Department of Obstetrics and gnaecology

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Browsing Department of Obstetrics and gnaecology by Author "Alobo, Gasthony"

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    Estimating the Risk of Maternal Death at Admission: A Predictive Model from a 5-Year Case Reference Study in Northern Uganda
    (Obstetrics and Gynecology International, 2022) Alobo, Gasthony; Reverzani, Cristina; Sarno, Laura; Giordani, Barbara; Greco, Luigi
    Background. Uganda is one of the countries in the Sub-Saharan Africa with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births. We aimed at exploring the main factors affecting maternal death and designing a predictive model for estimation of the risk of dying at admission at a major referral hospital in northern Uganda. Methods. )is was a retrospective matched case-control study, carried out at Lacor Hospital in northern Uganda, including 130 cases and 336 controls, from January 2015 to December 2019. Multivariate logistic regression was used to estimate the net effect of the associated factors. A cumulative risk score for each woman based on the unstandardised canonical coefficients was obtained by the discriminant equation. Results. )e average maternal mortality ratio was 328 per 100,000 live births. Direct obstetric causes contributed to 73.8% of maternal deaths; the most common were haemorrhage (42.7%), sepsis (24.0%), hypertensive disorders (18.7%) and complications of abortion (2.1%), whereas malaria (23.5%) and HIV/AIDS (20.6%) were the leading indirect causes. )e odds of dying were higher among women who were aged 30 years or more (OR 1.12; 95% CI, 1.04–1.19), did not attend antenatal care (OR 3.11; 95% CI, 1.36–7.09), were HIV positive (OR 3.13; 95% CI, 1.41–6.95), had a caesarean delivery (OR 2.22; 95% CI 1.13–4.37), and were referred from other facilities (OR 5.57; 95% CI 2.83–10.99). Conclusion. Mortality is high among mothers referred late from other facilities who are HIV positive, aged more than 30 years, lack antenatal care attendance, and are delivered by caesarean section. )is calls for prompt and better assessment of referred mothers and specific attention to antibiotic therapy before and after caesarean section, especially among HIV-positive women.
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    Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa: a qualitative systematic review protocol
    (JBI Database of Systematic Reviews and Implementation Reports, 2019) Bayo, Pontius; Alobo, Gasthony; Feyissa, Garumma Tolu; Belaid, Loubna
    Objective: The objective of this review is to explore the experiences of mothers with the practice of kangaroo mother care (KMC) for preterm neonates at home in sub-Saharan Africa. Introduction: About 7000 newborn babies die every day around the world. About 80% of these deaths occur in sub-Saharan Africa and southern Asia. Preterm birth and low birth weight (LBW) are major causes of newborn deaths in these regions. Kangaroo mother care is an alternative way to care for LBW preterm neonates; however, the rate of practice remains low. Studies have identified a range of barriers, primarily at the healthcare system level, but there is a dearth of evidence on the factors and enablers at the community level. Inclusion criteria: The review will consider studies conducted in sub-Saharan Africa on the perceptions and experiences of mothers who have given birth to preterm babies and have practiced KMC at home. Qualitative studies in English and French conducted from January 1979 to the present that exclusively use qualitative research methods including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research will be included. Methods: PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Academic Search Complete, CINAHL complete, Education Source and Health source: Nursing/Academic Edition will be searched. Eligible studies will be critically appraised using the standardized Joanna Briggs Institute tool. Findings will be pooled using the meta-aggregative approach, and confidence will be assessed according to the ConQual approach.
