Browsing by Author "Zaake, Daniel"

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Adverse Pregnancy Outcomes Associated With Moderate Elevations in Blood Pressure or Blood Glucose in Ugandan Women: A Prospective Cohort Study
(Elsevier, 2021-05) Milln, Jack; Nakabuye, Betty; Natamba, Barnabas; Sekitoleko, Isaac; Mubiru, Michael; Namara, Arthur; Tumwesigire, Samuel; Tino, Salome; Mirembe, Mandy; Kakanda, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Kalema, Herbert; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annette; Webb, L. Emily; Nyirenda, J. Maffat
BACKGROUND: The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recentevidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE: This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN: This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization’s criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS: Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36−5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20−2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74−3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17−3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16−2.30). CONCLUSION: Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Antenatal Management and Maternal/fetal Outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda: A prospective cohort study
(BMC, 2021-05-19) Nakabuye, Betty; Sekitoleko, Isaac; Mubiru, Michael; Tumwesigire, Samuel; Tino, Salome; Mirembe, Sandy; Kakande, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Kalema, Herbert; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annettee; Webb, Emily L.; Nyirenda, Moffat J.; Milln, Jack; Natamba, Barnabas Kahiira
Background: Hyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women. Methods: A prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Results: Two hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM. Conclusion: HIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.
Future fertility among pediatric cancer patients: experiences and perspectives of health workers in a low-resource setting
(Sage Publications, 2024-08-02) Kayiira, Antony; McLaughlin, Sarah; John, Neda Jennifer; Zaake, Daniel; Xiong, Serena; Balagadde, Kambugu Joyce; Gomez-Lobo, Veronica; Wabinga, Henry; Ghebre, Rahel
Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.
Gestational Diabetes (GDM) Does Not Predict Large Birthweight or Perinatal Death in a Relatively Untreated Population in Uganda: A Prospective Observational Cohort Study.
(Elsevier, 2021-05) Milln, Jack; Nakabuye, Betty; Natamba, Barnabas; Sekitoleko, Isaac; Mubiru, Michael; Namara, Arthur; Tumwesigire, Samuel; Tino, Salome; Wilja, Mandy; Kakande, Ayoub; Agaba, Brian; Nansubuga, Faridah; Zaake, Daniel; Ayiko, Ben; Nakubulwa, Sarah; Sekikubo, Musa; Nakimuli, Annettee; Webb, Emily; Nyirenda, Moffat
BACKGROUND The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recent evidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization's criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36–5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20–2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74–3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17–3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16–2.30). CONCLUSION Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Impact of Genital Chlamydia Trachomatis Infection on Reproductive Outcomes Among Infertile Women Undergoing Tubal Flushing
(BioMed Central Ltd, 2019-12-12) Kayiira, Anthony; Zaake, Daniel; Lwetabe, Webba Michael; Sekweyama, Peter
Background: The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. Methods: A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. Results: Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18–0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14–0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08–1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. Conclusion: Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.
Perceptions, Expectations and Challenges Among Men During in Vitro Fertilization Treatment in a Low Resource Setting: A Qualitative Study
(Springer Nature, 2019-07-04) Zaake, Daniel; Kayiira, Anthony; Namagembe, Imelda
Introduction: Partner support is very important in alleviating the burden of infertility related stress and although understudied, partner coping patterns also play a key role in the other partner’s ability to cope with the infertility experience which eventually affects treatment outcomes. Very few studies more so in a low to middle income setting, explore the psychological and social aspects of infertility in men. There is a need for a deeper understanding into men’s perceptions, expectations and challenges of fertility treatment in our low resource setting. Objective: To explore men’s perceptions, expectations, challenges and experiences during IVF treatment among men in a low resource setting. Methods: A qualitative research design was utilised. The study was conducted at life sure fertility and gynaecology centre. The study participants were men participating in the IVF cycles. They were selected purposefully by maximum variation sampling. All the interviews took place on the day of enrolment for treatment and inductive content analysis was used to draw meaning from the transcripts. Ethical approval for the study will be sought from Nsambya Hospital IRB/REC. Results: Seven major themes arose, and these included: (1) Societal influence on IVF treatment experience; (2) Social support during IVF treatment; (3) Feeling insignificant; (4) Financial burden; (5) IVF as an emotional bridge; (6) Inadequate sensitization; (7) Fear of treatment failure. Conclusion: Men’s experiences during IVF treatment were negatively affected by the society’s perceptions of IVF treatment and infertility, cost of treatment, perceived men’s involvement and insufficient knowledge about the IVF process. However, spouse and friends’ support helped with coping and the IVF treatment experience strengthened emotional bonds
Prevalence, regional distribution, and determinants of infertility in Uganda between 2006 and 2016: analysis of three demographic and health surveys
(2024) Zaake, Daniel; Amongin, Dinah; Beňová, Lenka; Kiwanuka, N. Suzanne; Nalwadda, K, Christine; Nakafeero, Mary; Riese, Sara; Kayiira, Anthony; Asefa, Anteneh
Low- and middle-income countries, particularly in the African region in-country distribution and determinants of infertility are understudied. In this study, we aimed to estimate the prevalence, regional distribution, and determinants of infertility in Uganda to inform programming. We estimated the prevalence of primary and secondary infertility among women aged 20-49 years using data from the three rounds of the Uganda Demographic and Health Survey 2006, 2011, and 2016, and compared the differences across geographic regions. We pooled data sets for all three years and conducted logistic regression to identify factors associated with infertility. We included 16,537 women aged 20-49 years for analysis of primary infertility and 12,628 for secondary infertility. The overall prevalence of infertility (pooled across the three surveys was 6.4%. The prevalence of primary infertility was 1.4% (95% Confidence interval, CI=1.0-1.8), 0.7% (95% CI=0.5-1.0) and 0.8% (95% CI=0.6-1.0) in 2006, 2011 and 2016, respectively. The prevalence of secondary infertility was 7.4% (95% CI=6.5-8.4), 6.9% (95% CI=5.9-8.0) and 7.1% (95% CI=6.4-7.9) in 2006, 2011, and 2016 respectively. The prevalence of primary infertility was similar across regions. Secondary infertility was highest in the Central (7.9%, 95% CI= 6.1-10.3, in 2016) and Northern regions (7.4%, 95% CI=6.1-8.9, in 2016). In all survey years, women with higher education had lower odds of secondary infertility compared to women with no education (adjusted odds ratio, aOR=0.54, 95% CI=0.35-0.83; P < 0.001). Our results suggest that the prevalence of primary infertility is similar across regions, whereas secondary infertility varies by region, with higher prevalence in Central and Northern regions. More research is required to understand the drivers behind the variation of secondary infertility across regions to inform policy and decision making