Ruptured uterus in rural Uganda: prevalence, predisposing factors and outcomes.

INTRODUCTION: A ruptured uterus is a life-threatening obstetric complication that remains a major public health concern in low-income countries, particularly in Africa. It is a significant cause of maternal and perinatal morbidity and mortality. In Uganda, the prevalence remains high largely because most women do not deliver in health facilities. Further review of this problem may be helpful in the development of appropriate preventive strategies. METHODS: A five-year retrospective review of all cases of ruptured uterus admitted to Mityana Hospital, Uganda from January 1, 2003 to December 31, 2007 was conducted. RESULTS: Out of 14,656 deliveries, 73 cases of ruptured uterus were recorded, resulting in a ratio of 1 in 200. The highest incidence was in patients aged 20-24 years old, of parity 1-4 and residing in the Kassanda sub-county. Other predisposing factors included not attending antenatal care (67.1 percent), which was associated with rupture at home or with traditional birth attendants (TBAs) (Odds Ratio [OR] 6.29; 95 percent confidence interval [CI] 2.01-19.67), obstructed or prolonged labour (68.5 percent), which increased the likelihood of rupture before admission (OR 3.28; 95 percent CI 1.05-10.26), residing more than 10 kilometres from the hospital (64.4 percent), which increased the likelihood of rupture before admission (OR 3.62; 95 percent CI 1.16-11.32) and the existence of previous scars (19.2 percent), which decreased the likelihood of rupture before admission (OR 0.24; 95 percent CI 0.07-0.81). All the women had surgery, of which 14 percent had a total hysterectomy, 22 percent had a subtotal hysterectomy, 25 percent had a repair and bilateral tubal ligation, and 39 percent had a repair only. Eight percent of the women died, while seven percent of the babies were born alive. CONCLUSIONS: Uterine rupture is a disturbing problem in Uganda. There is a need to put in place a functional referral system for pregnant women that links the community and TBAs to the hospital, and a need to intensify information, education and communication programmes to encourage women and their partners to use the reproductive health services that are available to them. In addition, greater accessibility to equipped health facilities, the use of a partogram to monitor labour and timely interventions will go a long way to reducing uterine rupture.

Factors Influencing Disclosure of HIV Positive Status in Mityana District of Uganda

Background: Disclosure of HIV positive sero-status to sexual partners; friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV/AIDS (PHA) never disclose. Objective: To identify factors associated with disclosure among PHAs in Mityana district of Uganda. Methods: Using a case control design; we compared 139 PHAs who had disclosed to 139 PHA who had not disclosed regarding socio demographic characteristics; sexual behaviour; individual experiences and perceptions about disclosure; as well as on health facility/community correlates of disclosure. Results: The independent factors that favour disclosure are not fearing negative outcomes of disclosure adjusted odds ratio (AOR) 7.00; 95confidence interval (95CI) 3.03-16.95; having communication skills to disclose (AOR 12.08; 95CI 4.94-29.51); having initiated anti-retroviral therapy (AOR 7.51; 95CI 3.42-16.49); not having tested for HIV during ante-natal clinic (AOR 5.07; 95CI 1.95-13.10); receiving ongoing counselling (AOR 4.33; 95CI 1.50-12.51) and having ever seen a PHA publicly disclose his/her HIV status AOR 2.73; 95CI 1.24-6.02). Conclusions: PHAs that have not initiated anti-retroviral therapy (ART); test for HIV in ante-natal clinic and fear negative outcomes need more help in disclosure. Measures that empower PHA to disclose such as those that lead to improved Counselingskills should be reinforced during ongoing counselling