Papers by Romano Nkumbwa Byaruhanga
Acta Obstetricia et Gynecologica Scandinavica, 2006
Background. For every maternal death, there are probably 100 or more morbidities, but the quality... more Background. For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. Methods. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Results. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. Conclusions. A systemic analysis found substandard care and records, and patient‐related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non‐threatening stimulus for improving the quality of obstetric care.
BMC Research Notes, May 2, 2017
Background: Women with hyperglycaemia detected during pregnancy are at greater risk for adverse p... more Background: Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Data on hyperglycaemia in pregnancy in sub-Saharan Africa is scanty and varied depending on the populations studied and the methodologies used to define hyperglycaemia in pregnancy. With the recent 2013 World Health Organisation (WHO) diagnostic criteria and classification, there is yet no sufficient data on the prevalence of hyperglycaemia in sub-Saharan Africa. The objective was to determine the prevalence of Hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes among patients attending antenatal care (ANC) at St. Francis Hospital Nsambya. Methods: A prospective cohort study. All women with no history of diabetes mellitus attending at or after 24 weeks gestation were eligible to participate in the study. Participants underwent a standard 75 g oral glucose tolerance test (OGTT) after an informed written consent. The primary outcome was diagnosis of hyperglycaemia. Enrolled participants were followed up to delivery to assess obstetric outcomes (secondary outcomes were birth weight, neonatal admission, maternal genital trauma, delivery mode, neonatal and maternal status at discharge). Results: 251 women were screened between December 2013 and February 2014. The prevalence of hyperglycaemia first detected in pregnancy was 31.9%. We found 23.8 % of women with hyperglycaemia had no known risk factor. Macrosomia was the only obstetric outcome that was significantly associated with hyperglycaemia. Conclusion: The prevalence of hyperglycaemia first detected in pregnancy was high in the studied population. Clinicians, therefore, should become more vigilant to screen for the condition. Selective screening may miss 23.8% of pregnant women with hyperglycaemia. However the cost/benefit implications of screening strategy and the recent 2013 WHO diagnostic criteria need to be studied in our setting.
Acta Paediatrica, Oct 1, 2005
Aim: To elucidate the impact of bathing on the prevalence of hypothermia among newborn babies exp... more Aim: To elucidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin-to-skin (STS) care technique before and after bathing. Methods: Non-asphyxiated newborns after vaginal delivery (n=249) in a Ugandan referral hospital were consecutively enrolled and randomized either to bathing at 60 min postpartum (n=126) or no bathing (n=123). All mothers practised skin-to-skin care of their newborns. Four rectal and tympanic registrations of newborn temperatures were carried out in both groups directly after drying at birth, and at 60, 70 and 90 min postpartum. Results: Bathing of newborns in the first hour after delivery resulted in a significantly increased prevalence of hypothermia, defined as temperature 536.5 C, at 70 and at 90 min postpartum despite the use of warmed water and the application of the STS method. There was no neonatal mortality. Aside from the bathing procedure, no background factor potentially predisposing the newborns to hypothermia was identified. Conclusion: Bathing newborn babies shortly after birth increased the risk of hypothermia despite the use of warm water and STS care for thermal protection of the newborn.
The cover picture shows a postpartum mother practicing Skin to Skin contact. The back picture dep... more The cover picture shows a postpartum mother practicing Skin to Skin contact. The back picture depicts a traditional birth attendant homestead where deliveries are conducted. All previously published papers were reproduced with permission from the publishers.
Tropical Doctor, Apr 1, 2000
Hypertension, 2021
In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) vis... more In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preeclampsia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95%...
