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Hakizimana T, Muhumuza J, Selamo FM, Ishimwe MPS, Kajabwangu R, Jelle OM, Muhumuza J, Kiyaka SM, Nyakato S, Fajardo Y. Prevalence and Factors Associated with Syphilis among Mothers with Missed Opportunities for Antenatal Syphilis Testing in Rural Western Uganda: A Cross-Sectional Study. Int J Reprod Med 2023; 2023:2971065. [PMID: 37664641 PMCID: PMC10471452 DOI: 10.1155/2023/2971065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/10/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023] Open
Abstract
Background Early prenatal syphilis testing and treatment are essential preventative measures for maternal syphilis and associated adverse pregnancy outcomes of pregnancy; however, data shows that two-thirds of all cases are missed among women who visit prenatal care center at least once but are not tested for syphilis. This study determined the prevalence and factors associated with syphilis infection among mothers with missed opportunities for antenatal syphilis testing in rural western Uganda delivered at Fort Portal Regional Referral Hospital (FRRH). Methods A cross-sectional study was done during the period from April 2022 to June 2022. A total of 124 participants had been recruited consecutively from postnatal ward of FRRH. Pretested questionnaires were used to obtain information on data required for analysis. Venous blood sampling (2 ml taken from the forearm using anticoagulant free vacutainer) was done for all mothers who missed opportunity for prenatal syphilis testing using both RPR and TPHA. Descriptive statistics followed by binary logistic regression analysis was done using SPSS version 22.0. Results The prevalence of syphilis infection was 27 (21.8%). After adjusted analysis, having more than one sexual partners in the past one year was associated with higher odds of syphilis infection (aOR = 24.922, 95% CI: 4.462-139.201, p < 0.001), and staying with the partner was found to be associated with lower odds of syphilis infection (aOR = 0.213, 95% CI: 0.040-1.142, p = 0.050). Conclusions The study identified high prevalence of syphilis infection among mothers with missed opportunities for antenatal syphilis testing, and this was positively associated with having more than one sexual partners in the past one year and negatively associated with not staying with partner.
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Affiliation(s)
- Theoneste Hakizimana
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | | | | | - Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | - Osman Mohamud Jelle
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Kampala International University, Western Campus, Uganda
| | - Sonye Magugu Kiyaka
- Department of Surgery, Kampala International University, Western Campus, Uganda
| | - Sandra Nyakato
- Department of Laboratory, Fort Portal Regional Referral Hospital, Kabarole, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
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Osman MJ, Muhumuza J, Fajardo Y, Kwikiriza A, Asanairi B, Kajabwangu R, Ishimwe MPS, Hakizimana T. Incidence and Factors Associated with Postspinal Headache in Obstetric Mothers Who Underwent Spinal Anesthesia from a Tertiary Hospital in Western Uganda: A Prospective Cohort Study. Anesthesiol Res Pract 2023; 2023:5522444. [PMID: 37599669 PMCID: PMC10435309 DOI: 10.1155/2023/5522444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/15/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023] Open
Abstract
Background The proportion of obstetric mothers reporting postspinal headache (PSH) in Uganda is high. The aim of this study is to determine the incidence and factors associated with postspinal headache among obstetric patients who underwent spinal anesthesia during cesarean section at a tertiary hospital in Western Uganda. Methods A prospective cohort study was done on 274 consecutively enrolled obstetric patients at Fort Portal Regional Referral Hospital (FRRH) from August to November 2022. Pretested questionnaires were used to obtain the data needed for analysis. The data were entered into Microsoft Excel version 16, coded, and transported into SPSS version 22 for analysis. Descriptive statistics was used to determine the incidence of postspinal headache. Binary logistic regression was computed to obtain factors associated with postspinal headache. Results The overall incidence of postspinal headache was 38.3% (95% CI: 32.5-44.4). Factors with higher odds of developing postspinal headache included using cutting needle (aOR 3.206, 95% CI: 1.408-7.299, p=0.006), having a previous