NRU :: Browsing by Author "Barageine, Justus K."

Browsing by Author "Barageine, Justus K."

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Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial
(PLoS ONE, 2021) Musaba, Milton W.; Wandabwa, Julius N.; Ndeezi, Grace; Weeks, Andrew D.; Mukunya, David; Waako, Paul; Nankabirwa, Victoria; Tulyamuhika Mugabe, Kenneth; Semakula, Daniel; Tumwine, James K.; Barageine, Justus K.
Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labor (dystocia). Its effectiveness and safety among women with obstructed labor is not known. Objective To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labor (OL) in Mbale hospital. Methods We conducted a double blind, randomized controlled trial from July 2018 to September 2019. The participants were women with OL at term (�37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements.
Effect of Pre-Operative Bicarbonate Infusion on Maternal and Perinatal Outcomes among Women with Obstructed Labour in Mbale Hospital: A Double Blind Randomized Controlled Trial
(PloS one, 2021-02-09) Musaba, Milton W.; Wandabwa, Julius N.; Ndeezi, Grace; Mukunya, David; Nankabirwa, Victoria; Barageine, Justus K.
Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (≥37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. The median maternal venous lactate was 6.4 (IQR 3.3–12.3) in the intervention and 7.5 (IQR 4.0–15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40–0.51) implying very little if any effect at all. The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels.
Effect of Preoperative Bicarbonate Infusion on Maternal and Perinatal Outcomes of Obstructed Labour in Mbale Regional Referral Hospital: a study protocol for a randomised controlled trial
(BMJ open, 2019-02-28) Musaba, Milton W.; Barageine, Justus K.; Ndeezi, Grace; Wandabwa, Julius N.; Andrew, Weeks
To improve maternal and fetal outcomes among patients with obstructed labour (OL) in low-resource settings, the associated electrolyte and metabolic derangements must be adequately corrected. Oral fluid intake during labour and preoperative intravenous fluid replacement following OL corrects the associated dehydration and electrolyte changes, but it does not completely reverse the metabolic acidosis, that is, a cause of intrapartum birth asphyxia and a risk factor for primary postpartum haemorrhage due to uterine atony. Sodium bicarbonate is a safe, effective, cheap and readily available acid buffer, that is widely used by sportspeople to improve performance. It also appears to improve fetal and maternal outcomes in abnormally progressing labour. However, its effects on maternal and fetal outcomes among patients with OL is unknown. We aim at establishing the effect of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal lactate levels and clinical outcomes among patients with OL.
Feasibility and Acceptability of Mobile Phone Data Collection for Longitudinal follow-up among Patients Treated for Obstetric Fistula in Uganda
(Health care for women international, 2020-10-08) El Ayadi, Alison M.; Nalubwama, Hadija; Barageine, Justus K.; Obore, Susan; Kakaire, Othman; Mwanje, Haruna; Byamugisha, Josaphat
Rapid dissemination of mobile technology provides substantial opportunity for overcoming challenges reaching rural and marginalized populations. We assessed feasibility and acceptability of longitudinal mobile data capture among women undergoing fistula surgery in Uganda (n = 60) in 2014–2015. Participants were followed for 12 months following surgery, with data captured quarterly, followed by interviews at 12 months. Participant retention was high (97%). Most respondents reported no difficulty with mobile data capture (range 93%–100%), and preferred mobile interview (88%–100%). Mobile data capture saved 1000 person-hours of transit and organizational time. Phone-based mobile data collection provided social support. Our results support this method for longitudinal studies among geographically and socially marginalized populations.
Identifying Opportunities for Prevention of Adverse Outcomes Following Female Genital Fistula Repair: Protocol for a Mixed‑Methods Study in Uganda
(Reproductive Health, 2025) El Ayadi, Alison M.; Obore, Susan; Kirya, Fred; Nalubwama, Hadija; Getahun, Monica; Eyul, Patrick; Twine, Robert; Andrew, Erin V. W.; Barageine, Justus K.
Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women’s health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations.
