Browsing by Author "Kakaire, Othman"

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    Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol
    (Reprod Health, 2015-12-18) Byamugisha, Josaphat; Obore, Susan; Kakaire, Othman; Nalubwama, Hadija; Miller, Suellen
    Obstetric fistula is a debilitating birth injury that affects an estimated 2–3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65–95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration.
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    The burden of maternal morbidity and mortality attributable to hypertensive disorders in pregnancy: a prospective cohort study from Uganda
    (BMC pregnancy and childbirth, 2016) Nakimuli, Annettee; Nakubulwa, Sarah; Kakaire, Othman; Osinde, Michael O.; Mbalinda, Scovia N.; Kakande, Nelson; Nabirye, Rose C.; Kaye, Dan K.
    Hypertensive disorders of pregnancy are a major cause of morbidity and mortality. The objective was to estimate the disease burden attributable to hypertensive disorders of pregnancy in two referral hospitals in Uganda. Methods: Through a prospective cohort study conducted in Jinja and Mulago hospitals in Uganda from March 1, 2013 and February 28, 2014, hypertension-related cases were analyzed. Maternal near miss cases were defined according to the WHO criteria. Maternal deaths were also analyzed. The maternal near miss incidence ratio, the case-specific severe maternal outcome ratio, the case-specific maternal mortality ratio and the case-fatality ratio were computed. Results: Of 403 women with hypertensive disorders of pregnancy, 218 (54.1 %) had severe preeclampsia, 172 (42.7 %) had eclampsia, and 13 had chronic hypertension or Hemolysis, elevated liver enzymes or low platelets (HELLP) syndrome. The case-specific maternal near miss incidence ratios was 8.60 per 1,000 live births for all hypertensive disorders, 3.06 per 1,000 live births for severe preeclampsia and 5.11 per 1,000 live births for eclampsia. The casespecific severe maternal outcome ratio was 9.37 per 1,000 live births for all hypertensive disorders, and was 3.25 per 1,000 live births for severe preeclampsia and 5.61 per 1,000 live births for eclampsia. The case-specific maternal mortality ratio was 780 per 100,000 live births for all hypertensive disorders, and was 1940 per 100,000 live births for severe preeclampsia and 501 per 100,000 live births for eclampsia. The case-fatality ratio was 5.1 % overall (for all hypertensive disorders), but was 8 times higher for eclampsia compared to severe preeclampsia. Cyanosis, abnormal respiration, oliguria, circulatory collapse, coagulopathy, thrombocytopenia, and elevated serum lactate were significantly associated with severe maternal outcomes. Conclusion: There is high morbidity attributable to hypertensive disorders in pregnancy. Since some of the complications associated with morbidity can be recognized early, it is possible to prevent severe morbidity through early intervention with delivery, antihypertensive therapy and prophylactic magnesium sulphate treatment. The findings highlight the feasibility of implementing a facility-based surveillance system for severe maternal morbidity due to hypertensive disorders.
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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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    Effectiveness of Early versus Standard Intrauterine Contraception following Medical 2 Management of First Trimester Incomplete Abortions: A Non-Inferiority Open-Label 3 Randomized Control Trial in central Uganda
    (2025) Kayiga, Herbert; Looft-Trägårdh, Emelie; Kakaire, Othman; Cleeve, Amanda; Rujumba, Joseph; Sekikubo, Musa; Tumwesigye, Nazarius M.; Byamugisha, Josaphat; Gemzell-Danielsson, Kristina
    Background: With paucity of information on ideal timing for intrauterine contraception placement, we set out to determine the effectiveness of early insertion (within one week) versus standard insertion (two-four weeks) of intrauterine contraception after medical management of first trimester incomplete abortions in central Uganda. Methods: In a multicenter non-inferiority trial at five public health facilities in central Uganda, 1,050 women with first trimester incomplete abortions managed by sublingual misoprostol, were recruited upon giving informed consent. After selecting either Copper or Levonorgestrel intrauterine devices (IUDs), participants were randomly assigned to early or standard insertion arms in a ratio of 1:1. The primary outcome was IUD expulsion rates at six-months. The non-inferiority margin was set at 5% for the upper limit of the confidence interval (CI) for the absolute risk difference. The trial was registered at ClinicalTrials.gov NCT05343546. Findings: Between 8th July 2023 to 31st May 2024, 528 (50·3%) participants were assigned to early and 522 (49·7%) participants to standard insertion arms. About 531 (50·6%) participants chose Levonorgestrel IUDs, 489 (46·6%) participants chose copper IUDs, while 30 (2·9%) participants opted against IUDs. In an intention-to-treat analysis, expulsion occurred in 23 (4·4%) of 528 participants in the early insertion arm and in 24 (4·6%) of 522 participants in the standard arm; Adjusted Risk Difference (standard-early) was -0·00006 (95% CI: -0·0008 to 0·00066, p = 0·93). No serious adverse events occurred in both arms. The IUD continuation rates at six-months were 91·1% in the early and 90·2% in the standard insertion arms. Interpretation: Early IUD insertion after medical treatment of first trimester incomplete abortions was non-inferior to standard IUD insertion with respect to expulsion. Early IUD insertion may help to prevent unintended pregnancies.
