Master of Medicine in Obstetrics, Reproductive Health and Gynecology

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    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.
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    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.
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    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
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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.
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    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.