BackgroundGlobally, most maternal and newborn deaths are within the first week of delivery. Early postnatal-care (EPNC) visits between 2 and 7 days detects early morbidity and averts deaths. However, there is scarcity of information on use of EPNC in Mundri East County, South Sudan. This study investigated factors associated with EPNC use among postpartum mothers in Mundri East County, South Sudan.MethodsThis was an analytical cross-sectional study of 385 postpartum mothers from 13 health facilities. Data was collected by structured questionnaires, entered in EpiData and analyzed with STATA at 5% significance level. Chi-squared, Fisher’s exact and Student’s t-tests were used for bivariate analysis and logistic regression for multivariable analysis.ResultsThe mean age of respondents was 27.9-years (standard deviation: 6.7), 276 (71.7%) were below 30-years, 163 (42.3%) were Muru ethnicity, 340 (88.3%) were single and 331 (86.1%) were unemployed. 44 (11.4%; 95% CI: 8.4–15.0) used EPNC. Poor health services access at government health facilities (Adjusted odds ratio (AOR) = 0.18; 95% CI: 0.05–0.61; P = 0.006), more than 1-h access to health facility (AOR = 0.27; 95% CI: 0.09–0.78; P = 0.015), at least secondary maternal education (AOR = 5.73; 95% CI: 1.14–28.74; P = 0.034) and receipt of PNC health education post-delivery (AOR = 3.47; 95% CI: 1.06–11.33; P = 0.004) were associated with EPNC use.ConclusionsUse of EPNC in Mundri East County, South Sudan was low. It was significantly reduced at government and inaccessible health facilities. However, it increased with receipt of PNC health education after delivery and at least secondary level of education.

EPNC was poorly utilized and prioritized. Its use was hindered by protracted hospitalization, care provision at public facilities, maternal unemployment or self-employment, and lack of information.

IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic.MethodsMixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting.ResultsThree periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth.ConclusionUtilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.

BackgroundInformation on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors. MethodsWe analyzed Uganda Demographic and Health Survey data of women age 20-24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression. ResultsAt the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had PLOS ONE

Objective 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. Methods 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. Results 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). Conclusion 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.

IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic.MethodsMixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting.ResultsWe identified three periods: first wave, slow period and second wave. The first wave was challenging for SHP given little knowledge about COVID-19, lack of infection prevention and control training, and difficulties reaching workplace. Challenges that persisted beyond the first wave were shortage of personal protective equipment and no rapid testing for women suspected with COVID-19. We noted no change in the proportion of caesarean sections during the pandemic, and a small increase in the proportion of labour inductions. All hospitals arranged isolation areas for women suspected/confirmed with COVID-19 and three hospitals provided care to women with suspected/confirmed COVID-19. Breastfeeding was not discouraged and newborns were not separated from mothers confirmed with COVID-19. Care provision was maintained through dedication of SHP, support from hospital management and remote communication between SHP.ConclusionRoutine maternal care provision was maintained in referral hospitals, despite first wave challenges. Referral hospitals and SHP contributed to guideline development for pregnant women suspected/confirmed with COVID-19. Maternity SHP, women and pregnancy must always be included in priority setting when responding to health system shocks, including outbreaks.

BackgroundBreast cancer, the third most frequent cancer of women is preventable through knowledge on breast self-examination. Of the 44% of women diagnosed with breast cancer at the Uganda Cancer Institute, only 22% go for check-up in less than three months. This study explored the effect of breast cancer knowledge on the uptake of breast cancer prevention modalities among women in Kyadondo County, Uganda.MethodsA household survey of women in Kyadondo County was conducted during June, 2014 to August, 2015. This involved studying in-depth using a questionnaire the level of breast cancer knowledge of the respondents. Data was analyzed using logistic regression model. Chi-square test was used to establish relationships between knowledge base factors and the uptake of breast cancer prevention modalities.ResultsThis study has established an empirical relationship between uptake of breast cancer prevention modalities and source of information especially radio (OR 1.94 95% CI: 1.16–3.24), television (OR 1.82 95%CI: 1.14–2.93), awareness of breast cancer (OR 4.03 95%CI: 1.01–15.98), knowledge on how to reduce risk of breast cancer (OR 1.98 95% CI: 1.20–3.27), what reduces breast cancer acquisition (OR 2.75 95% CI: 1.42–5.35), how to check for signs of breast cancer especially through breast self-examination (OR 3.09 95% CI: 1.62–5.88), and other methods of breast cancer diagnosis in a health care set up.ConclusionThe women’s level of breast cancer awareness as a primary prevention strategy was found wanting, and requires a boost through community health education.

Introduction: Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women. Methods: We estimated the percentage of women 20-24 years at each of the six Uganda Demographic and Health Surveys (1988/ 89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years ("adolescent childbirth"), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey.