Dataset Information

Retinopathy among women with hypertensive disorders of pregnancy attending hospitals in Mbarara city, south-western Uganda: a cross-sectional study.

ABSTRACT:

Objective

Retinopathy is one of the complications occurring among women with hypertensive disorders of pregnancy. We sought to determine the prevalence and factors associated with retinopathy among women with hypertensive disorders of pregnancy in southwestern Uganda.

Design

This was a hospital-based cross-sectional study from November 2019 to March 2020.

Setting

Three selected hospitals in Mbarara city, south-western Uganda.

Participants

The study included all pregnant women with hypertensive disorders of pregnancy.

Primary and secondary outcome measures

The participants were screened for retinopathy using a fundus camera. Data on participant's sociodemographics, obstetrics and medical factors were collected. The prevalence of retinopathy was determined and multivariable logistic regression was used to determine the independent factors associated with retinopathy.

Results

A total of 216 women with hypertensive disorders of pregnancy were enrolled in this study. The prevalence of retinopathy was 60.2% (130/216). The most common retinal lesions were grade 1 retinopathy (narrowing of arterioles) accounting for 86.9% (113/130), grade 3 (retinal haemorrhages) was present in 10% (13/130) of women and grade 4 (papilloedema) in 3% (4/130). In an adjusted analysis, severe hypertension was significantly associated with retinopathy (aOR=2.8; 95% CI: 1.36 to 5.68). Grandmultigravida women were also associated with retinopathy (aOR=2.4; 95% CI: 0.99 to 5.72) with a tendency towards significancy, p=0.051.

Conclusions

In our study, retinopathy was common among women with hypertensive disorders of pregnancy. Women presenting with severe hypertension were likely to have retinopathy. There is a need to integrate screening for retinopathy in the care cascade of women with hypertensive disorders of pregnancy.

SUBMITTER: Zamaladi I

PROVIDER: S-EPMC10565131 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Retinopathy among women with hypertensive disorders of pregnancy attending hospitals in Mbarara city, south-western Uganda: a cross-sectional study.

Zamaladi Ibrahimu I Ruvuma Sam S Mceniery Carmel M CM Kwaga Teddy T Wilkinson Ian B IB Atwine Daniel D Lugobe Henry Mark HM

BMJ open 20231010 10

<h4>Objective</h4>Retinopathy is one of the complications occurring among women with hypertensive disorders of pregnancy. We sought to determine the prevalence and factors associated with retinopathy among women with hypertensive disorders of pregnancy in southwestern Uganda.<h4>Design</h4>This was a hospital-based cross-sectional study from November 2019 to March 2020.<h4>Setting</h4>Three selected hospitals in Mbarara city, south-western Uganda.<h4>Participants</h4>The study included all pregn ...[more]

PMID: 37816570

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Project description:IntroductionPreterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, different predictors influence the risk of neonatal mortality in different populations. Understanding the predictors of preterm neonatal mortality in the low-resource setting where we conducted our study could guide the development of interventions to improve outcomes for preterm neonates. We thus aimed to determine the incidence and predictors of mortality among preterm neonates born at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda.MethodsWe prospectively enrolled 538 live preterm neonates born at MRRH from October 2019 to September 2020. The neonates were followed up until death or 28 days, whichever occurred first. We used Kaplan Meier survival analysis to describe preterm neonatal mortality and Cox proportional hazards regression to assess predictors of preterm neonatal mortality over a maximum of 28 days of follow up.ResultsThe cumulative incidence of preterm neonatal mortality was 19.8% (95% C.I: 16.7-23.5) at 28 days from birth. Birth asphyxia (adjusted hazard ratio [aHR], 14.80; 95% CI: 5.21 to 42.02), not receiving kangaroo mother care (aHR, 9.50; 95% CI: 5.37 to 16.78), delayed initiation of breastfeeding (aHR, 9.49; 95% CI: 2.84 to 31.68), late antenatal care (ANC) booking (aHR, 1.81 to 2.52; 95% CI: 1.11 to 7.11) and no ANC attendance (aHR, 3.56; 95% CI: 1.51 to 8.43), vaginal breech delivery (aHR, 3.04; 95% CI: 1.37 to 5.18), very preterm births (aHR, 3.17; 95% CI: 1.24 to 8.13), respiratory distress syndrome (RDS) (aHR, 2.50; 95% CI: 1.11 to 5.64) and hypothermia at the time of admission to the neonatal unit (aHR, 1.98; 95% CI: 1.18 to 3.33) increased the risk of preterm neonatal mortality. Attending more than 4 ANC visits (aHR, 0.35; 95% CI: 0.12 to 0.96) reduced the risk of preterm neonatal mortality.ConclusionsWe observed a high cumulative incidence of mortality among preterm neonates born at a low-resource regional referral hospital in Uganda. The predictors of mortality among preterm neonates were largely modifiable factors occurring in the prenatal, natal and postnatal period (lack of ANC attendance, late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome, and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). These findings suggest that investment in and enhancement of ANC attendance, intrapartum care, and the feasible essential newborn care interventions by providing the warm chain through kangaroo mother care, encouraging early initiation of breastfeeding, timely resuscitation for neonates when indicated and therapies reducing the incidence and severity of RDS could improve outcomes among preterm neonates in this setting.

