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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.