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    Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa: a systematic review of qualitative evidence
    (JBI Evidence Synthesis, 2022) Bayo, Pontius; Alobo, Gasthony; Sauve, Caroline; Feyissa, Garumma Tolu
    Objective: The objective of this review was to explore the experiences of mothers with the practice of kangaroo mother care for preterm neonates at home in sub-Saharan Africa. Introduction: Newborn deaths globally have remained high despite the significant reductions in deaths among under-fives over the past few decades. More than 7000 deaths occur daily around the globe, but mostly in sub- Saharan Africa. Of these deaths, 60% to 80% are due to preterm birth and low birth weight. Kangaroo mother care is known to offer a cheap and effective way to care for low birth weight, preterm neonates; however, its practice is still low. There is limited evidence on the factors that hinder or facilitate the practice of kangaroo mother care at the community level. Inclusion criteria: The review considered studies conducted in sub-Saharan Africa on the perceptions and experiences of mothers who had given birth to preterm babies and had practiced kangaroo mother care wholly or in part at home. Qualitative studies in English and French conducted from January 1979 to March 2019 were considered for inclusion if they exclusively used qualitative research methods including, but not limited to, phenomenology, grounded theory, ethnography, action research, or feminist research. Methods: PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Academic Search Complete, CINAHL Complete, Education Source, and Health Source: Nursing/Academic Edition were searched in March 2019. Eligible studies were critically appraised using the standardized JBI tool. Findings were pooled using the metaaggregative approach, and confidence was assessed according to the ConQual approach. Results: Following the systematic search and critical appraisal process, six studies were included in the review for data extraction and synthesis of findings. Three of the six studies were based on in-depth individual interviews, while two employed both individual interviews and focus group discussions, and one study used only focus group discussions. Twenty-six primary findings were generated from the review process that were aggregated into 10 categories, which generated four meta-synthesized findings: i) Cultural and contextual factors: The traditional way of carrying babies on the back and providing them warmth through lighting lamps or charcoal make kangaroo mother care appear odd and shameful (level of confidence: low). ii) The technical content of the intervention: The practice of kangaroo mother care is perceived to be technically cumbersome, especially because it has to be continuous; there is fear of making the baby’s cord bleed; it creates difficulty in positioning for breastfeeding; and there is difficulty in maintaining the position while sleeping and doing other household chores (level of confidence: moderate). iii) Health system factors: The health care systems have no clear strategies to promote kangaroo mother care at the community level. Most mothers learned about the practice for the first time from health care workers only after birthing; however, peer-to-peer information sharing was noted to be a powerful source of trusted information about kangaroo mother care. Community leaders and religious leaders could be used to promote use of kangaroo mother care (level of confidence: moderate). iv) Individual and family factors: Although mothers realize the importance of kangaroo mother care for their infants’ recovery, their individual and family conditions affect their decision to practice the intervention (level of confidence: moderate). Conclusions: There is a link between the perceptions and experiences of kangaroo mother care that influences its practice in sub-Saharan Africa. The health care systems have failed to create awareness among communities before the birth of a preterm neonate. The traditional practices make kangaroo mother care stigmatizing at the community level, and the practice is perceived to be difficult and cumbersome, requiring substantial social support. Strategies to make the practice less cumbersome need to be devised, focusing on the comfort of mothers. Further qualitative studies are needed to explore community-level experiences of kangaroo mother care in sub-Saharan Africa.
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    Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu’s arteritis - a case report and literature review
    (African Health Sciences, 2021-06-02) Alobo, Gasthony; Nahurira, Violah; Omona, Venice; Bayo, Pontius; Olum, Sam
    Background: Neurological manifestation of Takayasu’s Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy. Objective: We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy. Case presentation: A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives. Conclusion: This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticulous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes.
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    Septic shock, acute renal and liver failure following unsafe abortion using bitter leaves and wandering jew in northern Uganda: A case series
    (Clinical Case Reports, 2022) Alobo, Gasthony; Reverzani, Cristina; Nahurira, Violah; Sarno, Laura
    Unsafe abortion is a major problem in Uganda, being one of the leading causes of maternal morbidity and mortality. Abortions are performed mostly under unsafe conditions, by people without medical training. In rural areas in northern Uganda, women often resort to traditional providers, who use local herbs as abortion remedies, usually with adverse outcomes. Little is known about the biological properties of these herbs and their toxicity profile. Here, we present the case series of two women, of 31 and 24 years of age, who underwent unsafe abortion for unintended pregnancy by using herbal medicines, that is, Commelina Africana (wandering jew) and Vernonia amygdalina (bitter leaf), respectively. While the first case resulted in uterine necrosis and pelvic peritonitis, which required multiple surgical interventions and the use of reserve antibiotics, the second case resulted in liver and renal failure that led to the death of the patient. This case series describes the unusual severe toxicity of two herbal medicines that are frequently used to induce abortion in northern Uganda. It highlights possible associations of Commelina Africana (wandering jew) with uterine necrosis complicated by sepsis, and of Vernonia amygdalina (bitter leaf) with acute liver and renal failure.
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    Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda
    (BMJ open, 2021) Alobo, Gasthony; Ochola, Emmanuel; Bayo, Pontius; Muhereza, Alex; Nahurira, Violah; Byamugisha, Josaphat
    Objectives To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting. Design This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants. Setting Thirteen primary healthcare centres, one general private-not- for- profit hospital, one regional referral hospital and one teaching hospital in northern Uganda. Participants Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling. Results After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and- forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional. Conclusion Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.