NRU :: Browsing by Author "Musaba, Milton W."

Browsing by Author "Musaba, Milton W."

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Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey
(BMC Women's Health, 2022-09-16) Sserwanja, Quraish; Turimumahoro, Patricia; Nuwabaine, Lilian; Kamara, Kassim; Musaba, Milton W.
Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone. This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25. Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization. In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.
Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda
(PloS one, 2020) Nteziyaremye, Julius; Iramiot, Stanley Jacob; Nekaka, Rebecca; Musaba, Milton W.; Wandabwa, Julius; Kisegerwa, Enoch; Kiondo, Paul
Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. Methods This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. Results Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20–24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02–0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. Conclusion There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications.
Barriers and enablers of adherence to infant nevirapine prophylaxis against HIV 1 transmission among 6-week-old HIV exposed infants: A prospective cohort study in Northern Uganda
(PLoS ONE, 2020) Napyo, Agnes; Tylleska, Thorkild; Mukunya, David; Tumuhamye, Josephine; Musaba, Milton W.; Arach, Anna Agnes O.; Waako, Paul; Tumwine, James K.; Ndeezi, Grace
Sub-optimal adherence to infant prophylaxis has been associated with mother-to-child transmission of HIV. However, the factors associated have not been well characterized in different settings. This study describes barriers and enablers of adherence to infant prophylaxis among 6-week-old HIV exposed infants in Lira district, Northern Uganda.
Cervicovaginal Bacteriology and Antibiotic Sensitivity Patterns among Women with Premature Rupture of Membranes in Mulago Hospital, Kampala, Uganda: A Cross-Sectional Study
(Infectious diseases in obstetrics and gynecology, 2017) Musaba, Milton W.; Kagawa, Mike N.; Kiggundu, Charles; Kiondo, Paul; Wandabwa, Julius
A 2013 Cochrane review concluded that the choice of antibiotics for prophylaxis in PROM is not clear. In Uganda, a combination of oral erythromycin and amoxicillin is the 1st line for prophylaxis against ascending infection. Our aim was to establish the current cervicovaginal bacteriology and antibiotic sensitivity patterns. Methods. Liquor was collected aseptically from the endocervical canal and pool in the posterior fornix of the vagina using a pipette. Aerobic cultures were performed on blood, chocolate, and MacConkey agar and incubated at 35–37∘C for 24–48 hrs. Enrichment media were utilized to culture for GBS and facultative anaerobes. Isolates were identified using colonial morphology, gram staining, and biochemical analysis. Sensitivity testing was performed via Kirby-Bauer disk diffusion and dilution method. Pearson’s chi-squared (𝜒2) test and the paired t-test were applied, at a 𝑃 value of 0.05. Results. Thirty percent of the cultures were positive and over 90% were aerobic microorganisms. Resistance to erythromycin, ampicillin, cotrimoxazole, and ceftriaxone was 44%, 95%, 96%, and 24%, respectively. Rupture of membranes (>12 hrs), late preterm, and term PROM were associated with more positive cultures. Conclusion. The spectrum of bacteria associated with PROM has not changed, but resistance to erythromycin and ampicillin has increased.
Continuum of maternal and newborn health in Sierra Leone: a 2019 national survey
(Archives of Public Health, 2022-08-09) Sserwanja, Quraish; Nuwabaine, Lilian; Mutebi, Ronald K.; Musaba, Milton W.
Globally, Sierra Leone has some of the worst maternal and child health indicators. The situation is worsened by a dearth of evidence about the level of continuum of care, an evidence-based intervention aimed at reducing maternal and perinatal morbidity and mortality. Hence this study aimed to assess the level of and factors associated with continuum of maternal and newborn care in Sierra Leone.
Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey
(BMC Women's Health, 2023-05-15) Sserwanja, Quraish; Nuwabaine, Lilian; Kamara, Kassim; Musaba, Milton W.
The quality of contraceptive counseling information received by prospective clients of family planning services can greatly influence both the uptake and continued use of contraceptives. Therefore, an understanding of the level and determinants of quality contraception information among young women in Sierra Leon could inform family programs, with the aim of reducing the high unmet need in the country.
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.
Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: evidence from the Uganda demographic health survey 2016
(BMC Health Services Research, 2021) Sserwanja, Quraish; Mukunya, David; Musaba, Milton W.; Kawuki, Joseph; Kitutu, Freddy Eric
Almost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda. Methods: We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25). Results: The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8–77.5). The odds of women aged 15–19years giving birth at health facilities were twice as those of women aged 40 to 49years (adjusted odds ratio, AOR=2.29; 95% CI: 1.71–3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR=3.13; 95% CI: 2.15–4.56). Women with tertiary education (AOR=4.96; 95% CI: 2.71–9.11) and those in the richest wealth quintile (AOR=4.55; 95% CI: 3.27–6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare. Conclusion: Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.
Factors associated with prolonged hospitalization of patients with corona virus disease (COVID‑19) in Uganda: a retrospective cohort study
(Tropical Medicine and Health, 2022) Ingabire, Prossie M.; Nantale, Ritah; Sserwanja, Quraish; Nakireka, Susan; Musaba, Milton W.; Muyinda, Asad; Tumuhaise, Criscent; Namulema, Edith; Bongomin, Felix; Napyo, Agnes; Ainembabazi, Rozen; Olum, Ronald; Munabi, Ian; Kiguli, Sarah; Mukunya, David
