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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.
Physical growth, puberty and hormones in adolescents with Nodding Syndrome; a pilot study
(Bio Med Central, 2014-11-28) Piloya-Were, Theresa; Odongkara-Mpora, Beatrice; Namusoke, Hanifa; Idro, Richard
Background: Nodding syndrome is an epidemic symptomatic generalized epilepsy syndrome of unknown cause in Eastern Africa. Some patients have extreme short stature. We hypothesized that growth failure in nodding syndrome is associated with specific endocrine dysfunctions. In this pilot study, we examined the relationship between serum hormone levels and stature, bone age and sexual development. Results: We recruited ten consecutive children, 13 years or older, with World Health Organization defined nodding syndrome and assessed physical growth, bone age, development of secondary sexual characteristics and serum hormone levels. Two children with incomplete results were excluded. Of the eight remaining, two had severe stunting (height for age Z [HAZ] score <-3) and three had moderate stunting (HAZ score between-3 and-2). The bone age was delayed by a median 3(range 0-4) years. Serum growth hormone levels were normal in all eight but the two patients with severe stunting and one with moderate stunting had low levels of Somatomedin C (Insulin like Growth Factor [IGF1]) and/or IGF binding protein 3 (IGFBP3), mediators of growth hormone function. A linear relationship was observed between serum IGF1 level and HAZ score. With the exception of one child, all were either pre-pubertal or in early puberty (Tanner stages 1 and 2) and in the seven, levels of the gonadotrophins (luteinising and follicle stimulating hormone) and the sex hormones (testosterone/oestrogen) were all within pre-pubertal ranges or ranges of early puberty. Thyroid function, prolactin, adrenal, and parathyroid hormone levels were all normal. Conclusions: Patients with nodding syndrome may have dysfunctions in the pituitary growth hormone and pituitary gonadal axes that manifest as stunted growth, delayed bone age and puberty. Studies are required to determine if such endocrine dysfunction is a primary manifestation of the disease or a secondary consequence of chronic ill health and malnutrition and if so, whether targeted interventions can improve outcome. Keywords: Nodding syndrome, Epilepsy, Growth, Puberty, Hormones
Use of a modified bubble continuous positive airway pressure (bCPAP) device for children in respiratory distress in low- and middle-income countries: a safety study
(Taylor & Francis, 2018-06-18) Bjorklund, Ashley R.; Odongkara Mpora, Beatrice; Steiner, Marie E.; Fischer, Gwenyth; Davey, Cynthia S.; Slusher, Tina M.
Background: While bubble continuous positive airway pressure (bCPAP) is commonly used in low- and middle-income countries (LMIC) to support neonates with respiratory distress, there are limited non-invasive support options for non-neonatal children. Aim: To demonstrate safety of a new device designed to support children during respiratory distress in LMIC. Methods: A paediatric bCPAP device was designed called SEAL-bCPAP (Simplified Ear-plug Adapted-bCPAP). SEAL-bCPAP is constructed from inexpensive, easily obtainable materials. The nasal prong interface was modified from previously described neonatal bCPAP set-ups using commercial ear-plug material to improve nasal seal. A prospective interventional study was conducted to evaluate safety in children with respiratory distress treated with SEAL-bCPAP. Patients aged 30 days to 5 years presenting to a hospital in northern Uganda from July 2015 to June 2016 were screened. Those with moderate–severe respiratory distress and/or hypoxia despite nasal cannula oxygen were eligible for study. Enrolled patients were supported with SEAL-bCPAP until respiratory improvement or death. Complications attributable to SEAL-bCPAP were recorded. Clinical outcomes were compared with historical control pre-trial data. Results: Eighty-three of 87 enrolled patients were included in the final analysis. No patients had significant SEAL-bCPAP complications. Five patients had mild complications which resolved (four with nasal irritation and one with abdominal distention). Trial patients had significant (P < 0.0001) improvement in their TAL score, respiratory rate and O2 sat after 2 h of SEAL-bCPAP. Fifty-two of 64 patients (62.7%) with severe illness at Time1 did not have severe illness at Time2 (after 2 h of SEAL-bCPAP) (p < 0.0001). Unadjusted mortality rates were 12.2% (6/49) and 9.6% (8/83), respectively, for pre-trial (historical control) and trial patients (p = 0.64); the study was not powered to show efficacy. Conclusions: The SEAL-bCPAP device is safe for treatment of respiratory distress in non-neonatal children in LMIC. There is a trend toward decreased mortality that should be evaluated with adequately powered clinical trials. Abbreviations: ACU, acute care unit; bCPAP, bubble continuous positive airway pressure; BUBBLES, bCPAP used beyond babies in low economic settings; cmH2 O, cm of water; CPAP, continuous positive airway pressure; LMIC, low- and middle-income countries; OR, odds ratio; O2 sat, oxygen saturation; RR, respiratory rate; SD, standard deviation; SEAL-bCPAP, simplified ear plug adapted low-cost bCPAP; TAL score, modified TAL clinical score
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, Endocrinology
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.
