Browsing by Author "Wandabwa, Julius"
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Item 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, PaulAsymptomatic 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.Item Burden of alcohol and other substance use and correlates among undergraduate students at Busitema University in rural Eastern Uganda after COVID-19 lockdown(Nature Publishing Group, 2024-03) Kirabira, Joseph; Kagoya, Enid Kawala; Mpagi, Joseph; Atala, Christine Etoko; Ndamanywa, Kalisiti; Okibure, Ambrose; Kibuuka, Ronald; Katongole, Fauz; Wandabwa, JuliusAbstract Use of alcohol and other substances remains a major health concern among higher learning institutions. This study aimed at assessing the prevalence of alcohol and other substance use among students at Busitema University in Eastern Uganda. A cross sectional survey was conducted among 658 undergraduate students using a questionnaire consisting of Alcohol, Smoking and Substance Involvement Screening Tool and participant sociodemographic and clinical factors. Logistic regression was used to explore the associations. Two hundred sixty-five (40.3%) students reported ever using alcohol and 158 (24.0%) had used in last 3 months. Seventy-four (11.2%) students reported ever use of other substances including tobacco, cannabis, cocaine, stimulants sedatives and hallucinogens and 36 (5.5%) had used within the recent 3 months. After controlling for potential confounders, recent alcohol use was associated with engaging in romantic relationship (odd ratio (OR) = 1.9, P value (P) = 0.045) while having chronic medical conditions was protective (OR = 0.3, P = 0.031). On the other hand, recent use of other substances was 7 times higher among males (OR = 7.0, P = 0.008) compared to females while fourth year of study was protective (OR = 0.05, P = 0.011). Although alcohol use is a worsening challenge among university students, use of other substances is also highly prevalent after COVID-19 lockdown. There is need for universities to identify students with above factors and design interventions to address them in order to prevent the likely undesirable outcomes of alcohol and substance use.Item 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, JuliusA 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.Item Elevated blood pressure among children born to women with obstructed labour in Eastern Uganda: a cohort study(BioMed Central Ltd, 2024-02) Mukunya, David; Musaba, Milton W; Nambozo, Brendah; Oguttu, Faith; Makoko, Brian Tonny; Napyo, Agnes; Nantale, Ritah; Wani, Solomon; Tumuhamye, Josephine; Auma, Prossy; Atim, Ketty; Wamulugwa, Joan; Nahurira, Doreck; Okello, Dedan; Ssegawa, Lawrence; Wandabwa, Julius; Kiguli, Sarah; Chebet, MartinAbstract BACKGROUNDGlobally, high systolic blood pressure accounts for 10.8 million deaths annually. The deaths are disproportionately higher among black people. The reasons for this disparity are poorly understood, but could include a high burden of perinatal insults such as birth asphyxia. Therefore, we aimed to assess the incidence of elevated blood pressure and to explore associated factors among children born to women with obstructed labour. METHODS We followed up children born to women with obstructed labour aged 25 to 44 months at Mbale regional referral hospital that had participated in the sodium bicarbonate trial ( Trial registration number PACTR201805003364421) between October 2021 and April 2022. Our primary outcome was elevated blood pressure defined as blood pressure (either systolic or diastolic or both) ≥ the 90th percentile for age, height, and sex in the reference population based on the clinical practice guideline for screening and management of high blood pressure in children and adolescents. We used logistic regression to estimate odds ratios between selected exposures and elevated blood pressure. RESULTS The incidence of elevated blood pressure was (39/140, 27.9%: 95% (CI: 20.6-36.1)). Participants aged three years and above had twice the odds of elevated blood pressure as those aged less than three years (Adjusted odds ratio (AOR) 2.46: 95% CI (1.01-5.97). Female participants had 2.81 times the odds of elevated blood pressure as their male counterparts (AOR 2.81 