Background: The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. Methods: A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. Results: Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18-0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14-0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08-1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. Conclusion: Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.

Background: Human Chorionic Gonadotropin (hCG) is secreted by the embryo as early as the first week of life. Several studies have proven the potential of a single serum β hCG level, at 12 to 14 days after embryo transfer, to predict pregnancy outcomes after In vitro fertilization. However, these studies show significant heterogeneity, with paucity of data from African populations. This study aimed to evaluate the prognostic value of a serum β-hCG level cut off, 12 days after embryo transfer, on predicting livebirth among Ugandan women. Methods: A Retrospective cross-sectional study. 337 fresh IVF cycles with serum β-hCG ≥5 mIU/mL, at 12 days after embryo transfer, were eligible. We abstracted participant characteristics, IVF cycle characteristics, livebirth, clinical pregnancy, and ongoing pregnancy data from each eligible cycle. We utilized the Youden index metric and the maximize_boot_metric method to link serum β-hCG levels to outcome data and determine the optimal cut off values. Results:The optimal serum β-hCG cut off value for predicting livebirth was 437.42mIU/ml with a corresponding sensitivity and false positive rate of 72% and 31% respectively. The cut-offs for clinical and ongoing pregnancy, were 239.58 mIU/ml and 353.66 mIU/ml respectively. These corresponded with a sensitivity of 83% and 77% respectively, and a false positive rate of 27% and 33% respectively. The serum β-hCG cut off had a poor discriminatory performance for predicting live birth but moderate performance for predicting clinical and ongoing pregnancies. Conclusion: A single serum β-hCG 12 days after cleavage embryo transfer has poor discriminatory performance in predicting live birth, albeit performing modestly in predicting clinical pregnancy and ongoing pregnancy among Uganda women.

Background: Hepatitis B virus (HBV) is mainly transmitted perinatally. Delaying the first dose of HBV vaccine to 6 weeks of age as is the current practice in Uganda may increase the risk of perinatal transmission. In this study, we aimed to assess the uptake of BCG vaccine within 24 hours after birth and to assess the feasibility of BCG/HBV vaccine co-administration in Uganda.Methods: This was a mixed-methods study. We retrospectively collected data on BCG vaccine uptake, the timing of vaccination, and reasons for missed/delayed vaccination, at two hospitals: capital city-based St. Francis Hospital Nsambya (SFHN), and upcountry-based Mbarara Regional Referral hospital. We also conducted a cross-sectional study at SFHN to explore factors associated with delayed or missed BCG vaccination within 24 hours after birth.Results: Of the 2,002 newborn babies randomly sampled, 1,534 (76.5%) received BCG vaccine within 24 hours. On chart review, 140 participants had identifiable reasons for delayed BCG vaccination as follows: admission to neonatal unit with birth asphyxia (56.2%, n= 73), and birth weight <2.5kg (30.8%, n=40). On interviewing 73 mothers at vaccination clinics, admission to a neonatal unit for prematurity (n= 42, 57.5%), birth asphyxia (n= 73, 56.2%) or birth weight < 2.5kg (n=40, 30.2%) were the reasons for missed/delayed vaccination. The median human cost for the BCG vaccination process was $0.14.Conclusions: Over three-fourth of neonates received their BCG vaccine within 24 hours after birth, providing a convincing basis for co-administration of BCG and HBV vaccines.