The Lancet Global Health, 2019
Background Every year, an estimated 2•7 million neonatal deaths and stillbirths occur worldwide. ... more Background Every year, an estimated 2•7 million neonatal deaths and stillbirths occur worldwide. Neonatal mortality in Uganda has been 27 deaths per 1000 births between 2008 and 2018, despite an increase in the rate of institutional deliveries from 59% to 74% over this time. Suboptimal care still occurs in hospitals, resulting in maternal and neonatal morbidity. Globally, perinatal death audit has been shown to reduce perinatal mortality by 30%. However, there is paucity of data on the effect of audit on perinatal outcomes in Uganda. Here, we describe perinatal outcomes after introduction of perinatal death audit in a tertiary hospital in Kampala, Uganda. Methods We undertook a prospective review of deaths between January, 2008, and December, 2015. Cause of death was identified through consensus between midwives, intern doctors, postgraduates, paediatricians, and neonatologists. We assessed standard of care against existing guidelines. We used data on outcomes from January, 2006, to December, 2007, for comparison and recorded changes to clinical practice that were implemented in response to cause-of-death data. Findings A total of 58 997 births and 2616 perinatal deaths occured between 2008 and 2015. Of these, 603 [23%] perinatal deaths were selected for audit. Perinatal mortality decreased from 48•4 deaths per 1000 births before the intervention to 43 per 1000 births in 2015; stillbirths decreased from 32•9 per 1000 births to 22 per 1000 births. The proportion of neonatal deaths reduced from 11•2% to 4•9%. The most common causes of death in the study period were: hypoxia (186, 35•4%) and unknown (227, 43•2%). Interventions included: neonatal resuscitation training; building of a new maternity theatre; partograph training; increased human resource for maternity and the newborn care unit; and provision of equipment such as ambubags, bubble continuous positive air way pressure (CPAP) machines, and radiant warmers. Skills introduced included: kangaroo mother care; and use of antenatal steroids, CPAP, surfactant, and phototherapy. Case fatality rates decreased for hypoxia (21•1% to 15•5%) and complications of prematurity (26•4% to 11•1%) but increased for infections (1•9% to 5•7%). Interpretation Perinatal death audits are feasible in Uganda. Furthermore, the data from audits can inform decisions about new training and interventions and might lead to improved perinatal outcomes.
BMC Pregnancy and Childbirth, 2017
Background: Globally, low involvement of men in maternal health care services remains a problem t... more Background: Globally, low involvement of men in maternal health care services remains a problem to health care providers and policy makers. Men's support is essential for making women's world better. There are increasing debates among policymakers and researchers on the role of men in maternal health programs, which is a challenge in patriarchal societies like Uganda. The aim of the study was to assess companionship during delivery; men's perception and experiences during pregnancy and delivery. Methods: This was a descriptive exploratory study using a qualitative approach. This study involved 16 male participants who were present in the labor room during the delivery of their child. In-depth interviews (IDIs) were the main data collection methods used in the study. Purposive sampling was used to select participants who share particular characteristics with the potential of providing rich, relevant, and diverse data. The interviews were tape-recorded with the permission of the participants; in addition, the interviewer took notes. Each interview lasted between 30 and 45 min. The transcripts were entered into ATLAS.ti for analysis. Manifest content analysis was used. Results: The major themes were; feelings about attending child birth, responsibilities during child birth, positive experiences and negative experiences about child birth. Men are willing to participate in child birth and should be encouraged as many are the decision makers in the family. Admission of men into the delivery room, improves family togetherness. The women felt loved and treasured. The men reported bondage to their partners and new born. Conclusions: Men's involvement in the child birth process was associated with a more perceived bondage with the partner and the newborn. Their presence helped to promote a calm and successful child birth process. Hospitals should work on measures encouraging male involvement.
BMC Pregnancy and Childbirth, 2017
Midwifery, 2011
Introduction: a set of evidence-based delivery and neonatal practices have the potential to reduc... more Introduction: a set of evidence-based delivery and neonatal practices have the potential to reduce neonatal mortality substantially. However, resistance to the acceptance and adoption of these practices may still be a problem and challenge in the rural community in Uganda. Objectives: to explore the acceptability and feasibility of the newborn care practices at household and family level in the rural communities in different regions of Uganda with regards to birth asphyxia, thermo-protection and cord care. Methods: a qualitative design using in-depth interviews and focus group discussions were used. Participants were purposively selected from rural communities in three districts. Six in-depth interviews targeting traditional birth attendants and nine focus group discussions composed of 10-15 participants among post childbirth mothers, elderly caregivers and partners or fathers of recently delivered mothers were conducted. All the mothers involved has had normal vaginal deliveries in the rural community with unskilled birth attendants. Latent content analysis was used. Findings: two main themes emerged from the interviews: 'Barriers to change' and 'Windows of opportunities'. Some of the recommended newborn practices were deemed to conflict with traditional and cultural practices. Promotion of delayed bathing as a thermo-protection measure, dry cord care were unlikely to be accepted and spiritual beliefs were attached to use of local herbs for bathing or smearing of the baby's skin. However, several aspects of thermo-protection of the newborn, breast feeding, taking newborns for immunisation were in agreement with biomedical recommendations, and positive aspects of newborn care were noticed with the traditional birth attendants. Conclusions: some of the evidence based practices may be accepted after modification. Behaviour change communication messages need to address the community norms in the country. The involvement of other newborn caregivers than the mother at the household and the community early during pregnancy may influence change of behaviour related to the adoption of the recommended newborn care practices.
