Master of Medicine in Obstetrics, Reproductive Health and Gynecology

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Immediate Foeto-maternal Outcomes and Factors associated with Induction of Labour at Kampala International University Teaching Hospital
(Kampala International University, 2020-01) Happy Tukirinawe
Background: Induction of labour has been increasing globally and it is therefore important to determine some of the factors associated with successful induction in various settings. This study assessed the immediate foeto-maternal outcomes and factors associated with successful induction of labour (IOL) among induced pregnant women admitted at Kampala International University Teaching Hospital (KIU-TH). Methods: A longitudinal study was conducted among a consecutive sample of 104 pregnant women with an indication of induction of labour admitted at maternity ward of KIU-TH between November 2019 and January 2020. 25μg vaginal Misoprostol was administered to consenting pregnant women with an indication of induction of labour (IOL). A pretested questionnaire was used to collect the data from the pregnant women. Women were followed up from the time of induction of labour (IOL) to a period of 72 hours after delivery. All the data was analyzed using Stata 14.2. Results: Of the 104 pregnant women induced with vaginal Misoprostol, vaginal delivery was 89 (85.6%) and the most common maternal complications were perineal tears, 26(25.0%) and post-partum haemorrhage, 4(3.8%). The immediate foetal-Neonatal outcomes observed were a good APGAR score ≥7, 103(99.1%) with registered small proportions of Neonatal Intensive Care Unit (NICU) admissions, 2(1.9%), fetal distress, 1(1.0%) and meconium passage, 1(1.0%).Pregnant women of ages 20 years and above showed a higher likely hood of successful IOL (AOR = 4.7, 95%CI: 1.02-21.33, p = 0.047) compared to their counterpart teenagers. Additionally, a Bishop Score ≥ 7 and no history of cervical procedures were associated with successful IOL. Conclusions: Induction of labour with vaginal misoprostol is good although it may be associated with perineal tears and post-partum haemorrhage as well as a good APGAR score ≥7, admissions to NICU, fetal distress and meconium passage. Implications of pregnant women of 20 years and above with a Bishop score of ≥7 and no history of cervical procedures are vital to successful induction of labour.
Prevalence of Premalignant Cervical Lesions and Factors influencing Uptake of Cervical Cancer Screening Services among HIV Positive Women attending the HIV Clinic at Kampala International University Teaching Hospital, Bushenyi, Uganda
(Kampala International University, 2020-01) Bekson Tayebwa
Background: Cervical cancer remains the leading gynecological malignancy causing deaths and morbidity in Africa. Nine in every 10 worldwide cervical cancer deaths occur in developing countries especially in Sub-Saharan Africa and is the leading cause of cancer deaths in females in Uganda. This study determined the uptake rate of cervical cancer screening services, Prevalence of premalignant cervical lesions, and factors influencing uptake of cervical cancer screening services among HIV positive women attending Kampala International University Teaching Hospital (KIU-TH) HIV/AIDS Clinic. Methods: This was a hospital-based descriptive cross-sectional study conducted at Kampala International University Teaching Hospital HIV/AIDS Clinic. Consecutive sampling method was used to recruit 210 women aged 21-65 years. Pretested interviewer administered questionnaires were used to collect data, then entered into Microsoft Excel version 10 and imported into Stata 14 for analysis. Descriptive statistics were used to describe the characteristics of study participants, their clinical characteristics, uptake rate of cervical cancer screening services and prevalence of premalignant cervical lesions. Pearson Chi-square test followed by logistic regression analysis were conducted to assess the relationship between socio-demographic and health system related factors and uptake of cervical cancer screening services stratified by location of residence. All independent variables with p-values ≤0.05 and those with biological plausibility were entered into a multivariate model. Results: Of the 210 HIV positive women recruited, the uptake rate of cervical cancer screening services was 160(76.2%). Out of the 160 women who participated in cervical cancer screening, 35(21.9%) had premalignant cervical lesions. Women with primary education (aOR = 0.8, 95% CI: 0.71-0.96, p = 0.02) and secondary education (aOR = 0.8, 95% CI: 0.61-0.91, p = 0.01) showed a lower statistical likelihood of uptake of cervical cancer screening services. Women who came far from the nearest health centre and had to use a vehicle also showed a lower statistical likelihood of uptake (aOR = 0.5, 95% CI: 0.26-0.89, p = 0.02). Fear of being diagnosed with cervical cancer led to a lower likelihood of uptake (aOR = 0.4, 95% CI: 0.29-0.67, p = 0.01). Preference of the health workers’ female gender [overall (aOR = 2.9, 95% CI: 1.59-0.5.34, p = 0.01) and either gender (aOR = 2.7, 95% CI: 1.52-4.92, p = 0.01) were associated with a higher likelihood of uptake of cervical cancer screening services. Conclusions: The study shows a moderately higher uptake of cervical cancer screening and low prevalence of premalignant cervical lesions among women attending HIV clinic at KIU-TH. Formal education, fear of being diagnosed with cervical cancer and far distance from the nearest health centre reduced uptake of cervical cancer screening services while preference of female or either gender of the health worker led to increased uptake of cervical cancer screening services. This study recommends routine cervical cancer screening at the HIV clinic, recruitment of more female health workers at cervical cancer screening clinics, health talks in the formal education sector and health education focusing on alleviating fear of being diagnosed with cervical cancer.