95% CI (1.16-6.82). Participants with reduced estimated glomerular filtration rate had 2.85 times the odds of having elevated blood pressure as those with normal estimated glomerular filtration rate (AOR 2.85 95% CI (1.00-8.13). We found no association between arterial cord lactate, stunting, wealth index, exclusive breastfeeding, food diversity and elevated blood pressure. CONCLUSION Our findings show a high incidence of elevated blood pressure among children. We encourage routine checking for elevated blood pressure in the pediatric population particularly those with known risk factors.Item Incidence and risk factors for postpartum hemorrhage in Uganda(Reproductive health, 2016) Ononge, Sam; Mirembe, Florence; Wandabwa, Julius; Campbell, Oona M. R.Globally, postpartum haemorrhage (PPH) remains a leading cause of maternal deaths. However in many low and middle income countries, there is scarcity of information on magnitude of and risk factors for PPH (blood loss of 500 ml or more). It is important to understand the relative contributions of different risk factors for PPH. We assessed the incidence of, and risk factors for postpartum hemorrhage among rural women in Uganda. Methods: Between March 2013 and March 2014, a prospective cohort study was conducted at six health facilities in Uganda. Women were administered a questionnaire to ascertain risk factors for postpartum hemorrhage, defined as a blood loss of 500 mls or more, and assessed using a calibrated under-buttocks drape at childbirth. We constructed two separate multivariable logistic regression models for the variables associated with PPH. Model 1 included all deliveries (vaginal and cesarean sections). Model 2 analysis was restricted to vaginal deliveries. In both models, we adjusted for clustering at facility level.Item Malaria preventive practices and delivery outcomes: A cross-sectional study of parturient women in a tertiary hospital in Eastern Uganda(PloS one, 2020) Nekaka, Rebecca; Nteziyaremye, Julius; Oboth, Paul; Iramiot, Jacob Stanley; Wandabwa, JuliusUganda ranks third in the number of deaths attributable to malaria and has some of the highest recorded malaria transmission rates in the general population. Malaria in Pregnancy is associated with detrimental effects for the mother and unborn baby and these effects seem to have long term effects and consequences on the life of the baby. Despite the preventive measures put in place by the World Health Organization in antenatal care, the burden of malaria in pregnancy is still high. We determined the use of malaria preventive strategies during pregnancy and the presence of plasmodium infection, anemia, and low birth weight babies at delivery among parturient women at Mbale regional referral hospital in eastern Uganda. Methods A cross-sectional study was conducted among 210 women delivering at MRRH between July 2017 and January 2018. Information on demographics, antenatal care, and prevention practices was collected using an interviewer-administered questionnaire. Maternal venous blood and cord blood samples were screened for Plasmodium infection by both microscopy of Giemsa-stained blood films and Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). Polymerase Chain Reaction (PCR) was done on cord blood. The presence of anemia was determined by the use of an automated hemoglobin analyzer. Data were analyzed using descriptive and analytical statistics. Results Of the 210 women, 3 (1.4%) and 19(9.1%) tested positive for malaria by using Giemsa stained blood smear microscopy and malaria rapid diagnosticMRDT tests respectively. PCR detected 4(%) of Plasmodium in cord blood. Twenty-nine percent of the women had anaemia and 11 (5.2%) had low birth weight babies. Only 23.3% of the women received at least three doses of IPTp-SP and 57.9% reported sleeping under an Insecticide Treated Net the night before the survey. The women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24–1.86) and those who reported taking fansidar as a directly observed therapy (OR 0.31, 95% CI: 0.04–2.39) appeared to have few chances of getting plasmodium infection though the findings were not statistically significant. Conclusion The effective use of malaria preventive strategies (IPT-SP and Insecticide