history of chronic headache (aOR 3.326, 95% CI: 1.409-7.85, p=0.006), having lost >1500 mls of blood intraoperatively (aOR 6.618, 95% CI: 1.582-27.687, p=0.010), initiation of ambulation >24 h after spinal anesthesia (aOR 2.346, 95% CI: 1.079-5.102, p=0.032), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (aOR 3.278, 95% CI: 1.263-8.510, p=0.015), undergoing 2 puncture attempts (aOR 7.765, 95% CI: 3.48-17.326, p ≤ 0.001), 3 puncture attempts (aOR 27.61, 95% CI: 7.671-99.377, p ≤ 0.001) and >3 puncture attempts (aOR 20.17, 95% CI: 1.614-155.635, p=0.004), those prescribed weak opioids (aOR 20.745, 95% CI: 2.964-145.212, p=0.002), nonsteroidal anti-inflammatory drug (NSAID) with nonopioids (aOR 6.104, 95% CI: 1.257-29.651, p=0.025), and NSAID with weak opioids (aOR 5.149, 95% CI: 1.047-25.326, p=0.044). Women with a body mass index (BMI) of 25-29.9 kg/m2 (aOR 0.471, 95% CI: 0.224-0.989, p=0.047) and a level of puncture entry at L3-4 (aOR 0.381, 95% CI: 0.167-0.868, p=0.022) had lower odds of developing PSH. Conclusions The incidence of postspinal headache is still high as compared to the global range. This was significantly associated with needle design, amount of cerebro-spinal fluid lost, number of puncture attempts, body mass index, previous diagnosis with chronic headache, amount of intraoperative blood loss, time at start of ambulation, level of puncture entry, and class of analgesic prescribed. We recommend the use of a smaller gauge needle, preventing CSF loss, deliberate attempts to ensure successful puncture with fewer attempts, puncture attempts at L3-4, reducing intraoperative blood loss, earlier ambulation, and prescribing adequate analgesia to reduce the incidence of postspinal headache.
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Affiliation(s)
- Mohamud Jelle Osman
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
| | - Andrew Kwikiriza
- Department of Anesthesia, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
| | - Baluku Asanairi
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
| | - Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
| | | | - Theoneste Hakizimana
- Department of Obstetrics and Gynecology, Faculty of Clinical Medicine and Dentistry, Kampala International University, Western Campus, Ishaka, Uganda
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Nang DW, Tukirinawe H, Okello M, Tayebwa B, Theophilus P, Sikakulya FK, Fajardo Y, Afodun AM, Kajabwangu R. Prevalence of high-risk human papillomavirus infection and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. BMC Womens Health 2023; 23:209. [PMID: 37118735 PMCID: PMC10148521 DOI: 10.1186/s12905-023-02342-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 04/10/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND High-risk HPV is considered a major risk factor for the development of cervical cancer, the most common malignancy among women in Uganda. However, there is a paucity of updated epidemiological data on the extent of the burden and factors associated with hr-HPV infection among women of reproductive age. The aim of this study was to determine the prevalence and genotype distribution of hr-HPV and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. METHODS We conducted a cross-sectional study from April to June 2022. A total of 216 women of reproductive age attending the gynecological outpatient clinic were consecutively enrolled. Interviewer-administered questionnaires were used to collect participant characteristics, cervical specimens were collected by clinicians, and molecular HPV testing was performed using the Cepheid Xpert HPV DNA test. Descriptive statistics followed by binary logistic regression were conducted using SPSS version 22. RESULTS The prevalence of hr-HPV was 16.67%. Other hr-HPV types other than HPV 16 and 18 were predominant, with a prevalence of 10.6%; HPV 18/45 (2.31%), HPV 16 (0.46%), and 3.24% of the study participants had more than one hr-HPV genotype. On multivariate logistic regression, an HIV-positive status (aOR = 7.06, CI: 2.77-10.65, p = 0.007), having 3 or more sexual partners in life (aOR = 15.67, CI: 3.77-26.14, p = 0.008) and having an ongoing abnormal vaginal discharge (aOR = 5.37, CI: 2.51-11.49, p = 0.002) were found to be independently associated with hr-HPV infection. CONCLUSIONS AND RECOMMENDATIONS The magnitude of hr-HPV is still high compared to the global prevalence. HIV-positive women and those in multiple sexual relationships should be prioritized in cervical cancer screening programs. The presence of abnormal vaginal discharge in gynecology clinics should prompt HPV testing.
