Background Neural tube defects (NTDs) are associated with high rates of neonatal mortality and morbidity worldwide. The promotion of folic acid fortification and supplementation in pregnant women by the Food and Drug Administration significantly decreased the incidence of NTDs in the United States. This practice is not widely adopted in Eastern Africa countries. We hypothesized that these countries experience a higher burden of NTDs than countries that promote the use of folic acid. We aimed to estimate the birth prevalence of NTDs in the United Nations (UN) Eastern African region. Methods PubMed (Medline), Embase, and Cochrane Library databases were systematically searched from inception to December 17, 2021. We included randomized controlled trials or observational studies that reported the prevalence estimates of NTDs in Eastern Africa. Random effects model was used to pool the effect estimates. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Outcome measures were overall and specific (spina bifida, anencephaly, encephalocele) rates of NTDs per 10,000 births, including live and stillborn cases. Results The meta-analysis included 20 studies consisting of 752,936 individuals. The pooled prevalence of all NTDs per 10,000 births in Eastern Africa was 33.30 (95% CI: 21.58 to 51.34). Between-study heterogeneity was high (I2 = 97%, p < 0.0001), The rate was highest in Ethiopia (60 per 10,000). Birth prevalence of spina bifida (20 per 10,000) was higher than anencephaly (9 per 10,000) and encephalocele (2.33 per 10,000). No studies on NTDs were identified in 70% of the UN Eastern Africa region. Birth prevalence increased by 4% per year from 1983 to 2018. The level of evidence as qualified with GRADE was moderate. Conclusion The birth prevalence of NTDs in the United Nations region of Eastern Africa is 5 times as high as observed in Western countries with mandatory folic acid supplementation in place. Therefore, mandatory folic acid supplementation of stable foods may decrease the risk of NTDs in Eastern Africa.

The active participation of staff from the outset of any health service or practice improvement process ensures they are more likely to become engaged in the implementation phases that follow initial service analyses. Graphic facilitation is a way of getting participants to develop an understanding of complex systems and articulate solutions from within them.This article describes how a graphic facilitation process enabled the members of a multidisciplinary team at a specialist paediatric neurosurgery hospital in Uganda to understand how their system worked. The large graphic representation the team created helped each team member to visualise their day-to-day practice, understand each person's contribution, celebrate their triumphs and highlight opportunities for service improvement. The process highlighted three features of their practice: an authentic interdisciplinary team approach to care, admission of the primary carer with the child, and previously unrecognised delays in patient flow through the outpatients department. The team's active participation and ownership of the process resulted in sustainable improvements to clinical practice.

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BackgroundThe rates for the delayed initiation of breastfeeding in Uganda remain unacceptably high and reasons for this are not well understood. We aimed to determine the prevalence and predictors for the delayed initiation of breastfeeding in Eastern Uganda. MethodsThis study employed a cross-sectional study design. A total of 404 mother-infant pairs were enrolled onto the study between July and November, 2020 at Mbale regional referral hospital (MRRH). They were interviewed on socio-demographic related, infant-related, labour and delivery characteristics using a structured questionnaire. We estimated adjusted odds ratios using multivariable logistic regression models.Results. The rate of delayed initiation of breastfeeding was 70% (n=283/404, 95% CI: 65.3% – 74.4%). The factors that were associated with delayed initiation of breastfeeding were maternal charateristics including: being single (AOR=0.37; 95%CI: 0.19 – 0.74), receiving antenatal care for less than 3 times while pregnant (AOR=1.85, 95%CI: 1.07 – 3.19) undergoing a caesarean section (AOR= 2.07; 95%CI: 1.3 – 3.19) and having a difficult labour (AOR=2.05; 95%CI: 1.25 – 3.35). Infant characteristics included: having a health issue at birth (AOR=9.8; 95%CI: 2.94 – 32.98).Conclusions:The proportion of infants that do not achieve early initiation of breastfeeding in this setting remains high. Women at high risk of delaying the initiation of breastfeeding include those who: deliver by caesarean section, do not receive antenatal care and have labour difficulties. Infants at risk of not achieving early initiation of breastfeeding include those that have a health issue at birth. We recommend increased support for women who undergo caesarean section in the early initiation of breastfeeding. Breastfeeding support can be initiated in the recovery room after caesarean delivery or in the operating theatre. The importance of antenatal care attendance should be emphasized during health education classes.

