%) were junior and mid-level faculty (senior lecturer and below). The PubMed and Google Scholar searches yielded 6927 published articles, of which 3399 (49%) full-text articles were downloaded for analysis, 426/3825 (11%) available as titles/abstracts only, and 598/4423 (14%) were excluded. Only 614 articles were published in 2014, giving a publication per capita of 2.1 for any authorship, and 0.3 for first and last authorship positions. MakCHS faculty increasingly contributed as first, second, third, and last authors. Up to 57% of research was in infectious diseases, followed by non-communicable diseases (20%) and non-communicable maternal child health (11%). Priority needs to improve research outputs, as expressed by faculty, were (1) an institutionally led faculty career development program, (2) skills building in research methods and scientific writing, (3) protected time for research related activities, (4) opportunities for collaborative research, and (5) use of individual development plans. CONCLUSION: Faculty research productivity was low and dominated by infectious diseases and non-communicable disease research. There is a need for structured institutional support to optimise faculty research outputs. Only with increased research productivity will MakCHS and other academic institutions be able to make a significant contribution in addressing national health challenges.


Assuntos
Pesquisa Biomédica/organização & administração , Pesquisa Biomédica/estatística & dados numéricos , Educação Médica/organização & administração , Docentes/estatística & dados numéricos , Publicações/tendências , Autoria , Eficiência , Feminino , Humanos , Universidades
4.
Reprod Health ; 14(1): 31, 2017 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-28253893

RESUMO

BACKGROUND: Acyclovir (ACV) given to HSV-2 positive women after 36 weeks reduces adverse outcomes but its benefit at lower gestation was undocumented. We determined the effect of oral acyclovir administered from 28 to 36 weeks on premature rupture of membranes (PROM) primarily and preterm delivery risk. METHODS: This was a randomized, double-blind placebo-controlled trial among 200 HSV-2 positive pregnant women at 28 weeks of gestation at Mulago Hospital, Uganda. Participants were assigned randomly (1:1) to take either acyclovir 400 mg orally twice daily (intervention) or placebo (control) from 28 to 36 weeks. Both arms received acyclovir after 36 weeks until delivery. Development of Pre-PROM by 36 weeks and preterm delivery were outcomes. RESULTS: One hundred women were randomised to acyclovir and 100 to placebo arms between January 2014 and February 2015. There was tendency towards reduction of incidence of PROM at 36 weeks but this was not statistically significant (4.0% versus 10.0%; RR 0.35; 95% 0.11-1.10) in the acyclovir and placebo arms respectively. However, there was a significant reduction in the incidence of preterm delivery (11.1% versus 23.5%; RR 0.41; 95% 0.20-0.85) in the acyclovir and placebo arms respectively. CONCLUSIONS: Oral acyclovir given to HSV-2 positive pregnant women from 28 to 36 weeks reduced incidence of preterm delivery but did not significantly reduce incidence of pre-PROM. TRIAL REGISTRATION: www.pactr.org, PACTR201311000558197 .


Assuntos
Aciclovir/administração & dosagem , Parto Obstétrico , Ruptura Prematura de Membranas Fetais/prevenção & controle , Herpes Genital/tratamento farmacológico , Herpesvirus Humano 2/fisiologia , Nascimento Prematuro/prevenção & controle , Adulto , Antivirais/administração & dosagem , Método Duplo-Cego , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Herpes Genital/complicações , Herpes Genital/virologia , Humanos , Recém-Nascido , Mães , Gravidez , Nascimento Prematuro/etiologia , Uganda
5.
Afr Health Sci ; 17(4): 963-973, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29937866

RESUMO

Introduction: Knowledge of a person's HIV status during pregnancy is critical for prevention of mother to child transmission of HIV. Objectives: To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital. Methods: This was a cross-sectional study of women that had just delivered. The women's demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher's exact test, Wilcoxon rank sum test and logistic regression were used to test associations. Results: The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 - 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/government accredited health facilities "opted out" of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one "opted out". Conclusion: Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.