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Affiliation(s)
- David Wol Nang
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda.
| | - Happy Tukirinawe
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Maxwell Okello
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Bekson Tayebwa
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Pius Theophilus
- Department of Medical Laboratory Science, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Franck Katembo Sikakulya
- Department of Surgery, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
| | - Adam Moyosore Afodun
- Department of Anatomy and Cell Biology, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Kampala International University Teaching Hospital, Ishaka-Bushenyi, Uganda
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Kanyesigye H, Ngonzi J, Mulogo E, Fajardo Y, Kabakyenga J. Health Care Workers' Experiences, Challenges of Obstetric Referral Processes and Self-Reported Solutions in South Western Uganda: Mixed Methods Study. Risk Manag Healthc Policy 2022; 15:1869-1886. [PMID: 36225611 PMCID: PMC9550169 DOI: 10.2147/rmhp.s377304] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction In resource limited settings, the highest burden of adverse maternal-fetal outcomes at referral hospitals is registered from emergency obstetric referrals from lower health facilities. Implementation of referral protocols has not been optimally successful possibly attributed to lack of understanding of profile of obstetric referrals and local challenges faced during implementation process. Objective This study described the profile of emergency obstetric referrals, challenges faced in implementation of obstetric referral processes and explored self-reported solutions by health workers. Methods This was a mixed methods study done at Mbarara Regional Referral Hospital (MRRH) and health centre IVs in South-Western Uganda. We consecutively recruited emergency obstetric referrals from Isingiro district for delivery at MRRH. Using a pre-tested questionnaire, we collected demographics, obstetric and referral characteristics. We described the profile of referrals using frequencies and proportions based on demographics, obstetric and referral characteristics. We conducted focus group discussions and in-depth interviews with health workers using discussion/interview guides. Using thematic analysis, we ascertained the challenges and health worker self-reported solutions. Results We recruited 161 referrals: 104(65%) were below 26 years, 16(10%) had no formal education, 11(7%) reported no income, 151(94%) had no professional-escort, 137(85%) used taxis, 151(96%) were referred by midwives. Common diagnoses were previous cesarean scar (24% [n=39]) and prolonged labour (21% [n=33]). There was no communication prior to referral and no feedback from MRRH to lower health facilities. Other challenges included inconsistencies of ambulance and anesthesia services, electric power, medical supplies, support supervision, and harassment by colleagues. Self-reported solutions included the use of phone call technology for communication, audit meetings, support supervision and increasing staffing level. Conclusion Most referrals are of poor social-economic status, use taxis, and lack professional-escort. Health workers suffer harassment, lack of communication and shortage of supplies. We need to experiment whether mobile phone technology could solve the communication gap.