Prevalence, Bacteriology and Factors associated with Pelvic Inflammatory Disease Among Women Attending the Gynecology Clinic at Kampala International University Teaching Hospital, Uganda.
(Kampala International University, 2020-01) Petrus Baruti
Background: Pelvic inflammatory disease (PID) is major health problem in developed and developing country involving more young women. It is associated with high rate of female reproductive health morbidity; it can complicate with ectopic pregnancy, infertility and chronic pelvic pain. A poor response therapy increases the likelihood of these complications; this could be due to an increase in antimicrobial resistant pathogens. Objectives: To determine prevalence, identify factors, common bacterial pathogens from endocervical swab of women with PID and antibacterial susceptibility pattern at Kampala International University Teaching Hospital. Research methods: This was a cross-sectional study conducted among women who attended gynecology clinic at Kampala International University Teaching Hospital. Consecutive enrolment of 324 participants who consented to participate was done daily until a required sample size was realized from November 2019 to January 2020. Structured questionnaires were used to collect data on associated factors; endocervical swab was taken from patient clinically diagnosed with PID. Culturing for colony characteristics followed by Gram stain was used for provisional identity of pathogenic bacteria. Further identification was done by a set of biochemical tests. Antibacterial susceptibility pattern of isolated bacterial pathogens was determined by Kirby Bauer disc diffusion method, a rapid diagnostic test to detect Chlamydia antibody in the endocervical swab sample was also used to identify the Chlamydia trachomatis carriers among the patients. Data was analyzed using STATA VERSION 14.2. Results: The prevalence of pelvic inflammatory disease was 19.1%. Not being educated, having two or more sexual partners, previous history of PID and induced abortion, also the previous use of contraceptives specifically the use of IUD ,were all significantly associated with Pelvic inflammatory disease (P value <0.05). The isolated bacteria was Staphylococcus aureus and the least-prevalent pathogen was citrobacter species. Staphylocccocus aureus showed high susceptibility to Imipenem. The high resistence rate of more than 60% was seen to the commonly prescribed antibiotics as recommended by Uganda clinical guideline these were Doxicillin, ciprofloxacin, Cefixim and Ceftriaxon. Conclusion and recommendations: The prevalence of PID is HIGH at KIU-TH. Not being educated, having two or more sexual partners, previous history of PID and induced abortion, also the previous use of contraceptives specifically the use of IUD are significantly associated with PID. Staphylococcus aureus is the commonest organism isolated from the endocervical swab of patients with PID. Awareness amongst health workers and patients about these major factors so that management can be directed. Rational use of antibiotics by health workers is paramount to combat resistance.
Factors Associated with Uptake of Cervical Cancer Screening Among Reproductive AgedWomen attending the Gynecology Outpatient Clinic at Kampala International UniversityTeaching Hospital
(Kampala International University, 2021-10) John Chidanga
Background. Cervical cancer remains one of leading causes of maternal morbidity and mortality. It contributes to about 7.9% of all women related cancers and is the ranked 4th among all women cancers. In the fight against cervical cancer, its prodromal and asymptomatic stage has been found to be detectable and curable. Several screening modalities like Visual Inspection with acetic acid and Lugol’s Iodine, Human Papilloma Virus DNA, Pap smear have largely been instrumental to the reduction of cervical cancer prevalence. However, the uptake to these lifesaving methods remains inexplicably low and several barriers exist towards this. These hindering factors include lack of knowledge about causes of cervical cancer, lack of knowledge on when to screen and when to start screening, personal factors like fear of pain, fear of a positive diagnosis and fear of embarrassment. The result is 80% of women who present to Uganda Cancer Institute, do so in late stage of disease and it poses a detrimental challenge to the patients, their families and the health infrastructure. Objective.To determine the factors associated with uptake of cervical cancer screening in women of reproductive age attending Gynecological OPD clinic at Kampala International University Teaching Hospital. Methodology.This was a hospital-based descriptive and analytical cross-sectional study conducted at the antenatal clinic and maternity ward of KIU-TH between August and October 2021. A sample of 309 women were recruited, open-ended questionnaires were administered and pap-smear tests were carried out for those who took up screening. Slides were analysed and results of patterns of cytological findings were documented. The datat was then analysed using logistic regression. Results. The uptake to cervical cancer screening was found to be 18.8% (95% CI, 14.8%-23.5%). In multivariable analysis, being from a rural residence, HIV positive and have 2 or more sexual partners was found to be statistically significant. Further analysis on pap smear results revealed 37.93% being normal pap smears not having any intra epithelial lesion or malignancy, 29.31% had inflammatory findings, 27.59% were LSIL, 3.45% were ASCUS, and 1.72%HSIL. Conclusion.The uptake of cervical cancer screening falls within the global range despite it being low. The patterns on pap smear dictate the majority being normal followed by inflammatory changes then low grade changes then other findings. Being of a rural residence, HIV positive and having two or more sexual partners confers a higher chance of screening for cervical cancer.
