Browsing by Author "Tumwine, James K."
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Item Adding video-debriefing to Helping-Babies Breathe training enhanced retention of neonatal resuscitation knowledge and skills among health workers in Uganda: a cluster randomized trial(Taylor & Francis, 2020-06-10) Odongkara, Beatrice; Tylleskär, Thorkild; Pejovic, Nicola; Achora, Vincentina; Mukunya, David; Ndeezi, Grace; Tumwine, James K.; Nankabirwa, VictoriaBackground: Skilled birth attendants must be competent to provide prompt resuscitation to save newborn lives at birth. Both knowledge and skills (competence) decline with time after training but the optimal duration for refresher training among frontline-skilled birth atten dants in low-resource settings is unknown. Objectives: We assessed the effect of an innovative Helping-Babies-Breathe simulation-based teaching method using video-debriefing compared to standard Helping-Babies-Breathe train ing on 1) neonatal resuscitation knowledge and skills attainment and 2) competence reten tion among skilled birth attendants in Northern Uganda. Methods: A total of 26 health facilities with 86 birth attendants were equally randomised to intervention and control arms. The 2nd edition of the American Association of Pediatrics Helping-Babies-Breathe curriculum was used for training and assessment. Knowledge and skills were assessed pre- and post-training, and during follow-up at 6 months. A mixed effects linear regression model for repeated measures was used to assess the short and long-term effects of the intervention on neonatal resuscitation practices while accounting for clustering. Results: Eighty-two (95.3%) skilled birth attendants completed follow-up at 6 months. Approximately 80% of these had no prior Helping-Babies-Breathe training and 75% reported practicing neonatal resuscitation routinely. Standard Helping-Babies-Breathe training with video-debriefing improved knowledge and skills attainment post-training [adjusted mean difference: 5.34; 95% CI: 0.82–10.78] and retention [adjusted mean difference: 2.97; 95% CI: 1.52–4.41] over 6 months post-training compared to standard training after adjusting for confounding and clustering. Factors that reduced knowledge and skills retention among birth attendants were monthly resuscitation of one neonate or more and being in service for more than 5 years. Conclusion: Adding video-debriefing to standard Helping-Babies-Breathe training had an effect on birth attendants’ competence attainment and retention over 6 months in Uganda. However, more research is needed to justify the proposed intervention in this contextItem Assessing a bundle of peer counseling, mobile phonemessages,andmamakitsin promoting timely initiation of and exclusive breastfeeding in Uganda: A cluster randomized controlled study(PLOS ONE, 2025-01-24) Mukunya, David; Tumwine, James K.; Ndeezi, Grace; Musaba, Milton W.; Tongun ,Justin Bruno; Tumuhamye , Josephine; Napyo, Agnes; Amanya, Daphine; Odongkara, Beatrice; Oguttu, Faith; Achora, Vincentina; Tylleskar, Thorkild; Nankabirwa, VictoriaItem Cultural beliefs and practices on perinatal death: a qualitative study among the Lango community in Northern Uganda(Springer Nature, 2023-04-03) Arach, Anna Agnes Ojok; Nakasujja, Noeline; Rujumba, Joseph; Mukunya, David; Odongkara, Beatrice; Musaba, Milton W.; Napyo, Agnes; Tumwine, James K.; Nankabirwa, Victoria; Ndeezi, Grace; Kiguli, JulietBackground Perinatal death has profound psychosocial effects on women and their families. Sociocultural con texts influence the burden, rituals and bereaved’s support. Little is known about cultural beliefs and practices related to perinatal death. This study explored the cultural perspectives of the Lango community on perinatal death. Methods This study utilised a focused ethnographic design anchored on a symbolic interactionist framework to understand the meanings attached to beliefs and practices on stillbirth or neonatal death among the Lango community in Lira District, Northern Uganda. Participants were sampled purposively for FGD while key informants were identified through snowballing technique. Data were audio recorded in Lango, transcribed, and later translated, a codebook was developed and data entered into Atlas. ti version 8.4.26 and then coded. It was analysed both deduc tively and inductively into themes. Results Stillbirth and early neonatal death both attract similar rituals as would an older child. Burial is not rushed and is attended by family members and close friends. Stillbirths and children that die before naming are buried with out names. Bereaved families are comforted and encouraged about future pregnancies. Currently, Lango associates the deaths to biomedical explanations such as teenage pregnancies, inadequate pregnancy care, health system chal lenges and poor health-seeking behaviour, unlike previously when they were attributed to consequences of unaccep table social behaviours, superstitious beliefs and witchcraft. Antenatal care and health facility childbirths are currently preferred over traditional practices for good pregnancy outcomes. Conclusion Stillbirth or early neonatal death is viewed as the death of a child, different from other settings. Thus, ritu als are performed to honour, create memory, and maintain the connection with deceased babies. Bereaved parents are supported. Health care workers need to provide culturally sensitive support to parents after perinatal loss. The prevailing beliefs of perinatal death cause in terms of biomedical explanations consistent with known determinants and preference for health facility care for prevention creates an opportunity for improving perinatal health. Keywords Culture, Perspectives, Beliefs, Practices, Stillbirth, Perinatal death, UgandaItem Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study(Springer Nature, 2021-07-15) Musaba , Milton W.; Ndeezi, Grace; Barageine, Justus K.; Weeks, Andrew D.; Wandabwa, Julius N.; Mukunya, David; Waako, Paul; Odongkara, Beatrice; Arach, Agnes; Mugabe, Kenneth Tulya-muhika; Napyo, Agnes Kasede; Nankabirwa, Victoria; Tumwine, James K.Background: In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. Methods: Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death. Results: Of the 623 women diagnosed with obstructed labour, 584 met the eligibility criteria. There were 24 fresh still births (FSB) and 32 early neonatal deaths (ENND) giving an FSB rate of 43.8 (95% CI 28.3–64.4) deaths per 1000 total births; early neonatal death rate of 58.4 (95% CI 40.3–81.4) deaths per 1000 and an overall perinatal mortality rate of 102.2 (95% CI 79.4–130.6) deaths in the first 7 days of life. A mother being referred in active labour adjusted risk ratio of 2.84 (95% CI: 1.35–5.96) and having high blood lactate levels at recruitment adjusted risk ratio 2.71 (95% CI: 1.26–4.24) were the determinants of perinatal deaths. Conclusions: The incidence of perinatal death was four times the regional and national average. Babies to women referred in active labour and those with high maternal blood lactate were more likely to die. Keywords: Obstructed labour, Perinatal death, Determinants, LactateItem Inequity in utilization of health care facilities during childbirth: a community-based survey in post-conflict Northern Uganda(Springer Nature, 2019-08) Mukunya, David; Tumwine, James K.; Ndeezi, Grace; Tongun, Tumuhamye, Josephine; Vincentina; Kizito, Samuel; Napyo, Agnes; Achora. Vincentina; Odongkara, Beatrice; Arach, Agnes Anna; Arach, Agnes AnnaAim To assess inequity in utilization of health care facilities during childbirth and factors associated with home births in Lira district, Northern Uganda. Subjects and methods In 2016, we surveyed 930 mothers with children under the age of 2 years in Lira district, Northern Uganda. We used multiple correspondence analysis to construct the wealth index in quintiles, based on household assets. The concentration index is the measure of socioeconomic inequality used in this article, which we calculated using the Stata DASP package. We also conducted multivariable logistic regression to assess factors associated with home births. Results A third of mothers (n=308) gave birth from home [33%, 95% confidence interval (CI) (26%–41%)]. Giving birth at a health facility was pro-rich with a concentration index of 0.10 [95% CI(0.05–0.14)]. Upondecomposing the concentration index, the most important determinant of inequity was the mother's residence. Factors associated with home births in multivariable logistic regression included rural residence [adjusted odds ratio (AOR) 3.1, 95% CI (1.8–5.3)], precipitate labor [AOR 4.18, 95% CI (2.61–6.71)], and labor starting in the evening or at night. Mothers who had previously given birth from home were more likely to give birth at home again [AOR 40.70, 95% CI (18.70–88.61)], whereas