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1.
Ultrasound Obstet Gynecol ; 61(4): 481-487, 2023 04.
Article in English | MEDLINE | ID: mdl-37011080

ABSTRACT

OBJECTIVE: The aim of this study was to determine the quality of fetal biometry and pulsed-wave Doppler ultrasound measurements in a prospective cohort study in Uganda. METHODS: This was an ancillary study of the Ending Preventable Stillbirths by Improving Diagnosis of Babies at Risk (EPID) project, in which women enroled in early pregnancy underwent Doppler and fetal biometric assessment at 32-40 weeks of gestation. Sonographers undertook 6 weeks of training followed by onsite refresher training and audit exercises. A total of 125 images for each of the umbilical artery (UA), fetal middle cerebral artery (MCA), left and right uterine arteries (UtA), head circumference (HC), abdominal circumference (AC) and femur length (FL) were selected randomly from the EPID study database and evaluated independently by two experts in a blinded fashion using objective scoring criteria. Inter-rater agreement was assessed using modified Fleiss' kappa for nominal variables and systematic errors were explored using quantile-quantile (Q-Q) plots. RESULTS: For Doppler measurements, 96.8% of the UA images, 84.8% of the MCA images and 93.6% of the right UtA images were classified as of acceptable quality by both reviewers. For fetal biometry, 96.0% of the HC images, 96.0% of the AC images and 88.0% of the FL images were considered acceptable by both reviewers. The kappa values for inter-rater reliability of quality assessment were 0.94 (95% CI, 0.87-0.99) for the UA, 0.71 (95% CI, 0.58-0.82) for the MCA, 0.87 (95% CI, 0.78-0.95) for the right UtA, 0.94 (95% CI, 0.87-0.98) for the HC, 0.93 (95% CI, 0.87-0.98) for the AC and 0.78 (95% CI, 0.66-0.88) for the FL measurements. The Q-Q plots indicated no influence of systematic bias in the measurements. CONCLUSIONS: Training local healthcare providers to perform Doppler ultrasound, and implementing quality control systems and audits using objective scoring tools in clinical and research settings, is feasible in low- and middle-income countries. Although we did not assess the impact of in-service retraining offered to practitioners deviating from prescribed standards, such interventions should enhance the quality of ultrasound measurements and should be investigated in future studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.


Subject(s)
Biometry , Ultrasonography, Doppler , Pregnancy , Female , Humans , Prospective Studies , Reproducibility of Results , Quality Control , Ultrasonography, Prenatal/methods , Reference Standards , Gestational Age , Umbilical Arteries/diagnostic imaging
2.
BMC Pregnancy Childbirth ; 20(1): 429, 2020 Jul 28.
Article in English | MEDLINE | ID: mdl-32723330

ABSTRACT

BACKGROUND: Globally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country. METHODS: A stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick's classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score. DISCUSSION: This stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries. TRIAL REGISTRATION: ISRCTN98617255 , retrospectively registered July 23, 2018.


Subject(s)
Emergency Medical Services/methods , Obstetrics/education , Simulation Training/methods , Emergencies , Female , Gynecology/education , Humans , Infant , Infant Mortality , Infant, Newborn , Maternal Mortality , Patient Care Team , Perinatal Mortality , Pregnancy , Uganda
3.
Glob Health Action ; 11(1): 1490106, 2018.
Article in English | MEDLINE | ID: mdl-29972099

ABSTRACT

Universal access to comprehensive abortion care (CAC) is a reproductive right and is essential to reduce preventable maternal mortality and morbidity. In East Africa, abortion rates are consistently high, and the vast majority of all abortions are unsafe, significantly contributing to unnecessary mortality and morbidity. The current debate article reflects and summarises key action points required to continue to speed the implementation of and expand access to CAC in the East, Central, and Southern African (ECSA) health community. To ensure universal access to quality CAC, a regional platform could facilitate the sharing of best practices and successful examples from the region, which would help to visualise opportunities. Such a platform could also identify innovative ways to secure women's access to quality care within legally restrictive environments and would provide information and capacity building through the sharing of recent scientific evidence, guidelines, and training programmes aimed at increasing women's access to CAC at the lowest effective level in the healthcare system. This type of infrastructure for exchanging information and developing co-creation could be crucial to advancing the Sustainable Development Goals 2030 agenda.