Factors associated with Immediate Adverse Maternal Outcomes among Referred Women in Labor attending Kampala International University Teaching Hospital
(Kampala International University, 2021-11) Hussein Osman Ahmed
Background: Maternal adverse outcomes remains a challenge in most health facilities and yet most pregnant women attend antenatal care. Contemporary evidence expresses that access to skilled care during the period of pregnancy and childbirth can alleviate adverse maternal outcomes. In this respect, carrying out risk profiling in the course of antenatal care and using a partogram to do intrapartum maternal-fetal surveillance are fundamental interventions that could help in early detection and management. An efficient referral system provides access to treatment and skills by linking different levels of care through appropriate referrals and is an essential component of any health systems. Therefore, this study assessed the incidence, maternal adverse outcomes, and associated factors among women in labor referred to Kampala international university teaching hospital. Objective: To assess the incidence,composite outcomes and factors associated with immediate adverse maternal outcomes, among women in labor referred to Kampala international university teaching hospital. Methods: This was a cohort study conducted among 215 pregnant women above 28 weeks in labor referred from other facilities to Kampala International University Teaching hospital with referral notes who were followed up for 72 hours after delivery. The study excluded self-referrals and was done from September to January 2021. Data were obtained from all the participants using a questionnaire and analyzed using Stata 14.0. The analyzed data was then presented in form of frequency tables and barchart. Results: This study enrolled 215 women with the incidence of adverse maternal outcomes being 7.44%. The majority 56.2% (9/16) had APH/PPH, 50.0% (8/16) had anemia and 31.2%(5/15) had a Cesarean hysterectomy. The factors independently associated with likelihood of adverse maternal outcomes in adjusted analysis at multivariate level were Gestational age < 34 weeks (aRR = 4.4, 95%CI: 1.25- 15.35, p = 0.02), and being with a compromised/unstable condition (aRR = 11.3, 95%CI: 2.58-49.46, p= 0.001). Conclusions: The incidence of adverse maternal outcomes among referred women in labor at KIU-TH was relatively high. The common composite immediate adverse maternal outcomes were APH, PPH, Anemia, and Cesarean hysterectomy. Women with a compromised/unstable xiv condition on admission and gestational age less than 34 weeks were more likely to have adverse maternal outcomes among referred women in labor
Endometrial Histological Patterns and Factors Associated with Abnormal Uterine Bleeding among Women Seeking Gynecological Services at Fort Portal Regional Referral Hospital
(Kampala International Univesrity, Faculty of Clinical Medicine and Dentistry, 2022-02) Joan Logose
Background: Women of all ages are susceptible to abnormal uterine bleeding, a relatively frequent gynecological issue. In the gynecology outpatient department, abnormal uterine bleeding is a problem that affects one-third of the patients, making them feel less financially secure and with a lower quality of life. Abnormal uterine bleeding and its complications are still a massive global burden with a global prevalence between 4 and 52 percent. Aim: To determine the prevalence, associated factors, and endometrial histological patterns of AUB among women seeking gynecological services at Fortportal Regional Referral Hospital in Uganda. Materials and Methods: A cross-sectional study was carried out from July to August. Descriptive statistics followed by binary logistic regression were conducted to achieve the study objectives using IBM SPSS statistics 20. Results: In this study, 361 participants were recruited, and 54(14.96%) had AUB. The commonest endometrial histological patterns among women with AUB were; proliferative endometrium 21(38.9%), simple endometrial hyperplasia without atypia 11(20.4%), and secretory endometrium 6(11.1%). Women with BMI ranging between 25-29.9(aOR=5.61) those with a history of genital infection in the past 1 year (aOR=2.49), those who were nulliparous (aOR=13.3), primiparous (aOR=4.3) and women who reported HIV positive serostatus (aOR= 3.65) were independently associated with AUB at FRRH. Conclusions and Recommendations: The prevalence of AUB was within the global prevalence. Simple endometrial hyperplasia without atypia and chronic endometritis were the commonest pathological patterns. BMI, History of genital infection, nulliparity, primiparity, and HIV serostatus were the factors that were independently associated with abnormal uterine bleeding. There is a need for routine assessment of endometrial histological patterns among women with abnormal uterine bleeding at FRRH
Incidence And Factors Associated with Adverse Perinatal Outcomes in the Second Twin of Women Delivering at Kampala International University Teaching Hospitals
(Kampala International University, 2023-03) Kambale Muhavuki