Journal of Tropical Pediatrics, 2005
The aim of the study was to determine the prevalence of neonatal hypothermia and associated risk ... more The aim of the study was to determine the prevalence of neonatal hypothermia and associated risk factors. A cross sectional, descriptive study of neonatal hypothermia was performed on 300 newborns consecutively recruited day and night during 2 months at a Ugandan periurban hospital. Parallel tympanic and rectal temperature measurements were made at 10, 30, 60, and 90 min post partum. Rectal temperatures taken at 10, 30, 60, and 90 min showed that 29, 82, 83, and 79 per cent of the newborns, respectively, were hypothermic. Newborns observed to have no body contact with the mother comprised 87 per cent of hypothermic newborns, whereas this was the case in 75 per cent of non-hypothermic newborns (p^0.03). The mean birthweight was 3218 g. Low birthweight newborns constituted 9/86 (10 per cent) among hypothermic newborns, whereas this was the case in 9/209 (4 per cent) among non-hypothermic newborns at 10 min (p^0.08). Adolescent mothers were encountered more often among mothers with neonatal hypothermia of the newborn than among non-hypothermic newborns (p^0.025). Parity, preterm delivery, daytime or night time delivery, rupture of membranes`24 h and location of newborns in theatre, labour ward, or nursery did not differ when hypothermic and non-hypothermic newborns were compared. A persistent pattern of high prevalence of neonatal hypothermia was confirmed and indicates that more vigorous efforts have to be undertaken, also in a tropical setting, to overcome problems of non-adherence to appropriate methods for thermoprotection of the newborn.
AIDS, 2005
Objective: To assess the safety of dextrin sulphate (DS) gel compared to placebo gel in terms of ... more Objective: To assess the safety of dextrin sulphate (DS) gel compared to placebo gel in terms of local and systemic adverse events, and to determine the acceptability of dextrin sulphate gel. Design: A 4-week randomized trial of DS intra-vaginal gel, partially blinded, with placebo and observation control arms. Participants were randomized to use DS gel twice daily, placebo gel twice daily, DS gel pre-sex, or into an observation only arm.
year: 2009, 2009
The cover picture shows a postpartum mother practicing Skin to Skin contact. The back picture dep... more The cover picture shows a postpartum mother practicing Skin to Skin contact. The back picture depicts a traditional birth attendant homestead where deliveries are conducted. All previously published papers were reproduced with permission from the publishers.
International Journal of Gynecology & Obstetrics
To assess whether the implementation of a package of activities through the joint action of the t... more To assess whether the implementation of a package of activities through the joint action of the three international healthcare professionals associations (HCPAs) increased the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda. A non-controlled before-and-after study was undertaken to evaluate the effect of a package of activities designed to change practice relating to nine EIs among providers. Coverage of the EIs was measured in a 3-month pre-implementation period and a 3-month post-implementation period in 2014. Data were obtained for women older than 18 years who delivered vaginally or by cesarean. Overall, 4816 women were included. Level of use remained high for EIs used widely at baseline. Some EIs that had low use at baseline did not show improvement after the implementation. Promotion of breastfeeding showed a significant improvement in the Kampala hospital, from 8.5% (8/94) to 25.6% (30/117; P=0.001), whereas promotion of hygiene in cord care improved at the Mbarara hospital, from 0.1% (2/1592) to 46.0% (622/1351; P<0.001). These exploratory results show that a package delivered through the joint work of the three HCPAs was feasible to implement along with rigorous data collection. Although the data show disparities, trends suggest that improvement could be achieved.
Acta Obstetricia Et Gynecologica Scandinavica, Feb 1, 2006
For every maternal death, there are probably 100 or more morbidities, but the quality of health c... more For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. A systemic analysis found substandard care and records, and patient-related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non-threatening stimulus for improving the quality of obstetric care.
Acta Paediat, 2007
To elucidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed ... more To elucidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin-to-skin (STS) care technique before and after bathing. Non-asphyxiated newborns after vaginal delivery (n = 249) in a Ugandan referral hospital were consecutively enrolled and randomized either to bathing at 60 min postpartum (n = 126) or no bathing (n = 123). All mothers practised skin-to-skin care of their newborns. Four rectal and tympanic registrations of newborn temperatures were carried out in both groups directly after drying at birth, and at 60, 70 and 90 min postpartum. Bathing of newborns in the first hour after delivery resulted in a significantly increased prevalence of hypothermia, defined as temperature <36.5 degrees C, at 70 and at 90 min postpartum despite the use of warmed water and the application of the STS method. There was no neonatal mortality. Aside from the bathing procedure, no background factor potentially predisposing the newborns to hypothermia was identified. Bathing newborn babies shortly after birth increased the risk of hypothermia despite the use of warm water and STS care for thermal protection of the newborn.
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Papers by Romano Nkumbwa Byaruhanga