scholarly journals Medical complications in pregnancy at Mulago Hospital, Uganda’s national referral hospital

2018 ◽  
Vol 12 (4) ◽  
pp. 168-174 ◽  
Author(s):  
JM Milln ◽  
A Nakimuli
Keyword(s):  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Medical Complications ◽  
High Dependency Unit ◽  
Medical Conditions ◽  
High Dependency ◽  
Obstetric Medicine ◽  
Sub Saharan ◽  
National Referral Hospital ◽  
In Pregnancy

Introduction Medical complications in pregnancy contribute significantly to maternal morbidity in sub-Saharan Africa. Anecdotally, obstetricians in Uganda do not feel equipped to treat complex medical cases, and receive little support from physicians. Methods The aim of the study was to quantify the burden of complex medical conditions on the obstetric high dependency unit at Mulago National Referral Hospital, and potential deficiencies in the referral of cases and training in obstetric medicine. A prospective audit was taken on the obstetric high dependency unit from April to May 2014. In addition, 50 trainees in obstetrics and gynaecology filled a nine-point questionnaire regarding their experiences. Results Complex medical disorders of pregnancy accounted for 22/106 (21%) admissions to the high dependency unit, and these cases were responsible for 51% of total bed occupancy, and had a case fatality rate of 6/22 (27.2%). Only 6/14 (43%) of referrals to medical specialties were fulfilled within 48 h. Of the six women who died due to medical conditions, three specialty referrals were made, none of which were fulfilled. Trainees reported deficiencies in obstetric medicine training and in referral of complex conditions. They were least confident addressing non-communicable conditions in pregnancy. Discussion Deficiencies exist in the care of women with complex medical conditions in pregnancy in Uganda. Frameworks of obstetric medicine training and referral of complex cases should be explored and adapted to the sub-Saharan African setting.

scholarly journals Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda

2021 ◽  
Vol 6 ◽  
pp. 302
Author(s):  
Olivie C. Namuju ◽  
Richard Kwizera ◽  
Robert Lukande ◽  
Katelyn A. Pastick ◽  
Jonee M. Taylor ◽  
...  
Keyword(s):  
Family Satisfaction ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Next Of Kin ◽  
Perceived Benefit ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Acceptance Rates ◽  
National Referral Hospital

Background: Human immunodeficiency virus (HIV)-related mortality remains high in sub-Saharan Africa. Clinical autopsies can provide invaluable information to help ascertain the cause of death. We aimed to determine the rate and reasons for autopsy refusal amongst families of HIV-positive decedents in Uganda. Methods: We consented the next-of-kin for post-mortem examinations among Ugandan decedents with HIV from 2017-2020 at Kiruddu National Referral Hospital. For those who refused autopsies, reasons were recorded. Results: In this analysis, 165 decedents with HIV were included from three selected wards at Kiruddu National Referral Hospital.  Autopsy was not performed in 45% of the deceased patients; the rate of autopsy refusal was 36%. The most common reasons for autopsy refusal were time constraints (30%), family satisfaction with clinical diagnosis (15%), fear of disfigurement of the remains (15%), and lack of perceived benefit (15%). By seeking consent from multiple family members and clearly explaining to them the purpose of performing the autopsy, we found a reduction in the rate of autopsy refusal among relatives of the deceased patients at this hospital compared to previous studies at the same site (36% vs. 60%). Conclusions: We found lower rates of autopsy refusal compared to previous studies at the same site. This underscores the importance of clearly explaining the purpose of autopsies as they increase active sensitization about their relevance and dispel myths related to autopsies among the general population. Good, culturally sensitive, and timely explanations to the family of the benefits of autopsy increase the rate of obtaining permission. Building capacity for performing autopsies by training more pathologists and increasing laboratory resources to decrease the turn-around-time for autopsy reports and extending these services to peripheral health facilities could improve autopsy acceptance rates.

Blood utilization at a national referral hospital in sub-Saharan Africa

Transfusion ◽  
2015 ◽  
Vol 55 (5) ◽  
pp. 1058-1066 ◽  
Author(s):  
Elissa K. Butler ◽  
Heather Hume ◽  
Isaac Birungi ◽  
Brenda Ainomugisha ◽  
Ruth Namazzi ◽  
...  
Keyword(s):  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Blood Utilization ◽  
Sub Saharan ◽  
National Referral Hospital

scholarly journals Prevalence and determinants of chronic kidney disease in women with hypertensive disorders in pregnancy in Nigeria: a cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Salisu M. Ishaku ◽  
Timothy Olusegun Olanrewaju ◽  
Joyce L. Browne ◽  
Kerstin Klipstein-Grobusch ◽  
Gbenga A. Kayode ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gestational Hypertension ◽  
Monitoring Program ◽  
Sub Saharan Africa ◽  
Future Research ◽  
Hypertensive Disorders ◽  
Hypertensive Disorders In Pregnancy ◽  
Sub Saharan ◽  
In Pregnancy