mothers who had experienced a complication during a previous birth were less likely to give birth at home [AOR 0.45, 95% CI (0.28–0.95)]. Conclusion There was inequity in the utilization of health facilities for childbirth. Programs that promote health facility births should prioritize poorer mothers and those in rural areas. Keywords Inequity .Homebirths .Uganda .Post-conflict .Healthfacilitybirth . HospitaldeliveryItem Neonatal hypothermia in Northern Uganda: a community- based cross- sectional study(BMJ OPEN, 2021-01-25) Mukunya , A David; Tumwine, James K.; Nankabirwa, Victoria; Odongkara, Beatrice; Tongun, Justin B.; Arach, Agnes A; Tumuhamye, Josephine; Napyo, Agnes; Zalwango, Vivian; Vicentina Achora,; Musaba , Milton W; Ndeezi, Grace; Tylleskär, ThorkildObjective To determine the prevalence, predictors and case fatality risk of hypothermia among neonates in Lira district, Northern Uganda. Setting Three subcounties of Lira district in Northern Uganda. Design This was a community- based cross- sectional study nested in a cluster randomised controlled trial. Participants Mother–baby pairs enrolled in a cluster randomised controlled trial. An axillary temperature was taken during a home visit using a lithium battery- operated digital thermometer. Primary and secondary outcomes The primary outcome measure was the prevalence of hypothermia. Hypothermia was defined as mild if the axillary temperature was 36.0°C to <36.5°C, moderate if the temperature was 32.0°C to <36.0°C and severe hypothermia if the temperature was <32.0°C. The secondary outcome measure was the case fatality risk of neonatal hypothermia. Predictors of moderate to severe hypothermia were determined using a generalised estimating equation model for the Poisson family. Results We recruited 1330 neonates. The prevalence of hypothermia (<36.5°C) was 678/1330 (51.0%, 95% CI 46.9 to 55.1). Overall, 32% (429/1330), 95% CI 29.5 to 35.2 had mild hypothermia, whereas 18.7% (249/1330), 95% CI 15.8 to 22.0 had moderate hypothermia. None had severe hypothermia. At multivariable analysis, predictors of neonatal hypothermia included: home birth (adjusted prevalence ratio, aPR, 1.9, 95% CI 1.4 to 2.6); low birth weight (aPR 1.7, 95% CI 1.3 to 2.3) and delayed breastfeeding initiation (aPR 1.2, 95% CI 1.0 to 1.5). The case fatality risk ratio of hypothermic compared with normothermic neonates was 2.0 (95% CI 0.60 to 6.9). Conclusion The prevalence of neonatal hypothermia was very high, demonstrating that communities in tropical climates should not ignore neonatal hypothermia. Interventions designed to address neonatal hypothermia should consider ways of reaching neonates born at home and those with low birth weight. The promotion of early breastfeeding initiation and skin- to- skin care could reduce the risk of neonatal hypothermia.Item Perinatal death in Northern Uganda: incidence and risk factors in a community-based prospective cohort study(Taylor & Francis, 2020-12-02) Arach, Anna Agnes Ojok; Tumwine, James K.; Nakasujja, Noeline; Ndeezi, Grace; Kiguli, Juliet; Mukunya, David; Odongkara, Beatrice; Achora, Vincentina; Tongun, Justin B.; Musaba, Milton W.; Napyo, Agnes; Tylleskar, Thorkild; Nankabirwa, VictoriaBackground: Perinatal mortality in Uganda remains high at 38 deaths/1,000 births, an estimate greater than the every newborn action plan (ENAP) target of ≤24/1,000 births by 2030. To improve perinatal survival, there is a need to understand the persisting risk factors for death. Objective: We determined the incidence, risk factors, and causes of perinatal death in Lira district, Northern Uganda. Methods: This was a community-based prospective cohort study among pregnant women in Lira district, Northern Uganda. Female community volunteers identified pregnant women in each household who were recruited at ≥28 weeks of gestation and followed until 50 days postpartum. Information on perinatal survival was gathered from participants within 24 hours after childbirth and at 7 days postpartum. The cause of death was ascertained using verbal autopsies. We used generalized estimating equations of the Poisson family to determine the risk factors for perinatal death. Results: Of the 1,877 women enrolled, the majority were ≤30 years old (79.8%), married or cohabiting (91.3%), and had attained only a primary education (77.7%). There were 81 peri natal deaths among them, giving a perinatal mortality rate of 43/1,000 births [95% confidence interval (95% CI: 35, 53)], of these 37 were stillbirths (20 deaths/1,000 total births) and 44 were early neonatal deaths (23 deaths/1,000 live births). Birth asphyxia, respiratory failure, infec tions and intra-partum events were the major probable contributors to perinatal death. The risk factors for perinatal death were nulliparity at enrolment (adjusted IRR 2.7, [95% CI: 1.3, 5.6]) and maternal age >30 years (adjusted IRR 2.5, [95% CI: 1.1, 5.8]). Conclusion: The incidence of perinatal death in this region was higher than had previously been reported in Uganda. Risk factors for perinatal mortality were nulliparity and maternal age >30 years. Pregnant women in this region need improved access to care during preg nancy and childbirth.Item 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.Item Prevalence and factors associated with neonatal hypoglycemia in Northern Uganda: a community-based cross sectional study(Springer Nature, 2020-11-04) Mukunya, David; Odongkara, Beatrice; Piloya, Thereza; Nankabirwa, Victoria; Achora ,Vincentina; Batte, Charles; Ditai, James; Tylleskar, Thorkild; Ndeezi, Grace; Kiguli, Sarah; Tumwine, James K.Background: Neonatal hypoglycemia is the most common endocrine abnormality in children, which is associated with increased morbidity and mortality. The burden and risk factors of neonatal hypoglycemia in rural communities in sub-Saharan Africa are unknown. Objective: To determine the prevalence and risk factors for neonatal hypoglycemia in Lira District, Northern Uganda. Methods: This was a community-based cross-sectional study, nested in a cluster randomized controlled trial designed to promote health facility births and newborn care practices in Lira District, Northern Uganda. This study recruited neonates born to mothers in the parent study. Random blood glucose was measured using an On Call® Plus glucometer (ACON Laboratories, Inc., 10125 Mesa Road, San Diego, CA, USA). We defined hypoglycemia as a blood glucose of < 47mg/dl. To determine the factors associated with neonatal hypoglycemia, a multivariable linear regression mixed-effects model was used. Results: We examined 1416 participants of mean age 3.1days (standard deviation (SD) 2.1) and mean weight of 3.2 kg (SD 0.5). The mean neonatal blood glucose level was 81.6 mg/dl (SD 16.8). The prevalence of a blood glucose concentration of < 47 mg/dl was 2.2% (31/1416): 95% CI 1.2%, 3.9%. The risk factors for neonatal hypoglycemia were delayed breastfeeding initiation [adjusted mean difference, − 2.6; 95% CI, − 4.4, − 0.79] and child age of 3 days or less [adjusted mean, − 12.2; 95% CI, − 14.0, − 10.4]. Conclusion: The incidence of neonatal hypoglycemia was low in this community and was predicted by delay in initiating breastfeeding and a child age of 3 days or less. We therefore suggest targeted screening and management of neonatal hypoglycemia among neonates before 3 days of age and those who are delayed in the onset of breastfeeding. Keywords: Hypoglycemia, Newborn care, Breastfeeding, Neonatal care, EndocrinologyItem prevalence and predictors for unintended pregnancy among HiV‑infected pregnant women in Lira, northern Uganda: a cross‑sectional study(Scientific Reports, 2020-10-01) Napyo , Agnes; Nankabirwa, Victoria; Mukunya, David; Tumuhamye, Josephine; Ndeezi, Grace; Arach, Anna Agnes Ojok; Odongkara, Beatrice; Waako, Paul; Tylleskär, Thorkild; Tumwine, James K.prevention of unintended pregnancies is a global strategy to eliminate mother‑to‑child transmission of HiV. factors surrounding unintended pregnancy among women living with HiV are not well understood. We aimed to determine the prevalence and predictors for unintended pregnancy among these women in Northern Uganda. We conducted a cross-sectional survey among 518 women using a structured questionnaire. We asked questions on socio‑demographic, reproductive‑related and HiV related characteristics. We conducted multivariable logistic regression and reported adjusted odds ratios. The prevalence of unintended pregnancy was 41.1%. The predictors for unintended pregnancy were: being single (not living with a partner or being in a marital union), having five or more children and taking antiretroviral drugs for long periods of time. HiV counselling services should target women living with HiV who are not in a marital union, those having a higher parity and those who have taken ARt for longer periods.