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    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.
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    Healthcare providers’ perceptions on post abortion intrauterine contraception: A qualitative study in central Uganda
    (PloS one, 2024) Kayiga, Herbert; Looft-Tragårdh, Emelie; Cleeve, Amanda; Kakaire, Othman; Tumwesigye, Nazarius M.; Byamugisha, Josaphat; Gemzell-Danielsson, Kristina
    Despite access to post abortion intrauterine contraception, the uptake of Intrauterine devices (IUDs) in Uganda remains low. Whether the perceptions of healthcare providers towards IUDs have a role in the provision of post abortion IUDs remains unclear. We explored perceptions on post abortion IUD provision among healthcare providers in Uganda, focusing on barriers and facilitators in regards to provision and uptake. Methods Between 1st August 2022 and 30th September 2022, forty-five in-depth interviews were conducted among healthcare providers of different cadres at sixteen public health facilities in central Uganda. We used the case study design to explore the healthcare providers’ perceptions. The interviews were primarily to help us understand the perceptions of healthcare providers towards IUDs. All interviews were audio-recorded and transcribed verbatim. Themes were identified using the conventional inductive content analysis. Results From the analysis, three themes emerged. Theme one covered health system related barriers in regards to IUD provision such as healthcare providers’ and health facility challenges. The second theme focused on the challenges in post abortion contraceptive counselling focusing on IUDs. The third theme covered the motivating factors and participants’ views on how to scale up IUD uptake and provision within post abortion care in Uganda. We found that lack of appropriate knowledge and skills on IUD provision, and heavy workloads, negatively impacted IUD provision. Inadequate facilities, IUD stock-outs, and minimal community sensitization also limited the utilization of IUDs. Furthermore, language barriers, community misconceptions around IUDs, long travel distances to the health facility, and partner refusal, contributed to the low uptake of post abortion IUDs. To address the identified barriers and scale up post abortion IUD provision, participants recommended addressing health system barriers, regular in-service refresher trainings, mentoring and supervision. They emphasized the importance of addressing contraceptive misconceptions and men’s opposition to IUDs through community sensitization. Conclusion In this study we identified several barriers to post abortion IUD provision, highlighting an urgent need to address health system barriers including healthcare providers’ skills and knowledge gaps, supply chain challenges, and to ensure that facilities are conducive to quality contraceptive counselling. Provision of on-job refresher trainings, mentoring and supervision, are key motivators that can be utilized in supporting healthcare providers towards post abortion IUD provision. To further increase uptake, efforts are needed to dispel contraceptive myths and misconceptions at the community level.
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    Immediate versus delayed postpartum use of levonorgestrel contraceptive implants: a randomized controlled trial in Uganda
    (American journal of obstetrics and gynecology, 2017) Averbach, Sarah; Kakaire, Othman; Kayiga, Herbert; Lester, Felicia; Sokoloff, Abby; Byamugisha, Josaphat; Dehlendorf, Christine; Steinauer, Jody
    Use of long-acting, highly effective contraception has the potential to improve women’s ability to avoid short interpregnancy intervals, which are associated with an increased risk of maternal morbidity and mortality, and preterm delivery. In Uganda, contraceptive implants are not routinely available during the immediate postpartum period. Objective The purpose of this study was to compare the proportion of women using levonorgestrel contraceptive implants at 6 months after delivery in women randomized to immediate or delayed insertion. Study Design This was a randomized controlled trial among women in Kampala, Uganda. Women who desired contraceptive implants were randomly assigned to insertion of a 2-rod contraceptive implant system containing 75 mg of levonorgestrel immediately following delivery (within 5 days of delivery and before discharge from the hospital) or delayed insertion (6 weeks postpartum). The primary outcome was implant utilization at 6 months postpartum. Results From June to October 2015, 205 women were randomized, 103 to the immediate group and 102 to the delayed group. Ninety-three percent completed the 6 month follow-up visit. At 6 months, implant use was higher in the immediate group compared with the delayed group (97% vs 68%; P < .001), as was the use of any highly effective contraceptive (98% vs 81%; P = .001). Women in the immediate group were more satisfied with the timing of implant placement. If given the choice, 81% of women in the immediate group and 63% of women in the delayed group would choose the same timing of placement again (P = .01). There were no serious adverse events in either group. Conclusion Offering women the option of initiating contraceptive implants in the immediate postpartum period has the potential to increase contraceptive utilization, decrease unwanted pregnancies, prevent short interpregnancy intervals, and help women achieve their reproductive goals.
