Maternal and Child Health I: Session 1

Maternal and Child Health I: Session 1

The Factors Associated with Preterm Births in Mulago Hospital

Elizabeth Ayebare, Gorrette Nalwadda, Peter Ntuyo

Introduction: Preterm birth defined as birth before 37 completed weeks of gestation is one of the leading causes of neonatal mortality worldwide. It accounts for 35 percent of all neonatal deaths worldwide and underlies the other causes of neonatal deaths. Uganda has one of the highest preterm birth rates in the world estimated at 13.6 per 1000 live births. In order to realise a reduction in pre-term births, interventions that target the risk factors are paramount.

Objective: This study aimed at identifying the socio-demographic, reproductive and pregnancy-related factors associated with preterm births.

Methods: This was a case control study among postpartum women in Mulago hospital, Kampala. Ninety-nine women who had delivered preterm new-borns were recruited as cases and 193 with full term babies were the controls. A semi-structured questionnaire was used to collect data. Data was entered into Epidata and exported to STATA 11 software for analysis.

Results: Maternal age of participants was comparable among the cases and controls. Socio-demographic factors associated with preterm birth included height less than 1.5 meters [aOR=131.08, 95% CI: 20.35- 844.02] and rural residence [aOR=6.56, 95%CI: 2.68-16.10]. Unemployment among the participants was a protective factor against preterm birth [aOR=0.36, 95%CI: 0.15-0.86]. Non-attendance of antenatal increased the likelihood for preterm births [aOR=8.88, 95%CI: 1.44-54.67]. Pregnancy related factors included PPROM [aOR= 287.11, 95%CI: 49.26-1673.28], antepartum haemorrhage [aOR=7.33, 95%CI: 1.23-43.72] and preeclampsia/eclampsia [aOR=16.24, 95%CI: 3.11-84.70]. Medical conditions in pregnancy were in higher proportions among cases.

Conclusion: Interventions to prevent and manage risk factors for preterm birth should be implemented locally and countrywide. Appropriate antenatal care, recognition and management of high risk conditions among pregnant women may lead to a reduction in preterm birth rates.

At the completion of this presentation the participants will

1. Appreciate the serious need to prevent pre-term births

2. Know the factors associated with pre-term births

3. Understand the interventions to prevent and manage risk factors

The lived experience of mothers who have had stillbirths
Maria Apoya

Stillbirth is delivery of a fetus that died intrauterine or during the birth process. Causes of stillbirth for approximately 50% of the cases remain unknown, though some factors are known to predispose stillbirth. In the Jopadhola and Iteso communities of Uganda, stillbirth is unwelcomed and is frequently associated with curses and bad omens. In these communities blame is put only on the woman and the clan of origin. Despite the painful experience for these mothers, they are denied the right to mourn their babies and must keep their grief only in their heart with no support or care from the husband or his family.

The study employed a phenomenological design using qualitative methods of inquiry. Six mothers who had had stillbirth within a period of one year were purposively selected. An in-depth interview guide was designed, pretested and used to solicit responses from the mothers. Approval was obtained from the research committee of Mbarara University and from the local council chief of the study area. Mothers gave a verbal consent before commencing the interview. All interviews were conducted in the local languages.

The responses were analysed and themes were generated. Mothers described feelings of shock, numbness, denial, anguish, living in fear and despair, painful memories, and separation. Some were occasionally blamed and mocked by their fellow women. Others got belittled, confused, shocked and psychologically traumatized, and became social misfits in the community. The study revealed that parents of the stillbirth did not receive consistent, relevant and competent professional and social care to enable them cope with the tragedy of death. Many social structures grounded on parenthood and kinship differed greatly, leaving a devastated social fabric. These mothers need to be listened to, their loss acknowledge and emotional support given.

