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1.
BMJ Open ; 11(2): e041723, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574146

RESUMO

OBJECTIVE: To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda. SETTING: Three subcounties of Lira district in Northern Uganda. DESIGN: This was a community-based cross-sectional study nested in a cluster randomised controlled trial. PARTICIPANTS: Mother-baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer. PRIMARY AND SECONDARY OUTCOMES: The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family. RESULTS: We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9). CONCLUSION: The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to-skin care could reduce the risk of neonatal hypothermia. TRIAL REGISTRATION NUMBER: ClinicalTrial.gov as NCT02605369.

2.
Glob Health Action ; 14(1): 1859823, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33446087

RESUMO

Background: Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective: We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods: This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results: Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion: The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.

3.
Trop Med Health ; 48(1): 89, 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33292804

RESUMO

BACKGROUND: Neonatal hypoglycemia is the most common endocrine abnormality in children, which is associated with increased morbidity and mortality. The burden and risk factors of neonatal hypoglycemia in rural communities in sub-Saharan Africa are unknown. OBJECTIVE: To determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda. METHODS: This was a community-based cross-sectional study, nested in a cluster randomized controlled trial designed to promote health facility births and newborn care practices in Lira District, Northern Uganda. This study recruited neonates born to mothers in the parent study. Random blood glucose was measured using an On Call® Plus glucometer (ACON Laboratories, Inc., 10125 Mesa Road, San Diego, CA, USA). We defined hypoglycemia as a blood glucose of < 47 mg/dl. To determine the factors associated with neonatal hypoglycemia, a multivariable linear regression mixed-effects model was used. RESULTS: We examined 1416 participants of mean age 3.1 days (standard deviation (SD) 2.1) and mean weight of 3.2 kg (SD 0.5). The mean neonatal blood glucose level was 81.6 mg/dl (SD 16.8). The prevalence of a blood glucose concentration of < 47 mg/dl was 2.2% (31/1416): 95% CI 1.2%, 3.9%. The risk factors for neonatal hypoglycemia were delayed breastfeeding initiation [adjusted mean difference, - 2.6; 95% CI, - 4.4, - 0.79] and child age of 3 days or less [adjusted mean, - 12.2; 95% CI, - 14.0, - 10.4]. CONCLUSION: The incidence of neonatal hypoglycemia was low in this community and was predicted by delay in initiating breastfeeding and a child age of 3 days or less. We therefore suggest targeted screening and management of neonatal hypoglycemia among neonates before 3 days of age and those who are delayed in the onset of breastfeeding.

4.
Sci Rep ; 10(1): 16319, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004969

RESUMO

Prevention of unintended pregnancies is a global strategy to eliminate mother-to-child transmission of HIV. Factors surrounding unintended pregnancy among women living with HIV are not well understood. We aimed to determine the prevalence and predictors for unintended pregnancy among these women in Northern Uganda. We conducted a cross-sectional survey among 518 women using a structured questionnaire. We asked questions on socio-demographic, reproductive-related and HIV-related characteristics. We conducted multivariable logistic regression and reported adjusted odds ratios. The prevalence of unintended pregnancy was 41.1%. The predictors for unintended pregnancy were: being single (not living with a partner or being in a marital union), having five or more children and taking antiretroviral drugs for long periods of time. HIV counselling services should target women living with HIV who are not in a marital union, those having a higher parity and those who have taken ART for longer periods.

5.
PLoS One ; 15(10): e0240409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048971

RESUMO

INTRODUCTION: Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. METHODS: We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded. RESULTS: Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. CONCLUSIONS: The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.

6.
Glob Health Action ; 13(1): 1743496, 2020 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-32524895

RESUMO

BACKGROUND: Skilled birth attendants must be competent to provide prompt resuscitation to save newborn lives at birth. Both knowledge and skills (competence) decline with time after training but the optimal duration for refresher training among frontline-skilled birth attendants in low-resource settings is unknown. OBJECTIVES: We assessed the effect of an innovative Helping-Babies-Breathe simulation-based teaching method using video-debriefing compared to standard Helping-Babies-Breathe training on 1) neonatal resuscitation knowledge and skills attainment and 2) competence retention among skilled birth attendants in Northern Uganda. METHODS: A total of 26 health facilities with 86 birth attendants were equally randomised to intervention and control arms. The 2nd edition of the American Association of Pediatrics Helping-Babies-Breathe curriculum was used for training and assessment. Knowledge and skills were assessed pre- and post-training, and during follow-up at 6 months. A mixed effects linear regression model for repeated measures was used to assess the short and long-term effects of the intervention on neonatal resuscitation practices while accounting for clustering. RESULTS: Eighty-two (95.3%) skilled birth attendants completed follow-up at 6 months. Approximately 80% of these had no prior Helping-Babies-Breathe training and 75% reported practicing neonatal resuscitation routinely. Standard Helping-Babies-Breathe training with video-debriefing improved knowledge and skills attainment post-training [adjusted mean difference: 5.34; 95% CI: 0.82-10.78] and retention [adjusted mean difference: 2.97; 95% CI: 1.52-4.41] over 6 months post-training compared to standard training after adjusting for confounding and clustering. Factors that reduced knowledge and skills retention among birth attendants were monthly resuscitation of one neonate or more and being in service for more than 5 years. CONCLUSION: Adding video-debriefing to standard Helping-Babies-Breathe training had an effect on birth attendants' competence attainment and retention over 6 months in Uganda. However, more research is needed to justify the proposed intervention in this context.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31100814

RESUMO

Knowledge of key decision makers and actors in newborn care is necessary to ensure that health interventions are targeted at the right people. This was a cross-sectional study carried out in Lira district, Northern Uganda. Multivariable logistic regression was used to determine factors associated with mothers being the key decision maker regarding where to give birth from and when to initiate breastfeeding. Fathers were the key decision makers on the place of birth (54.3%, n = 505) and on whether to seek care for a sick newborn child (47.7%, n = 92). Grandmothers most commonly bathed the baby immediately after birth (55.5%, n = 516), whereas mothers and health workers were common decision makers regarding breastfeeding initiation. Predictors for a mother being the key decision maker on the place of birth included: Mother having a secondary education (AOR 1.9: 95% C.I (1.0-3.6)) and mother being formally employed (AOR 2.0: 95% (1.5-2.9)). Mothers, fathers, grandmothers, health-workers, and traditional birth attendants were the most influential in the selected newborn care practices. Programs that aim to promote newborn care need to involve husbands, grandmothers, and health workers in addition to mothers.


Assuntos
Tomada de Decisões , Cuidado do Lactente , Inquéritos e Questionários , Adulto , Aleitamento Materno , Pré-Escolar , Estudos Transversais , Pai , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Tocologia , Mães , Parto , Gravidez , Uganda
8.
Midwifery ; 67: 95-102, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30286379

RESUMO

OBJECTIVE: To identify barriers and enablers to conducting safe uninterrupted skin-to-skin contact (SSC) in the first hour after birth in a low-resource setting and to evaluate how health care professionals coped with the identified barriers after completion of an intervention package. DESIGN AND SETTING: A qualitative method using focus-group and individual interviews with health professionals at a governmental hospital in Uganda. PARTICIPANTS: 81 health professionals. INTERVENTIONS: A 6-step intervention package including, amongst other things, showing a DVD on safe uninterrupted SSC following birth and discussing with the professionals what barriers and possibilities there were to changing practice to allow SSC for one hour. MEASUREMENTS AND FINDINGS: The thematic analysis of the intervention interviews yielded the following themes: Perceived barriers including medical events, psychosocial issues and standard midwifery practice; Pragmatic barriers including economic constraints in the hospital and community; Anticipated barriers by staff and families; Enabling events including staff involvement. Most of the barriers involving expenses were not solved. When the mother and infant had to move to the postnatal ward within one hour after birth, there were difficulties in keeping SSC during the transportation, but this obstacle was partly solved. A few mothers (i.e. depressed and/or adolescent) were considered to be unwilling to keep the infant skin-to-skin; this difficulty was not solved. Practising SSC led the participants to find advantages such as reduced work load and positive effects on pain during suturing. CONCLUSIONS: SSC following birth was shown to be applicable and accepted by the health professionals. The involvement of professionals had clinical implications, such as initiatives to broadcast the message of SSC by radio to the community and introduce SSC to women having a Caesarean section.


Assuntos
Atitude do Pessoal de Saúde , Barreiras de Comunicação , Parto Obstétrico , Método Canguru , Tocologia , Educação de Pacientes como Assunto , Feminino , Grupos Focais , Humanos , Recém-Nascido , Entrevistas como Assunto , Gravidez , Uganda
9.
BMC Pediatr ; 18(1): 336, 2018 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373538

RESUMO

BACKGROUND: There's abundant sunshine in the tropics but severe rickets is still observed. Nutritional rickets is associated with an increased risk of acute lower respiratory infections. Pneumonia is the leading cause of death in the under 5 -year old children with the highest burden in developing countries. Both Pneumonia and rickets are common in the developing countries and may affect clinical presentation and outcome. This study aimed to determine the prevalence and associated factors of nutritional rickets in children admitted with severe pneumonia. METHODS: This was a cross-sectional study of children aged 2-59 months presenting with severe pneumonia at an emergency unit. We enrolled 221 children between February and June 2012 after consent. A pre-coded questionnaire was used to collect data on socio-demographic, nutritional and past medical history. Physical exam was done for signs of rickets and anthropometric measurements. Serum calcium, phosphorus, and alkaline phosphatase (ALP) were assessed. Children with any physical signs of rickets or biochemical rickets (ALP > 400 IU); had a wrist x-ray done. Nutritional rickets was defined as the presence of radiological changes of cupping or fraying and/ or metaphyseal thickening. Severe pneumonia was defined using the WHO criteria. Statistical analysis was performed using the Stata 10 statistical package. P- value < 0.05 was significant. RESULTS: The prevalence of nutritional rickets among children with severe pneumonia is 9.5%. However, 14.5% had raised ALP (biochemical rickets). The factors independently associated with rickets was an elevated alkaline phosphatase; p-value < 0.001, or 32.95 95% CI (10.54-102.93). Other factors like breastfeeding, big family size, birth order were not significantly associated with rickets. Low serum calcium was detected in 22 (9.9%) of the 221 participants. Overall few children with rickets had typical clinical features of rickets on physical examination. CONCLUSION: Rickets is a common problem in our setting despite ample sunshine. Clinicians should actively assess children for rickets in this setting and screen for rickets in those children at high risk even without clinical features.


Assuntos
Países em Desenvolvimento , Pneumonia/epidemiologia , Raquitismo/epidemiologia , Fosfatase Alcalina/sangue , Cálcio/deficiência , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pneumonia/complicações , Prevalência , Raquitismo/sangue , Raquitismo/complicações , Raquitismo/enzimologia , Uganda/epidemiologia
10.
Glob Health Action ; 10(1): 1410975, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29243560

RESUMO

BACKGROUND: Initiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality. OBJECTIVE: To determine the prevalence and factors associated with delayed initiation of breastfeeding. METHODS: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software ( https://opendatakit.org ). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding. RESULTS: Almost half [48.2%, 95% confidence interval (CI) (44.3-52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breastfeeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73-33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41-2.88)], home delivery [AOR 1.43 95% CI (1.04-1.97)] and mother being responsible for initiating breastfeeding as compared to a health worker or relative [AOR 1.73 95% CI (1.33-2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30-0.96)] to delay initiation of breastfeeding as compared to those with no education. CONCLUSION: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Mães/psicologia , Cesárea/estatística & dados numéricos , Criança , Estudos Transversais , Escolaridade , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Razão de Chances , Gravidez , Prevalência , Inquéritos e Questionários , Uganda
11.
Confl Health ; 9: 24, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26265935

RESUMO

BACKGROUND: Northern Uganda was severely affected by two decades of civil war that led to the displacement and encampment of an estimated 1.6 million inhabitants. The objective of this study was to assess community perspectives, attitude and factors that influence use of family planning (FP) services in post conflict Gulu district. METHODS: We conducted a cross sectional study using multistage sampling technique. All three counties in the district were purposely selected. Two sub-counties per county and four parishes per sub-county were randomly selected. A total of 24 parishes (clusters) and 21 adult heads of households per cluster were randomly selected and interviewed. In total, 500 adults 117 males (23.4 %) and 383 females (76.6 %) were interviewed. We conducted 8 focus group discussions and 6 key informant interviews with family planning managers and service providers. Quantitative data were entered in EPI data and analyzed using STATA version 12. Qualitative data were analyzed manually using thematic content analysis. RESULTS: Contraceptive prevalence rate was 47.5 %. Communities perceive FP as acceptable, beneficial and geographically, temporally and financially accessible. Factors associated with FP use included age 26-35 years (AOR 1.92, 95 % CI 1.18-3.10, p = 0.008), and 36-45 years (AOR 2.27, 95 % CI 1.21-4.25, p = 0.010), rural residence (AOR = 0.41, 95 % CI 0.24-0.71, p = 0.001), cohabitation (AOR = 2.77, 95 % CI 1.15-6.65, p = 0.023), and being a farmer (AOR 0.59, 95 % CI 0.35-0.97, p = 0.037). The main reason for non-use of family planning was fear of side effects 88.2 %. The main source of FP services was government health facilities 94.2 %. CONCLUSION: Use of family planning is relatively high and communities view FP services as acceptable, beneficial and accessible. Family planning use is mainly determined by age, residence, occupation and marital status. Fear of side effects is the main impediment to FP use. There is need to increase awareness and effectively manage side effects of family planning in the settings.

12.
PLoS One ; 10(4): e0123240, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25874411

RESUMO

BACKGROUND: We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control. METHODS: In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting ≥14 days were enrolled and evaluated for pertussis using DNA polymerase chain reaction (PCR) and ELISA serology tests. RESULTS: Pertussis prevalence was 67 (15% (95% Confidence Interval (CI): 12-18)) and 81 (20% (95% CI: 16-24)) by PCR and ELISA, respectively among 449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination coverage of 94% in this age group. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30%) had a coughing household member and 316 (70%) did not. Among 133 children that had a coughing household member, sex of child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR) 7.16 (95% CI: 1.24-41.44)). Among the 316 children that did not have a coughing household member, age <23 months, having or contact with a coughing individual in neighborhood, a residence with one room, and having a caretaker with >40 years of age were the factors associated with pertussis. Age <23months was three times more likely to be associated with pertussis compared to age 24-59 months (OR 2.97 (95% CI: 1.07-8.28)). CONCLUSION: Findings suggest high prevalence of pertussis among children with persistent cough at a health facility and it was marked in children >59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.


Assuntos
Vacina contra Coqueluche/administração & dosagem , Coqueluche/epidemiologia , Coqueluche/transmissão , Fatores Etários , Bordetella pertussis/fisiologia , Criança , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Lactente , Masculino , Razão de Chances , Prevalência , Uganda , População Urbana , Coqueluche/imunologia , Coqueluche/prevenção & controle
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