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Affiliation(s)
- Hamson Kanyesigye
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda,Correspondence: Hamson Kanyesigye, Tel +256752806921, Email
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jerome Kabakyenga
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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Kanyesigye H, Kabakyenga J, Mulogo E, Fajardo Y, Atwine D, MacDonald NE, Bortolussi R, Migisha R, Ngonzi J. Improved maternal-fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study. BMC Pregnancy Childbirth 2022; 22:684. [PMID: 36064375 PMCID: PMC9442930 DOI: 10.1186/s12884-022-05007-0] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency obstetric referrals develop adverse maternal-fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may bridge such communication challenges. We investigated effect of a phone call communication prior to referral of mothers in labour as intervention to reduce preparation delays and improve maternal-fetal outcome at a referral hospital in a resource limited setting. METHODS This was a quasi-experimental study with non-equivalent control group conducted at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda from September 2020 to March 2021. Adverse maternal-fetal outcomes included: early neonatal death, fresh still birth, obstructed labour, ruptured uterus, maternal sepsis, low Apgar score, admission to neonatal ICU and hysterectomy. Exposure variable for intervention group was a phone call prior maternal referral from a lower health facility. We compared distribution of clinical characteristics and adverse maternal-fetal outcomes between intervention and control groups using Chi square or Fisher's exact test. We performed logistic regression to assess association between independent variables and adverse maternal-fetal outcomes. RESULTS We enrolled 177 participants: 75 in intervention group and 102 in control group. Participants had similar demographic characteristics. Three quarters (75.0%) of participants in control group delayed on admission waiting bench of MRRH compared to (40.0%) in intervention group [p = < 0.001]. There were significantly more adverse maternal-fetal outcomes in control group than intervention group (obstructed labour [p = 0.026], low Apgar score [p = 0.013] and admission to neonatal high dependency unit [p = < 0.001]). The phone call intervention was protective against adverse maternal-fetal outcome [aOR = 0.22; 95%CI: 0.09-0.44, p = 0.001]. CONCLUSION The phone call intervention resulted in reduced delay to patient admission at a tertiary referral hospital in a resource limited setting, and is protective against adverse maternal-fetal outcomes. Incorporating the phone call communication intervention in the routine practice of emergency obstetric referrals from lower health facilities to regional referral hospitals may reduce both maternal and fetal morbidities. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR20200686885039.
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Affiliation(s)
- Hamson Kanyesigye
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Jerome Kabakyenga
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edgar Mulogo
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Daniel Atwine
- Department of Clinical Research, SOAR Research Foundation, Mbarara, Uganda
| | - Noni E MacDonald
- Faculty of Medicine & MicroResearch International, Dalhouise University, Halifax, Canada
| | - Robert Bortolussi
- Faculty of Medicine & MicroResearch International, Dalhouise University, Halifax, Canada
| | - Richard Migisha
- Department of Physiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joseph Ngonzi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Ngonzi J, Bebell LM, Boatin AA, Owaraganise A, Tiibajuka L, Fajardo Y, Lugobe HM, Wylie BJ, Jacquemyn Y, Obua C, Haberer JE, Geertruyden JPV. Impact of an educational intervention on WHO surgical safety checklist and pre-operative antibiotic use at a referral hospital in southwestern Uganda. Int J Qual Health Care 2021; 33:6352323. [PMID: 34390247 DOI: 10.1093/intqhc/mzab089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/31/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends adherence to its surgical safety checklist (SSC) to optimize patient safety and reduce cesarean surgical site infection (SSI). Educational interventions combined with audit and feedback mechanisms on the checklist use by clinicians have the potential to improve adherence and clinical outcomes. Despite the increase in cesarean delivery rates, there is a paucity of data on how such interventions can improve adherence in resource-limited settings. OBJECTIVE We performed a quality improvement project to measure the impact of an educational intervention with daily audit and feedback procedures on rates of WHO SSC adherence, including pre-operative antibiotic administration and SSI at Mbarara Regional Referral Hospital maternity ward in Uganda. METHODS The study involved chart abstraction of WHO SSC and pre-operative antibiotic use during cesarean deliveries and signs of subsequent SSI in three phases. First, we conducted a retrospective review of all charts from May to June 2018 (pre-intervention phase). Second, we instituted an educational intervention on the WHO SSC and pre-operative antibiotics use, followed by a daily audit of charts and feedback to clinicians from July to August 2018 (the intervention phase). Third, we reviewed charts from September to October 2018 (the post-intervention phase). The WHO SSC adherence, pre-operative antibiotic administration and SSI rates were measured as the proportion of the total cesarean deliveries per study phase and then compared across the three phases. RESULTS We reviewed 678 patients' charts (200 in the pre-intervention phase, 230 in the intervention phase and 248 in the post-intervention phase). The mean patient age was 25 years. The use of the WHO SSC was 7% in the pre-intervention phase compared to 92% in the intervention phase (P < 0.001), and 77% in the post-intervention phase (P < 0.001). Pre-intervention antibiotic receipt was 18% compared to 90% in the intervention phase (P < 0.001) and 84% in the post-intervention phase (P < 0.001). The documented SSI rate in the pre-intervention phase was 15% compared to 7% in the intervention phase (P = 0.02) and 11% in the post-intervention phase (P = 0.20). CONCLUSIONS An educational intervention, daily audit and feedback to clinicians increased the use of the WHO SSC and prophylactic antibiotics for cesarean delivery-although the rates waned with time. Research to understand factors influencing the checklist use and antibiotic prophylaxis including prescriber knowledge, motivation and clinical process is required. Implementation interventions to sustain usage and impact on clinical outcomes need to be explored.