Identification of factors predicting prolonged hospitalization of patients with coronavirus disease (COVID-19) guides the planning, care and flow of patients in the COVID-19 Treatment Units (CTUs). We determined the length of hospital stay and factors associated with prolonged hospitalization among patients with COVID-19 at six CTUs in Uganda. Methods: We conducted a retrospective cohort study of patients admitted with COVID-19 between January and December 2021 in six CTUs in Uganda. We conducted generalized linear regression models of the binomial family with a log link and robust variance estimation to estimate risk ratios of selected exposure variables and prolonged hospitalization (defined as a hospital stay for 14 days or more). We also conducted negative binomial regression models with robust variance to estimate the rate ratios between selected exposures and hospitalization duration. Results: Data from 968 participants were analyzed. The median length of hospitalization was 5 (range: 1–89) days. A total of 136/968 (14.1%: 95% confidence interval (CI): 11.9–16.4%) patients had prolonged hospitalization. Hospitalization in a public facility (adjusted risk ratio (ARR) = 2.49, 95% CI: 1.65–3.76), critical COVID-19 severity scores (ARR = 3.24: 95% CI: 1.01–10.42), and malaria co-infection (adjusted incident rate ratio (AIRR) = 0.67: 95% CI: 0.55–0.83) were associated with prolonged hospitalization. Conclusion: One out of seven COVID-19 patients had prolonged hospitalization. Healthcare providers in public health facilities should watch out for unnecessary hospitalization. We encourage screening for possible co-morbidities such as malaria among patients admitted for COVID-19.
Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020
(BMC health services research, 2022-06-22) Sserwanja, Quraish; Nuwabaine, Lilian; Gatasi, Ghislaine; Wandabwa, Julius N.; Musaba, Milton W.
Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample.
“I have come to remove it because of heavy bleeding”: a mixed-methods study on early contraceptive implant removal and the underlying factors in eastern Uganda
(Contraception and reproductive medicine, 2024-04-16) Abiyo, Janet; Nambozo, Brendah; Mukunya, David; Musaba, Milton W.; Epuitai, Joshua
Early contraceptive implant removal without intentions to conceive predisposes women to unintended pregnancies.. Some of the unintended pregnancies end in unsafe abortions which further increases the risk of maternal mortality and morbidity. Therefore, we assessed the proportion of women who had early contraceptive implant removal. We also explored the reasons for early contraceptive implant removalamong women at Mbale Regional Referral Hospital in eastern Uganda. We conducted a sequential explanatory mixed methods study at Mbale Regional Referral Hospital between November 2022 to December 2022. For quantitative data, we performed a secondary analysis on data extracted from the integrated family planning registers. We used systematic random sampling to select 600 clients’ serial numbers from the registers. The outcome variable was early contraceptive implant removal defined as removal of the implant by the woman before 18 months from the time of insertion. For qualitative data, we conducted 11 in-depth interviews among women who had come for contraceptive implant removal at the family planning clinic. We also conducted two key informant interviews with midwives working at the family planning unit. Quantitative data were analysed using Stata version 14.0 (Stata Corp LLC, College Station, Texas, USA) while qualitative data were analysed by thematic content analysis. In this study, 15% (91/600) of the women discontinued contraceptive implants within 12 months, 29% (175/600) within 18 months, 38% (230/600) within 24 months and 40% (240/600) within 36 months of insertion. Among the women who discontinued contraceptive implant use, only 6.7% (40/600) switched to another family planning method. Out of the 175 women who removed contraceptive implants early, side effects 61.1% (107/175) desire to conceive 53.1% ( 93/175),, and gender-based violence 8.6% (15/175) were the major reasons for removal. From the qualitative interviews, the major reasons for early contraceptive implant removal were side effects such as heavy menstrualbleeding. A third of women discontinued contraceptive implant use within 18 months. Addressing concerns regarding side effects and male partner disapproval of modern contraceptives may improve continued use of implants.
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.
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.
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, Thorkild
To 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.
Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study
(Conflict and health, 2015) Ojok Arach, Anna Agnes; Tumwine, James K.; Nakasujja, Noeline; Ndeezi, Grace; Kiguli, Juliet; Mukunya, David; Odongkara, Beatrice; Achora, Vincentina; Tongun, Justin B.; Musaba, Milton W.; Napyo, Agnes; Tylleskar, Thorkild; Nankabirwa, Victoria
Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective: We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods: This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results: Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 perinatal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infections and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion: The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during pregnancy and childbirth.
Prevalence and factors associated with teenage pregnancy in Sierra Leone: evidence from a nationally representative Demographic and Health Survey of 2019
(BMC Public Health, 2023-03-20) Nuwabaine, Lilian; Sserwanja, Quraish; Kamara, Kassim; Musaba, Milton W.
Globally, teenage pregnancy remains a public health concern because of the associated maternal and perinatal morbidity and mortality. To address the extensive social, political and economic effects of teenage pregnancy, there is need for current epidemiological evidence on its prevalence and associated factors, especially from low resource settings where the burden is highest.
Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey
(BMC public health, 2022-01-14) Sserwanja, Quraish; Nuwabaine, Lilian; Kamara, Kassim; Musaba, Milton W.
Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone.
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.

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