Postpartum resolution of hypertension, proteinuria and acute kidney injury among women with preeclampsia and severe features at Mulago National Referral Hospital, Uganda: a cohort study.

Background: The resolution of hypertension, proteinuria and AKI postpartum among women with preeclampsia is not well documented in Uganda. Objective: To determine the time to resolution of hypertension, proteinuria and AKI postpartum until 6 weeks among women with preeclampsia in Mulago Hospital, Uganda. Methods: Between August 2017 and April 2018, we measured blood pressure, urine protein and serum creatinine on days 1,7,21 and 42 postpartum among 86 women with preeclampsia. The primary outcomes were time to the resolution of hypertension, proteinuria and AKI. We fitted accelerated failure models using Stata 17's stintreg. command with a log normal distribution and obtained time ratios of selected exposures on time to resolution of hypertension, proteinuria and AKI intervals. Results: The median time to resolution of hypertension, proteinuria and AKI was seven (7) days (Inter quartile range, IQR 1-21). The time to resolution of hypertension among primiparous women was 3.5 times that of multiparous women [TR 3.5, 95%CI 1.1, 11.3]. No differences were observed in resolution of hypertension, proteinuria and acute kidney injury. Conclusion: The time to resolution of hypertension, proteinuria and AKI was seven days. We recommend larger studies with longer follow-up beyond six-weeks postpartum to inform revision of our guidelines.

Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program.

Despite scale up of perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions, postnatal continuity of comprehensive HIV/AIDS care, for both the mother and baby, remains a challenge in developing countries. We determined adherence to the postnatal PMTCT program (PN-PMTCT) and the associated factors among mothers at a public urban hospital in Uganda. We interviewed HIV-positive postnatal mothers on discharge and we determined adherence to PN-PMTCT by the proportion of mothers that honored their return appointments by the end of eight weeks postpartum. We had focus group discussions to assess factors that influence adherence to PN-PMTCT. Of 289 mothers, only 110 (38%) adhered to PN-PMTCT. Previous attendance of a routine postnatal review and having access to a phone were significantly associated with adherence to PMTCT among mothers older than 25 years (odds ratio (OR) 3.6 (95% confidence interval (CI); 1.2-10.4)) and (OR 3.1 (95% CI; 1.3-7.1)), respectively. On the other hand, Christianity (OR 3.2 (95% CI; 1.1-9.0)) was significantly associated with adherence to PN-PMTCT among mothers below 25 years of age. Mothers' perceived benefits of the PN-PMTCT program, easy access to the program, and presence of social support from a spouse were important motivators for mothers to adhere to PN-PMTCT. Even with improved antenatal and intra-partum PMTCT services, only a third of the HIV-infected mothers adhered to the PN-PMTCT program. Mothers who previously attended a routine postnatal care were 3.6 fold more likely to adhere to PN-PMTCT. We recommend strategies to increase mothers' adherence to PN-PMTCT interventions in order to increase access to HIV/AIDS care for mothers and children in sub-Saharan Africa.