Browsing by Author "Ndeezi , Grace"

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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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    Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study
    (BCM, 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.
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    Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda:
    (PLOS ONE, 2020-10-10) OjokArach , Anna Agnes .; Nakasujja ,Noeline; Nankabirwa, Victoria; Ndeezi , Grace; Kigule, Juliet .; Mukunya , David; JustinOdongkara , Beatrice; Tylleskar , Thorkild; Achora , Vincentina; Tongun , Bruno Justin; Wamboko Musaba , Milton; Tumwine , JamesK.; Napyo, Agnes; Zalwango , Vivian; Tylleskar , Thorkild; Tumwine ,K. James
    Abstract 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; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. Methods We conducted a community-based cross-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 week postpartum. We used generalized 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 symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [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 women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.