Browsing by Author "Okong, Pius"

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Audit of Severe Maternal Morbidity in Uganda – Implications for Quality of Obstetric Care
(John Wiley & Sons, Inc., 2006-07-01) Okong, Pius; Byamugisha, Josaphat; Mirembe, Florence; Byaruhanga, Romano; Bergström, Staffan
Background. For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. Methods. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Results. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. Conclusions. A systemic analysis found substandard care and records, and patient‐related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non‐threatening stimulus for improving the quality of obstetric care.
Comparison of tympanic and rectal thermometry: Diagnosis of neonatal hypothermia in Uganda
(Elsevier, 2004-01-01) Bergström, Anna; Byaruhanga, Romano; Okong, Pius
Although newborn body temperature monitoring is not a routine occurrence in labour wards in Uganda, postnatal hypothermia is a significant problem. This study was undertaken to find a convenient and accurate method of measuring body temperature in order to assess the prevalence of neonatal hypothermia in a low-income tropical setting. Tympanic thermometry was compared to rectal thermometry in three hundred newborns up to 90 minutes after birth.
The Impact of Newborn Bathing on the Prevalence of Neonatal Hypothermia in Uganda: A Randomized, Controlled Trial
(John Wiley & Sons, Inc., 2005-10-01) Bergström, Anna; Byaruhanga, Romano; Okong, Pius
Aim: To elucidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin‐to‐skin (STS) care technique before and after bathing. Methods: Non‐asphyxiated newborns after vaginal delivery (n=249) in a Ugandan referral hospital were consecutively enrolled and randomized either to bathing at 60 min postpartum (n=126) or no bathing (n=123). All mothers practised skin‐to‐skin care of their newborns. Four rectal and tympanic registrations of newborn temperatures were carried out in both groups directly after drying at birth, and at 60, 70 and 90 min postpartum. Results: Bathing of newborns in the first hour after delivery resulted in a significantly increased prevalence of hypothermia, defined as temperature <36.5°C, at 70 and at 90 min postpartum despite the use of warmed water and the application of the STS method. There was no neonatal mortality. Aside from the bathing procedure, no background factor potentially predisposing the newborns to hypothermia was identified. Conclusion: Bathing newborn babies shortly after birth increased the risk of hypothermia despite the use of warm water and STS care for thermal protection of the newborn.
Neonatal Hypothermia in Uganda: Prevalence and Risk Factors
(Oxford University Press, 2005-08-01) Byaruhanga, Romano; Bergstrom, Anna; Okong, Pius
The aim of the study was to determine the prevalence of neonatal hypothermia and associated risk factors. A cross sectional, descriptive study of neonatal hypothermia was performed on 300 newborns consecutively recruited day and night during 2 months at a Ugandan periurban hospital. Parallel tympanic and rectal temperature measurements were made at 10, 30, 60, and 90 min post partum. Rectal temperatures taken at 10, 30, 60, and 90 min showed that 29, 82, 83, and 79 per cent of the newborns, respectively, were hypothermic. Newborns observed to have no body contact with the mother comprised 87 per cent of hypothermic newborns, whereas this was the case in 75 per cent of non-hypothermic newborns ( p^0.03). The mean birthweight was 3218 g. Low birthweight newborns constituted 9/86 (10 per cent) among hypothermic newborns, whereas this was the case in 9/209 (4 per cent) among non-hypothermic newborns at 10 min ( p^0.08). Adolescent mothers were encountered more often among mothers with neonatal hypothermia of the newborn than among non-hypothermic newborns ( p^0.025). Parity, preterm delivery, daytime or night time delivery, rupture of membranes `24 h and location of newborns in theatre, labour ward, or nursery did not differ when hypothermic and non-hypothermic newborns were compared. A persistent pattern of high prevalence of neonatal hypothermia was confirmed and indicates that more vigorous efforts have to be undertaken, also in a tropical setting, to overcome problems of non-adherence to appropriate methods for thermo protection of the newborn.