Incidence and determinants of perinatal mortality among women with obstructed labor in eastern Uganda: a prospective cohort study
(Maternal health, neonatology and perinatology, 2021) Musaba, Milton W.; Ndeezi, Grace; Barageine, Justus K.; Weeks, Andrew D.; Wandabwa, Julius N.; Mukunya, David; Waako, Paul; Odongkara, Beatrice; Arach, Agnes; Tulya-muhika Mugabe, Kenneth; Kasede Napyo, Agnes; Nankabirwa, Victoria; Tumwine, James K.
In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. Methods: Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death.
Incidence and Determinants of Perinatal Mortality among Women with Obstructed Labour in Eastern Uganda: A Prospective Cohort Study
(Maternal health, neonatology and perinatology, 2021-07-15) Musaba, Milton W. Musaba; Ndeezi, Grace; Barageine, Justus K.; Wandabwa, Julius N.; Mukunya, David; Waako, Paul; Odongkara, Beatrice; Arach, Agnes; Mugabe, Kenneth Tulya-muhika; Napyo, Agnes Kasede; Nankabirwa, Victoria; Tumwine, James K.
In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death. Of the 623 women diagnosed with obstructed labour, 584 met the eligibility criteria. There were 24 fresh still births (FSB) and 32 early neonatal deaths (ENND) giving an FSB rate of 43.8 (95% CI 28.3–64.4) deaths per 1000 total births; early neonatal death rate of 58.4 (95% CI 40.3–81.4) deaths per 1000 and an overall perinatal mortality rate of 102.2 (95% CI 79.4–130.6) deaths in the first 7 days of life. A mother being referred in active labour adjusted risk ratio of 2.84 (95% CI: 1.35–5.96) and having high blood lactate levels at recruitment adjusted risk ratio 2.71 (95% CI: 1.26–4.24) were the determinants of perinatal deaths. The incidence of perinatal death was four times the regional and national average. Babies to women referred in active labour and those with high maternal blood lactate were more likely to die.
Maternal and Umbilical Cord Blood Lactate for Predicting Perinatal Death: a secondary analysis of data from a randomized controlled trial
(BMC Pediatr, 2023-04-18) Musaba, Milton W.; Nambozo, Brendah; Barageine, Justus K.; Ndeezi, Grace
In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths. labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1–130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h.
Perceived Causes of Obstetric Fistula and Predictors of Treatment Seeking among Ugandan Women: Insights from Qualitative Research
(African journal of reproductive health, 2020-07-24) Nalubwama, Hadija; El Ayadi, Alison M.; Barageine, Justus K.; Byamugisha, Josaphat; Kakaire, Othman; Obore, Susan; Mwanje, Haruna; Miller, Suellen
Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uganda. We explored women‘s perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June–August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women‘s suffering.
Prevalence and Factors Associated with Second Trimester Pregnancy Loss among Women Admitted at a National Referral Hospital in Uganda: a cross-sectional study
(African Health Sciences, 2025-01-11) Irumba, Charles; Kaye, Dan K.; Barageine, Justus K.; Ampwera,Rodgers; Atwiine, Hope
Second trimester pregnancy loss (abortion) refers to induced or spontaneous termination of pregnancy from 13 to the end of 26 weeks of gestation. Second trimester abortions contribute to a high proportion of maternal morbidity, mortality and psychological stress especially in low-resource countries with restricted access to safe abortion services. While globally, the prevalence of second trimester abortions is 10–15%, the prevalence at Kawempe National Referral Hospital was not known. The study objective was to determine the prevalence and factors associated with second trimester abortion at Kawempe National Referral Hospital.
Rehabilitation and Reintegration Programming adjunct to Female Genital Fistula Surgery: A systematic scoping review
(International Journal of Gynecology & Obstetrics, 2020-01-13) El Ayadi, Alison M.; Obore, Susan; Byamugisha, Josaphat; Barageine, Justus K.
Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services adjunct to fistula surgery. To examine rehabilitation and reintegration services provided adjunct to genital fistula surgery, map existing programming and outcomes, and identify areas for additional research. We searched the published and grey literature from January 2000 to June 2019. Two reviewers screened articles and extracted data using standardized methods. Research and programmatic articles describing service provision in addition to female genital fistula surgery were included. Of 3047 published articles and 2623 unpublished documents identified, 26 and 55, respectively, were analyzed. Programming identified included combinations of health education, physical therapy, social support, psychosocial counseling, and economic empowerment, largely in sub-Saharan Africa. Improvements were noted in physical and psychosocial health. Existing literature supports holistic fistula care through adjunct reintegration programming. Improving the evidence base requires implementing robust study designs, increasing reporting detail, and standardizing outcomes across studies. Increased financing for holistic fistula care is critical for developing and supporting programming to ensure positive outcomes.
Risk Factors for Obstructed Labour in Eastern Uganda: A case control study
(PloS one, 2020-02-10) Musaba, Milton W.; Ndeezi , Grace; Barageine, Justus K.; Nankabirwa, Victoria; Wandabwa, Julius N.
Obstructed labour (OL) is an important clinical and public health problem because of the associated maternal and perinatal morbidity and mortality. Risk factors for OL and its associated obstetric squeal are usually context specific. No epidemiological study has documented the risk factors for OL in Eastern Uganda. This study was conducted to identify the risk factors for OL in Mbale Hospital.
The Gendered Socioeconomic Impact of the COVID-19 Pandemic on Women with Fistula Repair in Uganda
(Adv Glob Health, 2023-05-09) Mekaleya, Tilahun; Mariko, Costantini; Nalubwama, Hadija; Barageine, Justus K.; Nalubega, Florence; Muleledhu, Andrew; El Ayadi, Alison M.
Public health mitigation strategies for SARS-COV-2 are effective in limiting the spread of COVID-19; however, these restrictions can create gendered socioeconomic impacts and further isolate marginalized communities from essential resources. Our qualitative study aimed to understand the gendered effects of the COVID-19 lockdown on a population of women in Uganda with a history of prior obstetric fistula repair, a group experiencing greater vulnerability and less support due to intersecting stigmatized identities. We conducted in-depth interviews among 30 women with prior genital fistula and corrective fistula repair surgery at 3 hospitals in Southern Uganda. We found that COVID-19 lockdown measures caused both financial and health-related impacts in this community such as inaccessibility of healthcare and loss of income. Understanding these experiences should inform strategies to ensure equitable, future pandemic responses.
The Social, Economic, Emotional, and Physical Experiences Of Caregivers for Women with Female Genital Fistula in Uganda: A Qualitative Study
(Global public health, 2023-09-06) El Ayadi, Alison M.; Nalubwama, Hadija; Semere, Wagahta; Barageine, Justus K.; Obore, Susan; Lucas, Ruby; Byamugisha, Josaphat
This study aimed to explore the firsthand experiences of informal primary caregivers of women with female genital fistula in Uganda. Caregivers that accompanied women for surgery at Mulago National Teaching and Referral Hospital were recruited between January and September 2015. Caregivers participated in in-depth interviews and focus groups. Data were analysed thematically and informed adaptation of a conceptual framework. Of 43 caregivers, 84% were female, 95% family members, and most married and formally employed. Caregivers engaged in myriad personal care and household responsibilities, and described being on call for an average of 22.5 h per day. Four overlapping themes emerged highlighting social, economic, emotional, and physical experiences/consequences. The caregiving experience was informed by specific caregiver circumstances (e.g. personal characteristics, care needs of their patient) and dynamic stressors/supports within the caregiver’s social context. These results demonstrate that caregivers’ lived social, economic, emotional, and physical experiences and consequences are influenced by both social factors and individual characteristics of both the caregiver and their patient. This study may inform programmes and policies that increase caregiving supports while mitigating caregiving stressors to enhance the caregiving experience, and ultimately ensure its feasibility, particularly in settings with constrained resources.

Browsing by Author "Barageine, Justus K."

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