Browsing by Author "Musaba, Milton W."

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Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda
(Springer Link, 2023-04-03) Ojok Arach, Anna Agnes; Nakasujja, Noeline; Rujumba, Joseph; Mukunya, David; Odongkara, Beatrice; Musaba, Milton W.; Napyo, Agnes; Tumwine, James K.; Nankabirwa, Victoria; Ndeezi, Grace; Kiguli, Juliet
Perinatal death has profound psychosocial efects on women and their families. Sociocultural contexts infuence the burden, rituals and bereaved’s support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death. This study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identifed through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deductively and inductively into themes. Stillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried without names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system challenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unacceptable social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes. Stillbirth or early neonatal death is viewed as the death of a child, diferent from other settings. Thus, rituals are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health.
Decreased renal function among children born to women with obstructed labour in Eastern Uganda: a cohort study
(BMC Springer Nature, 2024-03-28) Mukunya, David; Oguttu, Faith; Nambozo, Brendah; Nantale, Ritah; Makoko, Brian Tonny; Napyo, Agnes; Tumuhamye, Josephine; Wani, Solomon; Auma, Prossy; Atim, Ketty; Nahurira, Doreck; Okello, Dedan; Wamulugwa, Joan; Ssegawa, Lawrence; Wandabwa, Julius; Kiguli, Sarah; Chebet, Martin; Musaba, Milton W.
Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for chronic kidney disease in later life. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour. We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula. We defined decreased renal function as eGFR less than 90 ml/min/1.73m2 . The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR of the children ranged from 55 to 163 ml/min/1.73m2 , mean 85.8±SD 15.9. Nearly one third of the children (45/144) had normal eGFR (>90 ml/Min/1.73m2 ), two thirds (97/144) had a mild decrease of eGFR (60–89 ml/Min/1.73m2 ), and only two children had a moderate decrease of eGFR (<60 ml/Min/1.73m2 ). Overall incidence of reduced eGFR was 68.8% [(99/144): 95% CI (60.6 to 75.9)]. We observed a high incidence of reduced renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
High burden of neurodevelopmental delay among children born to women with obstructed labour in Eastern Uganda: a cohort study
(MDPI, 2023-02-16) Chebet, Martin; Musaba, Milton W.; Mukunya, David; Makoko, Brian; Napyo, Agnes; Nantale, Ritah; Auma, Proscovia; Atim, Ketty; Nahurira, Doreck; Lee, Seungwon; Okello, Dedan; Ssegawa, Lawrence; Bromley, Kieran; Burgoine, Kathy; Ndeezi, Grace; Tumwine K., James; Wandambwa, Julius; Kiguli, Sarah
Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8–75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.
Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial
(BMC Springer Nature, 2023-04-18) Musaba, Milton W.; Nambozo, Brendah; Mukunya, David; Wandabwa, Julius; Barageine, Justus K.; Kiondo, Paul; Napyo, Agnes; Sserwanja, Quraish; Weeks, Andrew D; Tumwine, James K; Ndeezi, Grace
In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h.Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.