At the completion of this presentation the participants will

1. Appreciate the trauma experienced by parents who have a stillbirth.

2. Understand the importance grief counseling for mothers and other family members with stillbirths.

3. Value the importance of transcultural nursing in our setting.

How Male Circumcision as an HIV preventive strategy was perceived among male immigrants from Southern and Eastern Africa residing in Leeds, UK

Catherine Atuhaire Kabanda

Introduction: Male Circumcision (MC) has been recommended to be integrated in the HIV prevention strategies. Since then, governments and non-government organizations have promoted the strategy across the globe most especially in non-circumcising communities especially in Southern and Eastern Africa. However, the success for such strategy relies on take up rates which is dependent on the perceptions of people among other factors.

Objectives: This study aimed at understanding how MC was perceived among male immigrants from Southern and Eastern Africa residing in Leeds, UK.

Methods: Through face to face interviews with 9 participants, the study investigated into how medical MC was perceived among male Immigrants who were residing in Leeds, UK. 8 interviews were analysed using thematic analysis.

Results: The study found that majority looked at MC as a practice to fulfil cultural and religious obligations other than HIV prevention. Few participants showed belief and certainty that it was an effective strategy of HIV prevention indicating limited knowledge. The participants also perceived dangers of male circumcision which also acted as barriers to accepting the procedure. These included fear of pain, complications from the procedure and possible infections most especially in traditionally carried out procedures.

Conclusion: To draw relevance to health promotion and health education theory, participants revealed that increasing awareness, making services available and addressing cost issues could encourage immigrants in Leeds to accept and take up the service. This study avowed that there was insufficient understanding of MC as HIV prevention strategies as majority continued to look at male circumcision with cultural and religious lenses. Considering that there is evidence that MC reduces HIV infection by 60%, concerted efforts have to be invested in increasing awareness, enhancing availability and affordability of medical male circumcision services.

At the completion of the presentation the participants will

1. Have knowledge and possibly allay the fears associated with medical MC
2. Appreciate that there was insufficient understanding of MC as majority continued to look at it with cultural and religious lenses.
3. Understand the necessity for increasing awareness and availing the services in our communities

Knowledge, Attitude, and Practices of Pregnant Mothers sharing a house with a smoker: Experience of women attending antenatal clinic at Kawempe Health Centre IV.

Margaret Kaggwa

Goal to find out the extent to which pregnant women are aware of the hazardous of second hand smoke, a silent killer in their lives, and the health worker’s helping hand to pregnant women who share homes with smokers.

Specific objectives;

1. Pregnant women’s knowledge on second hand smoking?

2. What are their feelings towards cigarette smoke?

3. What is being done about smoking in a house?

Data: This study focused on the pregnant women’s knowledge, attitudes and practices in relation to exposure to second hand smoke due to sharing a house with a cigarette smoker posing a silent public health problem. Sixty nine pregnant women exposed to second hand smoking were purposively selected at antenatal clinic and interviewed. Only 3(4%) of women were aware of the hazardous effects of SHS, 30 (43%) believed smokers had a right to smoke anywhere and all 69 (100%) admitted nothing could be done about it.

Recommendations:

• There is need for health workers to pass knowledge on to pregnant women about SHS.
• Community sensitization on effects of cigarette smoke
• Make your home, car and other public places smoke free.

At the completion of the presentation the participants will:

1. Recognize the health risks of second hand smoke
2. Appreciate the study findings of the knowledge, attitude and practices of pregnant women
at Kawempe Health Centre IV.
3. Implement the recommendation, especially a smoke free environment

Nursing Care in a Clinical Condition: Session 2

Nurses’ Experience In The Care Of Patients With Diabetic foot Ulcers at
Mbarara Regional Referral Hospital

Esther Beebwa

Introduction

Diabetes is one of non-communicable diseases that affect both males and females. Worldwide over 366 million people have diabetes and 80% of these live in low and middle-income countries. In 2011 diabetes caused 4.6 million deaths and was responsible for 11% of total health care expenditures worldwide. It was also noted that apart from the impact on health, the economic cost of diabetes and its complications is enormous both in health care and loss of productivity to society.