Background. It was not known the exact Incidence of adverse perinatal outcomes in second twins of women who delivered at Kampala International University – Teaching hospitals, in Uganda. These hospitals had reports of twin deliveries every week with some adverse perinatal outcomes such as stillbirth, low APGAR score at 5 minutes, and neonatal deaths of second twins. This study was crucial to address the gaps and elucidate the incidence of adverse perinatal outcomes of second twin deliveries, to identify their types and the factors associated with adverse perinatal outcomes. Methods. Hospital - based prospective cohort study was conducted with 117 women twin pregnant who were admitted and delivered from Kampala International University-Teaching Hospitals during three months from November 2022 to January 2023. Consecutive sampling technique allowed to get data and data were entered in Excel 2019 then transferred to STATA 14.2 for analysis was according to objectives: frequencies, proportion and logistic regression run both in bivariate and multivariate. All variables with p value < 0.20 in bivariate logistic regression analysis fulfilled the criteria for multivariable logistic regression analysis; adjusted odds ratio with 95% confidence interval was used to measure the association variable with p < 0.05. Results. The incidence of adverse perinatal outcomes in second twins was 38.5%, fresh stillbirth accounted 12.8%, low APGAR score 24.0% and neonatal deaths 8.6 %. Fresh still birth was highly observed in peasant women (aOR: 12.69; 95%CI: 1.28-142.76, p = 0.040); vaginal delivery (aOR: 0.01; 95%CI: 0.00-0.50, p = 0.022) had protective properties for adverse fetal outcomes in second twin deliveries. Conclusions and Recommendations. Incidence of adverse fetal outcomes in second twins is high, and the occupation of women with twin pregnancy is highly a risk of adverse perinatal outcomes in second twins.
Relationship between Hypovitaminosis D and Uterine Leiomyomas among women of reproductive age attending selected Hospitals, Uganda
(Kampala International University, 2023-03) Nightingale Khamonya Senaji
Background: Uterine leiomyoma, is a common benign neoplasm among women of reproductive age with a potential of causing significant health complications and financial burdens in severe cases. Recent research suggests a possible link between vitamin D deficiency and uterine leiomyoma development; however, this relationship has not been established in the Ugandan population. For this reason, there is no individualized or public health interventions targeting this modifiable risk factor. Aim: To determine the relationship between hypovitaminosis D and uterine leiomyoma. Methods and material: A cross-sectional multicenter study was conducted at Jinja, Lira and Fort Portal Regional Referral Hospitals. 246 non-pregnant women of reproductive age were included in the study. Questionnaires were administered to the participants, their serum vitamin D analysed and a transabdominal pelvic scan done. Results: The prevalence of hypovitaminosis D among partipants was high at 54.1%. There was no significant difference in the proportions of leiomyoma among those with and without hypovitaminosis D (χ2=0.503, p= 0.478 >0.05). The mean serum vitamin D level was lower in individuals with uterine leiomyomas compared to those without (19.954 ± 9.77 versus 21.552 ± 9.54 [95% CI: -0.04 to 4.24, p=0.235]). A 22% increased likelihood of occurrence of uterine leiomyoma in the presence of hypovitaminosis D was observed but the relationship was not statistically significant (Phi (φ) = 0.045 p=0.478>0.05). There was a weak negative correlation observed between serum vitamin D levels and leiomyoma site number (r= -0.2482, p=0.0342<0.05). Conclusion: There was no statistically significant relationship between hypovitaminosis D and uterine leiomyomas despite a weak negative correlation between vitamin D levels and leiomyoma site number which was statistically significant. The high prevalence of hypovitaminosis D underscores the need for health education and public health measures to manage suboptimal status in order to prevent vitamin D deficiency-related morbidity among women of reproductive age. Further research is needed to investigate the potential association between hypovitaminosis D and uterine leiomyoma, particularly with regards to increased site number, among the African population.
Prevalence and Factors Associated with Histological Placental Abnormalities among Malaria Smear Positive Women Delivering at Two Tertiary Hospitals, Uganda
(Kampala International University; Faculty of Cinical Medicine and Dentistry, 2023-03) Lutula Yumbi
Background: Malaria in pregnancy, a major public health concern, remains one of the commonest and easily preventable cause of poor pregnancy outcomes worldwide, and placental abnormality is believed to be the main mechanism by which malaria in pregnancy causes adverse obstetric outcomes. Knowledge of the prevalence and factors associated with histological placental abnormality is a mainstay strategy, which can help to reduce the burden of poor obstetric outcomes among malaria smear positive women. Methods: This was a multicenter hospital-based cross-sectional study conducted at the maternity wards of JRRH and HRRH between September and November 2022. A sample of 124 malaria smear positive women were recruited, open-ended questionnaires were administered, and after delivery, Gross and histological assessment of the placenta was done. Slides were analyzed and results of histologic findings were documented. The factors associated with histological placental abnormality were assessed using logistic regression. Results: The prevalence of histological placental abnormality among malaria smear positive women admitted for delivery at JRRH and HRRH was 61.3%. The commonest histological placental abnormalities finding was infarction (29.8%) followed by inflammation (26.6%). Level of parasitemia (aOR: 5.03, 95%C.I:2.19-6.56, p=0.01), primigravidae (aOR: 2.82, 95% C.I: 1.19-3.57 p=0.04) and history of malaria in the pregnancy (aOR: 11.26(1.08-17.37; p=0.04) were associated with histological placental abnormalities among malaria smear positive women delivering at JRRH and HRRH. Conclusions: The prevalence of histological placental abnormalities was high compared to the national levels. The most common histological placental abnormalities were infarction and inflammation. Primigravidae, history of malaria in the pregnancy and level of parasitemia >1000ul are the independent predictors of placental histological abnormalities among blood smear positive women delivering at JRRH and HRRH.
