Browsing by Author "Mutyaba, Twaha"

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    Acceptability of study procedures (self‑collected introital swabs, blood draws and stool sample collection) by students 10–16 years for an HPV vaccine effectiveness study: a pilot study
    (BMC Research Notes, 2016-03-16) Nakalembe, Miriam; Mutyaba, Twaha; Mirembe, Florence
    A cohort study was planned to evaluate vaccine immunogenicity and effect of malaria and helminth co-infections on the bivalent Human papilloma virus (HPV) vaccine. The study would involve self collected introital swabs, blood draws and stool sample collection. We therefore conducted a pilot study to assess the acceptability of these procedures among the students and their parents. A cross-sectional study among forty four students from two purposively selected primary schools of Western Uganda. Exit interviews and two focus group discussions (FGD) (for parents) were conducted. Acceptability was measured by willingness to undergo the procedures again, recommending the procedures to others as well as proportion of introital swabs positive for β globulin. FGD determined acceptability of the parents and explored opinions and perceptions that would influence their decisions. HPV-16/18 and β globulin deoxyribonucleic acid (DNA) were analysed using a polymerase chain reaction (PCR) kit. All the students (100 %) in the study were willing to provide a self- collected introital swab and a stool sample as well as recommending their friends while (86.3 %) were willing for blood draws. There were 40/44 (90.1 %) self collected introital swabs that had positive result for human β globulin though none of them was positive for HPV-16/18. In the FGD, it emerged that parents concerns were on the blood draws and introital swab collection which were addressed. The study procedures were highly acceptable among this study population of students and their parents. Follow-up to assess HPV vaccine effectiveness and factors that may influence the vaccine in this age group is feasible.
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    Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program
    (AIDS care, 2009-10-07) Nassali, Mercy; Nakanjako, Damalie; Kyabayinze, Daniel; Beyeza, Jolly; Okoth, Anthony; Mutyaba, Twaha
    Despite scale up of perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions, postnatal continuity of comprehensive HIV/AIDS care, for both the mother and baby, remains a challenge in developing countries. We determined adherence to the postnatal PMTCT program (PN-PMTCT) and the associated factors among mothers at a public urban hospital in Uganda. We interviewed HIV-positive postnatal mothers on discharge and we determined adherence to PN-PMTCT by the proportion of mothers that honored their return appointments by the end of eight weeks postpartum. We had focus group discussions to assess factors that influence adherence to PN-PMTCT. Of 289 mothers, only 110 (38%) adhered to PN-PMTCT. Previous attendance of a routine postnatal review and having access to a phone were significantly associated with adherence to PMTCT among mothers older than 25 years (odds ratio (OR) 3.6 (95% confidence interval (CI); 1.2–10.4)) and (OR 3.1 (95% CI; 1.3–7.1)), respectively. On the other hand, Christianity (OR 3.2 (95% CI; 1.1–9.0)) was significantly associated with adherence to PN-PMTCT among mothers below 25 years of age. Mothers’ perceived benefits of the PN-PMTCT program, easy access to the program, and presence of social support from a spouse were important motivators for mothers to adhere to PN-PMTCT. Even with improved antenatal and intra-partum PMTCT services, only a third of the HIV-infected mothers adhered to the PN-PMTCT program. Mothers who previously attended a routine postnatal care were 3.6 fold more likely to adhere to PN-PMTCT. We recommend strategies to increase mothers’ adherence to PN-PMTCT interventions in order to increase access to HIV/AIDS care for mothers and children in sub-Saharan Africa.
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    Aerobic cervical bacteriology and antibiotic sensitivity patterns in patients with advanced cervical cancer before and after radiotherapy at a national referral hospital in Uganda
    (International Journal of Gynecology & Obstetrics, 2014-07-18) Mubangizi, Louis; Namusoke, Fatuma; Mutyaba, Twaha
    To determine prevalent aerobic cervical bacteria and sensitivity to commonly used antibiotics in patients with advanced cervical cancer before and after 4 weeks of external beam radiotherapy (EBRT). Cervical swabs were collected prior to the initial radiation dose and after 4 weeks of radiotherapy at Mulago Hospital. Aerobic culture was performed on blood agar, chocolate agar, and MacConkey agar, and incubated at 35–37 ° for 24–48 hours. Isolates were identified using colonial morphology, Gram staining, and biochemical analysis. Sensitivity testing was performed via Kirby–Bauer disk diffusion and dilution. Differences in the proportions of bacteria isolated before and after radiotherapy were compared. Paired t test was used to obtain differences in sensitivity before and after radiotherapy. Normal flora increased significantly after EBRT (P = 0.02). There was no significant change in overall proportion of positive cultures. Sensitivity to commonly used antibiotics improved (P = 0.05) and resistance significantly decreased (P = 0.005). Significant differences were seen mainly with ciprofloxacin, ceftriaxone, and gentamicin. Four weeks of EBRT did not sterilize the cervix but resulted in an increase in normal flora. Radiotherapy appeared to reduce resistance to commonly used antibiotics. Sensitivity to chloramphenicol was higher than for the more commonly used antibiotics.
