Introduction Positive HIV results disclosure plays a significant role in the successful prevention and care of HIV infected patients. It provides significant social and health benefits to the individual and the community. Non-disclosure is one of the contextual factors driving the HIV epidemic in Uganda. Study objectives: to determine the frequency of HIV disclosure, associated factors and disclosure outcomes among HIV positive pregnant women at Mbarara Hospital, southwestern Uganda. Methods A cross-sectional study using quantitative and qualitative methods among a group of HIV positive pregnant women attending antenatal clinic was done and consecutive sampling conducted. Results The total participant recruitment was 103, of which 88 (85.4%) had disclosed their serostatus with 57% disclosure to their partners. About 80% had disclosed within less than 2 months of testing HIV positive. Reasons for disclosure included their partners having disclosed to them (27.3%), caring partners (27.3%) and encouragement by health workers (25.0%). Following disclosure, 74%) were comforted and 6.8% were verbally abused. Reasons for non-disclosure were fear of abandonment (33.3%), being beaten (33.3%) and loss of financial and emotional support (13.3%). The factors associated with disclosure were age 26-35 years (OR 3.9, 95% CI 1.03-15.16), primary education (OR 3.53, 95%CI 1.10-11.307) and urban dwelling (OR 4.22, 95% CI 1.27-14.01). Conclusion Participants disclosed mainly to their partners and were comforted and many of them were encouraged by the health workers. There is need to optimize disclosure merits to enable increased participation in treatment and support programs.

Objective We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. Methods This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05). Conclusion The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole.

IntroductionAccess to high-quality emergency care in low- and middle-income countries (LMIC) is lacking. Many countries utilise a strategy known as “task-shifting” where skills and responsibilities are distributed in novel ways among healthcare personnel. Point-of-care ultrasound (POCUS) has the potential to significantly improve emergency care in LMICs.MethodsPOCUS was incorporated into a training program for a ten-person cohort of non-physician Emergency Care Providers (ECPs) in rural Uganda. We performed a prospective observational evaluation on the impact of a remote, rapid review of POCUS studies on the primary objective of ECP ultrasound quality and secondary objective of ultrasound utilisation. The study was divided into four phases over 11 months: an initial in-person training month, two middle month blocks where ECPs performed ultrasounds independently without remote electronic feedback, and the final months when ECPs performed ultrasounds independently with remote electronic feedback. Quality was assessed on a previously published eight-point ordinal scale by a U.S.-based expert sonographer and rapid standardised feedback was given to ECPs by local staff. Sensitivity and specificity of ultrasound exam findings for the Focused Assessment with Sonography for Trauma (FAST) was calculated.ResultsOver the study duration, 1153 ultrasound studies were reviewed. Average imaging frequency per ECP dropped 61% after the initial in-person training month (p = 0.01) when ECPs performed ultrasound independently, but rebounded once electronic feedback was initiated (p = 0.001), with an improvement in quality from 3.82 (95% CI, 3.32–4.32) to 4.68 (95% CI, 4.35–5.01) on an eight-point scale. The sensitivity and specificity of FAST exam during the initial training period was 77.8 (95% CI, 59.2–83.0) and 98.5 (95% CI, 93.3–99.9), respectively. Sensitivity improved 88% compared to independent, non-feedback months whereas specificity was unchanged.ConclusionsRemotely delivered quality assurance feedback is an effective educational tool to enhance provider skill and foster continued and sustainable use of ultrasound in LMICs.

Background Severe anaemia after caesarean section adversely affects the woman and the new-born. While prenatal anaemia is extensively studied, the literature on post-caesarean section anaemia is limited and characteristics of women at the highest risk of developing severe anaemia after caesarean section are unknown. This study aimed to determine the prevalence and factors associated with severe anaemia on day three post caesarean section. Methods On the third day after caesarean section, women were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital (MRRH). Women who got transfused peripartum were excluded. For every woman, we measured haemoglobin (Hb) concentration and collected data on sociodemographic, obstetric, and medical characteristics. The primary outcome was severe anaemia after caesarean section, defined as Hb < 7 g/dl. We used logistic regression analysis to determine factors associated with severe anaemia after caesarean section. P-value < 0.05 was considered statistically significant. Results From December 2019 to March 2020, 427 of 431 screened women were enrolled in the study. Their mean age was 26.05 (SD ± 5.84) years. Three hundred thirteen (73.3%) had attended at least four antenatal care visits. The prevalence of severe anaemia post-caesarean section was 6.79%. Foetus with macrosomia (aOR 7.9 95%CI: 2.18–28.85, p <  0.01) and having mild or moderate anaemia pre-caesarean section (aOR:9.6, 95%CI: 3.91–23.77, p <  0.01) were the factors associated with severe anaemia after caesarean section. Conclusion Severe anaemia in women post-caesarean section is relatively uncommon at our institution. It is associated with preoperative anaemia and macrosomic birth. Women with a low preoperative Hb concentration and those whose foetus have macrosomia could be targeted for haemoglobin optimisation before and during caesarean section.

