Reports
http://ir.must.ac.ug/xmlui/handle/123456789/200
2024-03-29T01:52:07ZThe impact of HIV on fertility aspirations in Uganda.
http://ir.must.ac.ug/xmlui/handle/123456789/3507
The impact of HIV on fertility aspirations in Uganda.
Snow, Rachel C; Mutumba, Massy; Powers, Gregory; Evans, Lindsey; Rukundo, Edith; Abesiga, Lenard; Kabasindi, Joy; Ford, Tegan; Mugyenyi, Godfrey
This paper reports on a study of whether a women’s personal HIV status, the presence of an HIV+ child in the household, or the presence of foster children in the household, has a measureable impact on a woman’s desire for future offspring, net of parity, or son parity, in an area of Uganda with high fertility norms. A survey of 1,594 women age 18-49 yrs visiting outpatient services at Mbarara Regional Hospital in Mbarara Uganda was conducted from June through August 2010. Among survey participants, 59.7% were HIV-positive (HIV+) and 40.3% were HIV-negative (HIV-); and 96.4% of the HIV+ women were currently on anti-retroviral therapy (ART). Logistic regression models were used to investigate the relationships between fertility desires and HIV status, household, and social factors. We found that, despite high fertility norms in Uganda and almost universal use of ART in our sample, HIV+ women were significantly less likely to desire future childbearing relative to HIV- women, and pregnant HIV+ women reported their pregnancies were a problem. The findings suggest a potential unmet need for family planning among HIV+ women in Uganda.
2011-01-01T00:00:00ZChronic Placental Inflammation Among Women Living With HIV in Uganda
http://ir.must.ac.ug/xmlui/handle/123456789/1949
Chronic Placental Inflammation Among Women Living With HIV in Uganda
Bebell, Lisa M.; Siedner, Mark J.; Ngonzi, Joseph; Le, Mylinh H.; Adong, Julian; Boatin, Adeline A.; Bassett, Ingrid V.; Roberts, Drucilla J.
Background: HIV-exposed, uninfected (HEU) children have poorer early-life outcomes than HIV-unexposed children. The determinants of adverse health outcomes among HEU children are poorly understood but may result from chronic placental inflammation (CPI).
Setting and methods: We enrolled 176 pregnant women living with HIV (WLWH) taking antiretroviral therapy in southwestern Uganda and 176 HIV-uninfected women to compare CPI prevalence by maternal HIV serostatus. Placentas were evaluated histologically by an expert pathologist for presence of CPI, defined as chronic chorioamnionitis, plasma cell deciduitis, villitis of unknown etiology, or chronic histiocytic intervillositis. Placentas with CPI were additionally, immunostained with CD3 (T cell), CD20 (B cell), and CD68 (macrophage) markers to characterize inflammatory cell profiles.
Results: WLWH and HIV-uninfected women had similar age, parity, and gestational age. Among WLWH, the mean CD4 count was 480 cells/mL, and 74% had an undetectable HIV viral load. We detected CPI in 16 (9%) placentas from WLWH and 24 (14%) from HIV-uninfected women (P = 0.18). Among WLWH, CPI was not associated with the CD4 count or HIV viral load. Villitis of unknown etiology was twice as common among HIV-uninfected women than WLWH (10 vs. 5%, P = 0.04). Among placentas with CPI, more villous inflammatory cells stained for CD3 or CD68 among HIV uninfected women than WLWH (79% vs. 46%, P = 0.07).
Conclusions: CPI prevalence did not differ by HIV serostatus. T-cell (CD3) and macrophage (CD68) markers were more prevalent in placental inflammatory cells from HIV-uninfected women. Our results do not support CPI as a leading mechanism for poor outcomes among HEU children in the antiretroviral therapy era.
2020-01-01T00:00:00ZPredictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda
http://ir.must.ac.ug/xmlui/handle/123456789/1692
Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda
Kayondo, Musa; Wasswa, Ssalongo; Kabakyenga, Jerome; Mukiibi, Nozmo; Senkungu, Jude; Stenson, Amy; Mukasa, Peter
Background: Obstetric fistula although virtually eliminated in high income countries, still remains a prevalent and debilitating condition in many parts of the developing world. It occurs in areas where access to care at childbirth is limited, or of poor quality and where few hospitals offer the necessary corrective surgery.
