Pregnancy Outcomes Among Teenagers at a National Referral Hospital in Uganda.

Introduction: Teenage pregnancy is a global public health challenge, and it is a major contributor to the high maternal and neonatal morbidity and mortality rates reported in sub-Saharan Africa and Uganda. However, there is a paucity of data regarding pregnancy outcomes and their associated factors among teenagers in Uganda. The purpose of this study was to determine the prevalence and factors associated with pregnancy outcomes among teenagers who delivered at a National Referral Hospital in Kampala, Uganda. Materials and Methods: This cross-sectional study was conducted among teenage mothers who delivered at a National Referral Hospital in Kampala, Uganda. Consecutive participant recruitment was done for those who fulfilled the eligibility criteria. The outcomes of interest included adverse maternal outcome with obstructed labor being used as a proxy and adverse fetal outcomes with birth asphyxia used as a proxy. Logistic regression analysis was used to determine the association between independent and dependent variables with a 5% level of statistical significance (α = 0.05). Results: Teenage pregnancy was associated with adverse maternal outcomes which included obstructed labor (18%) and preterm labor (5.5%). There were no maternal deaths during the study period. Adverse fetal outcomes observed in this study population included low birth weight (83%), birth asphyxia (18%), and stillbirth (4%). The only factor associated with adverse maternal outcome was gestational age where teenage mothers had 4 times likelihood of delivering before 37 weeks. Relatedly, teenage mothers had an 81% chance of having a preterm birth. Conclusion: Teenage pregnancy was generally not associated with adverse maternal or fetal outcomes except for preterm birth. The reasons for adverse pregnancy outcomes may reflect a combination of gynecological and biological immaturity, as well as adverse socioeconomic pressures.

Perceptions of Lecturers, Administrators, and Students About the Workplace as Learning Environment for Undergraduate Medical Students at a National Referral and Teaching Hospital in Uganda.

Purpose: The workplace is an important element of the learning ecosystem for medical students during their competence development. It offers engagement opportunities that enable students to participate in clinical activities as part of learning in their preparation for future clinical practice. The purpose of this study was to explore the perceptions and experiences of lecturers, administrators, and students of Makerere University College of Health Sciences about the workplace, at Mulago National Referral and Teaching Hospital, as a learning environment for the undergraduate medical students with the ultimate aim of identifying opportunities and challenges to learner competence development in the learning environment for purposes of improvement. Methods: The study design was cross-sectional descriptive with a qualitative approach using key informant interviews for the lecturers and administrators and focus group discussions for the students. The framework method was used to perform thematic data analysis. Results: The workplace was perceived to be well endowed with adequate patient numbers, a suitable case mix and unrestricted access to patients which enhanced competence development. The challenges reported included inadequate resources, such as infrastructure, equipment and supplies and overcrowding, which compromised competence development. The resource challenge appeared insurmountable in the context of two autonomous institutions with divergent planning priorities in terms of teaching, research, and patient care. Conclusion: There were mixed perceptions about the learning environment at the hospital with both enabling and challenging factors on the backdrop of two autonomous institutions with divergent planning priorities in terms of teaching, research, and patient care. In order to improve the workplace as a learning environment, it is imperative that the two institutions find common ground in terms of clinical care, students' teaching and provision of supplies that are essential not only for patient care but competence development of the learners who are the clinicians of tomorrow.

Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach.

BACKGROUND: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask-wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. OBJECTIVE: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. METHODS: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. RESULTS: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. CONCLUSIONS: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28905.