Project description:BackgroundPostpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother's response to the child's needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda.MethodsThis was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks' postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression.ResultsOverall prevalence of PPD was 27.1% (95% CI: 22.2-32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively.Conclusion and recommendationsPrevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.

Project description:BackgroundLife-threatening obstetric complications usually lead to the need for referral and constitute the commonest direct causes of maternal deaths. Urgent management of referrals can potentially lower the maternal mortality rate. We explored the experiences of women referred with obstetric emergencies to Mbarara Regional Referral Hospital (MRRH) in Uganda, in order to identify barriers and facilitating factors.MethodsThis was an exploratory qualitative study. In-depth interviews (IDIs) were conducted with 10 postnatal women and 2 attendants as key informants. We explored health system and client related factors to understand how these could have facilitated or hindered the referral process. Data was analyzed deductively employing the constructs of the Andersen Healthcare Utilization model.ResultsWomen experienced transport, care delays and inhumane treatment from health care providers (HCPs). The obstetric indications for referral were severe obstructed labor, ruptured uterus, and transverse lie in advanced labor, eclampsia and retained second twin with intrapartum hemorrhage. The secondary reasons for referral included; non-functional operating theatres due to power outages, unsterilized caesarian section instruments, no blood transfusion services, stock outs of emergency drugs, and absenteeism of HCPs to perform surgery. Four (4) themes emerged; enablers, barriers to referral, poor quality of care and poor health facility organization. Most referring health facilities were within a 30-50 km radius from MRRH. Delays to receive emergency obstetric care (EMOC) led to acquisition of in-hospital complications and eventual prolonged hospitalization. Enablers to referral were social support, financial preparation for birth and birth companion's knowledge of danger signs.ConclusionThe experience of obstetric referral for women was largely unpleasant due to delays and poor quality of care which contributed to perinatal mortality and maternal morbidities. Training HCPs in respectful maternity care (RMC) may improve quality of care and foster positive postnatal client experiences. Refresher sessions on obstetric referral procedures for HCPs are suggested. Interventions to improve the functionality of the obstetric referral pathway for rural south-western Uganda should be explored.

Project description:BackgroundThe presence of depression among hypertensive patients leads to a lack of adherence to treatment and poor compliance with lifestyle adjustments.ObjectivesTo assess the magnitude and associated factors of depression among hypertensive patients attending hospitals in Arba Minch town, Gamo zone, south Ethiopia, 2024.MethodsAn institution-based cross-sectional study was employed from 1 May to 30 June 2024. The total sample size was 395. A systematic random sampling technique was used. Data was collected through face-to-face interviews. Data was entered into Epi Data version 3.1 and then exported to the SPSS version 25 statistical package for analysis. Logistic regression analysis tested the association between the independent and the outcome variables. Finally, a significant independent association was interpreted at a P-value of less than 0.05 with 95%CI.ResultThe magnitude of depression among hypertensive patients was 43.6% with 95% CI (38.2-48.7). Taking multiple antihypertensive medications [AOR: 2.19, 95%CI: 1.16-4.16], history of admission [AOR: 0.24, 95%CI: 0.12-0.46], blood pressure status [AOR: 0.07, 95%CI: 0.03-0.16], body mass index <18.5 kgm2 [AOR: 0.12, 95%CI: 0.02-0.83], 18.5-24.9 kgm2 [AOR: 0.14, 95%CI: 0.04-0.52], 25-29.9 kgm2 [AOR: 0.23, 95%CI: 0.06-0.91], family history of hypertension [AOR: 3.06, 95%CI: 1.27-7.37], family history of depression [AOR: 5.01, 95%CI: 2.02-12.43], ever alcohol drinker [AOR: 3.37, 95%CI: 1.32-8.58], and ever smoke cigarette [AOR: 3.44, 95%CI: 1.26-9.34] were associated with depression among hypertensive patients.ConclusionThe number of antihypertensive medications, history of admission, blood pressure status, body mass index, family history of hypertension, family history of depression, ever alcohol drinker, and ever smoked cigarette were significantly associated with depression among hypertensive patients. Therefore, limiting the number of medications, controlling blood pressure, reducing body mass index, screening and treating family-related hypertension and depression, and abstinence from alcohol and smoking might reduce the burden of depression among hypertensive patients.

