“The Influence of Lifestyle on Adoption of Breast Cancer Prevention Modalities among Women.” A Case Study of Kyaddondo County in Uganda

Background: In Uganda, breast cancer is the third most frequent cancer of women that is preventable through change in life style habits such as reduction in alcohol uptake, obesity, none use of tobacco products, use of hormonal pills and increase in physical activities thereby reducing the risk of women acquiring breast cancer. The objectives of this study are to establish the influence of lifestyle on the adoption of breast cancer prevention modalities among women in Kyaddondo County. Methodology: A household survey of women in Kyaddondo County using a self-administered questionnaire was undertaken to establish the influence of lifestyle on breast cancer prevention modalities. A sample of 414 females with at least 1 female per household was randomly selected. Results: The results using chi-square to establish an association to adoption of breast cancer prevention modalities showed that the significant determinants of the adoption of breast cancer prevention modalities were: taking alcohol, a woman gives birth, children ever born, breast feeding, frequency of breast feeding and a woman doing exercises. There was no significant relationship between frequency of alcohol intake, tobacco usage, frequency use of tobacco, use of family planning, type of family planning method used(orals pills and injectables), length of use of family planning, type of work done for a living and frequency of exercises in relation to adoption of breast cancer prevention modalities. Logistic regression analysis revealed that the lifestyle key determinants of adoption of breast cancer prevention modalities are limiting alcohol consumption (OR 2.084 95% CI: 1.260-3.449), family planning uptake (OR 3.479 95% CI: 1.331-9.095) and exercising (OR 2.524 95% CI: 1.613-3.949). Conclusions: This study inculcates participation of women and their communities’ evidence based lifestyle educational programs to help improve the health of women but also their level of knowledge so as to increase the adoption of breast cancer prevention modalitie

Factors Associated with Stillbirths at Mbarara Regional Referral Hospital

Background: Still births contribute more than half 39(65%) to perinatal deaths but can be minimized if pregnancy is adequately monitored during antenatal care and adequate intrapartum care is given. Perinatal mortality is a key outcome indicator for obstetric care, preventable through EMOC and routine antenatal care of a pregnant woman that allows early detection, prompt diagnosis and early treatment of any pregnancy related conditions that improve perinatal outcome. Thus the objective of this study was to determine factors associated with still births among women at Mbarara Regional Referral Hospital in Mbarara District.Methods: An unmatched case control study was adopted. A total of 300 mothers who delivered at or above 28 weeks between august and December 2013 were interviewed using administered questionnaires. Data was analyzed using STATA.Results: We found that 102(34%) mothers had stillbirths and 198(66%) had live births. The mean age (in complete years) of mothers that had live births (25.1±5.45) and those that experienced a stillbirth (25.8±5.89). Mothers in the 30-45 age bracket experienced high 32(31.7%) stillbirth frequency, contrary to younger mothers in the 25-29 age bracket that had the lowest 19(18.8%) stillbirth frequency Therefore, the key determinants of stillbirths at Mbarara Regional Referral Hospital were: obstetric and health systems factors that include (cOR, 95%) inadequate antenatal care: ≤ 3 visits (2.10, 1.12-4.0, P= 0.0312) cord prolapsed (5.8, 1.50-4.28, P=0.012), referral status (3.4, 1.74-6.74, P=0.000), lack of partogram use (6.44, 2.3-7.90, P=0.000) and antenatal booking health facility II (3.9, 1.36-11.26 P=0.000) and anemia (2.75 1.60-6.50 P=0.0213 was the medical factor found to be associated with stillbirth.Conclusions: To significantly lower stillbirth rates at MRRH, there is need to strengthen goal oriented antenatal care so as to identify and address the aforementioned factors during antenatal visits and delivery. Key words: Stillbirth, Case, Control, Fresh stillbirth (intrapartum stillbirth), Macerated stillbirth (ante partum stillbirth) and Perinatal

Predictors of Length of Hospital Stay among Burns Patients in Mulago National Referral Hospital, Kampala- Uganda

Background: According to WHO (2014), burn injuries are a major problem to health care worldwide. Ninety five per cent of all burn cases occur in LMICs leading to prolonged and expensive hospital stays (WHO, 2009). In Uganda, burn injuries account for 11% of all childhood injuries (Nakitto & Lett, 2010). Burns Unit at Mulago National Referral Hospital is the only specialized burns care unit in the country. However, it was observed that patients in this unit spends unusually longer time in admission than the WHO (2015) recommended time. Thus the objective of this study was to determine the predictors of length of hospital stay among burn patients in Mulago National Referral Hospital Kampala, Burns Care Unit from July, 2014 to June, 2015.Methods: A retrospective study design was used by reviewing medical records of patients discharged from the Burns Care Unit from July, 2014 to June, 2015. Results: More than half (57.1%) of the patients in the study were male with children 5 years and below constituting 55.2%. The majority of patients (86.2%) got burnt at home. The average length of stay for patients was 24.3 days (±22.1 days). The degree/ depth of burns (OR=44.22, 95% CI =10.86-180.08, P=0.000) was the single most significant predictor of length of stay of patients with burns at multivariate analysis level. Keywords: Burns, length of stay, predictor

The effect of knowledge on uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda

Abstract Background Breast cancer, the third most frequent cancer of women is preventable through knowledge on breast self-examination. Of the 44% of women diagnosed with breast cancer at the Uganda Cancer Institute, only 22% go for check-up in less than three months. This study explored the effect of breast cancer knowledge on the uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda. Methods A household survey of women in Kyadondo County was conducted during June, 2014 to August, 2015. This involved studying in-depth using a questionnaire the level of breast cancer knowledge of the respondents. Data was analyzed using logistic regression model. Chi-square test was used to establish relationships between knowledge base factors and the uptake of breast cancer prevention modalities. Results This study has established an empirical relationship between uptake of breast cancer prevention modalities and source of information especially radio (OR 1.94 95% CI: 1.16–3.24), television (OR 1.82 95%CI: 1.14–2.93), awareness of breast cancer (OR 4.03 95%CI: 1.01–15.98), knowledge on how to reduce risk of breast cancer (OR 1.98 95% CI: 1.20–3.27), what reduces breast cancer acquisition (OR 2.75 95% CI: 1.42–5.35), how to check for signs of breast cancer especially through breast self-examination (OR 3.09 95% CI: 1.62–5.88), and other methods of breast cancer diagnosis in a health care set up. Conclusion The women’s level of breast cancer awareness as a primary prevention strategy was found wanting, and requires a boost through community health education

Provision of family planning vouchers and early initiation of postpartum contraceptive use among women living with HIV in southwestern Uganda: A randomized controlled trial.

BackgroundUnwanted pregnancies remain a burden for women living with HIV (WLWH). Family planning prevents unplanned pregnancies while promoting longer birth intervals, key strategies to eliminate perinatal transmission of HIV and promote maternal and child health. We evaluated the effect of a family planning voucher, inclusive of immediate postpartum counseling, on uptake, early initiation, and continuation of modern contraceptive methods among recently postpartum WLWH delivering at a publicly funded regional referral hospital in rural, southwestern Uganda.Methods and findingsWe performed a randomized controlled trial between October, 2016 and June, 2018 at a referral hospital in southwestern Uganda. This interim analysis includes adult WLWH randomized and enrolled equally to receive a family planning voucher or standard of care (control). Enrolled postpartum WLWH completed an interviewer-administered questionnaire at enrollment and 6 months postpartum. Our primary outcome of interest for this analysis is initiation of a modern family planning method within 8 weeks postpartum. Secondary outcomes included family planning initiation at 12, 14, 16, and 20 weeks postpartum, family planning discontinuation and/or change, pregnancy incidence, and mean time without contraception. The trial was registered with clinicaltrials.gov (NCT02964169). At enrollment, half of the women in both the voucher (N = 87, 55%) and control (N = 86, 54%) groups wanted to have a child in 2 years postpartum. Over 80% of referent pregnancies in the voucher (N = 136, 86%) and control (N = 128, 81%) groups were planned. All women were accessing ART. The mean CD4 count was 396 cells/mm3 (SD = 61) for those enrolled in the control group versus 393 cells/mm3 (SD = 64) in the family planning voucher group. By 8 weeks postpartum, family planning was initiated in 144 (91%) participants in the voucher group and 83 (52%) participants in the control group (odds ratio [OR] 9.42; CI 4.67-13.97, P ConclusionThese findings indicate that a well-structured, time-bound family planning voucher program appeared to increase early postpartum contraceptive uptake and continuation in a setting in which users are faced with financial, knowledge, and structural barriers to contraceptive services. Further work should clarify the role of vouchers in empowering WLWH to avoid unintended pregnancies over time.Trial registrationClinicalTrials.gov NCT02964169

Measuring Post-Partum Haemorrhage in Low-Resource Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in Hemoglobin

Background: Accurate estimation of blood loss is central to prompt diagnosis and management of post-partum hemorrhage (PPH), which remains a leading cause of maternal mortality in low-resource countries. In such settings, blood loss is often estimated visually and subjectively by attending health workers, due to inconsistent availability of laboratory infrastructure. We evaluated the diagnostic accuracy of weighed blood loss (WBL) versus changes in peri-partum hemoglobin to detect PPH. Methods: Data from this analysis were collected as part of a randomized controlled trial comparing oxytocin with misoprostol for PPH (NCT01866241). Blood samples for complete blood count were drawn on admission and again prior to hospital discharge or before blood transfusion. During delivery, women were placed on drapes and had pre-weighed sanitary towels placed around their perineum. Blood was then drained into a calibrated container and the sanitary towels were added to estimate WBL, where each gram of blood was estimated as a milliliter. Sensitivity, specificity, negative and positive predictive values (PPVs) were calculated at various blood volume loss and time combinations, and we fit receiver-operator curves using blood loss at 1, 2, and 24 hours compared to a reference standard of haemoglobin decrease of >10%. Results: A total of 1,140 women were enrolled in the study, of whom 258 (22.6%) developed PPH, defined as a haemoglobin drop >10%, and 262 (23.0%) had WBL ≥500mL. WBL generally had a poor sensitivity for detection of PPH (85%) in high prevalence settings when WBL exceeds 750mL. Conclusion: WBL has poor sensitivity but high specificity compared to laboratory-based methods of PPH diagnosis. These characteristics correspond to a high PPV in areas with high PPH prevalence. Although WBL is not useful for excluding PPH, this low-cost, simple and reproducible method is promising as a reasonable method to identify significant PPH in such settings where quantifiable red cell indices are unavailable

Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital

Objective. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. Methods. This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results. The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05). Conclusion. The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations. We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole