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Kirabira J, Kayondo M, Bawakanya SM, Nsubuga EJ, Yarine F, Namuli A, Namugumya R, Natulinda CH, Atwine R, Birungi A, Lugobe HM, Tibaijuka L, Kisombo D, Jjuuko M, Agaba DC, Saturday P, Atupele SM, Tumusiime M, Migisha R, Kajabwangu R. Association between HIV Serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study. BMC Womens Health 2024; 24:266. [PMID: 38678278 PMCID: PMC11055386 DOI: 10.1186/s12905-024-03108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Uganda has approximately 1.2 million people aged 15-64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected women are more likely to have human papilloma virus (HPV) infection progress to cancer than women not infected with HIV. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS We conducted a comparative cross-sectional study of 210 women aged 22-65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were obtained for microscopy to observe premalignant cervical lesions. Multivariate logistic regression was performed to determine the association between HIV status and premalignant cervical lesions. RESULTS The overall prevalence of premalignant cervical lesions in the study population was 17% (n = 72; 95% C.I: 14.1-21.4), with 23% (n = 47; 95% C.I: 17.8-29.5) in women living with HIV and 12% (n = 25; 95% C.I: 8.2-17.1) in women not living with HIV (p < 0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n = 35) and women not living with HIV (80%; n = 20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27-4.42; p = 0.007). CONCLUSION Premalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.
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Affiliation(s)
- Justus Kirabira
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda.
| | - Musa Kayondo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | | | | | - Fajardo Yarine
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Alexcer Namuli
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara City, Uganda
| | - Rita Namugumya
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara City, Uganda
| | | | - Raymond Atwine
- Department of Pathology, Mbarara University of Science & Technology, Mbarara City, Uganda
| | - Abraham Birungi
- Department of Pathology, Mbarara University of Science & Technology, Mbarara City, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Leevan Tibaijuka
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara City, Uganda
| | - Dean Kisombo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Mark Jjuuko
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - David Collins Agaba
- Department of Physiology, Mbarara University of Science & Technology, Mbarara City, Uganda
| | - Pascal Saturday
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Subira Mlangwa Atupele
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Matthew Tumusiime
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science & Technology, Mbarara City, Uganda
| | - Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, Uganda
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Agaba DC, Lugobe HM, Migisha R, Jjuuko M, Saturday P, Kisombo D, Atupele SM, Kirabira J, Tumusiime M, Katamba G, Mugyenyi G, Masembe S, Kayondo M, Ngonzi J. Abnormal obstetric shock index and associated factors among immediate postpartum women following vaginal delivery at a tertiary hospital in southwestern Uganda. BMC Pregnancy Childbirth 2024; 24:31. [PMID: 38178057 PMCID: PMC10768342 DOI: 10.1186/s12884-023-06238-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/29/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Early recognition of haemodynamic instability after birth and prompt interventions are necessary to reduce adverse maternal outcomes due to postpartum haemorrhage. Obstetric shock Index (OSI) has been recommended as a simple, accurate, reliable, and low-cost early diagnostic measure that identifies hemodynamically unstable women. OBJECTIVES We determined the prevalence of abnormal obstetric shock index and associated factors among women in the immediate postpartum period following vaginal delivery at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. METHODS We conducted a cross-sectional study at the labour suite and postnatal ward of MRRH from January 2022 to April 2022. We systematically sampled women who had delivered vaginally, and measured their blood pressures and pulse rates at 1 h postpartum. We excluded mothers with hypertensive disorders of pregnancy. Sociodemographic, medical and obstetric data were obtained through interviewer-administered questionnaires. The prevalence of abnormal OSI was the proportion of participants with an OSI ≥ 0.9 (calculated as the pulse rate divided by the systolic BP). Logistic regression analysis was used to determine associations between abnormal OSI and independent variables. RESULTS We enrolled 427 women with a mean age of 25.66 ± 5.30 years. Of these, 83 (19.44%), 95% CI (15.79-23.52) had an abnormal obstetric shock index. Being referred [aPR 1.94, 95% CI (1.31-2.88), p = 0.001], having had antepartum haemorrhage [aPR 2.63, 95% CI (1.26-5.73), p = 0.010] and having a visually estimated blood loss > 200 mls [aPR 1.59, 95% CI (1.08-2.33), p = 0.018] were significantly associated with abnormal OSI. CONCLUSION Approximately one in every five women who delivered vaginally at MRRH during the study period had an abnormal OSI. We recommend that clinicians have a high index of suspicion for haemodynamic instability among women in the immediate postpartum period. Mothers who are referred in from other facilities, those that get antepartum haemorrhage and those with estimated blood loss > 200mls should be prioritized for close monitoring. It should be noted that the study was not powered to study the factors associated with AOSI and therefore the analysis for factors associated should be considered exploratory.
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Affiliation(s)
- David Collins Agaba
- Department of Physiology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda.
| | - Henry Mark Lugobe
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Mark Jjuuko
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Pascal Saturday
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Dean Kisombo
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Subira Mlangwa Atupele
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Justus Kirabira
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Matthew Tumusiime
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Godfrey Katamba
- Department of Physiology, King Ceasor University, P.O Box 88, Kampala, Uganda
| | - Godfrey Mugyenyi
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Sezalio Masembe
- Department of Obstetrics & Gynaecology, Kabale University, P.O Box 317, Kabale, Southwestern, Uganda
| | - Musa Kayondo
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics & Gynaecology, Mbarara University of Science & Technology, P.O Box 1410, Mbarara, Southwestern, Uganda
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