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, Victoria
Background: 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.
Pertussis Prevalence and Its Determinants among Children with Persistent Cough in Urban Uganda
(PLOS ONE, 2015-04-15) Kayina, Vincent; Kyobe, Samuel; Katabazi, Fred A; Kigozi, Edgar; Okee, Moses; Odongkara, Beatrice; Babikako, Harriet M.; Whalen, Christopher C.; Joloba, Moses L.; Musoke, Philippa M.; Mupere, Ezekiel
Background We determined prevalence of pertussis infection and its associated host and environmental factors to generate information that would guide strategies for disease control. Methods In a cross-sectional study, 449 children aged 3 months to 12 years with persistent cough lasting 14 days were enrolled and evaluated for pertussis using DNA polymerase chain re action (PCR) and ELISA serology tests. Results Pertussis prevalence was 67 (15% (95% Confidence Interval (CI): 12–18)) and 81 (20% (95%CI: 16–24)) by PCRandELISA,respectively among449 participating children. The prevalence was highest in children with >59 months of age despite high vaccination cover age of 94%inthis agegroup. Study demographic and clinical characteristics were similar between pertussis and non-pertussis cases. Of the 449 children, 133 (30%) had a coughing household member and 316(70%)didnot. Among133children that hadacoughinghouse hold member, sexof child, sharing bed with a coughing household member and having a coughing individual in the neighborhood were factors associated with pertussis. Children that had shared a bed with a coughing household individual had seven-fold likelihood of having pertussis compared to children that did not (odds ratio (OR) 7.16 (95% CI: 1.24 41.44)). Among the 316 children that did not have a coughing household member, age <23 months, having or contact with a coughing individual in neighborhood, a residence with one room, and having acaretaker with >40 years of age were the factors associated with pertus sis. Age <23months wasthree times more likely to be associated with pertussis compared to age 24–59months(OR2.97(95%CI:1.07–8.28)). Conclusion Findings suggest high prevalence of pertussis among children with persistent cough at a health facility and it was marked in children >59 months of age, suggesting the possibility of waning immunity. The factors associated with pertussis varied by presence or absence of a coughing household member.
Perceptions, attitude and use of family planning services in post conflict Gulu district, northern Uganda
(Bio Med Central, 2015-08-11) Orach, Christopher Garimoi; Otim, George; Aporomon, Juliet Faith; Amone, Richard; Okello, Stephen Acellam; Odongkara, Beatrice; Komakech, Henry
Background: Northern Uganda was severely affected by two decades of civil war that led to the displacement and encampment of an estimated 1.6 million inhabitants. The objective of this study was to assess community perspectives, attitude and factors that influence use of family planning (FP) services in post conflict Gulu district. Methods: We conducted a cross sectional study using multistage sampling technique. All three counties in the district were purposely selected. Two sub-counties per county and four parishes per sub-county were randomly selected. A total of 24 parishes (clusters) and 21 adult heads of households per cluster were randomly selected and interviewed. In total, 500 adults 117 males (23.4 %) and 383 females (76.6 %) were interviewed. We conducted 8 focus group discussions and 6 key informant interviews with family planning managers and service providers. Quantitative data were entered in EPI data and analyzed using STATA version 12. Qualitative data were analyzed manually using thematic content analysis. Results: Contraceptive prevalence rate was 47.5 %. Communities perceive FP as acceptable, beneficial and geographically, temporally and financially accessible. Factors associated with FP use included age 26–35 years (AOR 1.92, 95 % CI 1.18-3.10, p =0.008), and 36–45 years (AOR 2.27, 95 % CI 1.21-4.25, p=0.010), rural residence (AOR =0.41, 95 % CI 0.24-0.71, p =0.001), cohabitation (AOR= 2.77, 95 % CI 1.15-6.65, p =0.023), and being a farmer (AOR 0.59, 95 % CI 0.35-0.97, p=0.037). The main reason for non-use of family planning was fear of side effects 88.2 %. The main source of FP services was government health facilities 94.2 %. Conclusion: Use of family planning is relatively high and communities view FP services as acceptable, beneficial and accessible. Family planning use is mainly determined by age, residence, occupation and marital status. Fear of side effects is the main impediment to FP use. There is need to increase awareness and effectively manage side effects of family planning in the settings. Keywords: Family planning services, Accessibility, Attitudes, Perceptions, Utilization, Post conflict, Northern Uganda