Assuntos
Sorodiagnóstico da AIDS/métodos , Infecções por HIV/prevenção & controle , Soropositividade para HIV/diagnóstico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Trabalho de Parto , Complicações Infecciosas na Gravidez/diagnóstico , Cuidado Pré-Natal , Adulto , Estudos Transversais , Parto Obstétrico , Feminino , Infecções por HIV/complicações , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , Prevalência , Uganda/epidemiologia , Adulto Jovem
6.
J Infect Dev Ctries ; 10(10): 1108-1115, 2016 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-27801374

RESUMO

INTRODUCTION: Herpes simplex virus type 2 (HSV-2) acquired during pregnancy is associated with adverse outcomes such as perinatal HSV-2 transmission. HSV-2 seroconversion occurs within four weeks of HSV-2 acquisition. There was neither documented incidence nor risk factors for HSV-2 seroconversion during pregnancy in Uganda. The objective of this study was to determine the incidence and risk factors for HSV-2 seroconversion among pregnant women in Mulago Hospital, Uganda. METHODOLOGY: A prospective study of 200 consenting HSV-2-negative women between 26 and 28 weeks of gestation was done between November 2013 and October 2014. HSV-2 serostatus was determined using HerpeSelect HSV-2 enzyme-linked immunosorbent assay (ELISA). Interviewer-administered questionnaires were used to collect socio-demographic characteristics and sexual history. Human immunodeficiency virus (HIV) serostatus was obtained from antenatal records. A total of 191 women completed follow-up and repeat HSV-2 serology by 38 weeks. Negative binomial regression analysis was used to estimate risk ratios for risk factors for HSV-2 seroconversion. RESULTS: Of 191 women, 15 (7.9%) seroconverted during pregnancy. Having multiple sexual partners, being in polygamous unions, and having HIV-positive serostatus were found to be risk factors for HSV-2 seroconversion. CONCLUSIONS: The incidence of HSV-2 seroconversion during pregnancy in Uganda was high. Multiple sexual partners, polygamy, and HIV-positive serostatus were risk factors for HSV-2 seroconversion during pregnancy. Strengthening health education on the avoidance of multiple sexual partners during pregnancy is paramount in prevention of HSV-2 seroconversion.


Assuntos
Anticorpos Antivirais/sangue , Herpes Genital/epidemiologia , Herpesvirus Humano 2/imunologia , Complicações Infecciosas na Gravidez/epidemiologia , Soroconversão , Adolescente , Adulto , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Incidência , Gravidez , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 16(1): 152, 2016 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-27402019

RESUMO

BACKGROUND: Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. METHODS: Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. RESULTS: There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p < 0.001 and 21.7 % vs. 50.5 %; P < 0.001 respectively after the second audit. There was no improvement in vital sign monitoring, delivery within two hours or blood grouping and cross matching. There was a decline in bladder catheterization (94 % vs. 68.9 %; p < 0.001. The overall mean care score in the first and second audits was 55.1 and 48.2 % respectively, p = 0.19. Healthcare factors (negative attitude, low numbers, poor team work, low motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. CONCLUSION: Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.


Assuntos
Parto Obstétrico/normas , Distocia/terapia , Hospitais/normas , Melhoria de Qualidade , Administração Intravenosa , Adolescente , Adulto , Antibacterianos/administração & dosagem , Atitude do Pessoal de Saúde , Tipagem e Reações Cruzadas Sanguíneas/normas , Equipamentos e Provisões Hospitalares/provisão & distribução , Feminino , Hidratação/normas , Administração Hospitalar , Humanos , Auditoria Médica , Monitorização Fisiológica/normas , Guias de Prática Clínica como Assunto , Gravidez , Estudos Prospectivos , Pesquisa Qualitativa , Uganda , Cateterismo Urinário/normas , Adulto Jovem
8.
BMC Pregnancy Childbirth ; 16: 24, 2016 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-26821716

