Browsing by Author "Okong, Pius"

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    Audit of severe maternal morbidity in Uganda - implications for quality of obstetric care
    (Acta Obstetricia et Gynecologica, 2006) Okong, Pius; Byamugisha, Josaphat; Mirembe, Florence; Byaruhanga, Romano; Bergstrom, Staffan
    For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. Methods. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Results. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. Conclusions. A systemic analysis found substandard care and records, and patient-related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non-threatening stimulus for improving the quality of obstetric care.
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    Perceptions among post-delivery mothers of skin-to-skin contact and newborn baby care in a periurban hospital in Uganda
    (Midwifery, 2008) Byaruhanga, Romano N.; Bergstro, Anna; Tibemanya, Jude; Nakitto, Christine; Okong, Pius
    To explore the perceptions among post-delivery mothers of skin-to-skin contact and newborn baby care. A qualitative design using focus-group discussions. Five focus groups were conducted with post-delivery mothers who had had normal deliveries. A latent content analysis was used to derive the themes from the focus-group discussions. 30 post-delivery mothers were purposively sampled from 249 mothers in the postnatal ward at St Francis Hospital, Nsambya, which is located in a periurban area in Kampala, Uganda. two main themes emerged from the focus-group discussions: ‘acceptability of health practices are influenced by knowledge and sensitisation’ and ‘pregnant women's choices are dependent on social, cultural and economic factors’. Mothers expressed varying opinions about the usefulness of skin-to-skin contact: some knew about its use to reduce the risk of hypothermia; others were ignorant, whereas some believed skin-to-skin contact was an intervention used to distract them from the pain in the post-delivery period. The vernix caseosa and the mixture of amniotic fluid with blood in the post-delivery period were perceived as dirty and infectious. The best informants for helping mothers understand the skin-to-skin intervention were the health-care providers. Social, cultural and economic factors, as well as the dominant role of the husband, were identified as important determinants for their choice and place of delivery. The gap between the knowledge and practice of skin-to-skin contact in hospital needs to be bridged. Health-care providers need to be encouraged to continuously advocate for, educate and implement regular skin-to-skin contact.
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    Prospective study to explore changes in quality of care and perinatal outcomes after implementation of perinatal death audit in Uganda
    (BMJ Open, 2020) Nakibuuka Kirabira, Victoria; Aminu, Mamuda; Emmanuel Dewez, Juan; Byaruhanga, Romano; Okong, Pius; Broek, Nynke van den
    To assess the effects of perinatal death (PND) audit on perinatal outcomes in a tertiary hospital in Kampala. Design Interrupted time series (ITS) analysis. Setting Nsambya Hospital, Uganda. Participants Live births and stillbirths. Interventions PND audit. Primary and secondary outcome measures Primary outcomes: perinatal mortality rate, stillbirth rate, early neonatal mortality rate. Secondary outcomes: case fatality rates (CFR) for asphyxia, complications of prematurity and neonatal sepsis. Results 526 PNDs were audited: 142 (27.0%) fresh stillbirths, 125 (23.8%) macerated stillbirths and 259 (49.2%) early neonatal deaths. The ITS analysis showed a decrease in perinatal death (PND) rates without the introduction of PND audits (incidence risk ratio (IRR) (95% CI) for time=0.94, p<0.001), but an increase in PND (IRR (95% CI)=1.17 (1.0 to –1.34), p=0.0021) following the intervention. However, when overdispersion was included in the model, there were no statistically significant differences in PND with or without the intervention (p=0.06 and p=0.44, respectively). Stillbirth rates exhibited a similar pattern. By contrast, early neonatal death rates showed an overall upward trend without the intervention (IRR (95% CI)=1.09 (1.01 to 1.17), p=0.01), but a decrease following the introduction of the PND audits (IRR (95% CI)=0.35 (0.22 to 0.56), p<0.001), when overdispersion was included. The CFR for prematurity showed a downward trend over time (IRR (95% CI)=0.94 (0.88 to 0.99), p=0.04) but not for the intervention. With regards CFRs for intrapartum-related hypoxia or infection, no statistically significant effect was detected for either time or the intervention. Conclusion The introduction of PND audit showed no statistically significant effect on perinatal mortality or stillbirth rate, but a significant decrease in early neonatal mortality rate. No effect was detected on CFRs for prematurity, intrapartum-related hypoxia or infections. These findings should encourage more research to assess the effectiveness of PND reviews on perinatal deaths in general, but also on stillbirths and neonatal deaths in particular, in low-resource settings.