Abstract Background Worldwide, hypertensive disorders in pregnancy (HDPs) complicate between 5 and 10% of pregnancies. Sub-Saharan Africa (SSA) is disproportionately affected by a high burden of HDPs and chronic kidney disease (CKD). Despite mounting evidence associating HDPs with the development of CKD, data from SSA are scarce. Methods Women with HDPs (n = 410) and normotensive women (n = 78) were recruited at delivery and prospectively followed-up at 9 weeks, 6 months and 1 year postpartum. Serum creatinine was measured at all time points and the estimated glomerular filtration rates (eGFR) using CKD-Epidemiology equation determined. CKD was defined as decreased eGFR< 60 mL/min/1.73m2 lasting for ≥ 3 months. Prevalence of CKD at 6 months and 1 year after delivery was estimated. Logistic regression analyses were conducted to evaluate risk factors for CKD at 6 months and 1 year postpartum. Results Within 24 h of delivery, 9 weeks, and 6 months postpartum, women with HDPs were more likely to have a decreased eGFR compared to normotensive women (12, 5.7, 4.3% versus 0, 2 and 2.4%, respectively). The prevalence of CKD in HDPs at 6 months and 1 year postpartum was 6.1 and 7.6%, respectively, as opposed to zero prevalence in the normotensive women for the corresponding periods. Proportions of decreased eGFR varied with HDP sub-types and intervening postpartum time since delivery, with pre-eclampsia/eclampsia showing higher prevalence than chronic and gestational hypertension. Only maternal age was independently shown to be a risk factor for decreased eGFR at 6 months postpartum (aOR = 1.18/year; 95%CI 1.04–1.34). Conclusion Prior HDP was associated with risk of future CKD, with prior HDPs being more likely to experience evidence of CKD over periods of postpartum follow-up. Routine screening of women following HDP-complicated pregnancies should be part of a postpartum monitoring program to identify women at higher risk. Future research should report on both the eGFR and total urinary albumin excretion to enable detection of women at risk of future deterioration of renal function.

scholarly journals A brief review on features of falciparum malaria during pregnancy

2017 ◽  
Author(s):  
Alexandre Manirakiza ◽  
Eugène Serdouma ◽  
Richard Norbert Ngbalé ◽  
Sandrine Moussa ◽  
Samuel Gondjé ◽  
...  
Keyword(s):  
Falciparum Malaria ◽  
Public Health Problem ◽  
Malaria In Pregnancy ◽  
Sub Saharan Africa ◽  
Malaria During Pregnancy ◽  
Concurrent Infections ◽  
Tropical Areas ◽  
Sub Saharan ◽  
Protection Against Infection ◽  
In Pregnancy

Malaria in pregnancy is a serious public health problem in tropical areas. Frequently, the placenta is infected by accumulation of Plasmodium falciparum-infected erythrocytes in the intervillous space. Falciparum malaria acts during pregnancy by a range of mechanisms, and chronic or repeated infection and co-infections have insidious effects. The susceptibility of pregnant women to malaria is due to both immunological and humoral changes. Until a malaria vaccine becomes available, the deleterious effects of malaria in pregnancy can be avoided by protection against infection and prompt treatment with safe, effective antimalarial agents; however, concurrent infections such as with HIV and helminths during pregnancy are jeopardizing malaria control in sub-Saharan Africa.

scholarly journals Factors Associated With Herbal Medicine Use in Pregnancy Among Postnatal Mothers in Mbarara Regional Referral Hospital in Western Uganda

2021 ◽  
Author(s):  
Laban Muteebwa ◽  
Ali Ssetaala ◽  
Dan Muramuzi ◽  
Annet Nanvubya ◽  
Yunia Mayanja
Keyword(s):  
Herbal Medicine ◽  
Pregnant Women ◽  
Herbal Medicines ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Medicine Use ◽  
Regional Referral Hospital ◽  
Factors Associated ◽  
Western Uganda ◽  
In Pregnancy

Abstract BackgroundThere is widespread use of herbal medicines among populations in sub-Saharan Africa. However, pregnant women should be conscious about medication taken during pregnancy including herbal medicines because their safety profiles are not known and some of them might affect the mother, fetus and pregnancy outcomes. Knowledge about use and safety of herbs in pregnant women is limited. This study aimed to assess the extent of use and the factors associated with use of herbal medicine in pregnancy.MethodsA cross-sectional study involving 385 women 6 weeks post-partum and below, receiving post-natal services at Mbarara Regional Referral Hospital in Western Uganda was conducted during May to August 2016. Simple random sampling was used to select participants. A structured pretested questionnaire was administered after written informed consent. Data was analyzed using logistic regression (STATA- 14).ResultsOf 385 respondents, 70.4% reported to have used herbal medicine during their most recent pregnancy. Associated factors were perception that herbal medicines are safe (aOR 9.8, 95% CI (4.2-23.0), perception that herbal medicines are important (aOR 12.4, 95% CI (5.2-29.5), staying more than 10KM from the heath facility (aOR 3.1, 95%CI (1.4-6.9), being a first time mother (aOR 2.6, 95%CI (1.1-6.2) and dissatisfaction with ANC services at health facility (aOR 2.6, 95%CI (1.1-6.3)ConclusionHerbal medicine use in pregnancy is common in the study area. Community Sensitization drives about the dangers of herbal medicine use in pregnancy is recommended. Healthcare workers should routinely screen for herbal medicine use during antenatal care visits and labor.

scholarly journals User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala

2021 ◽  
Vol 21 (1) ◽  
pp. 248-53
Author(s):  
Jane Namakula Katende ◽  
Kizito Omona
Keyword(s):  
Health Care Providers ◽  
Health Workers ◽  
Service Integration ◽  
Referral Hospital ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Hiv Services ◽  
Provider Perspectives ◽  
Mulago National Referral Hospital ◽  
National Referral Hospital

Background: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services. Objectives: To establish the users and the provider’s perspectives in overcoming the challenges of TB/HIV services inte- gration at Mulago National Referral Hospital. Methods: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration. Findings: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health. Conclusion: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services. Keywords: User - provider perspectives; TB/HIV service integration; Mulago National Referral Hospital.

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