Papers by Byonanuwe Simon, MD
ACTA MEDICA IRANICA
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To establish the predictors of anemia among pregnant teenagers presenting at Hoima Regional Refer... more To establish the predictors of anemia among pregnant teenagers presenting at Hoima Regional Referral Hospital, mid-western Uganda Methods This was a cross-sectional study conducted in the months of August 2021 to October 2021. A total of 288 pregnant teenagers aged between 13 and 19 years attending antenatal care (ANC) at Hoima Regional Referral Hospital (HRRH) were consecutively enrolled. Interviewer-administered questionnaires and laboratory report forms were used to obtain data. Descriptive statistics followed by binary logistic regression were conducted. All data analyses were conducted using IBM SPSS 23. Results The prevalence of anemia was 26%, with 53% having mild anemia, 40% moderate anemia, and 7% severe anemia. The key predictors of anemia among pregnant teenagers attending ANC at HRRH were lack of formal education (aOR = 17.39, CI:4.655-64.988; p < 0.001), nulliparity (aOR = 0.47, CI:0.225-0.989; p = 0.047) and ANC visits less than four times (aOR = 8.80, CI:2.888-27.811; p < 0.001) Conclusion The prevalence of anemia among pregnant teenagers at HRRH was higher than the estimated national anemia prevalence in this age group. Lack of formal education and poor ANC attendance are the key predictors of anemia at HRRH. Nulliparity is a protective factor for this obstetric complication in this age group of women at this facility.
Background: Management decision on whether to use medical or surgical method in women diagnosed w... more Background: Management decision on whether to use medical or surgical method in women diagnosed with incomplete abortion particularly in the first trimester has been a controversial topic in Uganda and the world in general with no local studies comparing effectiveness and secondary outcomes between the two approaches. This has posed a big challenge to the attending clinicians as regards making informed management options when encountered with such cases.Methods: A five months prospective open labeled randomized clinical trial involving 100 consecutively recruited participants was conducted from June 1st, 2018 to October 30th, 2018. Ethical clearance was obtained from KIUREC and UNCST. Data collection was achieved using an investigator administered questionnaire; in-depth face to face interviews as well as laboratory and ultrasound scan report forms. Baseline demographic and clinical characteristics were assessed using univariate analysis. Statistical difference was considered when p...
International Journal of Scientific Reports, 2022
Background: Anemia remains a serious health burden all over the world, more so among pregnant wom... more Background: Anemia remains a serious health burden all over the world, more so among pregnant women. A lot of morbidity and mortality has been attributed to anemia in pregnancy. The problem is even much bigger among special groups of pregnant women such as the teenagers. The common morphologic type of this obstetric complication however remains a mystery among several populations across the world.Methods: We carried out a cross-sectional study for three months; between August 2021 and October 2021. A total of 288 pregnant teenagers aged between 13 and 19 years attending antenatal care at Hoima Regional Referral Hospital (HRRH) in western Uganda were consecutively enrolled. Short interviewer-administered questionnaires and laboratory report forms were used to obtain data. Descriptive statistics using SPSS version 23 was applied to present the data. Â Â Results: 75 (26%) out of the 288 pregnant teenagers had anemia. Majority 40 (53.3%) had microcytic anemia, followed by normocytic anemi...
European Journal of Medical Case Reports, 2021
Background: Conjoined twins have invariably been a subject of revulsion among many societies acro... more Background: Conjoined twins have invariably been a subject of revulsion among many societies across the world despite the fact that they can be diagnosed early in pregnancy and optimal obstetric management instituted accordingly. Case Presentation: We present a case of a prenatally undiagnosed derodidymus (dicephalous diauchenos) twins, an extremely unusual variant of conjoined twins. The case was such a petrifying unanticipated phenomenon to both the parents and medical staff. Conclusion: Routine prenatal ultrasonograhy and careful prenatal screening must be strongly emphasized if we are to minimize such perinatal mysteries.