Nutritional rickets among children admitted with severe pneumonia at Mulago hospital, Uganda: a cross-sectional study
(Springer Nature, 2019-10-29) Piloya, Thereza; Odongkara, Beatrice; Were, Edward Maloba; Ameda, Faith; Mworozi, Edison; Laigong, Paul
Background: There’s abundant sunshine in the tropics but severe rickets is still observed. Nutritional rickets is associated with an increased risk of acute lower respiratory infections. Pneumonia is the leading cause of death in the under 5-year old children with the highest burden in developing countries. Both Pneumonia and rickets are common in the developing countries and may affect clinical presentation and outcome. This study aimed to determine the prevalence and associated factors of nutritional rickets in children admitted with severe pneumonia. Methods: This was a cross-sectional study of children aged 2–59 months presenting with severe pneumonia at an emergency unit. We enrolled 221 children between February and June 2012 after consent. A pre-coded questionnaire was used to collect data on socio-demographic, nutritional and past medical history. Physical exam was done for signs of rickets and anthropometric measurements. Serum calcium, phosphorus, and alkaline phosphatase (ALP) were assessed. Children with any physical signs of rickets or biochemical rickets (ALP > 400 IU); had a wrist x-ray done. Nutritional rickets was defined as the presence of radiological changes of cupping or fraying and/ or metaphyseal thickening. Severe pneumonia was defined using the WHO criteria. Statistical analysis was performed using the Stata 10 statistical package. P- value < 0.05 was significant. Results: The prevalence of nutritional rickets among children with severe pneumonia is 9.5%. However, 14.5% had raised ALP (biochemical rickets). The factors independently associated with rickets was an elevated alkaline phosphatase; p-value < 0.001, or 32.95 95% CI (10.54–102.93). Other factors like breastfeeding, big family size, birth order were not significantly associated with rickets. Low serum calcium was detected in 22 (9.9%) of the 221 participants. Overall few children with rickets had typical clinical features of rickets on physical examination. Conclusion: Rickets is a common problem in our setting despite ample sunshine. Clinicians should actively assess children for rickets in this setting and screen for rickets in those children at high risk even without clinical features. Keywords: Rickets, Pneumonia, Children, Uganda
New Biologically Active Compounds from 1, 3-Diketones
(Research Journal of Chemical Sciences, 2011-06-07) George, Mulongo; Jolocam, Mbabazi; Odongkara, B.; Twinomuhwezi, H; Mpango, G.B.
The ready availability of cyclohexanones and the enhanced reactivity at their α-positions render them starting materials of choice in the present study. The synthesis of new compounds of antimicrobial activity was undertaken by the coupling of aromatic amines with 5,5-dimethyl cyclohexan-1,3-dione (dimedone). The products were refluxed with N–benzyl-N-phenylhydrazine in acetic acid. The structures of the products were elucidated using micro- and IR-spectral analyses. They were confirmed using 1H NMR at 60MHz and TMS as internal standard. The diketone derivatives were tested for their biological activity against gram-positive Cocci and Bacilli, and gram-negative Bacilli. The study showed that the derivatives gave a wide range of activity from inactive to highly active, which proves it to be of fresh pharmaceutical interest. Key words: Dimedone, Antimicrobial activity, Gram-positive Cocci and Bacilli, Gram-negative Bacilli
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, Thorkild
Objective 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.