Subject(s)
Abortion, Induced/methods , Comprehensive Health Care/organization & administration , Developing Countries , Quality of Health Care/organization & administration , Abortion, Induced/standards , Africa , Comprehensive Health Care/standards , Health Knowledge, Attitudes, Practice , Health Services Accessibility/organization & administration , Humans , Quality of Health Care/standards
4.
Int J STD AIDS ; 23(2): 111-4, 2012 Feb.
Article in English | MEDLINE | ID: mdl-22422685

ABSTRACT

We conducted a prospective cohort study of 306 HIV-1-infected women, followed from seroconversion for median 6.4 years in Uganda (UG) and Zimbabwe (ZM) to describe the incidence of major clinical outcomes (MCOs), defined as World Health Organization stage 4 conditions and any tuberculosis (TB). In Uganda, 19 MCOs occurred in 13 participants at median 4.6 years and a median CD4 count of 213 cells/mm(3). In Zimbabwe, 29 MCOs occurred in 27 participants at median 4.0 years (P < 0.001 versus UG) and median CD4 count of 219 cells/mm(3) (P = 0.83 versus UG). MCO incidence was not statistically different (UG: 2.82 cases/100 person-years versus ZM: 2.45; P = 0.64) except for TB (UG: 0.59 versus ZM: 2.02 cases/100 person-years; P = 0.02). This significant difference in TB incidence is primarily due to a TB screening and isoniazid prevention therapy programme that was implemented in Uganda, but not in Zimbabwe, highlighting the importance of integrated TB screening and treatment within HIV programmes.


Subject(s)
HIV Infections/pathology , HIV Seropositivity/pathology , HIV-1/isolation & purification , AIDS-Related Opportunistic Infections/microbiology , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/therapy , Adult , Female , HIV Infections/microbiology , HIV Infections/therapy , HIV Seropositivity/therapy , Humans , Prospective Studies , Treatment Outcome , Tuberculosis/pathology , Tuberculosis/therapy , Tuberculosis/virology , Uganda , Zimbabwe
5.
Int J Tuberc Lung Dis ; 14(12): 1647-9, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21144254

ABSTRACT

We studied the acceptability of isoniazid preventive therapy (IPT) in newly human immunodeficiency virus (HIV) infected Ugandan women. Women were followed in an out-patient clinic where they received HIV care including IPT. Of 52 women who were purified protein derivative-positive, 48 were eligible for IPT and 39 (81%) completed therapy. This completion rate was higher than reported in similar observational studies.


Subject(s)
Antitubercular Agents/therapeutic use , HIV Infections/complications , Isoniazid/therapeutic use , Latent Tuberculosis/drug therapy , Adolescent , Adult , Cohort Studies , Female , Humans , Latent Tuberculosis/complications , Latent Tuberculosis/diagnosis , Prospective Studies , Treatment Outcome , Tuberculin Test , Tuberculosis/prevention & control , Uganda , Young Adult
6.
Int J STD AIDS ; 21(5): 342-5, 2010 May.
Article in English | MEDLINE | ID: mdl-20498104