Prevalence, Bacteriological Trends and Factors Associated with Septic Abortion among Women Attending Hoima and Fortportal Regional Referral Hospitals Western Uganda
(Kampala International University, 2023-05) Guled Bashir Abdi
Background: Septic abortion is clinical evidence of infection of the uterus and its contents. Lack of antiseptic and asepsis, inadequate evacuation, and inadvertent damage to the genital organs, can cause infection to arise during or soon after an abortion. Most infections experienced in septic abortion are polymicrobial. WHO estimates that 68,000 die annually due to complications of unsafe abortion with sepsis as the primary cause of death. Globally post abortion infection accounts for 22.1% of severe maternal illnesses and 9.5% of the global burden of maternal infections. In women with septic abortion, we aimed to identify prevalence, bacteriological trends and associated factors in women admitted two tertiary hospitals in Uganda. Methodology: This hospital based cross-sectional study was carried out from September 2022 to January 2023. Using a consecutive sampling method, 207 septic abortion women were enrolled. Data on socio-demographics and other factors associated with septic abortion were collected using pre-tested structured questionnaires. Endocervical swab was taken for culture and sensitivity by disc diffusion modified Kirby-Bauer’s method on Mueller Hinton agar. Data was analyzed using SPSS version 23. A bivariable and multivariable logistic regression model were used to show association between the dependent and independent variables considering P < 0.05 and the 95% confidence interval. Results: The prevalence of septic abortion was 13%. Endocervical isolates from women with septic abortion in this study were poly microbial infections, with 48.1% were Escherichia coli followed by Staphylococcus aureus 18.5%, and Citrobacter spp 11.1%. In 90% of cases organism were sensitive to Imipenem, Peperacillin Tazobactam, Chloramphenicol and Vancomycin. A high resistance was noted with Ampicillin, Augmentine and cefotaxime. In this study, no history of contraceptives uses, being residence from rural areas were the two factors found to be significantly associated with septic abortion. Conclusion: In this study, the prevalence of septic abortion was high compared to the global level. There is need to intense health education and awareness on danger of septic abortion by health care authorities. Health care providers should provide close surveillance and special care with women from rural residence and those with no history of contraceptive use.
Relationship between Hypovitaminosis D and Uterine Leiomyomas among Women of Reproductive Age attending Selected Hospitals, Uganda
(Kampala International University, 2023-05) Nightingale Khamonya Senaji
Background: Uterine leiomyoma, is a common benign neoplasm among women of reproductive age with a potential of causing significant health complications and financial burdens in severe cases. Recent research suggests a possible link between vitamin D deficiency and uterine leiomyoma development; however, this relationship has not been established in the Ugandan population. For this reason, there is no individualized or public health interventions targeting this modifiable risk factor. Aim: To determine the relationship between hypovitaminosis D and uterine leiomyoma. Methods and material: A cross-sectional multicentre study was conducted at Jinja, Lira and Fort Portal Regional Referral Hospitals. 246 non-pregnant women of reproductive age were included in the study. Questionnaires were administered to the participants, their serum vitamin D analysed and a transabdominal pelvic scan done. Results: The prevalence of hypovitaminosis D among participants was high at 54.1%. There was no significant difference in the proportions of leiomyoma among those with and without hypovitaminosis D (χ2=0.503, p= 0.478 >0.05). The mean serum vitamin D level was lower in individuals with uterine leiomyomas compared to those without (19.954 ± 9.77 versus 21.552 ± 9.54 [95% CI: -0.04 to 4.24, p=0.235]). A 22% increased likelihood of occurrence of uterine leiomyoma in the presence of hypovitaminosis D was observed but the relationship was not statistically significant (Phi (φ) = 0.045 p=0.478>0.05). There was a weak negative correlation observed between serum vitamin D levels and leiomyoma site number (r= -0.2482, p=0.0342<0.05). Conclusion: The prevalence of hypovitaminosis D was high among women of reproductive age. There was no statistically significant relationship between hypovitaminosis D and uterine leiomyomas despite a weak negative correlation between vitamin D levels and leiomyoma site number which was statistically significant. Recommendations: High prevalence of hypovitaminosis D underscores the need for health education and public health measures by healthcare providers to manage and prevent vitamin D deficiency-related morbidity among women of reproductive age. Further research by the scientists is needed to investigate the potential association between hypovitaminosis D and uterine leiomyoma, in regards to increased site number, among the African population.