Management of Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar States
(Journal Gurus, 2024) Mungai, L N Wainaina; Abdalla, Asmahan T Msuya, levina J.; Odongkara, Beatrice; Iroro, Yarhere; Ameyaw, Emmanuel; Bodieu, Adele Chetcha; Majaliwa, Edna Siima; Mandilou, Steve Vassili Missambou; Omondi, Vincent O.; Hanas, Ragnar; Abdullah, Mohamed
The global rise in diabetes mellitus prevalence has implications for Africa, with diabetic ketoacidosis (DKA) being its most severe acute complication. In Sub-Saharan Africa, DKA rates at first diagnosis among children and adolescents range from 24%-82% constituting 76% of paediatric endocrine admissions. DKA and hyperglycaemic hyperosmolar state (HHS) result in significant morbidity and mortality. Yet, healthcare disparities and unique issues such as severe malnutrition challenge African Management in Africa. Methodology: Diagnosis criteria for DKA include symptoms like polyuria, polydipsia, and weight loss combined with hyperglycaemia (>11 mmol/L), venous pH <7.3, and ketonemia (blood ß-hydroxybutyrate ≥3 mmol/L) or significant Ketonuria. Emergency management prioritizes restoring circulation, obtaining relevant laboratory samples, and initiating fluid and insulin therapy. Special attention is given to unique considerations, like administering oral rehydration solution (ORS) without IV fluids or handling severe malnutrition with RESOMAL. Treatment: Fluid therapy involves administering deficit replacement plus maintainance. Based on clinical conditions, potassium is added, and bicarbonate is reserved for severe cases. Insulin, vital for treatment, is introduced an hour after fluid therapy. Monitoring for cerebral oedema, especially in high-risk groups, is critical. Following the acute treatment phase, preventative measures are underscored to mitigate recurrence. For HHS, a subset of patients with particular diagnostic criteria, including elevated plasma glucose (>33.3 mmol/L) and higher pH levels, management focuses on restoring volume, renal perfusion, and a steady decline in serum sodium concentration and osmolality. The approach diverges from DKA regarding fluid volume, insulin timing, and monitoring specifics. Conclusion: Effective diagnosis and Management of DKA and HHS are pivotal in the African context, considering healthcare limitations and unique challenges. Guidelines that consider these intricacies ensure comprehensive care for affected individuals.
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 Anna
Aim 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 . Hospitaldelivery
Infant behaviour and maternal adaptation after uninterrupted skin-to-skin contact for 1 hour following birth in northern Uganda
(AJM, 2019-09-25) Svensson, Kristin; Mbalinda, Scovia; Nissen, Eva; Odongkara, Beatrice Mpora; Waiswa, Peter; Hjelmstedt, Anna
Background/aims Uninterrupted skin-to-skin contact in the first hour after birth increases the chance of exclusive breastfeeding, a practice which improves health outcomes for both mothers and neonates. This study aimed to compare mother–infant pairs who had or did not have skin-to-skin contact 1 hour after birth and investigate infant behaviour and maternal adaptation as a result. Methods This study investigated the impact of skin-to-skin contact on a number of health indicators after birth of both mother and child. Two groups were included: 51 mother–infant pairs with skin-to-skin contact and 152 with no skin-to-skin contact, who were observed for 1 hour after birth. Mothers were interviewed at discharge and at 14 weeks postpartum about their sociodemographic background, ability to interpret their infant’s signals and interaction with the infant, their own health and their infant’s health and feeding. The Student’s t-test and Chi squared test were used to assess the associations between the groups and sociodemographic characteristics. The Cramer’s V test was used to assess the effect size for variable latch on. Factor analysis was conducted on statements from interviews on mothers’ feelings regarding motherhood. Results More infants latched on in the skin-to-skin contact group and the first breastfeeding was more often directed by the infants, compared to the no skin-to-skin contact group. Mothers in the skin-to-skin contact group were less likely to need help to breastfeed and tended to be more confident that they could provide sufficient milk for their child. They were also more likely to breastfeed longer and took no initiative to supplement the infant during the hospital stay, while mothers in the non-skin-to-skin contact group did so. More mothers in the skin-to-skin contact group believed that their infant could comfort itself. conclusions The results suggest benefits to uninterrupted skin-to-skin contact between mothers and newborns 1 hour after birth in regard to initiation of breastfeeding, intended time to breastfeed, maternal self-confidence and infant self-regulation. Interventions to promote skin-to-skin contact should be implemented in this setting. Key words: Breastfeeding; Breastfeeding self-efficacy; Feelings about motherhood; Infant interaction; Interpretation of infant cues; Skin-to-skin contact
Health seeking behaviour of small income market vendors: Diabetes primary care in Gulu Municipality, northern Uganda
(South Sudan Medical Journal, 2020-08) Loum, S.L.; Wanyama, Ronald; Anywar, Denis; Odongkara, Beatrice M.; Odongo, Pancras