ABSTRACT

We conducted a cross-sectional study with 208 HIV-uninfected and 188 HIV-infected women in Uganda and Zimbabwe to investigate differences in median CD4 counts. Absolute CD4 counts were determined by flow cytometry. Multivariate analyses were used to examine the association of country and HIV-infection status on CD4 counts. Median CD4 counts were significantly lower in Zimbabwe than in Uganda overall (649 and 783 cells/mm(3), P = 0.009) and among HIV-infected women (470 and 614 cells/mm(3), P = 0.003). In separate multivariable models, CD4 counts were significantly lower in Zimbabwe in HIV-uninfected (P = 0.014) and infected (P < 0.001) women, controlling for age, contraceptive method, education and living with partner status. In a model combining HIV-uninfected and infected women, there was no significant interaction between country and HIV infection status (P = 0.344), suggesting that the relationship between country and CD4 count was not significantly modified by HIV infection status. This study reinforces the importance of establishing country-specific reference CD4 levels as CD4 count continues to be used as a key biomarker in clinical decision-making for HIV-infected individuals in sub-Saharan Africa.


Subject(s)
CD4 Lymphocyte Count , HIV Infections/immunology , Adolescent , Adult , Contraceptives, Oral , Cross-Sectional Studies , Female , HIV Infections/epidemiology , Humans , Pregnancy , Sampling Studies , Uganda/epidemiology , Young Adult , Zimbabwe/epidemiology
7.
Afr Health Sci ; 10(4): 349-52, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21416036

ABSTRACT

BACKGROUND: Asymptomatic bacteriuria in pregnancy is associated with potential urinary and obstetric complications. However the prevalence aetiology and antimicrobial sensitivity patterns of asymptomatic bacteriurea among women attending ante-natal care in our Hospital is not known. OBJECTIVE: To determine the prevalence and identify the aetiological agents associated with asymptomatic bacteriurea in antenatal mothers in Mulago Hospital. We also intended to determine the anti-microbial sensitivity patterns of the common uropathogen in this population METHODS: We performed culture and anti-microbial sensitivity tests on urine samples from 218 consecutive ante-natal mothers in Mulago Hospital. All participants did not have any clinical symptoms attributable to urinary tract infection. RESULTS: Twenty nine (13.3%) of the samples had significant bacterial growth and E.coli was the commonest isolate (51.2%). There was a high level (20-62%) of anti-bacterial resistance to the commonly used antibiotics. CONCLUSION: Asymptomatic bacteriuria is common among ante-natal mothers in Mulago. E. Coli that is resistant to the most commonly used antibiotics is the commonest isolate."


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria/isolation & purification , Bacteriuria/drug therapy , Bacteriuria/microbiology , Mothers , Pregnancy Complications, Infectious/microbiology , Bacteria/classification , Bacteria/drug effects , Bacteriuria/epidemiology , Cross-Sectional Studies , Drug Resistance, Multiple, Bacterial , Female , Hospitals , Humans , Microbial Sensitivity Tests , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/epidemiology , Prenatal Care , Prevalence , Sensitivity and Specificity , Socioeconomic Factors , Uganda/epidemiology
8.
Afr Health Sci ; 5(4): 338-40, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16615847

ABSTRACT

A 25-year-old HIV-infected woman participating in a study of the effects of hormonal contraception on HIV disease progression was started on antiretroviral therapy-Combivir & Nevirapine (NVP) on May 27, 2004. NVP was 200mg daily initially for two weeks to be increased to 200mg bid thereafter. On day twelve, she presented with a mild skin rash on the trunk, purulent conjunctivitis, pharyngitis and fever. She was treated symptomatically and sent home. The following day she returned with a generalized erythematous eruption. She was admitted to JCRC (Joint Clinical and Research Centre) on June 14 and was diagnosed with Stevens - Johnson syndrome (SJS). Antiretroviral therapy was stopped. By July 05, 2004, she had improved and was discharged. After recovery she was restarted on Combivir and Efavirenz and is subsequently doing well on this regimen.


Subject(s)
Anti-HIV Agents/adverse effects , Nevirapine/adverse effects , Stevens-Johnson Syndrome/chemically induced , Adult , Female , Humans , Nevirapine/administration & dosage , Stevens-Johnson Syndrome/physiopathology , Treatment Outcome
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