RESUMO

BACKGROUND: Maternal near misses occur more often than maternal deaths and could enable more comprehensive analysis of risk factors, short-term outcomes and prognostic factors of complications during pregnancy and childbirth. The study determined the incidence, determinants and prognostic factors of severe maternal outcomes (near miss or maternal death) in two referral hospitals in Uganda. METHODS: A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, where cases of severe pregnancy and childbirth complications were included. The clinical conditions included abortion-related complications, obstetric haemorrhage, hypertensive disorders, obstructed labour, infection and pregnancy-specific complications such as febrile illness, anemia and premature rupture of membranes. Near miss cases were defined according to the WHO criteria. Multivariate logistic regression analysis was conducted to identify prognostic factors for severe maternal outcomes. RESULTS: Of 3100 women with severe obstetric complications, 130 (4.2%) were maternal deaths and 695 (22.7%) were near miss cases. Severe pre-eclampsia was the commonest morbidity (incidence ratio (IR) 7.0%, case-fatality rate (CFR) 2.3%), followed by postpartum haemorrhage (IR 6.7%, CFR 7.2%). Uterine rupture (IR 5.5%) caused the highest CFR (17.9%), followed by eclampsia (IR 0.4%, CFR 17.8%). The three groups (maternal deaths, near misses and non-life-threatening obstetric complications) differed significantly regarding gravidity and education level. The commonest diagnostic criteria for maternal near miss were admission to the high dependency unit (HDU) or to the intensive care unit (ICU). Thrombocytopenia, circulatory collapse, referral to a more specialized unit, intubation unrelated to anaesthesia, and cardiopulmonary resuscitation were predictive of maternal death (p < 0.05). Gravidity (ARR 1.4, 95% C1 1.0-1.2); elevated serum lactate levels (ARR 4.5, 95% CI 2.3-8.7); intubation for conditions unrelated to general anaesthesia (ARR 2.6 (95% CI 1.2-5.7), cardiovascular collapse (ARR 4.9, 95% CI 2.5-9.5); transfusion of 4 or more units of blood (ARR 1.9, 95% CI 1.1-3.1); being an emergency referral (ARR 2.6, 95% CI 1.2-5.6); and need for cardiopulmonary resuscitation (ARR 6.1, 95% CI 3.2-11.7), were prognostic factors. CONCLUSIONS: The analysis of near misses is a useful tool in the investigation of severe maternal morbidity. The prognostic factors for maternal death, if instituted, might save many women with obstetric complications.


Assuntos
Morte Materna/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/mortalidade , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Escolaridade , Feminino , Número de Gestações , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Morte Materna/etiologia , Mortalidade Materna , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/mortalidade , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/mortalidade , Gravidez , Complicações na Gravidez/etiologia , Estudos Prospectivos , Fatores de Risco , Uganda/epidemiologia , Ruptura Uterina/etiologia , Ruptura Uterina/mortalidade , Adulto Jovem
9.
BMC Res Notes ; 8: 624, 2015 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-26518174

RESUMO

BACKGROUND: Elective caesarean sections (ECS) have been implicated in increased risk of adverse neonatal outcomes. The primary objective was to assess the incidence and determinants of neonatal morbidity after elective caesarean section deliveries. The secondary objective was to describe the maternal morbidity associated with elective caesarean section. METHODS: This was a prospective cohort study of women admitted for ECS, as well as their newborns, conducted at Mulago hospital from March 1, 2013 to February 28, 2014. These were followed from the time of the operation until 6 weeks after hospitalization following the caesarean delivery. Data was collected using an interviewer-administered questionnaire and review of medical records for demographic characteristics, obstetric history, current pregnancy complications and pregnancy outcomes up to hospital discharge. Study outcomes were maternal and neonatal morbidity. The data was analyzed using Stata version 12. RESULTS: There were 25,846 deliveries during the study period, of which 20,083 (77.7%) were vaginal deliveries or assisted deliveries, and 5763 (22.3%) were caesarean sections. Of the caesarean sections, 920 (15.9%) were ECS. The commonest maternal morbidity was hemorrhage (17.2%). A birth weight less than 2500 g (aRR 11.0 [95% CI 8.1-17.2]) or more than 4000 g (aRR 12.2 [95% CI 10.6-23.2]), delivery at gestation age less than or equal to 38 weeks (aRR 1.62 [95% 1.20-2.10]), multigravidity (aRR 1.70 [95% CI 1.20-2.90]) and using general anaesthesia (aRR 2.43 [95% CI 1.20-5.90]) were associated with risk of neonatal morbidity. The commonest neonatal morbidity is respiratory distress especially if delivery occurs at a gestation age of 37 weeks or lower, if the birth weight is less than 2500 g or more than 4000 g, and if general anesthesia is used. CONCLUSION: Our study shows that at Mulago Hospital, ECS is associated with significant neonatal and maternal morbidity. We recommend that elective caesarean sections be performed after 39 weeks of gestation, and preferably avoid using general anaesthesia.


Assuntos
Cesárea/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Doenças do Recém-Nascido/epidemiologia , Adolescente , Adulto , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Uganda/epidemiologia , Adulto Jovem
10.
Reprod Health ; 12: 107, 2015 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-26585992

