Browsing by Author "Achora, Vicentina"
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Item Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda(British Medical Journal Publishing Group, 2024-02) Nankabirwa, Victoria; Mukunya, David; Ndeezi, Grace; Odongkara, Beatrice; Arach, Agnes A; Achora, Vicentina; Mugenyi, Levi; Sebit, Mohammad Boy; Wandabwa, Julius N; Waako, Paul; Tylleskär, Thorkild; Tumwine, James KAbstract ObjectiveTo assess the effect of an integrated intervention package compared with routine government health services on the frequency of health facility births.SettingThree subcounties of Lira district in Northern Uganda.DesignA cluster randomised controlled trial where a total of 30 clusters were randomised in a ratio of 1:1 to intervention or standard of care.ParticipantsPregnant women at ≥28 weeks of gestation.InterventionsParticipants in the intervention arm received an integrated intervention package of peer support, mobile phone messaging and birthing kits during pregnancy while those in the control arm received routine government health services (‘standard of care’).Primary and secondary outcome measuresThe primary outcome was the proportion of women giving birth at a health facility in the intervention arm compared with the control arm. Secondary outcomes were perinatal and neonatal deaths.ResultsIn 2018–2019, 995 pregnant women were included in 15 intervention clusters and 882 in 15 control clusters. The primary outcome was ascertained for all except one participant who died before childbirth. In the intervention arm, 754/994 participants (76%) gave birth at a health facility compared with 500/882 (57%) in the control arm. Participants in the intervention arm were 35% more likely to give birth at a health facility compared with participants in the control arm, (risk ratio 1.35 (95% CI 1.20 to 1.51)) and (risk difference 0.20 (95% CI 0.13 to 0.27)). Adjusting for baseline differences generated similar results. There was no difference in secondary outcomes (perinatal or neonatal mortality or number of postnatal visits) between arms. Conclusion The intervention was successful in increasing the proportion of facility-based births but did not reduce perinatal or neonatal mortality.Trial registration numberNCT02605369Item Neonatal hypothermia in Northern Uganda: a community-based cross-sectional study(BMJ open, 2021) Mukunya, David; Tumwine, James K.; Nankabirwa, Victoria; Odongkara, Beatrice; Tongun, Justin B.; Arach, Agnes A.; Tumuhamye, Josephine; Napyo, Agnes; Zalwango, Vivian; Achora, Vicentina; Musaba, Milton W.; Ndeezi, Grace; Tylleskär, ThorkildTo determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda. Setting Three subcounties of Lira district in Northern Uganda. Design This was a community-based cross-sectional study nested in a cluster randomised controlled trial. Participants Mother–baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery-operated digital thermometer. Primary and secondary outcomes The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family. Results We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9). Conclusion The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin-to- skin care could reduce the risk of neonatal hypothermia.