Cite this article: Ruiru D, Byonanuwe S, Oguttu B, Nzabandora E (2021) Severity Patterns and Dete... more Cite this article: Ruiru D, Byonanuwe S, Oguttu B, Nzabandora E (2021) Severity Patterns and Determinants of Thrombocytopenia among Women Delivering at Kampala International University Teaching Hospital, Western Uganda. Med J Obstet Gynecol 9(1): 1141. *Corresponding author Simon Byonanuwe, Department of Obstetrics and Gynecology, Kampala International University Western Campus, P. O. Box 71, Bushenyi, Uganda; Tel: 256 775 730088, Email: [email protected]
International Journal of Scientific Reports, 2021
Background: We aimed to establish pre-pregnancy and prenatal care risk factors for spontaneous pr... more Background: We aimed to establish pre-pregnancy and prenatal care risk factors for spontaneous premature delivery at Kampala international university teaching hospital (KIUTH) so as to enable us draw a platform upon which specific interventions can be formulated.Methods: This was a hospital based unmatched case-control study conducted in the months of March to June 2019. A total of 110 cases and 330 controls admitted at KIUTH maternity and postnatal units were enrolled into the study. Interviewer administered questionnaires and respondent’s medical records were used to collect data. Chi square test and multiple logistic regression analysis were performed to establish the risk factors for spontaneous premature delivery at this facility. All data analyses were done using SPSS statistics version 20.Results: Nulliparity, previous premature delivery, history of premature rupture of membranes, previous cervical procedures, history of not having received preconception care, urinary tract i...
Background: Whereas many authorities across the world recommend that trial of labor after cesarea... more Background: Whereas many authorities across the world recommend that trial of labor after cesarean section be offered to all those eligible, it is crucial that women be counseled about the benefits and associated harm so as to help with this decision. However, there is lack of robust comprehensive information on the associated outcomes and their determinants so as to enable the counseling of the eligible women about this choice. Materials and Methods: A prospective cohort study was conducted in the months of August 2021 to October 2021. A total of 350 pregnant women above 28 weeks of gestation with previous cesarean section admitted at the maternity ward of HRRH were consecutively enrolled. Interviewer administered questionnaires were used to obtain data. Descriptive statistics followed by binary logistic regression were conducted. All data analyses were conducted using STATA 14.2. Results: The incidence of adverse maternal outcomes was 87%. The determinants of adverse maternal outcomes were rural residence (aOR=3.01, CI:0.002-4.059; p<0.001), low family income (aOR=4.8, CI:2.21-10.46; p<0.001) and short interpregnancy interval (aOR=0.2, CI:0.05-0.57; p=0.004). Pregnant women with history of vaginal delivery following previous cesarean section were less likely to experience the adverse outcomes. Conclusion: The incidence of adverse maternal outcomes among pregnant women undergoing TOLAC at HRRH is very high. Most women who undergo TOLAC at HRRH do not succeed. Women of rural residence; low family income and short interpregnancy interval have higher odds of adverse maternal outcomes while pregnant those who have had vaginal delivery following previous cesarean section are less likely to experience adverse outcomes.
We established the severity patterns and determinants of thrombocytopenia among women delivering ... more We established the severity patterns and determinants of thrombocytopenia among women delivering at Kampala International University Teaching Hospital (KIUTH), to guide us on future interventions. This was a three months cross-sectional study conducted in the months of May 2019 to August 2019 at
KIUTH. A total of 386 participants were consecutively enrolled. Interviewer administered questionnaires and laboratory result forms were used to collect data. Binary logistic regression was conducted to identify the determinants of thrombocytopenia. All data analyses were conducted using STATA version 14.2. Majority of the women had mild thrombocytopenia 34 (55.7%), followed by moderate thrombocytopenia 23 (37.7%), and then severe thrombocytopenia 4 (6.6%). The determinants of thrombocytopenia at this hospital were hypertension in pregnancy (aOR: 18.9, 95% CI: 8.8-43.13, p<0.001), HIV positive status (aOR: 21.2 95% CI: 5.15-87.56, p< 0.001), young age (aOR: 4.3, 95% CI: 1.17–15.94, p=0.028) and anaemia in pregnancy (aOR: 4.48, 95% CI: 1.3-15.5, p=0.018). Majority of the women who deliver at KIUTH have mild-to-moderate thrombocytopenia. Early recognition and treatment of the above determinants could go a long way towards preventing thrombocytopenia at this facility.
Background: Management decision on whether to use medical or surgical method in women diagnosed w... more Background: Management decision on whether to use medical or surgical method in women diagnosed with incomplete abortion particularly in the rst trimester has been a controversial topic in Uganda and the world in general with no local studies comparing effectiveness and secondary outcomes between the two approaches. This has posed a big challenge to the attending clinicians as regards making informed management options when encountered with such cases. Methods: A ve months prospective open labeled randomized clinical trial involving 100 consecutively recruited participants was conducted from June 1 st , 2018 to October 30 th , 2018. Ethical clearance was obtained from KIUREC and UNCST. Data collection was achieved using an investigator administered questionnaire; in-depth face to face interviews as well as laboratory and ultrasound scan report forms. Baseline demographic and clinical characteristics were assessed using univariate analysis. Statistical difference was considered when p<0.05. Numerical variables were summarized using means, medians for non-normally distributed variables, and frequencies or proportions for categorical variables. All statistical analysis was carried out using IBM SPSS Statistics software version 23.0. Results: The effectiveness of surgical management was higher than that of medical management (RRR=11.7%; p=0.043). Majority in the medical arm reported mild pain (64% vs 4%; p<0.001) while most of those in surgical arm reported severe pain (78% vs 8%; p<0.001). Bleeding was prolonged in the medical arm method with majority of those in surgical arm reporting bleeding for less than six hours (94% vs 46%; p=0.0002). Although medical method had longer bleeding, it was associated with lesser symptoms of headache, dizziness, syncope and blood transfusion. 90% of those in medical arm and only 50% of those in surgical method would recommend the method assigned (p<0.001). Fever, chills and nausea were more common in medical method. Average hospital stay was longer in medical method (p=0.03). Only one participant in surgical arm developed infection while no patient had genitourinary trauma. There was no statistical signi cant difference between the satisfaction levels in the two arms. Conclusion: Surgical management is more effective than medical management. Although medical management has prolonged expulsion bleeding, prolonged hospital stay and increased fevers, chills and nausea that are self-limiting; it has reduced pain. Most patients are satis ed with and would recommend medical management.
Background: Chronic hypertension is one of the major sequelae of preeclampsia with associated lon... more Background: Chronic hypertension is one of the major sequelae of preeclampsia with associated long term morbidity and mortality among previously normotensive women diagnosed with preeclampsia. We identi ed the predictors of developing this complication in women with preeclampsia admitted at the Carlos Manuel de Cèspedes Teaching Hospital in Cuba based on histological assessment of their placenta so as to guide the health care providers in early identi cation of the patients at risk for timely intervention against this vicious condition. Methods: A three-year prospective cohort study was conducted between March 2017 and March 2020. A cohort of 178 women diagnosed with preeclampsia was recruited and followed up at 12 weeks postpartum for chronic hypertension. Histological studies were done on their placenta following delivery and the respective result forms used to collect the data. Cox's hazards regression model was applied to estimate the risk using STATA version 14.2.
Background: Premature rupture of membranes (PROM) remains a great burden to mothers and their unb... more Background: Premature rupture of membranes (PROM) remains a great burden to mothers and their unborn children all over the world with several adverse maternal and fetal outcomes. This study aimed at determining common bacterial pathogens and their susceptibility patterns in women with PROM at Kampala International University Teaching Hospital (KIU-TH). Methods: This was a cross-sectional study conducted in the months of September 2019 to November 2019. A total of 334 pregnant mothers above 28 weeks of pregnancy admitted in maternity ward of KIU-TH were consecutively enrolled. Interviewer administered questionnaires and laboratory forms were used to collect data. Endocervical swabs were obtained from those with PROM and taken to the laboratory for culture and susceptibility tests. Descriptive statistics were used using STATA 14.2. Results: 46 (13.8%) mothers had PROM. Of these, the most common bacterial pathogens identified were S. aureus (29.6%), E. coli (25.9%) and N. gonorrhoeae (25.9%). Antibacterial susceptibility tests revealed highest sensitivity to imipenem (100%), nitrofurantoin (92.6%), cloxacillin (85.2%) and azithromycin (81.5%). Total resistance to amoxacillin, ceftriaxone and ampicillin was found. Conclusion: Women with PROM predominatly have Staphylococcus aureus, Escherichia coli and Neisseria gonorrhoeae. Imipenem, nitrofurantoin, cloxacillin and azithromycin are the most effective antibiotics among patients with PROM.