Perceptions Among Post-delivery Mothers of Skin-to-Skin Contact and Newborn Baby Care in a Periurban Hospital in Uganda
(Elsevier, 2006-09-06) Byaruhanga, Romano; Bergstro¨m, Anna; Tibemanya, Jude; Nakitto, Christine; Okong, Pius
Objective: to explore the perceptions among post-delivery mothers of skin-to-skin contact and newborn baby care. Design: a qualitative design using focus-group discussions. Five focus groups were conducted with post-delivery mothers who had had normal deliveries. A latent content analysis was used to derive the themes from the focus-group discussions. Settings and participants: 30 post-delivery mothers were purposively sampled from 249 mothers in the postnatal ward at St Francis Hospital, Nsambya, which is located in a periurban area in Kampala, Uganda. Findings: two main themes emerged from the focus-group discussions: ‘acceptability of health practices are influenced by knowledge and sensitisation’ and ‘pregnant women’s choices are dependent on social, cultural and economic factors’. Mothers expressed varying opinions about the usefulness of skin-to-skin contact: some knew about its use to reduce the risk of hypothermia; others were ignorant, whereas some believed skin-to-skin contact was an intervention used to distract them from the pain in the post-delivery period. The vernix caseosa and the mixture of amniotic fluid with blood in the post-delivery period were perceived as dirty and infectious. The best informants for helping mothers understand the skin-to-skin intervention were the health-care providers. Social, cultural and economic factors, as well as the dominant role of the husband, were identified as important determinants for their choice and place of delivery. Key conclusions and implications for practice: the gap between the knowledge and practice of skin-to-skin contact in hospital needs to be bridged. Health-care providers need to be encouraged to continuously advocate for, educate and implement regular skin-to-skin contact.
Prospective Study to Explore Changes in Quality of Care and Perinatal Outcomes after Implementation of Perinatal Death Audit in Uganda
(BMJ Publishing Group Ltd, 2020-01-22) Kirabira, Nakibuuka Victoria; Aminu, Mamuda; Dewez, Emmanuel Juan; Byaruhanga, Romano; Okong, Pius; Broek, Nynke van den
Objective To assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala. Design Interrupted time series (ITS) analysis. Setting Nsambya Hospital, Uganda. Participants Live births and stillbirths. Interventions PND audit. Primary and secondary outcome measures Primary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis. Results 526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention. Conclusion The introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.
A Randomised Placebo-Controlled Safety and Acceptability Trial of PRO 2000 Vaginal Microbicide Gel in Sexually Active Women in Uganda
(BMJ Publishing Group, 2010) Kamali, Anatoli; Byomire, Helen; Muwonge, Catherine; Bakobaki, Julie; Rutterford, Clare; Okong, Pius; Profy, Albert; Byaruhanga, Romano; Namukwaya, Stella; McCormack, Sheena; Grosskurth, Heiner; Nunn, J Andrew; Lacey, J.N. Charles
Abstract Objectives To determine the safety of 0.5% and 2% PRO 2000 gel in terms of local and systemic adverse events (AE) and the acceptability of gel use. Design A randomised placebo-controlled trial among healthy, sexually active African women aged 18–45 years. Between June 2003 and September 2004, 180 consenting women were randomly assigned to one of four groups: PRO 2000 gel (0.5% or 2%), placebo gel, or condom use only. Participants were screened for sexually transmitted infections, with HIV counselling and testing. Women randomly assigned to gel used this intravaginally twice a day for 28 days. Follow-up visits were fortnightly up to 6 weeks from enrolment, and comprised a physical examination including colposcopy, laboratory testing and questionnaire interviews. Results Ten women were lost to follow-up, none due to AE. Adherence with total gel doses was 69%. Observed rates of the primary toxicity endpoints, ulceration greater than 2×1 cm and clinically relevant coagulation abnormalities were, for PRO 2000 0.5%: 1.6% (95% CI 0.04% to 8.5%) and 0% (97.5% CI 0% to 5.7%), and for PRO 2000 2%: 0% and 0% (97.5% CI 0% to 5.9%). Women randomly assigned to active gels did not show an increased rate of AE. Gel use had no significant effect on haematology and biochemistry results. Women found gel use highly acceptable. Conclusions Both concentrations of PRO 2000 gel were found to be safe and well tolerated. These data justified testing the gels in large-scale effectiveness trials.