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    Maternal near misses from two referral hospitals in Uganda: a prospective cohort study on incidence, determinants and prognostic factors
    (BMC pregnancy and childbirth, 2016) Nakimuli, Annettee; Nakubulwa, Sarah; Kakaire, Othman; Osinde, Michael O.; Mbalinda, Scovia N.; Nabirye, Rose C.; Kakande, Nelson; Kaye, Dan K.
    Background: Maternal near misses occur more often than maternal deaths and could enable more comprehensive analysis of risk factors, short-term outcomes and prognostic factors of complications during pregnancy and childbirth. The study determined the incidence, determinants and prognostic factors of severe maternal outcomes (near miss or maternal death) in two referral hospitals in Uganda. Methods: A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, where cases of severe pregnancy and childbirth complications were included. The clinical conditions included abortion-related complications, obstetric haemorrhage, hypertensive disorders, obstructed labour, infection and pregnancy-specific complications such as febrile illness, anemia and premature rupture of membranes. Near miss cases were defined according to the WHO criteria. Multivariate logistic regression analysis was conducted to identify prognostic factors for severe maternal outcomes. Results: Of 3100 women with severe obstetric complications, 130 (4.2 %) were maternal deaths and 695 (22.7 %) were near miss cases. Severe pre-eclampsia was the commonest morbidity (incidence ratio (IR) 7.0 %, case-fatality rate (CFR) 2.3 %), followed by postpartum haemorrhage (IR 6.7 %, CFR 7.2 %). Uterine rupture (IR 5.5 %) caused the highest CFR (17.9 %), followed by eclampsia (IR 0.4 %, CFR 17.8 %). The three groups (maternal deaths, near misses and non-life-threatening obstetric complications) differed significantly regarding gravidity and education level. The commonest diagnostic criteria for maternal near miss were admission to the high dependency unit (HDU) or to the intensive care unit (ICU). Thrombocytopenia, circulatory collapse, referral to a more specialized unit, intubation unrelated to anaesthesia, and cardiopulmonary resuscitation were predictive of maternal death (p < 0.05). Gravidity (ARR 1.4, 95 % C1 1.0–1.2); elevated serum lactate levels (ARR 4.5, 95 % CI 2.3–8.7); intubation for conditions unrelated to general anaesthesia (ARR 2.6 (95 % CI 1.2–5.7), cardiovascular collapse (ARR 4.9, 95 % CI 2.5–9.5); transfusion of 4 or more units of blood (ARR 1.9, 95 % CI 1.1–3.1); being an emergency referral (ARR 2.6, 95 % CI 1.2–5.6); and need for cardiopulmonary resuscitation (ARR 6.1, 95 % CI 3.2–11.7), were prognostic factors. Conclusions: The analysis of near misses is a useful tool in the investigation of severe maternal morbidity. The prognostic factors for maternal death, if instituted, might save many women with obstetric complications
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    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.
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    Still births, neonatal deaths and neonatal near miss cases attributable to severe obstetric complications: a prospective cohort study in two referral hospitals in Uganda
    (BMC pediatrics, 2015) Nakimuli, Annettee; Mbalinda, Scovia N.; Nabirye, Rose C.; Kakaire, Othman; Nakubulwa, Sarah; Osinde, Michael O.; Kakande, Nelson; Kaye, Dan K.
