Browsing by Author "Mukunya , David"

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    Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda
    (BMJ OPEN, 2024-01-29) Nankabirwa, Victoria; Mukunya , David; Ndeezi , Grace; Odongkara, Beatrice; Arach, Agnes A; Achora, Vicentina; Mugenyi, Levi; Sebit, Mohammad Boy; Wandabwa, Julius N; Waako, Paul; Tylleskär, Thorkild; Tumwine, James K
    Objective To assess the effect of an integrated intervention package compared with routine government health services on the frequency of health facility births. Setting Three subcounties of Lira district in Northern Uganda. Design A cluster randomised controlled trial where a total of 30 clusters were randomised in a ratio of 1:1 to intervention or standard of care. Participants Pregnant women at ≥28 weeks of gestation. Interventions Participants in the intervention arm received an integrated intervention package of peer support, mobile phone messaging and birthing kits during pregnancy while those in the control arm received routine government health services (‘standard of care’). Primary and secondary outcome measures The primary outcome was the proportion of women giving birth at a health facility in the intervention arm compared with the control arm. Secondary outcomes were perinatal and neonatal deaths. Results In 2018–2019, 995 pregnant women were included in 15 intervention clusters and 882 in 15 control clusters. The primary outcome was ascertained for all except one participant who died before childbirth. In the intervention arm, 754/994 participants (76%) gave birth at a health facility compared with 500/882 (57%) in the control arm. Participants in the intervention arm were 35% more likely to give birth at a health facility compared with participants in the control arm, (risk ratio 1.35 (95% CI 1.20 to 1.51)) and (risk difference 0.20 (95% CI 0.13 to 0.27)). Adjusting for baseline differences generated similar results. There was no difference in secondary outcomes (perinatal or neonatal mortality or number of postnatal visits) between arms. Conclusion The intervention was successful in increasing the proportion of facility- based births but did not reduce perinatal or neonatal mortality.
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    Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: Acommunity-basedcross sectional study
    (PLOS ONE, 2020-10-13) Arach, Anna Agnes Ojok; Nakasujja, Noeline; Nankabirwa, Victoria; Ndeezi, Grace; Kiguli, Juliet; Mukunya , David; Odongkara, Beatrice; Achora, Vincentina; Tongun, Justin Bruno; Musaba, Milton Wamboko; Napyo, Agnes; Zalwango, Vivian; Tylleskar, Thorkild; Tumwine, James K.
    Introduction Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women;someendingupwithpostpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. Methods We conducted acommunity-basedcross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one weekpostpartum. We usedgeneralized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores �14) and perinatal death. Mothers who lost their babies between 7–49 days postpartum were excluded. Results Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symp toms. The prevalence of postpartum depressive symptoms among the 77women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (�7 days of life)) was62.3%[95%CI:50.8%,72.6%] comparedto19.2% [95%CI:17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. Conclusions The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among womenwhohadhada perinatal death in Northern Uganda. Womenexperiencing aperinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.