Methodology

This study utilized a qualitative descriptive design with a phenomenological approach. Focus groups were conducted in Mbarara Regional Referral Hospital (MRRH). Using purposive sampling the participants included all employed nurses who were educated and registered in the practice of nursing. Immediately after the group interviews, the researcher transcribed the narratives and proceeded with analysis of the data. Finally, data were examined to identify descriptive patterns that described the experience of nurses in the care of patients with diabetic foot ulcers.

Results The sixteen focus group participants were men and women whose ages ranged from 18-45 years. Six of the participants were Registered Nurses, seven Enrolled Nurses and three Intern Nurses. There were 10 thematic categories that were identified in the analysis. From these thematic categories four themes emerged: frustration and helplessness, sadness and disappointment, affection and bonding, and unfulfilled expectations.

These findings suggested that as a result of their work, nurses’ experience increased discouragement because of poor patient outcomes. Nonetheless, these also trigger their compassion and commitment to patients. Furthermore, the nursing values of compassion and commitment to caring were deeply entrenched in nurses who cared for patients with diabetic foot ulcers.

Conclusion

It is quite evident that despite the challenges nurses experience working in the areas of patients with diabetic foot ulcers, they also experience a significant job satisfaction as they care, defend and advocate for their patients.

At the completion of the presentation the audience will

1. Explore the experiences of nurses who care for patients with diabetic foot ulcers at the
Mbarara Regional Referral Hospital.
2. Identify challenges nurses face in the care of patients with diabetic foot ulcers
3. Determine satisfaction of nurses towards care provided to patients with diabetic foot ulcers
in Mbarara Regional Referral Hospital.

Nurse’s implementation of the nursing process with patients having difficulty breathing in two hospitals in Uganda

Nakaye Aidah Sekinemye

Background/Purpose: The nursing process is a term referring to a scientific method implemented in the nursing profession. It is an approach that guides nursing documentation, a method to organize the nursing work and a system of problem solving. In Uganda, many nurses oppose the use of standardized nursing process language, stating, “It’s just another label” in spite of the benefits of the nursing process in facilitating quality nursing care. This study examined how Ugandan nurses from two district hospitals implemented the nursing process.

Theoretical/Conceptual Framework: Ida Jean Orlando’s theory of nursing process was used. The theory was developed to motivate nurses to act based on meeting patients’ needs, acknowledging patient participation in planning care and responding to patient feedback.

Methodology: A cross-sectional descriptive survey design with quantitative and qualitative items was used. Using convenience sampling, 133 nurses from two district hospitals, one faith-based and the other one public, were invited to participate in the study. Only 90 returned the questionnaire giving a response rate of 68%. Of the 90 questionnaires returned, 17 were incomplete therefore the final sample was 73 (55%).

Results: The results of the study showed that a large number of nurses (78.1%) knew that assessment was important and 91.8% performed vital observations during their assessment. The results also showed that nurses did not know how to formulate a nursing diagnosis. Only (6.8%) were able to identify the nursing diagnosis. However a large number of nurses (91.8%) knew what to do (implementation) when they received a patient with respiratory problems. Only1.4% thought it was important to include the patient in his own management.

Conclusion: It was evident that nurses carry out assessment when they receive patients, they also make nursing diagnosis although do not use nursing language, they act accordingly and document their findings although they do not involve patients in their own management.

Recommendations: To promote the use of a standardized language in the nursing profession, the nurses should be educated and encouraged to apply the nursing process because they are already using it, this should also be done in continuing nursing education.

At the completion of the presentation the audience will

1. Understand the importance of the nursing process in providing care.
2. Be aware of how the nurses in these two hospitals used the nursing process and areas where they needed more direction.
3. Implement the recommendation as possible to promote a standardized language in the nursing profession.