RESUMO

BACKGROUND: Despite being a key component to be addressed during postnatal period, sexuality has long been a subject of secrecy and taboo in Africa. Resumption of sexual intercourse after giving birth has been shown to reduce extramarital affairs and consequently reduce risk of sexually transmitted infections like HIV/AIDS. Consequences of early resumption of sexual intercourse include unwanted pregnancy, genital trauma and puerperal infection. The objective of the study was to assess prevalence and factors associated with early resumption of sexual intercourse among postnatal mothers attending postnatal clinic at a National referral Hospital in Uganda. METHODOLOGY: A cross-sectional study that employed an interviewer-administered questionnaire was conducted among 374 women who delivered six months prior to conducting the study. The independent variables included socio-demographic characteristics of the participant, socio-demographic characteristics of the spouse, perceived cultural norms, medical history, mode of delivery, and postpartum complications. The dependent variable was timing of resumption of sexual intercourse after childbirth (before or after six weeks postpartum). Data were analysed using SPSS version 16.0. RESULTS: The study showed that 105 participants (21.6%) had resumed sexual intercourse before 6 weeks after childbirth. The participants' education level, occupation, and parity; education level of the spouse, age of baby and use of family planning were the factors associated with early resumption of sexual intercourse after child birth (before six weeks postpartum) (p < 0.05). CONCLUSION: Many women resumed sexual intercourse after six weeks. Women with high income, low parity, who ever-used contraception or had a spouse with high education level were more likely to have early resumption of sexual intercourse.


Assuntos
Coito/psicologia , Período Pós-Parto/psicologia , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Aleitamento Materno/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/métodos , Escolaridade , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Ocupações/estatística & dados numéricos , História Reprodutiva , Fatores de Tempo , Uganda , Adulto Jovem
11.
Health Qual Life Outcomes ; 13: 170, 2015 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-26490047

RESUMO

BACKGROUND: With increased survival of perinatally HIV - infected adolescents due to antiretroviral therapy (ART), the focus of HIV care has shifted to health-related quality of life (HRQoL) as a measure of disease progression, effects of ART co-morbidity and prognosis. We assessed factors associated with better HRQoL in perinatally HIV -infected adolescents in Uganda by determining the associations between sexual and reproductive health (SRH) or lifestyle experiences on HRQoL. METHODS: In a cross-sectional study, data on SRH, lifestyle experiences, socio demographic factors, communication with parents on sexuality and satisfaction of SRH services in ART clinics were collected from 614 HIV perinatally infected adolescents aged 10-19 using an interviewer-administered survey questionnaire. HRQoL data were collected using the Medical Outcomes Study HIV Health Survey instrument (MOS-HIV). Factors associated with better HRQoL were analysed using multiple logistic regression. RESULTS: The mean age was 16.2 ± 2.1 years, 362 (58.8 %) were females and 210 (34.2 %) were sexually active. Adolescents on ART were twice likely to present with better physical health (AOR = 2.07, 95 % CI: 1.24-3.46) and four times more likely to present with better mental health (AOR = 3.9, 95 % CI: 2.22-6.92) than those who were not on ART. There were no statistically significant associations between SRH (ever had sex, ever been pregnant, condom use, contraceptive use) or life style factors and physical health or mental health. Those with secondary or tertiary education were more likely to present with a better mental health (AOR = 5.3, 95 % CI: 1.86-15.41) compared those who had attained primary or no education. Participants who desired to have a child in future more likely (AOR 1.7, 95 % CI: 1.05-3.00) to present with a better mental health. Lack of communication with guardians on sexuality (AOR = 0.6, 95 % CI: 0.40-0.89), or dissatisfaction with SRH services (AOR 0.34, 95 % CI: 0.18-0.62) were associated with poorer mental health. CONCLUSION: Among perinatally HIV-infected adolescents in Uganda, being on ART was associated with better physical and mental health while lack of communication with guardians on sexuality or dissatisfaction with SRH services was associated with poor mental health. Adolescents with pregnancy intentions were more likely to have a better mental health.


Assuntos
Infecções por HIV/congênito , Infecções por HIV/transmissão , Estilo de Vida , Qualidade de Vida , Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Criança , Comunicação , Estudos Transversais , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Transmissão Vertical de Doença Infecciosa , Modelos Logísticos , Masculino , Pais , Comportamento Sexual/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Uganda , Adulto Jovem
12.
BMC Res Notes ; 8: 573, 2015 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-26475265