Early Adverse Maternal Outcomes and Factors Associated with Fetal Macrosomia among Women Delivering at Fort Portal Regional Referral Hospital Western Uganda
(Kampala International University; Faculty of Clinical Medicine and Dentistry, 2023-05) Ifrah Mohamed Hassan
Background: Fetal macrosomia is a seriously growing obstetric problem among many developing nations and has profoundly contributed to maternal and neonatal morbidity and mortality the world over. Variation regarding prevalence, pregnancy outcomes, and associated factors of fetal macrosomia has been noted among different scholars across the world. There is however a great paucity of information regarding such in Uganda, more so in this area of the current study. Aim: To document early adverse maternal outcomes and associated factors of fetal macrosomia among women delivering at Fortportal Regional Referral Hospital, western Uganda Materials and Methods: A hospital-based cross-sectional study involving 384 women who delivered at FRRH was conducted over three months from 3rd November 2022 to 4th February. Interviewer-administered questionnaires were used to obtain data. Descriptive statistics followed by binary logistic regression were conducted to achieve the study objectives. All data analyses were conducted using STATA statistics package version 14. Results: Of the 384 deliveries, the prevalence of fetal macrosomia was 7%. The majority, 78.6% of macrosomia deliveries suffered early adverse maternal outcomes mainly PPH 13(59.1%) and cesarean delivery 13(59.1%). Significant independent associated factors of fetal macrosomia at this hospital were history of macrosomia delivery (aOR=4.85, CI: 1.830-12.789, p=0.001) and fetal male sex (aOR=2.84, CI: 1.099-7.325, p=0.031). Conclusions and Recommendations: The prevalence of fetal macrosomia at FRRH was comparable to the global incidence. Large numbers of women with macrosomic fetuses suffer devastating outcomes with PPH and cesarean delivery being the most common. Previous history of fetal macrosomia, and fetal male sex were the independent predictor factors for macrosomic delivery at this hospital. Early detection and management of women with fetal macrosomia during ANC and/or labor is key to preventing this deadly obstetric complication and its associated adverse consequences at FRRH.
The Accuracy of Ultrasound versus Clinical Methods for Estimating Fetal Weight among Term Pregnant Women Delivering at Kiryandongo General Hospital Uganda
(Kampala International University; Faculty of Clinical Medicine and Dentistry, 2023-11) Fred Mutabazi
Background: The EFW established in the third trimester, usually around 30 weeks of gestation, is normally used to predict the fetal weight at term. Researchers have proposed various formulae to estimate fetal weight over the years, but no simple and easily applied formula has yet been proposed to transform an external maternal measurement into an EFW. Aim of the study: To determine the accuracy of ultrasound versus clinical methods for estimating fetal weight among term pregnant women delivering at Kiryandongo hospital. Materials and Methods: A 3-months cross-sectional study involving 246 participants was conducted from December 2022 to February 2023 at Kiryandongo general hospital. Interviewer administered questionnaires were used to obtain data. Data was analyzed in line with study objectives using STATA version 14.2. Correlation coefficient "r" was computed to determine the relationship between weight at birth and weight determined clinically and sonographically Results: A linear relationship (R2) between ultrasound scan fetal weight estimation and clinical methods with actual birth weights at varying levels; with ultrasound scan as the highest (R2 = 0.593) followed by Dares’ formula (R2 = 0.447) and lastly Johnson’s formula (R2 = 0.383) Conclusions: Hadlock ultrasonography EFW were more precise than the clinical methods used to estimate birth weight. Johnson's method was less accurate than both Hadlock ultrasonography method and Dare's clinical method. Dare's method was less accurate than Hadlock method, however was more accurate than Johnson's formula among the clinical techniques. Recommendation: Ultrasound scan should be emphasized in estimating fetal weight at this facility. Where ultrasound scan services are not available or affordable, a simple and low-cost Dare's clinical method over Johnson's clinical method should be employed by the attending doctor or midwife in estimating fetal weight at this facility Recommendations: The ministry of health and other pertinent individuals or groups must stress the significance of EFW during the prenatal and intrapattern phases. At this facility, the ultrasound scan should be prioritized for EFW. The attending physician or midwife at this facility should use the straightforward and less expensive Dare's method rather than Johnson's clinical method when calculating EFW in cases of no/expensive ultrasound scan services
Incidence of post cesarean surgical site infection, and factors associated with wound severity patterns among women delivering in Mubende Regional Referral Hospital
(Kampala International University, 2023-12) Omara Samuel
Background: Post caesarean surgical site infection (PCSSI) is a significant major concern in maternal health, contributing to increased morbidity, mortality and high healthcare costs in Sub-Saharan Africa where Uganda is not exempted and this attributed to poor patient preventive and follow up measures in different setups. Therefore, this study aimed to investigate the incidence of PCSSI and explore factors associated with wound severity patterns among women who underwent caesarean delivery at Mubende Regional Referral Hospital. Methods: A prospective cohort study was conducted involving 204 participants who underwent caesarean section at the hospital. Participants' demographic, obstetrical, and interventional characteristics were recorded. The Southampton wound severity score was used to assess wound severity patterns and culture done on those who developed post-caesarean surgical site infections. Statistical analysis, including chi-square tests and relative risk calculations, were employed to identify significant associations. Results: The study revealed incidence rates of PCSSI was high at 16.18%. Wound severity pattern was assessed by the use of Southampton wound grading system; grade 0 (53.27%), grade 1 (10.05%), grade 2 (11.06%), grade 3 (9.05%), grade 4 (10.5%), and grade 5 (6.53%). Southampton wound grade 4 and 5 are the grades with wound severity pattern. Factors such as education level(aRR=1.85; p-value=0.002), income level(aRR=0.08; p-value=0.008), referral status(aRR=2.02; p-value<0.001), obstructed labor(aRR=2.97; p-value<0.001), prolonged labor(aRR=1.37; p-value=0.012), chorioamnionitis(aRR=2.73; p-value<0.001) PROM(aRR=2.05; p-value=0.003), preoperative antibiotics use(aRR=0.77; p-value<0.001) and WBC counts(aRR=17.7; p-value=0.004) were statistically significant and independently associated with wound severity patterns. Most predominant pathogen isolated was E. coli (42.42%), followed by K. Pneumoniae (36.36%) then S. aureus (21.21%). Conclusion: The incidence of Post caesarean surgical site infection at Mubende Regional Referral Hospital was high, Southampton wound score grade 4 and 5 were the wound severity pattern and identifies key factors influencing wound severity were education level, income level, referral status, obstructed labor, prolonged labor, Chorioamnionitis, PROM, preoperative use of antibiotics and raised white blood cell counts. The most common pathogen isolated from mothers who had developed severity pattern was E. coli followed by K. pneumoniae and S. aureus.
Prevalence, Associated Factors and Immediate Adverse Neonatal Outcome of Primary Caesarean Section among Multiparous Mothers Who Delivered At Lira Regional Referral Hospital.
(Kampala International University, 2023-12) Omiat Denis Dickson
Title: Prevalence, Associated Factors, and Immediate Adverse Neonatal Outcomes of Primary Caesarean Section among Multiparous Mothers Delivered at Lira Regional Referral Hospital Introduction: The escalating prevalence of primary caesarean sections (CS) among multiparous mothers has sparked substantial concern within the medical community. This study investigates the prevalence, associated factors, and immediate adverse neonatal outcomes of primary CS among multiparous mothers, with a focus on cases delivered at Lira Regional Referral Hospital. Methods: Data were gathered from 321 multiparous moms who gave birth at Lira Regional Referral Hospital using an extensive research methodology. The study utilized both methodical medical record reviews and structured interviews to gather information on sociodemographic traits, obstetric history, and immediate neonatal outcomes. By using both bivariate and multivariate analysis, this research examined the variables that affect the probability of primary CS. Results: The prevalence of primary CS among multiparous mothers was determined to be 22%. Fetal malpresentation (25.8%) and unsatisfactory fetal heart rate tracing (24.6%) emerged as primary reasons for primary CS. The study unveiled immediate adverse neonatal outcomes in 29.6% of cases, encompassing low Apgar scores (54.6%) and neonatal intensive care unit admissions (36.4%). Significant associations were identified between primary CS and factors including marital status, history of hypertension, and history of diabetes mellitus. Conclusion: This study contributes vital insights into the prevalence, associated factors, and immediate adverse neonatal outcomes of primary CS among multiparous mothers at Lira Regional Referral Hospital. The findings underscore the need for informed decision-making in obstetric care, aiming to reduce primary CS rates and enhance neonatal well-being. Keywords: primary caesarean section, multiparous mothers, prevalence, associated factors, neonatal outcomes
Prevalence, Associated Factors of Vulvovaginal Candidiasis and Antifungal Susceptibility Patterns among Non-Pregnant Women who Attended Gynecology Clinic at Hoima Regional Referral Hospital
(Kampala International University; Faculty of Cinical Medicine and Dentistry, 2023-12) M’Mebwa Mtende Luc
Background: The first isolated C. albicans specimens were discovered in the nineteenth century ( James A. et al. 2008). 75% of women develop VVC at least once in their lifetime (Denning et al., 2018). Candida is a benign commensal of a host of vaginal epithelial tissues. However, a variety of factors might make it have a pathogenic effect (antibiotics, diabetes, bacterial vaginosis, prior vaginal infections, age etc.). (Bitew et al.2018). Factors associated with VVC differ region by region according to sociodemographic characteristics and other factors (Arfiputri et al., 2018). In Uganda, there is an increase in resistance of conventional antifungal drugs (fluconazole and itraconazole) to non-Albicans sp. among pregnant women (Mukasa et al., 2015). This study investigates VVC among 278 women attending Hoima Regional Referral Hospital in Uganda, aiming to comprehend its prevalence, associated factors, and antifungal sensitivity patterns. Methods: A cross-sectional design was employed, using questionnaires and laboratory analyses. Descriptive statistics, chi-square analysis, and logistic regression were used for data analysis. Results: The study found a VVC prevalence of 27.70%, with significant associations noted between VVC and age, HIV status, hormonal contraceptive use, and previous VVC. HIV-positive status emerged as a robust predictor of VVC, emphasizing the importance of integrated care. Antifungal sensitivity patterns underscore the need for tailored treatment approaches based on local resistance profiles. Conclusion: This study provides critical insights into VVC epidemiology, risk factors, and management. The findings highlight the necessity of integrated healthcare models, awareness campaigns, provider training, and improved antifungal accessibility. By emphasizing the importance of translating research into policies and recommending further studies, this research contributes to advancing women's reproductive health and VVC management practice. Keywords: vulvovaginal candidiasis, prevalence, associated factors, and susceptibility patterns
Incidence and Factors Associated with Failed Induction of Labor Among Women Delivering at Jinja Regional Referral Hospital, Uganda.