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Affiliation(s)
- Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Lisa M Bebell
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Adline A Boatin
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Aspihas Owaraganise
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Leevan Tiibajuka
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Blair J Wylie
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Yves Jacquemyn
- Global Health Institute, University of Antwerp, Wilrijkstraat 10; 2650 Edegem, Antwerp, Belgium
| | - Celestino Obua
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara +256, Uganda
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
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Ngonzi J, Bebell LM, Fajardo Y, Boatin AA, Siedner MJ, Bassett IV, Jacquemyn Y, Van Geertruyden JP, Kabakyenga J, Wylie BJ, Bangsberg DR, Riley LE. Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Pregnancy Childbirth 2018; 18:270. [PMID: 29954356 PMCID: PMC6022296 DOI: 10.1186/s12884-018-1891-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background There is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa. Methods We enrolled 4231 women presenting to a Ugandan regional referral hospital for delivery or postpartum care into a prospective cohort and measured vital signs postpartum. Women developing fever (> 38.0 °C) or hypothermia (< 36.0 °C) underwent symptom questionnaire, structured physical exam, malaria testing, blood, and urine cultures. Demographic, treatment, and post-discharge outcomes data were collected from febrile/hypothermic women and a random sample of 1708 normothermic women. The primary outcome was in-hospital postpartum infection. Multivariable logistic regression was used to determine factors independently associated with postpartum fever/hypothermia and with confirmed infection. Results Overall, 4176/4231 (99%) had ≥1 temperature measured and 205/4231 (5%) were febrile or hypothermic. An additional 1708 normothermic women were randomly selected for additional data collection, for a total sample size of 1913 participants, 1730 (90%) of whom had complete data. The mean age was 25 years, 214 (12%) were HIV-infected, 874 (51%) delivered by cesarean and 662 (38%) were primigravidae. Among febrile/hypothermic participants, 174/205 (85%) underwent full clinical and microbiological evaluation for infection, and an additional 24 (12%) had a partial evaluation. Overall, 84/4231 (2%) of participants met criteria for one or more in-hospital postpartum infections. Endometritis was the most common, identified in 76/193 (39%) of women evaluated clinically. Twenty-five of 175 (14%) participants with urinalysis and urine culture results met criteria for urinary tract infection. Bloodstream infection was diagnosed in 5/185 (3%) participants with blood culture results. Another 5/186 (3%) tested positive for malaria. Cesarean delivery was independently associated with incident, in-hospital postpartum infection (aOR 3.9, 95% CI 1.5–10.3, P = 0.006), while antenatal clinic attendance was associated with reduced odds (aOR 0.4, 95% CI 0.2–0.9, P = 0.02). There was no difference in in-hospital maternal deaths between the febrile/hypothermic (1, 0.5%) and normothermic groups (0, P = 0.11). Conclusions Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.