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    Evaluation of 'see-see and treat' strategy and role of HIV on cervical cancer prevention in Uganda
    (Reproductive Health, 2010) Mutyaba, Twaha; Mirembe, Florence; Sandin, Sven; Weiderpass, Elisabete
    There is scant information on whether Human Immunodeficiency Virus (HIV) seropositivity has an influence on the outcome of treatment of precancerous cervical lesions using cryotherapy. We studied the prevalence of cervical abnormalities detectable by visual inspection and cervical lesions diagnosed by colposcopy according to HIV serostatus and described the outcomes of cryotherapy treatment. Trained nurses examined women not previously screened for cervical cancer using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) in two family planning/post natal clinics in Kampala, Uganda, from February 2007 to August 2008. Women with abnormal visual inspection findings were referred for colposcopic evaluation and HIV testing. Women with precancerous cervical lesions detected at colposcopy were treated mainly by cryotherapy, and were evaluated for treatment outcome after 3 months by a second colposcopy.
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    Incidence of postcesarean infections in relation to HIV status in a setting with limited resources
    (Acta Obstetricia et Gynecologica Scandinavica, 2005) Björklund, Kenneth; Mutyaba, Twaha; Nabunya, Evelyn; Mirembe, Florence
    The aim of the present study was to assess the incidence of postcesarean infections in relation to HIV status in a setting where resources are limited, HIV infection is common, and antiretroviral treatment is not generally available. Methods. The setting was a tertiary African obstetric unit with 27 000 deliveries annually. The study design was prospective and the sample consisted of 1600 of cesarean sections. All women requiring cesarean section were eligible for inclusion. HIV status was registered from the antenatal card only. For the analysis, the participants were divided into two categories: those with negative or unknown HIV status and those with positive HIV status. The main outcome measures are endometritis, wound infection, and mobilization parameters. Results. A total of 1526 cases, of which 1492 were emergency cesarean sections, were included in the analysis. HIV status was negative or unknown in 1430 cases and positive in 96. In the HIV-negative/unknown group, the incidence of endometritis was 8.5% (121/ 1430), wound infection 5.0% (71/1430), and endometritis and/or wound infection 10.8% (154/1430). In the HIV-positive group, the corresponding incidences were 51.0% (49/96), 29.2% (28/96), and 65.5% (63/96), respectively. The indication for cesarean section was dystocia in 79% (134/170) of the women who developed endometritis. Conclusions. The results indicate that women with untreated HIV infection are at very high risk of postcesarean infection in low resourced settings.
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    Influences on uptake of reproductive health services in Nsangi community of Uganda and their implications for cervical cancer screening
    (Reproductive Health, 2007) Mutyaba, Twaha; Faxelid, Elisabeth; Mirembe, Florence; Weiderpass, Elisabete
    Cervical cancer is the most common female cancer in Uganda. Over 80% of women diagnosed or referred with cervical cancer in Mulago national referral and teaching hospital have advanced disease. Plans are underway for systematic screening programmes based on visual inspection, as Pap smear screening is not feasible for this low resource country. Effectiveness of population screening programmes requires high uptake and for cervical cancer, minimal loss to follow up. Uganda has poor indicators of reproductive health (RH) services uptake; 10% postnatal care attendance, 23% contraceptive prevalence, and 38% skilled attendance at delivery. For antenatal attendance, attendance to one visit is 90%, but less than 50% for completion of care, i.e. three or more visits.
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    Male partner involvement in reducing loss to follow-up after cervical cancer screening in Uganda
    (International Journal of Gynecology & Obstetrics, 2009) Mutyaba, Twaha; Mirembe, Florence; Sandin, Sven; Weiderpass, Elisabete
    To evaluate the efficacy of male partner involvement in reducing loss to follow-up among women in Uganda referred for colposcopy after a positive cervical cancer-screening test. Methods: In 2 familyplanning/ postnatal clinics at Mulago Hospital, Kampala, Uganda, 5094 women were screened for cervical lesions. Those who screened positive were referred for colposcopy; half were allocated to the intervention group and half to the control group. In the intervention group, information about the screening findings and a request to assist their partner in attending the next examination were sent to male partners. In the control group, a standard service was provided, which did not include a letter to the male partner. Logistic regression models were applied to calculate the probability of women returning for colposcopy. Results: Of the 834 women referred, 209 (25%) did not return for colposcopy: 143/419 (34%) from the control group and 66/415 (16%) from the intervention group. Women in the intervention group were more likely to return (odds ratio 2.8; 95% confidence interval, 1.9–3.9). Conclusion: Male partner involvement significantly reduced loss to follow-up among women referred for colposcopy.
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    Urologic complications among women with advanced cervical cancer at a tertiary referral hospital in Uganda
    (International Journal of Gynecology & Obstetrics, 2011-08-16) Atuhairwe, Susan; Busingye, Robert B.; Sekikubo, Musa; Nakimuli, Annettee; Mutyaba, Twaha
    To determine the prevalence of and factors associated with urologic complications among women with advanced cervical cancer before treatment in Uganda. In total, 283 women with histologically confirmed stage IIB–IVB cervical cancer who were admitted to Mulago Hospital over a 6-month period were studied. Abdominopelvic scan was carried out to check for hydronephrosis and hydroureter and to measure the tumor volume. Serum creatinine and urea levels were measured, and the presence of anuria and vesicovaginal fistula (VVF) was ascertained from self-reporting and clinical records. Urologic complications were present in 138 (48.8%) women. Hydronephrosis, VVF, hydroureter, and anuria were present in 112 (39.6%), 21 (7.4%), 11 (3.9%), and 9 (3.2%) women, respectively; serum creatinine and urea levels were elevated in 48 (17.0%) women. Stage of disease was significantly associated with urologic complications: stage IIIB odds ratio (OR) 3.36 (95% confidence interval [CI], 1.57–7.20); stage IVA OR 17.10 (95% CI, 6.07–48.16); P < 0.001. There is a high prevalence of urologic complications among women with advanced cervical cancer; these complications are significantly associated with the stage of cervical cancer.