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Background: Neonatal mortality remains a public health concern in developing countries such as Uganda. Three-quarters of all newborn deaths occur in the first week of life, with 50% occurring during the first 24-hours. The World Health Organization developed essential newborn care measures to improve neonatal outcomes.This study aimed at determining maternal knowledge attitude and practices towards essential newborn care in Mbale district, Eastern Uganda.Methods: A hospital-based cross-sectional survey employing quantitative and qualitative methods was conducted at selected health facilities in Mbale district. 366 postnatal mothers were interviewed using a structured pretested and validated questionnaire. Knowledge was assessed using closed-ended questions; a score of ‘one’ was allocated for ‘correct knowledge’ and ‘zero’ for ‘incorrect knowledge’. The attitude was assessed using a 5-point Likert scale. Practices were evaluated through open-ended questions and by 15 in-depth interviews. Data were analyzed using STATA version 14.0 and Nvivo version 11.0Results: The majority, 341(93.2%) of the mothers, knew the signs of eye infection. All the mothers, 366(100%) knew about thermal care. The majority of the mothers, 315(86.1%) didn’t know the disease prevented by the BCG vaccine. Most 260(71.4%) didn’t know the dangers of leaving an umbilical stump wet. Most mothers, 332(91.0%) agreed that skin-to-skin contact should be ensured and warm clothing be provided to the neonate. The majority 352(96.2%) of the mothers practiced skin-to-skin contact as a thermal protective measure. A few mothers, 65(17.8%) did not bathe their babies within 24 hours of birth. Poor cord care practices like the use of gecko droppings were still in existence in the community. Mothers practised and described exclusive breastfeeding as cheap and affordable with all food values.Conclusion: There was good knowledge and positive attitude towards WHO essential newborn care but knowledge on some aspects of cord care and immunization was still lacking. Postnatal mothers demonstrated unsatisfactory practices towards essential newborn care. There is a need to educate mothers during antenatal visits, postnatal clinics, and Young Child Clinic to improve their knowledge on immunization and cord care and practice essential newborn care measures.

Introduction Epilepsy has been found to affect caregivers’ quality of life, lifestyle, psychological health, social well-being, and working time. Caregivers in Uganda as in the rest of the world are important in assisting a person with epilepsy in complying with medical directions and are actively involved in communicating with healthcare professionals. Little is known about the lived experiences of caregivers of persons afflicted with epilepsy in Uganda. The purpose of this study was to determine the lived experiences of caregivers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital, eastern Uganda. Methods and materials The caregivers’ lived experiences were elicited directly from them and their health workers who work with them in the care of the patients. Forty participants which consisted of 30 caregivers and 10 key informant health workers were selected for the study through purposive sampling. Face-to-face in-depth interviews with an unstructured interview guide were conducted to gather participants’ information. The principal investigator conceptualized the interview guide, the guide was then reviewed by co-investigators, and revised and approved as the final data collection instrument after an extensive and comprehensive literature review. The interview guide comprised two sections; the first section comprised the questions that elicited the participants’ social-demographic information. The second section comprised questions that explored caregivers’ experiences of persons afflicted with epilepsy. Notations were taken and a digital recorder was used purposely for audio recordings. All interviews lasted for an hour and were audio-recorded with the participant’s consent. An inductive thematic analysis was employed and adopted to identify the patterns emerging from the texts. Results The caregivers majorly perceived epilepsy as a burden. Four main themes were revealed from the analysis and these are: psychological burdens which included, worries about the future of the patient, being looked down upon; social burdens which entailed, affected public relations, feelings of stigma; an economic burden which included interference with the source of income, affected productivity at work; and physical burdens which included, Feelings of uneasiness and disrupted sleep among others. Conclusion The caregivers majorly perceived epilepsy as a serious burden. This burden can be psychological, social, economic, and physical. Therefore, services and plans targeting patients with epilepsy need to consider the burden that caregivers encounter to comprehensively manage epilepsy.