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Affiliation(s)
- Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Lisa M Bebell
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Adeline A Boatin
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Ingrid V Bassett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Yves Jacquemyn
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Jerome Kabakyenga
- Institute of Maternal Newborn and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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Bebell LM, Ngonzi J, Bazira J, Fajardo Y, Boatin AA, Siedner MJ, Bassett IV, Nyehangane D, Nanjebe D, Jacquemyn Y, van Geertruyden JP, Mwanga-Amumpaire J, Bangsberg DR, Riley LE, Boum Y. Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital. PLoS One 2017; 12:e0175456. [PMID: 28406949 PMCID: PMC5391058 DOI: 10.1371/journal.pone.0175456] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/27/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking. METHODS We performed a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care, measured vital signs after delivery, performed structured physical exam, symptom questionnaire, and microbiologic evaluation of febrile and hypothermic women. Malaria rapid diagnostic testing, blood and urine cultures were performed aseptically and processed at Epicentre Mbarara Research Centre. Antimicrobial susceptibility and breakpoints were determined using disk diffusion per EUCAST standards. Hospital diagnoses, treatments and outcomes were abstracted from patient charts. RESULTS Mean age was 25 years, 12% were HIV-infected, and 50% had cesarean deliveries. Approximately 5% (205/4176) with ≥1 temperature measurement recorded developed postpartum fever or hypothermia; blood and urine samples were collected from 174 (85%), and 17 others were evaluated clinically. Eighty-four (48%) had at least one confirmed source of infection: 39% (76/193) clinical postpartum endometritis, 14% (25/174) urinary tract infection (UTI), 3% (5/174) bloodstream infection. Another 3% (5/174) had malaria. Overall, 30/174 (17%) had positive blood or urine cultures, and Acinetobacter species were the most common bacteria isolated. Of 25 Gram-negatives isolated, 20 (80%) were multidrug-resistant and cefepime non-susceptible. CONCLUSIONS For women in rural Uganda with postpartum fever, we found a high rate of antibiotic resistance among cultured urinary and bloodstream infections, including cephalosporin-resistant Acinetobacter species. Increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities.
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Affiliation(s)
- Lisa M. Bebell
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Massachusetts General Hospital Center for Global Health, Boston, MA, United States of America
| | - Joseph Ngonzi
- Mbarara University of Science and Technology, Mbarara, Uganda
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Joel Bazira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yarine Fajardo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adeline A. Boatin
- Massachusetts General Hospital Center for Global Health, Boston, MA, United States of America
- Division of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mark J. Siedner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Massachusetts General Hospital Center for Global Health, Boston, MA, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ingrid V. Bassett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
| | | | | | - Yves Jacquemyn
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Epicentre Mbarara Research Centre, Mbarara, Uganda
| | - David R. Bangsberg
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America
- Massachusetts General Hospital Center for Global Health, Boston, MA, United States of America
| | - Laura E. Riley
- Division of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yap Boum
- Mbarara University of Science and Technology, Mbarara, Uganda
- Epicentre Mbarara Research Centre, Mbarara, Uganda
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Fajardo Y, Gómez E, Garcias F, Cerdà V, Casas M. Development of an MSFIA-MPFS pre-treatment method for radium determination in water samples. Talanta 2007; 71:1172-9. [DOI: 10.1016/j.talanta.2006.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 05/24/2006] [Accepted: 06/07/2006] [Indexed: 11/28/2022]
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10
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Fajardo Y, Gómez E, Garcias F, Cerdà V, Casas M. Multisyringe flow injection analysis of stable and radioactive yttrium in water and biological samples. Anal Chim Acta 2005. [DOI: 10.1016/j.aca.2005.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Fajardo Y, Gómez E, Mas F, Garcias F, Cerdà V, Casas M. Multisyringe flow injection analysis of stable and radioactive strontium in samples of environmental interest. Appl Radiat Isot 2004; 61:273-7. [PMID: 15177357 DOI: 10.1016/j.apradiso.2004.03.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A multisyringe flow injection (MSFIA) method for the determination of stable and radioactive strontium, using a solid phase resin (Sr-Resin), has been developed. Strontium concentrations are determined by atomic emission spectroscopy and by a low background proportional counter. The method has been applied to different samples (water, milk and soil) of environmental interest. The LLD of the stable and radioactive Sr were 10 microg/l and 0.01 Bq, respectively. The standard deviation of the separation procedure is 2% (n=10).
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Affiliation(s)
- Y Fajardo
- Department of Chemistry, University of the Balearic Islands, Palma E-07122, Spain
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