Project description:BackgroundPerinatal mortality remains high globally and remains an important indicator of the quality of a health care system. To reduce this mortality, it is important to provide the recommended care during the perinatal period. We assessed the prevalence and factors associated with appropriate perinatal care (antenatal, intrapartum, and postpartum) in Bunyoro region, Uganda. Results from this study provide valuable information on the perinatal care services and highlight areas of improvement for better perinatal outcomes.MethodsA cross sectional survey was conducted among postpartum mothers attending care at three district hospitals in Bunyoro. Following consent, a questionnaire was administered to capture the participants' demographics and data on care received was extracted from their antenatal, labour, delivery, and postpartum records using a pre-tested structured tool. The care received by women was assessed against the standard protocol established by World Health Organization (WHO). Poisson regression with robust standard errors was used to assess factors associated with appropriate postpartum care.ResultsA total of 872 mothers receiving care at the participating hospitals between March and June 2020 were enrolled in the study. The mean age of the mothers was 25 years (SD = 5.95). None of the mothers received appropriate antenatal or intrapartum care, and only 3.8% of the participants received appropriate postpartum care. Factors significantly associated with appropriate postpartum care included mothers being >35 years of age (adjusted prevalence ratio [aPR] = 11.9, 95% confidence interval [CI] 2.8-51.4) and parity, with low parity (2-3) and multiparous (>3) mothers less likely to receive appropriate care than prime gravidas (aPR = 0.3, 95% CI 0.1-0.9 and aPR = 0.3, 95% CI 0.1-0.8 respectively).ConclusionsAntenatal, intrapartum, and postpartum care received by mothers in this region remains below the standard recommended by WHO, and innovative strategies across the continuum of perinatal care need to be devised to prevent mortality among the mothers. The quality of care also needs to be balanced for all mothers irrespective of the age and parity.

Project description:BackgroundProvision of effective care to all women and newborns during the perinatal period is a viable strategy for achieving the Sustainable Development Goal 3 targets on reducing maternal and neonatal mortality. This study examined perinatal care (antenatal, intrapartum, postpartum) and its association with perinatal deaths at three district hospitals in Bunyoro region, Uganda.MethodsA cross-sectional study was conducted in which a questionnaire was administered consecutively to 872 postpartum women before discharge who had attended antenatal care and given birth in the study hospitals. Data on care received during antenatal, labour, delivery, and postpartum period, and perinatal outcome were extracted from medical records of the enrolled postnatal women using a pre-tested structured tool. The care received from antenatal to 24 h postpartum period was assessed against the standard protocol of care established by World Health Organization (WHO). Poisson regression was used to assess the association between care received and perinatal death.ResultsThe mean age of the women was 25 years (standard deviation [SD] 5.95). Few women had their blood tested for hemoglobin levels, HIV, and Syphilis (n = 53, 6.1%); had their urine tested for glucose and proteins (n = 27, 3.1%); undertook an ultrasound scan (n = 262, 30%); and had their maternal status assessed (n = 122, 14%) during antenatal care as well as had their uterus assessed for contraction and bleeding during postpartum care (n = 63, 7.2%). There were 19 perinatal deaths, giving a perinatal mortality rate of 22/1,000 births (95% Confidence interval [CI] 8.1-35.5). Of these 9 (47.4%) were stillbirths while the remaining 10 (52.6%) were early neonatal deaths. In the antenatal phase, only fetal examination was significantly associated with perinatal death (adjusted prevalence ratio [aPR] = 0.22, 95% CI 0.1-0.6). No significant association was found between perinatal deaths and care during labour, delivery, and the early postpartum period.ConclusionWomen did not receive all the required perinatal care during the perinatal period. Perinatal mortality rate in Bunyoro region remains high, although it's lower than the national average. The study shows a reduction in the proportion of perinatal deaths for pregnancies where the mother received fetal monitoring. Strategies focused on strengthened fetal status monitoring such as fetal movement counting methods and fetal heart rate monitoring devices during pregnancy need to be devised to reduce the incidence of perinatal deaths. Findings from the study provide valuable information that would support the strengthening of perinatal care services for improved perinatal outcomes.

