Browsing by Author "Barageine, Justus"

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    Characteristics and Outcomes of Patients with Pelvic Organ Prolapse: an Analysis of Data from Mulago National Referral Hospital from 2007–2016
    (African Health Sciences, 2023-04-11) Byamugisha, Josaphat; Barageine, Justus; Kakaire, Othman; Nalubwama, Haddy; Obore, Susan; Mukasa, David Christopher; Mwanje, Haruna; Alia, Godfrey; El Ayadi, Alison
    Pelvic organ prolapse (POP) is associated with negative physical, social, psychological, and sexual experiences. There is paucity of data in low and middle income countries like Uganda. The purpose of this study was to describe clinical characteristics and outcomes of patients undergoing surgery for POP from 2007 to 2016. The study was conducted at Mulago National Referral Hospital from 2014 to 2016. We conducted a retrospective review of the urogynecology surgical records using a standardized medical record abstraction form. Data of 222 POP patients were abstracted and managed using REDCap. Analysis was performed using Stata statistical software, v14. The mean participant age and parity was 57 years and 7 respectively. Ninety four percent of participants presented with a mass protruding from the vagina, 38% with uterine prolapse and 32% with cystocoele. Anaemia and hypertension were common comorbidities. Women underwent a variety of surgery types, and 35% experienced persistent pain post-operatively. At hospital discharge, 83% had achieved either complete resolution or improvement in their condition. Measures encouraging presentation for care as soon as symptoms are experienced and reduction of total fertility rate will be beneficial. Patients with POP should be routinely screened for anaemia and hypertension.
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    Contraceptive Preferences and Adoption Following Female Genital Fistula Surgery in Uganda: A Mixed‑Methods Study
    (Reproductive Health, 2023-08-19) El Ayadi, Alison M.; Nalubwama, Hadija; Kakaire, Othman; Miller, Suellen; Barageine, Justus; Byamugisha, Josaphat; Obore, Susan; Harper, Cynthia C.
    Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes. We examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use. Median participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods. A high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.
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    Development and Preliminary Validation of a Post-fistula Repair Reintegration Instrument among Ugandan Women
    (Reproductive health, 2017-09-02) El Ayadi, Alison; Nalubwama, Hadija; Barageine, Justus; Byamugisha, Josaphat; Kakaire, Othman; Mwanje, Haruna; Miller, Suellen
    Obstetric fistula is a debilitating and traumatic birth injury affecting 2–3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov’s ρ and Pearson’s correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. Themes central to women’s experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled ‘Mobility and social engagement’, ‘Meeting family needs’, ‘Comfort with relationships’, and ‘General life satisfaction’, and goodness of fit statistics supported a higher-order latent variable of ‘Reintegration.’ Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.
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    Factors Associated with Reintegration Trajectory Following Female Genital Fistula Surgery in Uganda
    (AJOG Global Reports, 2023-11-13) Bigley, Rachel; Barageine, Justus; Nalubwama, Hadija; Obore, Susan; Byamugisha, Josaphat; El Ayadi, Alison M.
    A female genital fistula, primarily caused by prolonged obstructed labor or after cesarean delivery in resource-limited countries, affects 500,000 to 2,000,000 women worldwide. Fistula is preventable with timely access to high-quality obstetrical care. Access to surgical repair of a female genital fistula has greatly increased over time. However, research surrounding postrepair reintegration, the process of returning to an individual's normal life, remains limited, and further efforts are needed to understand the factors shaping women's ability to rebuild their relationships and lives following repair. This study aimed to characterize the 12-month reintegration trajectory after female genital fistula repair by participant sociodemographic and clinical characteristics. This study analyzed quantitative survey and medical record data of women (N=60) participating in a longitudinal cohort study assessing recovery after genital fistula repair in Uganda, with baseline and 4 quarterly follow-up assessments in 12 months. The primary outcome of reintegration was assessed using a 19-item postfistula repair reintegration instrument (range, 0–100) where a higher score represents better reintegration. Predictors of interest included parity and living children, quality of life, depressive symptoms at baseline, self-esteem, stigma, trauma, physical symptoms, and social support. We described participant baseline characteristics using means and proportions and estimated a series of mixed-effects linear regression models, including interactions of characteristics with time to understand how these characteristics influence reintegration trajectory in the 12 months after repair. The participants’ physical and psychosocial morbidities at baseline were high; more than 80% of participants reported fistula-related physical symptoms, 82% of participants described their general health as poor, and measures of self-esteem, overall social support, and overall quality of life were low. The mean reintegration score at baseline was 33 (standard deviation, 20), which increased to 78 (standard deviation, 19) at 12 months after fistula repair. The participant sociodemographic characteristics statistically associated with reintegration included any living children (β, 1.08; 95% confidence interval, −0.08 to 2.23). Moreover, psychosocial factors significantly affected reintegration with steeper trajectories for women with depressive symptoms (β, 0.89; 95% confidence interval, 0.02–1.75) or women experiencing internalized stigma (β, 0.05; 95% confidence interval, −0.00 to 0.11) and less steep for those with higher self-esteem (β, −0.11; 95% confidence interval, −0.24 to 0.01), overall social support (β, −0.06; 95% confidence interval, −0.12 to −0.01), and partner support (β, −0.21; 95% confidence interval, −0.35 to −0.07). Understanding the prominent factors associated with differences in reintegration trajectories across the year after genital fistula surgery has the potential to inform interventions that mitigate challenges and improve women's postrepair recovery experiences.
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    Trajectories of Women’s Physical and Psychosocial Health following Obstetric Fistula Repair in Uganda: A Longitudinal Study
    (Tropical Medicine & International Health, 2018-10-29) El Ayadi, Alison M.; Barageine, Justus; Kakaire, Othman; Obore, Susan; Byamugisha, Josaphat; Nalubwama, Hadija; Mwanje, Haruna; Tripathi, Vandana
    To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014–June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI −30.1, −12.4). Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.