(Kampala International University; Faculty of Cinical Medicine and Dentistry, 2024-01) Ephraim Oluoch Onanga
Background: Induction of labor is the process of artificially initiating labor to attain Vaginal Delivery. The proportion of induced deliveries is increasing steadily among referral hospitals of Uganda. However, there is limited information regarding failure rate of this intervention. Factors associated with the failure rate has also not been well documented. Therefore, this study aimed to determine the incidence and factors associated with failed induction of labor at Jinja Regional Referral Hospital in Uganda. Materials and Methods: A hospital based prospective cohort study was conducted among 138 women undergoing labor induction at Jinja Regional Referral Hospital from 15th June, 2023 to 15th August, 2023. A consecutive sampling technique was used to recruit study participants and data was collected using pretested questionnaire. The collected data was entered into Microsoft excel and exported to Stata 14.2 for further analysis. A multivariate logistic regression analysis was performed to estimate effect of each of associated factors on fIOL after controlling for potential confounders. Statistical significance was declared at p-value <0.05 associated factors. Results: The incidence of failed induction of labor was found to be 49(35.51%). Statistically significant factors associated with failed induction of labor were nulliparity (aOR=2.26, 95% CI; 1.01-5.06), Pre-induction Bishop score <6 (aOR=4.82, 95% CI;2-10.87).There was a linear relationship of latent phase of labor and pre-induction Bishop score with Pearson correlation of (-0.804) Conclusion: The study highlights a significant burden of failed induction of labor among women delivering at Jinja Regional Referral. Clinicians should prioritize review of the execution of IOL services taking into consideration parity and pre-induction Bishop score that highly predicts failure before performing IOL. Finally,there is need to do pre-induction cervical assessment and determination of Bishop score in the setting of induction to improve outcome. Keywords: Failed Induction of Labor, Factors Associated, Jinja Regional Referral Hospital.
Prevalence and Factors Associated with Histological Chorioamnionitis Among Mothers with Premature Rupture of Membranes Delivering at Three Tertiary Hospitals, Uganda
(Kampala International University; Faculty of Cinical Medicine and Dentistry, 2024-02) Abdinasir Abdi Ibrahim
Background: Histological chorioamnionitis (HCA) unlike clinical chorioamnionitis continues to be a silent major threat to the mother and fetus all over the world. A few reports emerging from different scholars have shown that this terrifying obstetric complication is growing steadily across the world, worse in the resource constrained countries. Information regarding its magnitude, common patterns and associated factors remains extremely scanty in most of the African countries, including Uganda. Aim: To determine the prevalence and factors associated with HCA among mothers with premature rupture of membranes (PROM) delivering at three tertiary hospitals in Uganda Methods: This cross-sectional investigation was carried out at three tertiary hospitals in Uganda in a period of 3 months from July 9th to October 9th 2023 involving 106 women with PROM. Data was collected by the use of questionnaires. Binary logistic regression was used after descriptive statistics, and these were done in order to achieve the study objectives using STATA14. Results: Out of the 106 patients with PROM that were considered for the study at the three tertiary hospitals, 44(42%) had HCA. The most common histological finding was Neutrophil infiltration, 22(50.0%) followed by funisitis, 13(29.6%). Referred status (OR=4.5, 95%CI: 1.511-13.315, p=0.007) and prenatal care attendance (OR=9.8, 95%CI: 2.802-14.504, p=0.000) were discovered to be connected separately with HCA at the three tertiary hospitals in Uganda. Conclusions and recommendations: The prevalence of HCA was high compared to prior reports in Uganda. Placental infarcts are the most common histological lesions. PROM patients referred from other health centers and those who have not attended PNC are likely to have HCA. Routine screening of all women with PROM for HCA is recommended. PROM patients referred from other health centers and women who have not attended PNC should be initiated on treatment for chorioamnionitis till ruled out.

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