Project description:BackgroundUrinary tract infections (UTIs) in pregnant women contribute about 25% of all infections and are among the most frequent clinical bacterial infections. Pregnancy changes in women that include anatomical, physiological and hormonal make them susceptible to develop UTI. Left untreated, UTI in pregnancy is associated with grave complications to the mother and fetus. These complications can be decreased by prompt and proper diagnosis and appropriate treatment that also reduces the emergency of drug resistance. Antimicrobial resistance is a major health problem in the treatment of UTI. We determined the prevalence, bacteriology and antimicrobial susceptibility of symptomatic urinary tract infection among pregnant women at Mbarara Regional Referral Hospital.MethodsWe conducted a cross-sectional study from November 2019 to February 2020 involving 400 pregnant women with symptomatic UTI. Patient information was obtained using a structured questionnaire. We collected clean-catch midstream urine specimens for culture and performed antimicrobial susceptibility testing following Clinical and Laboratory Standards Institute standards. Data was entered into RED-cap Version 8.2 software and then exported to Stata Version 14.1 for analysis.ResultsThe proportion of culture-positive UTI was 140/400 (35%). Gram-negative bacteria were more prevalent (73%): Klebsiella pneumoniae 52(37.41%), Escherichia coli 40(28.78%), Pseudomonas aeruginosa and Proteus mirabilis 7(5.04% each), Citrobacter freundii 1(1%). Staphylococcus aureus 33(23.57%) was the only gram-positive isolate. All the isolates were resistant to ampicillin, amoxicillin, amoxicillin/clavulanic acid and ceftazidime/clavulanic acid (95.7, 95.0, 72.9 and 50.7% respectively). Prevalence of extended-spectrum beta-lactamases producing Enterobacteriaceae was 29.0% while that of methicillin-resistant Staphylococcus aureus was 33.3%. All cultures demonstrated resistance to more than one drug. Majority of the bacterial isolates were sensitive to ciprofloxacin, ceftriaxone, nitrofurantoin, cefotaxime and gentamicin at 82.9, 81.4, 79.3, 78.6, 66.4 and 65.7% respectively.ConclusionsKlebsiella pneumoniae was the most prevalent isolate followed by E. coli. These two organisms were highly resistant to the commonly used antibiotics. Our study recorded a higher prevalence of culture-positive UTI in pregnancy than all the studies in Uganda. Empirical treatment of UTI should be minimized as sensitivity varies for each organism, for each drug and over time.

Project description:Metal fabrication workshops (MFWs) are common businesses in Ugandan cities, and especially those producing metallic security gates, window and door frames (burglar-proof), and balcony and staircase rails. The objective of this study was to comparatively assess the pollution levels and potential health risks of manganese (Mn), chromium (Cr), cadmium (Cd), lead (Pd) and nickel (Ni) in pooled surface soil samples from four 5-, 7-, 8-, and 10-year-old MFWs (n = 28) and a control site (n = 8) in Mbarara City, Uganda. The concentration of the potentially toxic elements (PTEs) was determined using inductively coupled plasma-optical emission spectrometry. Contamination, ecological, and human health risk assessment indices and models were used to identify any risks that the PTEs could pose to the pristine environment and humans. Our results showed that PTE pollution of soils is occuring in the MFWs than at the control site. The mean concentrations of the PTEs (mg kg-1) in the samples were: Mn (2012.75 ± 0.23-3377.14 ± 0.31), Cr (237.55 ± 0.29-424.93 ± 0.31), Cd (0.73 ± 0.13-1.29 ± 0.02), Pb (107.80 ± 0.23-262.01 ± 0.19), and Ni (74.85 ± 0.25-211.37 ± 0.14). These results indicate that the PTEs could plausibly derive from the fabrication activities in these workshops, which is supported by the high values of contamination factors, index of geoaccumulation, and the overall increase in pollution load indices with the number of years of operation of the MFWs. Human health risk assessment showed that there are non-carcinogenic health risks that could be experienced by children who ingest PTEs in the soils from the 7-, 8- and 10-year-old MFWs. The incremental life cancer risk assessment suggested that there are potential cancerous health effects of Cd and Ni that could be experienced in children (who ingest soils from all the four MFWs) and adults (ingesting soils from the 8- and 10-year-old MFWs). This study underscores the need to implement regulatory guidelines on the operation and location of MFWs in Uganda. Further research should be undertaken to investigate the emission of the PTEs during welding operations in the MFWs.

Dataset Information

Retinopathy among women with hypertensive disorders of pregnancy attending hospitals in Mbarara city, south-western Uganda: a cross-sectional study.

Objective

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Retinopathy among women with hypertensive disorders of pregnancy attending hospitals in Mbarara city, south-western Uganda: a cross-sectional study.

Similar Datasets

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