Methods: This was a prospective observational study where all women who attended Mbarara Regional Referral Hospital in western Uganda with obstetric fistula during the study period were assessed pre-operatively for social demographics, fistula characteristics, classification and outcomes after surgery. Assessment for fistula closure and stress incontinence after surgery was done using a dye test before discharge
Results: Of the 77 women who were recruited in this study, 60 (77.9%) had successful closure of their fistulae. Unsuccessful fistula closure was significantly associated with large fistula size (Odds Ratio 6 95% Confidential interval 1.46-24.63), circumferential fistulae (Odds ratio 9.33 95% Confidential interval 2.23-39.12) and moderate to severe vaginal scarring (Odds ratio 12.24 95% Confidential interval 1.52-98.30). Vaginal scarring was the only factor independently associated with unsuccessful fistula repair (Odds ratio 10 95% confidential interval 1.12-100.57). Residual stress incontinence after successful fistula closure was associated with type IIb fistulae (Odds ratio 5.56 95% Confidential interval 1.34-23.02), circumferential fistulae (Odds ratio 10.5 95% Confidential interval 1.39-79.13) and previous unsuccessful fistula repair (Odds ratio 4.8 95% Confidential interval 1.27-18.11). Independent predictors for residual stress incontinence after successful fistula closure were urethral involvement (Odds Ratio 4.024 95% Confidential interval 2.77-5.83) and previous unsuccessful fistula repair (Odds ratio 38.69 95% Confidential interval
2.13-703.88).
Conclusions: This study demonstrated that large fistula size, circumferential fistulae and marked vaginal scarring are predictors for unsuccessful fistula repair while predictors for residual stress incontinence after successful fistula closure were urethral involvement, circumferential fistulae and previous unsuccessful fistula repair.
2011-12-07T00:00:00ZImpact of malaria during pregnancy on pregnancy outcomes in a Ugandan prospective cohort with intensive malaria screening and prompt treatment
http://ir.must.ac.ug/xmlui/handle/123456789/1288
Impact of malaria during pregnancy on pregnancy outcomes in a Ugandan prospective cohort with intensive malaria screening and prompt treatment
Beaudrap, Pierre De; Turyakira, Eleanor; White, Lisa J; Nabasumba, Carolyn; Tumwebaze, Benon; Muehlenbachs, Atis; Guérin, Philippe J; Boum, Yap; Gready, Rose Mc; Piola, Patrice
Background: Malaria in pregnancy (MP) is a major public health problem in endemic areas of sub-Saharan Africa and has important consequences on birth outcome. Because MiP is a complex phenomenon and malaria epidemiology is rapidly changing, additional evidence is still required to understand how best to control malaria.
This study followed a prospective cohort of pregnant women who had access to intensive malaria screening an prompt treatment to identify factors associated with increased risk of MiP and to analyse how various characteristics of MiP affect delivery outcomes.
Methods: Between October 2006 and May 2009, 1,218 pregnant women were enrolled in a prospective cohort.
After an initial assessment, they were screened weekly for malaria. At delivery, blood smears were obtained from the mother, placenta, cord and newborn. Multivariate analyses were performed to analyse the association between mothers’ characteristics and malaria risk, as well as between MiP and birth outcome, length and weight at birth.
This study is a secondary analysis of a trial registered with ClinicalTrials.gov, number NCT00495508.
Results: Overall, 288/1,069 (27%) mothers had 345 peripheral malaria infections. The risk of peripheral malaria was higher in mothers who were younger, infected with HIV, had less education, lived in rural areas or reported no bed net use, whereas the risk of placental infection was associated with more frequent malaria infections and with infection during late pregnancy. The risk of pre-term delivery and of miscarriage was increased in mothers infected with HIV, living in rural areas and with MiP occurring within two weeks of delivery.
In adjusted analysis, birth weight but not length was reduced in babies of mothers exposed to MiP (−60g, 95%CI: -120 to 0 for at least one infection and -150 g, 95%CI: -280 to −20 for >1 infections).
Conclusions: In this study, the timing, parasitaemia level and number of peripherally-detected malaria infections, but not the presence of fever, were associated with adverse birth outcomes. Hence, prompt malaria detection and treatment should be offered to pregnant women regardless of symptoms or other preventive measures used during pregnancy, and with increased focus on mothers living in remote areas.
2013-04-24T00:00:00Z