Belief and Practices regarding splenomegaly among caretakers of children under five

Harriet Nabulo

Splenomegaly means enlargement of the spleen and is a sign of underlying disease. The purpose of this study was to find out the beliefs and practices regarding splenomegaly among caretakers of children under five on paediatrics ward of Mbarara Regional Referral Hospital (MRRH). This quantitative, descriptive study enrolled 70 participants.

It was conducted on Paediatrics, Toto ward of MRRH, Mbarara Uganda. It included caretakers of children below 5 years, regardless of whether their children had splenomegaly or not. Non probability sampling methods were used.

Semi-structured, interviewer-administered questionnaires were used to collect data which was manually analyzed, processed and presented in tables, graphs and pie charts using Microsoft Word and Micro Soft Excel computer packages.

Fifty-nine participants (41.3%) acknowledged that splenomegaly is an enlarged spleen, and majority thought it was caused by malaria 34 (27.9%). Other causes cited included use of dirty water (4.1%), eating groundnuts (8.2%), taking milk (3.3%), worm infestations (7.4%), excess blood that collects in the spleen (10.7%), and witchcraft (9.8%). While 74.3% of the respondents would seek treatment for splenomegaly from hospitals, 17.9% would give quinine syrup, bought from over the counter. A considerable number sought the services of a traditional healer that involved tattooing, branding and use of herbal concoctions to drink.

Continuing nurse education sessions (CNES) are encouraged so that nurses on Paediatric Ward are stimulated to address splenomegaly as a potential cause of morbidity among children, so they could dispel related misconceptions among caretakers.

A health education campaign should be mounted by the authorities of MRRH, Toto ward and Mbarara District Health Office to sensitize the masses about the causes of splenomegaly, and the dangers associated with its management by traditional healers. Rational use of quinine syrup should be enhanced, its use alongside traditional treatments, poses risk for drug interactions between quinine and the herbs.

It can be deduced that splenomegaly is a common condition in this geographic area which is endemic for malaria, as 49 (70%) of the respondents had heard about it, 21 (20%) had seen it, 10 caretakers themselves had it, and 16 children of the 70 seen, actually had it.

At the completion of the presentation the audience will

1. Understand the importance of the diagnosis of splenomegaly to a child’s caretaker
2. Be aware of the perceived causes of splenomegaly among the caretakers
3. Know actions that can be taken to decrease the potentially harmful ways of treating it by
traditional healers and herbalist, with rational use of quinine

Nurse’s knowledge, practice, and barriers in care of patients with pressure ulcers in a Ugandan Teaching Hospital

Ivan Mwebaza, Godfrey Katende, Sara Groves, Joyce Nankumbi

Background: Pressure ulcers have been identified as one of the major burdens of long hospitalization all over the world. There are several reasons why their proper prevention and management should be one of the nursing care priorities. The most common reason is that disease conditions which are associated with pressure ulcers are on increase. This means such patients are more likely to get pressure ulcers and their consequences like sepsis, tissue destruction and increasing the hospital costs. Nurses are usually at fore front of preventing pressure ulcers in clients who are under their care. The purpose of this study was to determine the nurses’ knowledge and practices regarding risk factors, prevention, and management of pressure ulcers at a teaching hospital in Uganda

Objectives

1) To determine the nurses’ knowledge about the risk factors, prevention strategies and management of pressure ulcers.

2) To determine the Nurses’ practices towards prevention and management of pressure ulcers during their routine care of patients.

3) To identify the barriers that hinder nurses to put in practice their skills and knowledge towards the prevention and management of pressure ulcers.

Methods The study employed a descriptive cross-sectional design. Fifty-six Ugandan registered practicing nurses were sampled. A composite self-administered questionnaire and an observation checklist were utilized

Results The nurses had limited knowledge about critical parameters of pressure ulcers. Prevention practices were observed to be unreliable and uncoordinated related to a significant shortage of staff and logistics for pressure ulcer prevention. Nurses had poor access to current literature on pressure ulcer prevention. Lack of education and poor access to literature about pressure ulcers were also cited as barriers to proper management of pressure ulcers.