Browsing by Author "Kyohere, Mary"

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    Maternal, Neonatal, Child, Sexual and Reproductive Health Services in Kampala, Uganda
    (medRxiv., 2021) Burt, Jessica; Ouma, Joseph; Amone, Alexander; Aol, Lorna; Sekikubo, Musa; Nakimuli, Annettee; Nakabembe, Eve; Mboizi, Robert; Musoke, Philippa; Kyohere, Mary; Namara, Emily; Khalil, Asma; Doare, Kirsty Le
    COVID-19 has impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown which severely limited the movements of individuals in Uganda will have impacted access to services. An observational study, using routinely collected health data from Electronic Medical Records was carried out, utilising data from July 2019 to December 2020 in Kawempe district, Kampala. The mean and 95% confidence intervals were calculated pre-COVID (July 2019 – February 2020) and post-COVID (March-December 2020). The means were compared using t-tests, and the monthly totals analysed as to whether they lay within or outside the normal range, compared to the previous 9 months. Antenatal attendances decreased 96% in April 2020 and remain below pre-COVID levels. We found a rise in adverse pregnancy outcomes for Caesarean sections (5%), haemorrhages related to pregnancy (51%), stillbirths (31%) and low-birth-weight (162%) and premature infant births (400%). We noted a drop in neonatal unit admissions, immunisation clinic attendance and delivery of all vaccinations except measles. There was an immediate drop in clinic attendance for prevention of mother to child transmission of HIV (now stabilised) and an increase of 348% in childhood malnutrition clinic attendance. Maternal and neonatal deaths, immediate post-natal care and contraceptive provision remained within normal limits.The response to COVID-19 in Uganda has negatively impacted maternal, child and neonatal health, with the biggest and longest lasting impact seen in complications of pregnancy, stillbirths and low-birthweight infants likely due to delayed care-seeking behaviour. The decline in vaccination clinic attendance has implications for all vaccine-preventable diseases, with a cohort of infants currently unprotected. Further consideration of the impacts of restricting movement and limiting access to preventative services must be undertaken in responding to future pandemics if key maternal and child health services are to be maintained.
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    Seroepidemiology Of Maternally-Derived Antibody Against Group B Streptococcus (GBS) in Mulago/Kawempe Hospitals Uganda - PROGRESS GBS
    (Gates Open Research, 2020) Kyohere, Mary; Davies, Hannah Georgia; Musoke, Philippa; Nakimuli, Annettee; Tusubira, Valerie; Tasimwa, Hannington Baluku; Nsimire, Juliet Sendagala; Heath, Paul; Cose, Stephen; Baker, Carol; Doare, Kirsty Le; Sekikubo, Musa
    Group B Streptococcus (GBS) is a major contributor to the high burden of neonatal and young infant infectious disease in resource- limited settings. As disease protection during the first six months of life is provided via placental transfer of maternal antibodies, a maternal GBS vaccine may provide an effective strategy to reduce infectious death and disability. An efficacy study may be difficult because of the large sample size required and alternative approaches such as serocorrelates of protection based on natural antibody concentration are being considered. Such studies would need to be undertaken in high burden settings such as Uganda. We therefore aim to evaluate the feasibility and acceptability of a GBS sero-epidemiology study in Kampala,Uganda.This is a prospective cohort and nested case-control study, conducted across two-centres with two entry points. A) consecutive women and their infants at birth, with collection of maternal swab, cord and maternal blood, and follow up by telephone until the infant is 3 months old; B) any infant under 3 months of age, presenting with signs of sepsis to any of the paediatric units, with collection of blood culture, cerebrospinal fluid and nasopharyngeal swabs. Any infants identified as having GBS disease (defined as GBS isolated from a normally sterile site) will be recruited and followed up for two years to assess their neurodevelopment. A nested qualitative study will investigate stakeholder (pregnant women and their families, healthcare workers and community leaders) opinions of sampling for such a study and understanding and potential uptake of vaccines in pregnancy. The primary aim is to determine anti-GBS antibody concentration in infants with GBS disease compared to healthy controls. Secondary outcomes include stillbirth and all-cause infection and acceptance of sample methods and vaccination. The findings will inform scalability and sustainability of the programme in Uganda.