RESUMO

BACKGROUND: Inflammatory mediators that weaken and cause membrane rupture are released during the course of genital infections among pregnant women. We set out to determine the association of common genital infections (Trichomonas vaginalis, syphilis, Neisseria gonorrhea, Chlamydia trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 and candidiasis) and premature rupture of membranes in Mulago hospital, Uganda. METHODS: We conducted an unmatched case-control study among women who were in the third trimester of pregnancy at New Mulago hospital, Uganda. The cases had PROM and the controls had intact membranes during latent phase of labour in the labour ward. We used interviewer-administered questionnaires to collect data on socio-demographic characteristics, obstetric and medical history. Laboratory tests were conducted to identify T. vaginalis, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus, Bacterial vaginosis, Herpes Simplex Virus Type 2 (HSV-2) and candidiasis. Logistic regression models were used to estimate the odds ratios (OR) and 95% CI of the association between genital infections and PROM. RESULTS: There was an association between PROM and abnormal vaginal discharge (OR = 2.02, 95% CI 1.10-3.70 and AOR = 2.30, 95% CI 1.18-4.47), presence of candidiasis (OR = 0.27, 95% CI 0.14-0.52 and AOR = 0.22, 95% CI 0.10-0.46) and T. vaginalis (OR = 2.98, 95% CI 1.18-7.56 and AOR = 4.22, 95% CI 1.51-11.80). However, there was no association between PROM and presence of C. trachomatis (OR = 2.05, 95% CI 0.37-11.49) and HSV-2 serostatus (OR = 1.15, 95% CI 0.63-2.09). Few or no patients with Bacterial vaginosis, Neisseria gonorrhoea, Group B streptococcus or syphilis were identified among the cases and controls. Co-infection of Trichomoniasis and candidiasis was not associated with PROM (AOR = 1.34, 95% CI 0.16-11.10). Co infection with T. vaginalis and C. trachomatis was associated with PROM (OR = 3.09, 95% CI 1.21-7.84 and AOR = 4.22, 95% CI 1.51-11.83). CONCLUSION: Trichomonas vaginalis alone, T. vaginalis with C. trachomatis co-infection and abnormal per vaginal discharge were found as risk factors for PROM. There was no association of HSV-2 serostatus, syphilis, N. gonorrhea, C. trachomatis, Group B Streptococcus and Bacterial vaginosis with PROM. Candidiasis seemed to have a protective effect on PROM.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Vaginose Bacteriana/epidemiologia , Adulto , Candida/isolamento & purificação , Candidíase/complicações , Candidíase/epidemiologia , Candidíase/microbiologia , Candidíase/patologia , Estudos de Casos e Controles , Infecções por Chlamydia/complicações , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/patologia , Chlamydia trachomatis/isolamento & purificação , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Ruptura Prematura de Membranas Fetais/patologia , Gonorreia/complicações , Gonorreia/epidemiologia , Gonorreia/microbiologia , Gonorreia/patologia , Herpes Genital/complicações , Herpes Genital/epidemiologia , Herpes Genital/patologia , Herpes Genital/virologia , Herpesvirus Humano 2/isolamento & purificação , Humanos , Recém-Nascido , Neisseria gonorrhoeae/isolamento & purificação , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/virologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/patologia , Fatores de Risco , Streptococcus/isolamento & purificação , Sífilis/complicações , Sífilis/epidemiologia , Sífilis/microbiologia , Sífilis/patologia , Treponema pallidum/isolamento & purificação , Vaginite por Trichomonas/complicações , Vaginite por Trichomonas/epidemiologia , Vaginite por Trichomonas/microbiologia , Vaginite por Trichomonas/patologia , Trichomonas vaginalis/isolamento & purificação , Uganda/epidemiologia , Vaginose Bacteriana/complicações , Vaginose Bacteriana/microbiologia , Vaginose Bacteriana/patologia
13.
BMC Health Serv Res ; 15: 190, 2015 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-25943551

RESUMO

BACKGROUND: Client satisfaction is a common outcome measure for quality of care and goal for quality improvement in healthcare. We assessed women's perceptions of the structure, process and outcome of intrapartum care in Mulago hospital, specifically, labor ward duty shift handovers. METHODS: Data was collected through 40 in-depth interviews conducted on two occasions: during the time of hospitalization and within 4-6 months after childbirth. Participants were women who delivered at the hospital, of whom some had life-threatening obstetric complications. Data was analyzed by thematic analysis. RESULTS: Maternity duty handovers were associated with patient dissatisfaction, particularly the process of hand-over, the decision-making that follows handovers and failure of communication of information to patients and their caretakers. Consequently, duty handovers were perceived inadequate. They were described as gaps in the continuity of care, and contributed to poor quality of care, birth trauma and mothers' dissatisfaction with the childbirth experience. CONCLUSION: The handover process and practices should be standardized using protocols and checklists. Health workers need training on handover practices, team work and communication skills (so as to improve patient-health provider and provider-provider interaction.


Assuntos
Continuidade da Assistência ao Paciente/normas , Trabalho de Parto , Transferência da Responsabilidade pelo Paciente , Satisfação do Paciente , Qualidade da Assistência à Saúde , Tomada de Decisões , Parto Obstétrico , Feminino , Pessoal de Saúde , Hospitalização , Hospitais , Humanos , Entrevistas como Assunto , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Pesquisa Qualitativa , Uganda
14.
BMC Pediatr ; 15: 44, 2015 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-25928880

RESUMO

BACKGROUND: Neonatal near miss cases occur more often than neonatal deaths and could enable a more comprehensive analysis of risk factors, short-term outcomes and prognostic factors in neonates born to mothers with severe obstetric complications. The objective was to assess the incidence, presentation and perinatal outcomes of severe obstetric morbidity in two referral hospitals in Central Uganda. METHODS: A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, in which all newborns from cases of severe pregnancy and childbirth complications were eligible for inclusion. The obstetric conditions included obstetric haemorrhage, hypertensive disorders, obstructed labour, chorioamnionitis and pregnancy-specific complications such as malaria, anemia and premature rupture of membranes. Still births, neonatal deaths and neonatal near miss cases (defined using criteria that employed clinical features, presence of organ-system dysfunction and management provided to the newborns were compiled). Stratified and multivariate logistic regression analysis was conducted to identify risk factors for perinatal death. RESULTS: Of the 3100 mothers, 192 (6.2%) had abortion complications. Of the remainder, there were 2142 (73.1%) deliveries, from whom the fetal outcomes were 257 (12.0%) still births, 369 (17.2%) neonatal deaths, 786 (36.7%) neonatal near misses and 730 (34.1%) were newborns with no or minimal life threatening complications. Of the 235 babies admitted to the neonatal intensive care unit (NICU), the main reasons for admission were prematurity for 64 (26.8%), birth asphyxia for 59 (23.7%), and grunting respiration for 26 (11.1%). Of the 235 babies, 38 (16.2%) died in the neonatal period, and of these, 16 died in the first 24 hours after admission. Ruptured uterus caused the highest case-specific mortality of 76.8%, and led to 16.9% of all newborn deaths. Across the four groups, there were significant differences in mean birth weight, p = 0.003. CONCLUSIONS: Antepartum hemorrhage, ruptured uterus, severe preeclampsia, eclampsia, and the syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome), led to statistically significant attributable risk of newborn deaths (still birth or neonatal deaths). Development of severe maternal outcomes, the mothers having been referred, and gravidity of 5 or more were significantly associated with newborn deaths.


Assuntos
Morte Perinatal , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Gravidez , Estudos Prospectivos , Fatores de Risco , Fatores Socioeconômicos , Uganda/epidemiologia
15.
Reprod Health ; 12: 23, 2015 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-25884387

RESUMO

BACKGROUND: Severe obstetric complications have potential negative impact on the family and household of the survivors, with potential negative effects during (and in the aftermath of) the traumatic obstetric events. The objective was to gain deeper understanding of how severe obstetric complications are perceived by male partners, and their impact on the livelihoods of the family and community. METHODS: Data was collected through 25 in-depth narrative interviews with male partners of women with severe obstetric morbidity. The interviews occurred 4-12 months after the traumatic childbirth events. To gain a deeper understanding of the meanings and spouses attach to the experiences, we employed the notions of social capital and resilience. RESULTS: Male partners' perceptions and experiences were mostly characterized by losses, dreams and dilemmas, disempowerment and alienation, seclusion and self isolation or reliance on the social networks. During the aftermath of the events, there was disruption of the livelihoods of the partners and the whole family. CONCLUSION: While a maternal near miss obstetric event might appear as a positive outcome for the survivors, partners and caregivers of women who experience severe obstetric morbidity are deeply affected by the experiences of this life-threatening episode.


Assuntos
Adaptação Psicológica , Complicações do Trabalho de Parto/psicologia , Complicações na Gravidez/psicologia , Resiliência Psicológica , Cônjuges/psicologia , Sobreviventes/psicologia , Adulto , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Gravidez , Fatores Socioeconômicos , Adulto Jovem
16.
Health Res Policy Syst ; 12: 60, 2014 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-25300499

RESUMO

BACKGROUND: Improved knowledge of obstetric danger signs, birth preparedness practices, and readiness for emergency complications are among the strategies aimed at both enhancing utilization of maternal health services and increasing access to skilled care during childbirth, particularly for women with obstetric complications. It is unclear whether knowledge of danger signs translates into improved birth preparedness and complication readiness. The objective was to assess the association between knowledge of danger signs and birth preparedness among women admitted with pregnancy complications. METHODS: The study included 810 women admitted in the antepartum period to Mulago hospital, Uganda. Data was collected on socio-demographic characteristics, reproductive history, pregnancy complications, knowledge of danger signs, and birth preparedness/complication readiness (BPCR). Logistic regression analyses were conducted to explore the relationship between knowledge of danger signs and birth preparedness. RESULTS: Only about 1 in 3 women were able to mention at least three of the five basic components of BPCR, and could be regarded as 'knowledgeable on BPCR'. One in every 4 women could not mention any of the five components. Women with history of obstetric problems during the previous pregnancy were more likely to be knowledgeable on danger signs when compared to those who had no complications in prior pregnancy. Women who were knowledgeable on danger signs were four times more likely to be knowledgeable on BPCR as compared to those who were not knowledgeable. CONCLUSIONS: Though awareness about danger signs was low, knowledge of danger signs was associated with knowledge of birth preparedness. More emphasis should be given to emergency/complication readiness during antenatal care sessions. There is a need to strengthen existing policy interventions to address birth preparedness and complication readiness for obstetric emergencies.


Assuntos
Parto Obstétrico , Conhecimentos, Atitudes e Prática em Saúde , Hospitalização , Complicações na Gravidez , Cuidado Pré-Natal , Adulto , Feminino , Humanos , Modelos Logísticos , Gravidez , Inquéritos e Questionários , Uganda , Adulto Jovem
17.
Int J Gynaecol Obstet ; 127(2): 201-5, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25270824

RESUMO

OBJECTIVE: To determine the incidence and risk factors for early neonatal death among newborns with severe perinatal morbidity. METHODS: A prospective cohort study was performed of 341 newborns with severe perinatal morbidity admitted to the neonatal intensive care unit of Mulago Hospital, Uganda. All newborns were followed up for 7 days or until time of death. Information surrounding the mother's obstetric history and pregnancy, the birth, and the neonatal history was collected using an interviewer-administered questionnaire and by review of relevant records. Multivariate logistic regression analysis was performed to assess factors independently associated with early neonatal death. RESULTS: A total of 37 (10.9%) neonates died within 7 days, giving an incidence of early neonatal death of 109 deaths per 1000 live births (3 per 100 person-days). In multivariate analysis, respiratory distress (adjusted risk ratio [aRR] 31.29; 95% CI, 4.17-234.20; P=0.001) and inadequate fetal heart monitoring during labor (aRR 6.0; 95% CI 1.40-25.67; P=0.016) were significantly associated with an increased risk of early neonatal death. CONCLUSION: Approximately one in 10 neonates with severe perinatal morbidity died within 7 days of birth. Respiratory distress and poor monitoring of labor were risk factors for early neonatal death.


Assuntos
Mortalidade Infantil , Doenças do Recém-Nascido/mortalidade , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/mortalidade , Unidades de Terapia Intensiva Neonatal , Masculino , Fatores de Risco , Fatores Socioeconômicos , Natimorto/epidemiologia , Uganda/epidemiologia , Adulto Jovem
18.
Int J Gynaecol Obstet ; 127(3): 265-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25087177

RESUMO

OBJECTIVE: To gain an understanding of how obstetric complications affect the lives and livelihoods of survivors. METHODS: A phenomenological study was conducted between April and August 2013 at Mulago Hospital, Kampala, Uganda. Data were collected through in-depth interviews among 36 women admitted with obstetric near miss. The interviews investigated perceptions, lived experiences, and meanings attached to such experiences by survivors. More specifically, the questions explored: self-rated health; anticipated social, sexual, and reproductive health challenges; and mitigating factors. RESULTS: The identified themes were prior expectations, vulnerability, body and social capital, and resilience. Women were found to approach childbirth with predetermined expectations that influenced their pregnancy and childbirth experience. Fatalism, expectations, and social insecurity markedly contributed to vulnerability. Resilience factors included ability to institute adaptations and to harness body and social capital. CONCLUSION: Vulnerabilities and their determinants were found to be inter-related. Individuals' social capital fluctuates over the acute crisis, necessitating multiple adaptations and coping strategies to reduce vulnerability or increase resilience. Although social and body capital may be mobilized to mitigate the effects of the obstetric crisis, they can either worsen vulnerability or increase resilience.


Assuntos
Adaptação Psicológica , Complicações na Gravidez/psicologia , Resiliência Psicológica , Sobreviventes/psicologia , Adolescente , Adulto , Feminino , Humanos , Complicações do Trabalho de Parto/psicologia , Percepção , Gravidez , Fatores Socioeconômicos , Uganda , Adulto Jovem
19.
Reprod Health ; 11: 31, 2014 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-24758354

RESUMO

BACKGROUND: Maternal mortality is a major public health challenge in Uganda. Whereas uterine rupture remains a major cause of maternal morbidity and mortality, there is limited research into what happens to women who survive such severe obstetric complications. Understanding their experiences might delineate strategies to support survivors. METHODS: This qualitative study used a phenomenological approach to explore lived experiences of women who developed uterine rupture following obstructed labor. In-depth interviews initially conducted during their hospitalization were repeated 3-6 months after the childbirth event to explore their health and meanings they attached to the traumatic events and their outcomes. Data were analyzed using thematic analysis. RESULTS: The resultant themes included barriers to access healthcare, multiple "losses" and enduring physical, psychosocial and economic consequences. Many women who develop uterine rupture fail to access critical care needed due to failure to recognise danger signs of obstructed labor, late decision making for accessing care, geographical barriers to health facilities, late or failure to diagnose obstructed labor at health facilities, and failure to promptly perform caesarean section. Secondly, the sequel of uterine rupture includes several losses (loss of lives, loss of fertility, loss of body image, poor quality of life and disrupted marital relationships). Thirdly, uterine rupture has grim economic consequences for the survivors (with financial loss and loss of income during and after the calamitous events). CONCLUSION: Uterine rupture is associated with poor quality of care due to factors that operate at personal, household, family, community and society levels, and results in dire physical, psychosocial and financial consequences for survivors. There is need to improve access to and provision of emergency obstetric care in order to prevent uterine rupture consequent to obstructed labor. There is also critical need to provide counselling and support to survivors to enable them cope with physical, social, psychological and economic consequences.


Assuntos
Complicações do Trabalho de Parto/psicologia , Qualidade de Vida , Sobreviventes/psicologia , Ruptura Uterina/psicologia , Adulto , Assistência à Saúde/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Hospitais , Humanos , Mortalidade Materna , Complicações do Trabalho de Parto/terapia , Gravidez , Uganda , Ruptura Uterina/terapia
20.
BMC Pregnancy Childbirth ; 14: 54, 2014 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-24479421

RESUMO

BACKGROUND: Development of appropriate interventions to increase male involvement in pregnancy and childbirth is vital to strategies for improving health outcomes of women with obstetric complications. The objective was to gain a deeper understanding of their experiences of male involvement in their partners' healthcare during pregnancy and childbirth. The findings might inform interventions for increasing men's involvement in reproductive health issues. METHODS: We conducted 16 in-depth interviews with men who came to the hospital to attend to their spouses/partners admitted to Mulago National Referral Hospital. All the spouses/partners had developed severe obstetric complications and were admitted in the high dependency unit. We sought to obtain detailed descriptions of men's experiences, their perception of an ideal "father" and the challenges in achieving this ideal status. We also assessed perceived strategies for increasing male participation in their partners' healthcare during pregnancy and childbirth. Data was analyzed by content analysis. RESULTS: The identified themes were: Men have different descriptions of their relationships; responsibility was an obligation; ideal fathers provide support to mothers during childbirth; the health system limits male involvement in childbirth; men have no clear roles during childbirth, and exclusion and alienation in the hospital environment. The men described qualities of the ideal father as one who was available, easily reached, accessible and considerate. Most men were willing to learn about their expected roles during childbirth and were eager to support their partners/wives/spouses during this time. However, they identified personal, relationship, family and community factors as barriers to their involvement. They found the health system unwelcoming, intimidating and unsupportive. Suggestions to improve men's involvement include creating more awareness for fathers, male-targeted antenatal education and support, and changing provider attitudes. CONCLUSIONS: This study generates information on perceived roles, expectations, experiences and challenges faced by men who wish to be involved in maternal health issues, particularly during pregnancy and childbirth. There is discord between the policy and practice on male involvement in pregnancy and childbirth. Health system factors that are critical to promoting male involvement in women's health issues during pregnancy and childbirth need to be addressed.


Assuntos
Parto Obstétrico , Conhecimentos, Atitudes e Prática em Saúde , Homens/psicologia , Cuidado Pré-Natal , Papel (figurativo) , Atitude do Pessoal de Saúde , Feminino , Hospitais , Humanos , Entrevistas como Assunto , Masculino , Complicações do Trabalho de Parto/psicologia , Percepção , Gravidez , Pesquisa Qualitativa , Uganda
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