so as to guide the health-care providers in early identification of the patients at risk for time... more so as to guide the health-care providers in early identification of the patients at risk for timely intervention. Patients and Methods: A three-year prospective cohort study was conducted between March 2017 and March 2020. A cohort of 178 women diagnosed with preeclampsia at the hypertension unit of Carlos Manuel de Cèspedes Teaching Hospital were recruited. Interviewer administered questionnaires and laboratory and ultrasound scan result forms were used to collect the data. Binary logistic regression was conducted to determine the predictors. All data analyses were conducted using STATA version 14.2. Results: Forty-five (27.8%) of the studied 162 patients were still hypertensive at 12 weeks postpartum. Maternal age of 35 years or more (aRR=1.14,95% CI:1.131-4.847, p=0.022), early onset preeclampsia (before 34 weeks of gestation) (aRR=7.93, 95% CI:1.812-34.684, p=0.006), and elevated serum creatinine levels of more than 0.8mg/dl (aRR=1.35, 95% CI:1.241-3.606, p=0.032) were the independent predictors of persisting hypertension at 12 weeks postpartum. Conclusion: Recognition of these predictors and close follow-up of patients with preeclampsia will improve the ability to diagnose and monitor women likely to develop persisting hypertension before its onset for timely interventions.
Background. Premature rupture of membranes (PROM) is a common condition in developed and developi... more Background. Premature rupture of membranes (PROM) is a common condition in developed and developing countries and poses a serious threat to the maternal and fetal well-being if not properly managed. This study delineated the prevalence and predictors of PROM in the western part of Uganda so as to guide specific preventive measures. Methods. A cross-sectional study design was conducted in the months of September 2019 to November 2019. A total of 334 pregnant women above 28 weeks of gestation admitted at the maternity ward of KIU-TH were consecutively enrolled. Interviewer-administered questionnaires were used to obtain the data. Descriptive statistics followed by binary logistic regression were conducted. All data analyses were conducted using STATA 14.2. Results. Of the 334 pregnant women enrolled, the prevalence of PROM was found to be 13.8%. The significant independent predictors associated with lower odds of PROM were no history of urinary tract infection (UTI) in the month preceding enrollment into the study (aOR = 0:5, 95% CI: 0.22-0.69, p = 0:038) and gestational age of 37 weeks or more (aOR = 0:3, 95% CI: 0.14-0.71, p = 0:01) while history of 3 or more abortions (aOR = 13:1, 95% CI: 1.12-153.62, p = 0:05) was associated with higher likelihood of PROM. Conclusions. Majorly urinary tract infections, low gestational age, and abortions influence premature rupture of membranes among women. There is a great need for continuous screening and prompt treatment of pregnant women for UTI especially those with history of 3 or more abortions at less than 34 weeks of gestation.
Background: Thrombocytopenia is a serious threat both to the mother and the fetus world over. We ... more Background: Thrombocytopenia is a serious threat both to the mother and the fetus world over. We established the prevalence and associated immediate maternal complications of thrombocytopenia among women delivering at Kampala International University Teaching Hospital (KIUTH) so as to help us draw a platform for provision of appropriate interventions. Methods: A prospective cross-sectional study involving 386 women was conducted in the months of May 2019 to August 2019. Questionnaires and laboratory result forms were used to obtain the data. Data analyses were conducted using STATA version 14.2. Results: The prevalence of thrombocytopenia was 15.8%. Significant immediate maternal outcomes were placenta abruption which was higher among women with thrombocytopenia (44.3%) than those with no thrombocytopenia (2.2%; p<0.001) and postpartum haemorrhage which was higher among those with thrombocytopenia (45.9%) than those with no thrombocytopenia (6.8%; p<0.001). Conclusions: Thrombocytopenia is a serious obstetric issue worth paying extra attention at this facility.
• Determinants of thrombocytopenia • Thrombocytopenia in pregnancy • Haematological disorders of ... more • Determinants of thrombocytopenia • Thrombocytopenia in pregnancy • Haematological disorders of pregnancy MATERIALS AND METHODS This was a cross-sectional study conducted over a period of three months of May 2019 and August 2019. The study was conducted in the maternity unit of Obstetrics and Gynecology department of KIUTH located in Ishaka-Bushenyi district, in southwestern Uganda about 370 kilometers from the center of Kampala city. This unit has a bed capacity of 85 and conducts approximately 200 deliveries per month. Sample size was determined using Keish and Leslie formula (1965), using an
Background: We aimed to establish pre-pregnancy and prenatal care risk factors for spontaneous pr... more Background: We aimed to establish pre-pregnancy and prenatal care risk factors for spontaneous premature delivery at Kampala international university teaching hospital (KIUTH) so as to enable us draw a platform upon which specific interventions can be formulated. Methods: This was a hospital based unmatched case-control study conducted in the months of March to June 2019. A total of 110 cases and 330 controls admitted at KIUTH maternity and postnatal units were enrolled into the study. Interviewer administered questionnaires and respondent's medical records were used to collect data. Chi square test and multiple logistic regression analysis were performed to establish the risk factors for spontaneous premature delivery at this facility. All data analyses were done using SPSS statistics version 20. Results: Nulliparity, previous premature delivery, history of premature rupture of membranes, previous cervical procedures, history of not having received preconception care, urinary tract infections during pregnancy and maternal obesity were independently associated with spontaneous premature delivery at this hospital. Conclusions: Guided by these factors, a high index of suspicion for spontaneous premature delivery among all pregnant women attending prenatal care is vital towards ameliorating this obstetric complication at KIUTH.
