Abstractobjective Pre-eclampsia contributes significantly to maternal, foetal and neonatal morbidity and mortality. conclusion The risk factors identified are similar to what has been found elsewhere. Health workers need to identify women at risk of pre-eclampsia and manage them appropriately so as to prevent the maternal and neonatal morbidity and mortality associated with this condition.

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BackgroundAround the world, health professionals and program managers are leading and managing public and private health organizations with little or no formal management and leadership training and experience.ObjectiveTo describe an innovative 2-year, long-term apprenticeship Fellowship training program implemented by Makerere University School of Public Health (MakSPH) to strengthen capacity for leadership and management of HIV/AIDS programs in Uganda.Implementation processThe program, which began in 2002, is a 2-year, full-time, non-degree Fellowship. It is open to Ugandan nationals with postgraduate training in health-related disciplines. Enrolled Fellows are attached to host institutions implementing HIV/AIDS programs and placed under the supervision of host institution and academic mentors. Fellows spend 75% of their apprenticeship at the host institutions while the remaining 25% is dedicated to didactic short courses conducted at MakSPH to enhance their knowledge base.AchievementsOverall, 77 Fellows have been enrolled since 2002. Of the 57 Fellows who were admitted between 2002 and 2008, 94.7% (54) completed the Fellowship successfully and 50 (92.3%) are employed in senior leadership and management positions in Uganda and internationally. Eighty-eight percent of those employed (44/54) work in institutions registered in Uganda, indicating a high level of in-country retention. Nineteen of the 20 Fellows who were admitted between 2009 and 2010 are still undergoing training. A total of 67 institutions have hosted Fellows since 2002. The host institutions have benefited through staff training and technical expertise from the Fellows as well as through grant support to Fellows to develop and implement innovative pilot projects. The success of the program hinges on support from mentors, stakeholder involvement, and the hands-on approach employed in training.ConclusionThe Fellowship Program offers a unique opportunity for hands-on training in HIV/AIDS program leadership and management for both Fellows and host institutions.

BackgroundOxidative stress plays a role in the pathogenesis of pre-eclampsia. Supplementing women with antioxidants during pregnancy may reduce oxidative stress and thereby prevent or delay the onset pre-eclampsia. The objective of this study was to evaluate the effect of supplementing vitamin C in pregnancy on the incidence of pre-eclampsia, at Mulago hospital, Kampala, Uganda.MethodsThis was a (parallel, balanced randomization, 1:1) placebo randomized controlled trial conducted at Mulago hospital, Department of Obstetrics and Gynecology. Participants included in this study were pregnant women aged 15-42 years, who lived 15 km or less from the hospital with gestational ages between 12-22 weeks. The women were randomized to take 1000mg of vitamin C (as ascorbic acid) or a placebo daily until they delivered. The primary outcome was pre-eclamsia. Secondary outcomes were: severe pre-eclampsia, gestational hypertension, preterm delivery, low birth weight and still birth delivery. Participants were 932 pregnant women randomized into one of the two treatment arms in a ratio of 1:1. The participants, the care providers and those assessing the outcomes were blinded to the study allocation.ResultsOf the 932 women recruited; 466 were randomized to the vitamin and 466 to the placebo group. Recruitment of participants was from November 2011 to June 2012 and follow up was up to January 2013. Outcome data was available 415 women in the vitamin group and 418 women in the placebo group.There were no differences in vitamin and placebo groups in the incidence of pre-eclampsia (3.1% versus 4.1%; RR 0.77; 95% CI: 0.37-1.56), severe pre-eclampsia (1.2% versus 1.0%; RR 1.25; 95% CI: 0.34-4.65), gestational hypertension(7.7% versus 11.5%; RR 0.67; 95% CI: 0.43-1.03), preterm delivery (11.3% versus 12.2%; RR 0.92; 95% CI: 0.63-1.34), low birth weight (11.1% versus 10.3%; RR 1.07; 95% CI: 0.72-1.59) and still birth delivery (4.6% versus 4.5%; RR 1.01; 95% CI: 0.54-1.87).ConclusionsSupplementation with vitamin C did not reduce the incidence of pre-eclampsia nor did it reduce the adverse maternal or neonatal outcomes. We do not recommend the use of vitamin C in pregnancy to prevent pre-eclampsia.Trial registrationThis study was registered at the Pan African Clinical Trial Registry, PACTR201210000418271 on 25th October 2012.

Abstractobjective Vitamin C alone or in combination with vitamin E has been proposed to prevent preeclampsia. In this study, we assayed the plasma vitamin C in women of reproductive age in Kampala and assessed its association with pre-eclampsia.methods Participants in this study were 215 women with pre-eclampsia, 400 women with normal pregnancy attending antenatal clinic and 200 non-pregnant women attending family planning clinic at Mulago Hospital's Department of Obstetrics and Gynaecology from 1st May 2008 to 1st May 2009. Plasma vitamin C was assayed using the acid phosphotungstate method; differences in the means of plasma vitamin C were determined by anova.results Mean plasma vitamin C levels were 1.72 (SD 0.68) · 10 3 lg ⁄ l in women with pre-eclampsia, 1.89 (SD 0.73) · 10 3 lg ⁄ l in women with normal pregnancy and 2.64 (SD 0.97) · 10 3 lg ⁄ l in nonpregnant women. Plasma vitamin C was lower in women with pre-eclampsia than in women with normal pregnancy (P = 0.005) and non-pregnant women (P < 0.001).conclusion Health workers need to advise women of reproductive age on foods that are rich in vitamin C, as this may improve the vitamin status and possibly reduce the occurrence of pre-eclampsia.keywords risk factors, pre-eclampsia, vitamin C, women of reproductive age, Uganda

The Positive Deviance-Hearth (PD-H) approach is important in controlling malnutrition; however, there is limited data on its effect in improving nutrition status. Objective: To assess the effect of PD-H and community health worker nutrition promotion (CHWNP) in improving nutrition status and recovery among the moderately malnourished under-five (MMU5) children in Burundi. Methodology: PD-H and CHWNP approaches were used in Karusi and Kirundo provinces, respectively. MMU5 children were enrolled at baseline for the intervention (PD-H, (358) and usual care (CHWNP, (310). Haemoglobin level and anthropometric indicators (MUAC, wasting, underweight and stunting) were taken at baseline for 12, 60 and 120 days. Changes in nutritional recovery were compared within groups exposed to each approach using ANOVA for continuous outcomes and chi-square for categorical outcomes. Further analysis compared changes between the two groups exposed to the two approaches using random effects logistic models for binary outcomes and mixed effect models for continuous outcomes. Results: The MMU5 children discharged cured after 60 days and at 120 days follow-up. When compared with the baseline, this was statistically significant in both CHWNP and PDH groups on anthropometric indicators (wasting, underweight, stunting, MUAC and weight) but not anaemia. After controlling for socio-demographic factors, MMU5 enrolled in CHWNP were more likely to be discharged cured than those in PD-H with respect to moderate wasting (AOR=2.74, 95% CI= 1.19-6.29), underweight (AOR=1.56, 95% CI= 1.01-2.43) as well as MUAC (AOR=1.21, 95% CI= 0.49-3.00). Conclusion: Both CHWNP and PD-H significantly improved nutrition status and recovery. However, the proportion of those who recovered was significantly larger in CHWNP compared to PD-H.

Background In many resource constrained countries Uganda inclusive, women continue to give birth from home/in the community where there are no weighing scales to measure and record birth weight. There is also lack of enough weighing scales and skilled health personnel at health facility level to ensure that birth weight for every child is timely determined. Birth weight is an indicator of the chances for survival, growth, long-term health and psychosocial development of neonates. Different anthropometric parameters are reliable surrogates of birth weight although they are highly contextual. This study assessed the best anthropometric surrogate of birth weight usable at facility and community levels in western Uganda. Methods A cross sectional study was conducted between July and September 2017, whereby anthropometric values of 553 neonates born at Mbarara Regional Referral Hospital were measured by two midwives and later repeated by two community health workers to determine the reproducibility. Data regarding birth weight, height, foot length and circumference of head, mid upper arm, chest, thigh and calf were collected and recorded. Frequencies, percentages and mean and standard deviation were used to describe categorical and continuous demographics of neonates respectively. Pearson correlations, specificity, sensitivity, likelihood ratios, diagnostic odds ratios and area under the curve (AUC) were determined and used to establish the most reliable anthropometric parameter that best estimates birth weight of neonates. Results Chest Circumference was the most reliable parameter (AUC= 0.89, DOR= 33.57). There were statistical significant mean differences in all the anthropometric measurements made by midwives and CHWs except for chest circumference (Mean difference = 0.03 cm, 95% CI: -0.22-0.29, p = 0.7963) and foot length (Mean difference = 0.03 cm, 95% CI: -0.22-0.29, p = 0.7963). Conclusions Chest circumference taken within 24 hours after birth is the best nthropometricsurrogate measure of birthweight. Community Health workers can measure chest circumference with almost the same accuracy like midwives.

Background: In many resource constrained countries, Uganda inclusive, women continue to give birth at home/in the community where there are no weighing scales to measure and record birth weight, and consequently low birth weight remains undetected. Low birth weight, if not urgently detected and attended to reduces chances for growth. This study was to compare newborn anthropometric measurements taken by midwives to those taken by community health workers and to determine cut offs to predict low birth weight in south western Uganda. Methods: A descriptive cross sectional study was conducted between July and September 2017, whereby anthropometric values of 638 newborns born at Mbarara Regional Referral Hospital were measured by two midwives but repeated anthropometric measurements by CHWs were taken only 553 newborns because of loss to follow up. Frequencies, means (standard deviation) were used to describe categorical and continuous demographics of newborns respectively. Pearson correlations were made to test for the associations between main explanatory variables. Specificity, sensitivity, likelihood ratios, diagnostic odds ratios (DOR) and area under the curve (AUC) were used to determine low birth weight at set cut off points of various anthropometric measurements. An independent paired t-test was then conducted to establish whether there was a statistical significant difference between the anthropometric measurements taken by midwives and CHWs. Results: Chest Circumference was the most predictor of low birth weight. Of the 29 (5.2%) low birth weight newborns, chest circumference at a cut off of 30.9 cm was able to predict the highest prevalence of low birth weight as per the anthropometric measurements taken by midwives. Also, anthropometric measurements taken by midwives and those taken by Community Health Workers (CHWs) showed no statistical significant mean differences. Conclusions: Chest circumference is the best predictor of low birth weight in western Uganda. Also, Community Health workers can measure chest circumference with almost the same accuracy like midwives. Keywords: Birth weight, anthropometric predictors, newborns