Background: Hepatitis B infection is a disease of public health significance. The burden of the disease among the pregnant women at Mbarara Regional Referral Hospital was not known yet determining seropositivity at antenatal care could prevent HBV in the newborn. This study assessed the prevalence and factors associated with hepatitis B surface antigen positivity among women attending antenatal care at Mbarara Regional Referral Hospital. Methods: This was a cross-sectional study that consisted of 385 pregnant women who attended antenatal care clinic at Mbarara Regional Referral Hospital in a period of three months beginning December 2018 to February 2018. Blood samples were tested for HBsAg using immune-chromatography and positive samples confirmed using the ARCHITECT S2000r system. Data was collected using a structured questionnaire. Logistic regression analysis to assess associated factors with HBsAg was done, results were presented in tables. Results: Three hundred eighty-five women were enrolled in the study. Their median age was 26 years. Prevalence of current (HBsAg) was 3.12% (95% CI 1.62-5.38%). Prevalence of HBsAg was higher. The factors associated with HBsAg positivity were having more than one sexual partner 10.3% or 4.695% CI (1.34-16.30) p-value=0.016, history of valval ulcerations 0. R=3.35(CI 1.04-10.77), p-value=0.045 and history of body piercing 12.88% (CI 1.34-124.40), p=0.0027. Conclusion: The prevalence of hepatitis B surface antigen positivity among pregnant women receiving antenatal care at Mbarara Regional Referral Hospital is high. According to the WHO classification of hepatitis B infection, results show intermediate endemicity, and this clearly points to the need for universal screening of all women attending antenatal care at Mbarara Hospital.

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Background: Severe anaemia post-caesarean section adversely affects the woman and the new-born. While prenatal anaemia is extensively studied, the literature on post-caesarean section anaemia is limited and characteristics of women more likely to develop severe anaemia after caesarean section are unknown. This study aimed to determine the prevalence and factors associated with severe anaemia on day three post caesarean section.Methods: Women at day three post-caesarean section were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital. We measured their haemoglobin (Hb) concentration and defined severe anaemia as Hb<7.0 g/dL. We excluded women diagnosed with severe pre-caesarean section anaemia and those who got blood transfusion without pre-transfusion Hb record. We interviewed the women and collected data on sociodemographic, obstetric, and medical characteristics. The primary outcome was severe anaemia post-caesarean section. We used logistic regression analysis to determine independent factors associated with severe anaemia after caesarean section. P-value <0.05 was considered statistically significant.Results: From December 2019 to March 2020, 427 of 431 screened women were enrolled in the study. Their mean age was 26.05 (SD ± 5.84) years. Three hundred thirteen (73.3%) had attended at least four antenatal care visits. The prevalence of severe post-caesarean section anaemia was 6.79 per cent. Fetal macrosomia (aOR 7.9 95%CI: 2.18-28.85, p<0.01) and having mild or moderate anaemia pre-caesarean section (aOR:9.6, 95%CI: 3.91- 23.77, p<0.01) were the factors associated with severe anaemia post-caesarean section.Conclusion: Severe anaemia post-caesarean section commonly occurs and is associated with anaemia preoperatively and delivering a foetus with macrosomia. Preoperative haemoglobin optimization and intraoperative blood conserving measures are imperative among such women to prevent postoperative anaemia—as well as post-caesarean section haemoglobin estimation before discharge from the hospital to detect anaemia early and optimise remedies.

Background: Abnormal vaginal discharge is a common complaint among women of reproductive age, affecting about a third of all women. In resource-limited settings where access to laboratory services is limited, treatment is usually syndromic. This approach may result in ineffective treatment, with high recurrence rates and a potential of developing antibiotic resistance. This study aimed to determine the bacterial isolates and antibiotic susceptibility among women with an abnormal vaginal discharge attending the gynecology clinic at a tertiary hospital in Southwestern Uganda. Methods: We conducted a hospital based cross-sectional study among women aged 15-49 years, presenting with abnormal vaginal discharge at the gynecology clinic of Mbarara Regional Referral Hospital from December 2020 to June 2021. Demographic characteristics were collected using a structured questionnaire. We collected cervical and vaginal sterile swabs and subjected them to wet preparation and gram stain. The specimens were cultured for bacterial isolates. Susceptibility testing was performed on samples with bacterial isolates using the Kirby-Bauer disc diffusion method, on the commonly prescribed antibiotics in this setting. We summarized and described the bacterial isolates and antibiotic susceptibility patterns as frequencies and percentages. Results: Bacteria were isolated in 29.6% (107/361) of the women, and the commonest isolates included; Staphylococcus aureus 48.6% (52/107), Klebsiella pneumoniae 29.9% (32/107) and Enterococcus fecalis 15% (16/107). Yeast cells were found in 17.7% (64/361) of the women with abnormal vaginal discharge. Cefuroxime (90.7%) and Ciprofloxacin (84.1%) had a high level of sensitivity while high levels of resistance were observed for Doxycycline (86%) and Azithromycin (67%). Conclusion: The common bacterial isolates were Staphylococcus aureus, Klebsiella pneumoniae and Enterococcus fecalis. The isolated bacteria were most sensitive to Cefuroxime and Ciprofloxacin but resistant to Doxycycline and Azithromycin. There is need for routine culture and susceptibility testing of women with abnormal vaginal discharge so as to guide treatment, minimize inappropriate antibiotic use and consequently reduce antibiotic resistance.