Introduction: Uganda faces a serious threat of non-communicable diseases including type 2 diabetes; sedentary lifestyles predispose people to these diseases. Objective: To understand the diabetes health seeking behaviour of market vendors at the main market, Gulu Municipality. Method: This cross-sectional study used quantitative and qualitative methods to understand experiences of market vendors on health seeking behaviour. After general sensitization and mobilisation in the market, 400 participants were enrolled for the study, however quantitative analysis was done only on data from 375 participants (316 women and 59 men); 25 participants had missing data; 30 of these 375 were interviewed and the qualitative analyses of their responses offered further insight on health seeking – and is reported here. The qualitative data will be reported later. Results: Mixed responses were obtained from these 30 market vendors about their health seeking behaviour for diabetes. The factors were responsible for their overall health seeking behaviour included crowded hospitals and low frequency of clinic days; lack of accurate knowledge, and uninformed beliefs on diabetes, and poor work-life balance. Major impediments to health seeking were the fear of losing work time and money, and feeling healthy and hence seeing no need for health check-ups or medical care. Conclusion: Awareness of diabetes and the need to seek health care exists, but market vendors are not well informed on tests and care. We recommend that more comprehensive simple-message sensitisation is undertaken to change health seeking behaviour and prevent escalation of non-communicable diseases in northern Uganda and beyond. Key words: health seeking behaviour; healthcare services; diabetes; sedentary lifestyle; hypertension; market vendors, Uganda
Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda
(Taylor & Francis, 2017-12-15) Mukunya, David; Tumwine, James K; Nankabirwa, Victoria; Ndeezi, Grace; Odongo, Isaac; Tumuhamye, Josephine; Tongun, Justin Bruno; Kizito, Samuel; Napyo, Agnes; Achora, Vincentina; Odongkara, Beatrice; Tylleskar, Thorkild
Background: Initiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality. Objective: To determine the prevalence and factors associated with delayed initiation of breastfeeding. Methods: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software (https://opendatakit.org). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding. Results: Almost half [48.2%, 95% confidence interval (CI) (44.3–52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breast feeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73–33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41–2.88)], home delivery [AOR 1.43 95% CI (1.04–1.97)] and mother being responsible for initiating breastfeed ing as compared to a health worker or relative [AOR 1.73 95% CI (1.33–2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30–0.96)] to delay initiation of breastfeeding as compared to those with no education. Conclusion: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.
Domestic violence in Gulu, Northern Uganda.
(COSECSA/ASEA, 2012-04) Kitara, D.L.; Odongkara, B.M.; Anywar, D.A.; Atim, P.; Amone, C.; Komakech, D.
Background: When guns fell silent in the post conflict northern Uganda, another form of physical injuries has come in place, Domestic Violence also commonly referred to as Gender based violence. This injury from violence leading to physical trauma is one of the leading public health problems in this region. We describe the occurrence and reasons for admission due to domestic violence to surgical ward of Gulu Hospital. Methods: A prospective observational study was conducted in Gulu Hospital over a period of two years (January 2008 to December 2009) using a prepared proforma designed to capture physical injuries admitted. Only patients that met the inclusion criteria for domestic injuries were registered. Informed consent and ethical approval was obtained from the committee of the Hospital. Results: Of 1880 patients registered with trauma, 454 were due to domestic violence (24.1%) and was the commonest form of physical trauma and mainly occurred in December and June and were lowest in February and March. Its frequency of occurrence was followed by boda boda injuries (21.4%). The majority of victims were females (73.6%) with a female to male ratio of 2.84:1.0 Conclusion: Domestic violence was commonest cause of trauma in Gulu Hospital. More females were affected than males. December and June had the highest incidence. It is a public health problem in the region which drains hospital resources.
Developing a Rational Policy on Plagiarism for Institutions of Higher Education: A Case of Gulu University
(EAST AFRICAN NATURE & SCIENCE ORGANIZATION, 2025) Ongaya, Kizito; Alidri , Agatha; Onen, Walter Yagos; Odongkara, Beatrice; Okumu, Charles
Globally, plagiarism is a pervasive issue in institutions of higher education, posing challenges to academic integrity and ethical standards. Developing a policy on plagiarism is crucial for maintaining the quality and credibility of academic work within these institutions. The purpose of this paper is to discuss the development of a rational policy on plagiarism. The following are the objectives; to benchmark requirements for anti-plagiarism; to model process of procurement and detection of plagiarism process in public universities in Uganda; to examine how the challenges of Inter-Repository Plagiarism was addressed at Gulu University. The study reviewed existing literature on plagiarism policies in higher education institutions worldwide. The findings were that universities have varying views on levels of plagiarism with some policies allowing as high as 30% plagiarism level in scholarly work. Most of the peer-reviewed journals demand much lower allowable levels of plagiarism to encourage originality and sustainable adherence to copyright and intellectual property policies.
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, Juliet
Background 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, Uganda
Clinical evidence and recommendation on the use of Type-2 Diabetes Mellitus drugs in Lactation
(PMX, 2027) Richardson, Katherine; Kiptoo, Joshua; Odongkara, Beatrice Mpora; Ojara, Francis Williams; Waitt, Catriona

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