Background: Anemia remains a serious health burden all over the world, more so among pregnant wom... more Background: Anemia remains a serious health burden all over the world, more so among pregnant women. A lot of morbidity and mortality has been attributed to anemia in pregnancy. The problem is even much bigger among special groups of pregnant women such as the teenagers. The common morphologic type of this obstetric complication however remains a mystery among several populations across the world. Methods: We carried out a cross-sectional study for three months; between August 2021 and October 2021. A total of 288 pregnant teenagers aged between 13 and 19 years attending antenatal care at Hoima Regional Referral Hospital (HRRH) in western Uganda were consecutively enrolled. Short interviewer-administered questionnaires and laboratory report forms were used to obtain data. Descriptive statistics using SPSS version 23 was applied to present the data. Results: 75 (26%) out of the 288 pregnant teenagers had anemia. Majority 40 (53.3%) had microcytic anemia, followed by normocytic anemia 25 (33.3%) while 10 (13.3%) had macrocytic anemia. Conclusions: Microcytic anemia remains the most common morphological type affecting pregnant teenagers at HRRH, western Uganda.
Introduction: Acutenon-puerperal inversion of the uterus is very rare and without a high index of... more Introduction: Acutenon-puerperal inversion of the uterus is very rare and without a high index of suspicion, severe complications are possible. Case Presentation: This study reports the case of a woman with an asymptomatic fibroid who presented in shock with a vaginal mass and bleeding. The mass was a uterine leiomyoma complicated with uterine inversion. She recovered well from an emergency total hysterectomy and bilateral salpingectomy. Conclusion: A high index of suspicion and immediate intervention are key points for all women presenting with a vaginal mass and vaginal bleeding.
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Papers by Byonanuwe Simon, MD
KIUTH. A total of 386 participants were consecutively enrolled. Interviewer administered questionnaires and laboratory result forms were used to collect data. Binary logistic regression was conducted to identify the determinants of thrombocytopenia. All data analyses were conducted using STATA version 14.2. Majority of the women had mild thrombocytopenia 34 (55.7%), followed by moderate thrombocytopenia 23 (37.7%), and then severe thrombocytopenia 4 (6.6%). The determinants of thrombocytopenia at this hospital were hypertension in pregnancy (aOR: 18.9, 95% CI: 8.8-43.13, p<0.001), HIV positive status (aOR: 21.2 95% CI: 5.15-87.56, p< 0.001), young age (aOR: 4.3, 95% CI: 1.17–15.94, p=0.028) and anaemia in pregnancy (aOR: 4.48, 95% CI: 1.3-15.5, p=0.018). Majority of the women who deliver at KIUTH have mild-to-moderate thrombocytopenia. Early recognition and treatment of the above determinants could go a long way towards preventing thrombocytopenia at this facility.
KIUTH. A total of 386 participants were consecutively enrolled. Interviewer administered questionnaires and laboratory result forms were used to collect data. Binary logistic regression was conducted to identify the determinants of thrombocytopenia. All data analyses were conducted using STATA version 14.2. Majority of the women had mild thrombocytopenia 34 (55.7%), followed by moderate thrombocytopenia 23 (37.7%), and then severe thrombocytopenia 4 (6.6%). The determinants of thrombocytopenia at this hospital were hypertension in pregnancy (aOR: 18.9, 95% CI: 8.8-43.13, p<0.001), HIV positive status (aOR: 21.2 95% CI: 5.15-87.56, p< 0.001), young age (aOR: 4.3, 95% CI: 1.17–15.94, p=0.028) and anaemia in pregnancy (aOR: 4.48, 95% CI: 1.3-15.5, p=0.018). Majority of the women who deliver at KIUTH have mild-to-moderate thrombocytopenia. Early recognition and treatment of the above determinants could go a long way towards preventing thrombocytopenia at this facility.