Treated Nets) was generally low. Most of the women took less than three doses of SP and there was no strict adherence to the recommended directly observed therapy. The prevalence of Plasmodium infection during pregnancy was low though maternal anaemia and low birth weight were relatively high.Item Predictors of unknown HIV serostatus at the time of labor and delivery in Kampala, Uganda(International Journal of Gynecology & Obstetrics, 2014) Onongea, Sam; Karamagi, Charles; Nakabiito, Clemensia; Wandabwa, Julius; Mirembe, Florence; Rukundo, Godfrey Z.; Jennings, LarissaTo determine factors associated with an unknown HIV serostatus among pregnant women admitted in labor to Mulago Hospital, Kampala, Uganda. Methods—In total, 665 pregnant women admitted to Mulago Hospital were interviewed about their sociodemographic characteristics, obstetric history, access to prenatal care, fears regarding HIV testing, and knowledge about modes of mother-to child-transmission (MTCT). Knowledge of the HIV serostatus was assessed by self-report and verified by prenatal card review. Results—The prevalence of unknown HIV serostatus at the time of labor was 27.1%. Factors associated with an unknown HIV serostatus included high parity (odds ratio [OR] 1.9; 95% confidence interval [CI], 1.16–3.14), preterm delivery (OR 2.60; 95% CI, 1.06–6.34), prenatal care at a private clinic (OR 12.87; 95% CI, 5.68–29.14), residence more than 5 km from the nearest prenatal clinic (OR 2.86; 95% CI, 1.18–17.9), high knowledge about MTCT (OR 0.25; 95% CI, 0.07–0.86), and fears related to disclosing the test result to the partner (OR 3.60; 95% CI, 1.84–7.06). Conclusion—The high prevalence of unknown HIV serostatus among women in labor highlights the need to improve accessibility to HIV testing services early during pregnancy to be able to take advantage of antiretroviral therapy.Item Prevalence of Cancerous and Pre-malignant Lesions of Cervical Cancer and their Association with Risk Factors as seen among women in the Regions of Uganda(Journal of Clinical and Laboratory Medicine, 2017) Okwi, Andrew Livex; Wandabwa, Julius; Okoth, Anthony; Othieno, EmmanuelCervical cancer is the second cause of death among women in Uganda. Little is known about the prevalence and risk factors associated with cancerous and pre-malignant lesions of cervical cancer in the regions of Uganda. Methods: A cross sectional survey was carried out in the regions of Uganda. Women who reported to Gynecology Clinics were consecutively screened for cancerous and pre-malignant lesions using the Papanicolaou method. A structured questionnaire was used to collect data on risk factors. The power of associations between the risk factors and cancerous and pre-malignant lesions of cervical cancer were determined using the odds ratio and 95% confidence interval. The p value <0.05 was considered as statistically significant. Results: Prevalence of 1.2% of cancerous and 11.2% of pre-malignant lesions was detected in all the regions. The risk factors for both cancerous and premalignant lesions were: Early coitus (OR 3.03, CI:1.01.10-10.05; p<0.024) and (OR 1.41 CI:0.98-2.20; p<0.032) respectively, sexually transmitted infections (STDs) (OR 6.07, CI: 1.77-27.22; p<0.001) and (OR 6.52, CI:4.33-9.10; p<0.001) respectively, polygamy (OR 3.13, CI: 0.98-11.77; p<0.027) and (OR 2.74, CI:1.71-4.43; p<0.001) correspondingly, alcohol (OR 3.72, CI: 1.19-13.77; p<0.011) and (OR 1.71, CI:1.20-2.47; p<0.001) respectively, increased sexual partners (OR 8.03, CI:2.20-53.1; p<0.001) and (OR 3.69, CI:2.51-5.48; p<0.001) respectively. Smoking and high parity were risk factor for only cancerous lesions. Although there was no statistical difference between women who had married more than once and those who had single marriage , the likelihood that women who had married more than once would get cancerous and premalignant lesions was high (OR 1.18, p<0.389) and (OR 1.36, p<0.122) respectively. Conclusion and Recommendations: Age at 1st coitus, STDs, polygamy, smoking, increased sexual partners and alcohol were the risk factors for cancerous and premalignant lesions. Sensitization of the communities and regularly screening for cervical cancer should be encouraged for its control and management.