    Neonatal near miss cases occur more often than neonatal deaths and could enable a more comprehensive analysis of risk factors, short-term outcomes and prognostic factors in neonates born to mothers with severe obstetric complications. The objective was to assess the incidence, presentation and perinatal outcomes of severe obstetric morbidity in two referral hospitals in Central Uganda. Methods: A prospective cohort study was conducted between March 1, 2013 and February 28, 2014, in which all newborns from cases of severe pregnancy and childbirth complications were eligible for inclusion. The obstetric conditions included obstetric haemorrhage, hypertensive disorders, obstructed labour, chorioamnionitis and pregnancy-specific complications such as malaria, anemia and premature rupture of membranes. Still births, neonatal deaths and neonatal near miss cases (defined using criteria that employed clinical features, presence of organ-system dysfunction and management provided to the newborns were compiled). Stratified and multivariate logistic regression analysis was conducted to identify risk factors for perinatal death. Results: Of the 3100 mothers, 192 (6.2%) had abortion complications. Of the remainder, there were 2142 (73.1%) deliveries, from whom the fetal outcomes were 257 (12.0%) still births, 369 (17.2%) neonatal deaths, 786 (36.7%) neonatal near misses and 730 (34.1%) were newborns with no or minimal life threatening complications. Of the 235 babies admitted to the neonatal intensive care unit (NICU), the main reasons for admission were prematurity for 64 (26.8%), birth asphyxia for 59 (23.7%), and grunting respiration for 26 (11.1%). Of the 235 babies, 38 (16.2%) died in the neonatal period, and of these, 16 died in the first 24 hours after admission. Ruptured uterus caused the highest case-specific mortality of 76.8%, and led to 16.9% of all newborn deaths. Across the four groups, there were significant differences in mean birth weight, p = 0.003. Conclusions: Antepartum hemorrhage, ruptured uterus, severe preeclampsia, eclampsia, and the syndrome of Hemolysis, Elevated Liver Enzymes, Low Platelets (HELLP syndrome), led to statistically significant attributable risk of newborn deaths (still birth or neonatal deaths). Development of severe maternal outcomes, the mothers having been referred, and gravidity of 5 or more were significantly associated with newborn deaths.
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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.
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    Uptake of Intrauterine Contraception after Medical Management of First Trimester Incomplete Abortion : A Cross-sectional study in central Uganda
    (2024) Kayiga, Herbert; Looft-Trägårdh, Emelie; Cleeve, Amanda; Kakaire, Othman; Tumwesigye, Nazarius M.; Sekikubo, Musa; Rujumba, Joseph; Gemzell- Danielsson, Kristina; Byamugisha, Josaphat
    Although intrauterine devices (IUDs) are readily available in Uganda, their utilization remains low, including within post abortion care. The level and factors associated with uptake of post abortion IUDs are not well documented. We set out to determine the uptake and factors associated with uptake of post abortion IUDs after medical management of first trimester incomplete abortions in central Uganda. Methods Between February 2023 and September 2023, we conducted a cross-sectional study among women aged 15 to 49 years, who expressed interest in initiating post abortion intrauterine contraception and were managed with Misoprostol for first trimester incomplete abortions at five health facilities in central Uganda. Healthcare providers received extensive training in post abortion contraceptive counselling and service provision. Data from 650 participants were collected using interviewer administered questionnaires. The primary outcome was uptake of post abortion IUDs, defined as the actual insertion of the post abortion IUDs. Data were collected during a post abortion follow up visit. The determinants of post abortion IUD uptake were assessed using the modified poisson regression. Results The proportion of women who took up IUDs after medical management of first trimester abortion, was 370/650 (56.9%). Among the other available contraceptive choices, 121(18.6%) women opted for injectable Depo-Provera (DMPA), 116(17.9%) women opted for implants, 35(5.4%) women opted for oral contraceptive pills, five (0.8%) of the women opted for condoms, and three (0.5%) women for periodic abstinence. The mean age of the participants was (27.3 ± SD 1.8) years. A high proportion of the women in the study were; Catholics (32.3%), unemployed (52.6%), cohabiting with their partners (84.0%) and had given birth to 2-3 children (38.5%). A high proportion (56%) of IUD users, opted for the copper IUDs. The post abortion IUD uptake was independently associated with religion- being a Pentecostal (Adjusted PR=2.49, CI= (1.19-5.23), p-value=0.016), monthly earning > one million Ugx (270 USD) (Adjusted PR=1.88, CI= (1.44-2.46), p-value<0.001), and staying <5 kilometres from the health facility (Adjusted PR=1.34, CI= (1.04-1.72), p-value=0.023). Women who were not cohabiting with their partners, were less likely to choose IUDs (Adjusted PR=0.59, CI= (0.44-0.79), p-value=0.001). Conclusion The uptake of IUDs among post abortion women was nearly 60% emphasizing the potential impacts of integrated contraceptive services in Post abortion care. The impact of comprehensive and updated training on post abortion contraceptive counselling is vital on the uptake of IUDs. Regardless of sociodemographic status, women seeking post abortion care in Uganda should be provided with high-quality integrated services by trained providers offering a range of contraceptive methods. Such efforts may not only prevent unintended pregnancies but also improve health equity across the country.
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    Use of surgical task shifting to scale up essential surgical services: a feasibility analysis at facility level in Uganda
    (MC health services research, 2013) Galukande, Moses; Kaggwa, Sam; Sekimpi, Patrick; Kakaire, Othman; Katamba, Achilles; Munabi, Ian; Mwesigye Runumi, Francis; Hagopian, Amy; Blair, Geoffrey; Barnhart, Scott; Luboga, Sam; Mills, Ed.
    The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level. Methods: 37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations. Results: Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting.