Department of Reproductive Health

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Caesarean section rates in a tertiary teaching hospital in northern Uganda: a retrospective analysis using the robson ten group classification system
(BMC Pregnancy and Childbirth, 2024) Eric Ssennuni; Felix Bongomin; Elvis Akuma; Kizito Lukujja; Henry Kule; Keneth Opiro; Silvia Awor; Baifa Arwinyo; Sande Ojara; Jimmyy Opee; Ayikoru Jackline; Akello Jackline; Pebalo Francis Pebolo
Background: The Robson Ten Groups Classification System (RTGCS) is increasingly used to assess, monitor, and compare caesarean section (CS) rates within and between healthcare facilities. We evaluated the major contributing groups to the CS rate at Gulu Regional Referral Hospital (GRRH) in Northern Uganda using the RTGCS. Methods: We conducted a retrospective analysis of all deliveries from June 2019 through July 2020 at GRRH, Gulu city, Uganda. We reviewed files of mothers and collected data on sociodemographic and obstetric variables. The outcome variables were Robson Ten Groups (1–10) based on parity, gestational age, foetal presentation, number of foetuses, the onset of labour, parity and lie, and history of CS. Results: We reviewed medical records of 3,183 deliveries, with a mean age of 24.6 ± 5.7 years. The overall CS rate was 13.4% (n = 427). Most participants were in RTGCS groups 3 (43.3%, n = 185) and 1 (29.2%, n = 88). The most common indication for CS was prolonged labour (41.0%, n = 175), followed by foetal distress (19.9%, n = 85) and contracted pelvis (13.6%, n = 58). Conclusion: Our study showed that GRRH patients had a low-risk obstetric population dominated by mothers in groups 3 and 1, which could explain the low overall CS rate of 13.4%. However, the rates of CS among low-risk populations are alarmingly high, and this is likely to cause an increase in CS rates in the future. We recommend group specific interventions through CS auditing to lower group-specific CS rates.
Characteristics of the COVID-19 Patients Treated at Gulu Regional Referral Hospital, Northern Uganda: A Cross-Sectional Study
(Journal of Infectious Diseases & Therapy, 2022) Okot, Christopher; Baguma, Steven; Alema Onira, Nelson; Odong Agings, Willis; Arwinyo, Baifa; Elima, James; Apiyo, Paska; Layet, Paska; Pebalo Pebolo, Francis; Acullu, Denis; Oloya, Johnson Nyeko; Oyat, Freddy Wathum Drinkwater; Oola, Janet; Aloyo, Judith; Ikoona, Eric Nzirakaindi; Kitara, David Lagoro
Background: Coronavirus Disease 2019 (COVID-19) is a severe respiratory disease that results from infection with a new coronavirus (SARS-CoV-2). One of the most critical issues related to the COVID-19 is the high rate of spread, millions of people have been infected around the world, and hundreds of thousands of people have died till now. However, reports from Africa paint a different picture of the SARS-CoV-2 and its effects on the population. Objectives: The objective of this study was to describe the characteristics of the COVID-19 patients treated at the Gulu Regional Referral Hospital and determine factors associated with COVID-19 manifestations, socio-demographic characteristics, and treatment outcomes from March 2020 to October 2021. Methods: A retrospective data abstraction of all COVID-19 hospital admissions registered in the Gulu Health Management Information System (HMIS) database and other tools were conducted. The period of study was from March 2020 to October 2021. Data that met the inclusion criteria were consecutively abstracted from the Gulu Hospital HMIS database. A local IRB approved the study. SPSS version 25.0 was used for data analysis, and a p-value of 0.05 was considered significant. Results: Data suggests there were three waves of COVID-19 in Uganda. Those with comorbidities, e.g., Diabetes mellitus 38(5.7%), hypertension 83(12.5%), cardiovascular diseases 58(8.7%), HIV and AIDS 61(9.2%), and other comorbidities such as liver cirrhosis and Hepatitis B 40(6.0%) were more susceptible and presented with more severe forms of the disease. Antibiotics 662(99.7%), steroids 73(11.0%), vitamin C 564(84.9%), Ivermectin 7(1.1%), and Vitamin D 24(3.6%) were the most used medicines for the treatment of COVID-19 patients. Most COVID-19 patients were unvaccinated 661(99.5%). However, the recovery rate was 632(95.2%). The commonest complications were pneumonia 60(9.0%), chronic fatigue 49(7.4%), acute respiratory distress syndrome (ARDS) 37(5.6%), depression 20(3.0%), systemic infections 19(2.9%), nightmares 15(2.3%) and septic shock 8(1.2%). The Adjusted Odds Ratios (AOR) on factors associated with recovery were treatment with steroids AOR=138.835 at 95% CI:12.258-1572.50;p<0.000 and Vitamin D AOR=31.4780 at 95% CI:1.902520.98; p=0.016. Conclusion: This study showed successful management of COVID-19 patients in low-resource settings with a recovery rate of 95.2%. The admission pattern suggests Uganda had three waves of COVID-19, contrary to the official government position of two. Treatment with steroids and Vitamin D is associated with the recovery among COVID-19 patients. There is a need to conduct more extensive studies on the role played by the two drugs in the successful recovery of COVID-19 patients.
Chronicles of an uncommon term abdominal pregnancy with successful outcome: a case report
(BioMed Central, 2024-01-24) Magezi, Joad; Wacha, Joshua; Pebalo, Pebolo Francis
Abstract Background Intra-abdominal pregnancies, while rare, present with unique diagnostic and management challenges. We present a case of a 25-year-old para 2+1, black African woman, who was referred from a peripheral Health Centre level IV in the Northern part of Uganda to a Regional Referral Hospital due to an abnormal presentation with easily palpable fetal parts. This case emphasizes the signifcance of prompt diagnosis, interdisciplinary collaboration, surgical planning, and managing the placenta in advanced intra-abdominal pregnancies. Case presentation A 25 year African black female, para 2+1 upon arrival at Regional Referral Hospital, a University Teaching Hospital during a weekend, an ultrasound was sourced from a nearby private clinic revealing an extra-uterine intra-abdominal pregnancy at 38 weeks of gestation and she was promptly sent back to the University Teaching Hospital. Following this diagnosis, the patient, who hailed from a remote village over 30 km away, returned to her family for discussions. After three days, she was readmitted. Emergency laparotomy unveiled an omental gestation sac with extensive placental attachment. A live female infant was delivered successfully, placenta was left in situ. The post-operative course was uneventful, with initial concerns about inadequate breast milk fow which resolved after placental removal during the second exploratory laparotomy. Conclusion This case highlights the uncommon occurrence of an advanced intra-abdominal pregnancies and emphasizes the importance of multi-disciplinary teamwork and placental management. The favorable outcome in the management was based on thorough assessment of the placental location, attachments and blood supply during surgery. It demonstrates the possibility of reduced risk of massive bleeding if there is a delayed removal of placenta with favorable attachment. This is particularly important for milk letdown as well as reducing the needs of blood transfusion in resource limited settings.
Comparing Flipped Classroom with Traditional Instruction for Post-Partum Intra-Uterine Device Training Among Medical Students in a Ugandan Public University:
(Research squares, 2023-09-07) Pebalo, Francis Pebolo; Bongomin, Felix; Awor, Sylvia; Arwinyo, Baifa; Ojara, Sande; Opee, Jimmy; Ayikoru, Jackline; Okot, Jerom; Ssenuni, Eric; Ouma, Simple; Nakimuli, Annettee
A two-arm, quasi-experimental design was used. The FC group underwent a pre-recorded lecture and video on PPIUD insertion, followed by interactive sessions and procedural practice. The traditional group received an hour-long lecture and onsite skills demonstration, followed by skill practice. Paired t tests were used to determine knowledge and skills acquisition in each group and independent samples t tests was be used to compare groups. Stata version 17 and GraphPad Prism version 9 were used for analysis. Results A total of 67 students were included in the final analysis, 37 in the traditional group and 30 in the FC group. There was a significant improvement in post-test scores compared to pre-test scores in both groups p < 0.001. The mean post-test score was higher for FC compared to the traditional teaching methods group although, it was not statistically significant (p = 0.069). Certain categories of students performed better with FC, especially those who failed pre-tests p = 0.021), in bachelor or of medicine and bachelor of surgery (MBChB) year 3 class (p = 0.011), students who joined the university directly from advanced level certificate (p = 0.018) and aged younger than 25 years (p = 0.002). There was no statistically significant difference in the mean procedure performance score between the intervention and the traditional teaching methods (p = 0.634). Conclusion The FC had shown a positive impact on the knowledge and skills of medical students indicating its role in reproductive health training in resource-limited settings. Additionally, future studies could investigate how FC can combined with other teaching methods to create a blended learning approach that maximizes the benefits and enhanced learning.
Correlates and prevalence of overweight and obesity among women of reproductive age (15-49 years) in Sierra Leone. A secondary data analysis of the demographic health survey of 2019
(2023-07-12) Okot Atim, Pamela; Alema, Nelson Onira; Pebolo, Francis Pebalo; Okot, Christopher; Ochula, Denis; Okot, Smart Geoffrey; Ikoona, Eric Nzirakaindi; Toure, Mame Awa; Namulemo, Lucy; Kamara, Kassim; Oyat, Freddy Wathum Drinkwater; Aloyo, Judith; Njenga, Amon; Kaluya, Ronald; Matovu, John Bosco; Olal, Emmanuel; Kitara, David Lagoro
Background: Overweight and obesity are emerging public health problems globally and are independent risk factors for heart, blood vessels, reproductive health, and metabolic disorders. This study aimed to determine the correlates and prevalence of overweight and obesity among women of reproductive age (15-49 years) in Sierra Leone using secondary data analysis of the Demographic Health Survey of 2019. Methods: This study was based on the 2019 Sierra Leone Demographic Health Survey (SLDHS) that used a two-stage stratified cluster sampling technique. A total of 7514 non-pregnant women of reproductive age (15-49 years) were used in the analysis. Simple descriptive, bivariable, and multivariable regression analyses were conducted with a significant p-value set at <0.05. Results: The prevalence of overweight and obesity among women of reproductive age in Sierra Leone was 19.7% and 7.4%, respectively. Overweight was more likely among women of 15-19 age group (adjusted Odds Ratios, aOR=1.933,95%CI:1.532- 2.348;p<0.001); women from the north (aOR=1.308,95%CI:1.104-1.581;p<0.006); women without formal education (aOR=1.211,95%CI:1.009-1.454;p<0.040); in poorest (aOR=1.501,95%CI:1.231-1.853;p<0.001) and poorer (aOR=1.419,95%CI:1.154-1.745;p=0.001) wealth indices. However, overweight was 39.9% less likely among 30-39-year (aOR=0.601,95%CI:0.507-0.713;p<0.001) and 49% less likely among 40-49-year (aOR=0.510,95%CI:0.415-0.628;p<0.001) age-groups. It was 27.3% less likely among married women (aOR=0.727,95%CI:0.613-0.863;p<0.001), 24.9% less likely in the south (aOR=0.751,95%CI:0.623-0.911;p=0.002), 38.2% and 48.7% less likely in richer (aOR=0.618,95%CI:0.494-0.773;p<0.001) and richest (aOR=0.513,95%CI:0.389-0.677;p<0.001) wealth indices, respectively. Also, obesity was more likely among women 15-19-year (aOR=2.051,95%CI:1.316-3.198;p=0.002); from the north (aOR=1.426,95%CI:1.038-1.958;p=0.044); in poorest (aOR=2.390,95%CI:1.618-3.532;p<0.001) and poorer (aOR=1.667,95%CI:1.151- 2.415;p=0.007) wealth indices. However, it was 68.3% and 79.6% less likely among women 30-39-year (aOR=0.317,95%CI:0.241-0.419;p<0.001) and 40-49-year (aOR=0.204,95%CI:0.149-0.278;p<0.001) age-groups, respectively. It was 36.8% less likely among female-headed households (aOR=0.732,95%CI:0.590-0.909;p=0.005) and 24% less likely among married women (aOR=0.760,95%CI:0.580-0.995;p=0.046); 26.2% less likely in the south (aOR=0.738,95%CI:0.550-0.992;p=0.044); 62.1% and 75.9% less likely in richer (aOR=0.379,95%CI:0.266-0.540;p<0.001) and richest (aOR=0.241,95%CI:0.159-0.367;p<0.001) wealth indices, respectively; and 39.9% less likely among women who listened to radios (aOR=0.601,95%CI:0.507-0.713;p<0.001). Conclusion: The prevalence of overweight and obesity among women of reproductive age (15-49 years) in Sierra Leone was higher compared to world data. Younger age groups, northern region, poorest and poorer wealth indices, and women without formal education were more likely to be overweight and obese. However, overweight and obesity were less likely among older age-groups, married, southern region, richer and richest wealth indices, female-headed households, and listening to radios. There is an urgent need for policymakers in Sierra Leone to tackle overweight and obesity among women of reproductive age (15-49 years) if the current trends are to be reversed.
Dual contraceptive use and associated factors among female sex workers in Gulu City, Uganda in 2023
(BioMed Central, 2023-08-16) Bongomin, Felix; Pebalo, Francis Pebolo; Kibone, Winnie; Okwir Apio, Pamela; Nsenga, Lauryn; Okot, Jerom; Madraa, Grace; Laker, Fiona Gladys; Akello, Martha; Ouma, Simple; Musoke, David
Background: Dual contraception is an essential approach to mitigating the heightened risks of unintended pregnancies and sexually transmitted infections faced by female sex workers (FSWs). We determined the prevalence and factors associated with dual contraceptive use among FSWs in Northern Uganda. Methods: A cross-sectional study was conducted in Gulu city, Uganda between February, and March 2023. Purposively selected FSWs aged 18 years or older who provided verbal informed consent were enrolled in the study. A sample size of 374 was estimated. Data on sociodemographic and reproductive health characteristics were collected using an interviewer-administered semi-structured questionnaire. Current dual contraception was defned the as concurrent use of a barrier and any other modern contraceptive methods within the last 3 months. Continuous variables were summarized using mean and standard deviation and categorical variables were summarized using frequencies and percentages. Modifed Poisson regression analysis was used to determine factors associated with dual contraceptive use. Results: We enrolled 314 FSWs, with a mean age of 28.8±6.4 years. About 13.8% (n=41) were living with HIV. In total, 66.2% (95%CI 60.8–71.3) of the participants (n=208) reported current dual contraceptive use. The most common modern contraceptive method used was the implants (52.4%, n=109), followed by injectable contraceptives (22.6.0%, n=47), and bilateral tubal ligation (0.5%, n=1) was the least utilized. Having had at least one previous pregnancy was positively associated with dual contraceptive use (adjusted PR: 1.87, 95%CI 1.40–2.51, p<0.001). Conclusions: A high proportion of FSWs in Gulu city were currently using dual contraceptives. Interventions are needed to facilitate the use of dual contraception, particularly among FSWs without a history of previous pregnancies.
Episiotomy related morbidities measured using redness, edema, ecchymosis, discharge and apposition scale and numerical pain scale among primiparous women in Mulago National Referral Hospital, Kampala, Uganda
(Pan African Medical Journal, 2020-08-26) Pebolo, Pebalo Francis; Ajeani, Judith; Kaye Kabonge, Dan
Introduction: episiotomy induced inflammatorysigns like redness, edema, ecchymosis and pain may remain beyond the period of hospitalization and can be objectively measured using redness, edema, ecchymosis, discharge and apposition (REEDA) scale. Pain in the postpartum period is a common problem and can be measured using the numerical pain scale (NPS). Episiotomy is normally poorly executed and poorly repaired with little attention to the subtle pain-free scar. Postpartum perineal pain has been found to affect more people with episiotomy compared to spontaneous perineal tears or contusion in the first two weeks. This study was aimed at comparing NPS and REEDA scores in the first two weeks of postpartum among primiparous parturients with or without episiotomy in Mulago National Referral Hospital. Methods: a prospective cohort study conducted by recruiting primiparous women systematically on the first postnatal day and categorizing them into episiotomy and no episiotomy group. NPS and REEDA scale were taken at baseline and 2 weeks postpartum. Results: the mean total REEDA score for primiparous women among the episiotomy group was significantly higher both on day 1 and day 14 with p-values <0.0001 and <0.0001 respectively as well as the day 14 mean NPS pvalue 0.001. Conclusion: episiotomy, a traumatic obstetric procedure, that heals slowly and with persistent perineal pain compare to spontaneous perineal contusion or tears.
Facemask wearing in COVID-19 pandemic:
(medRxiv, 2023-10-24) Alema, Nelson Onira; Okot, Christopher; Olal, Emmanuel; Ikoona, Eric Nzirakaindi; Oyat, Freddy Wathum Drinkwater; Baguma, Steven; Ochula, Denish Omoya; Olwedo, Patrick Odong; Oloya, Johnson Nyeko; Pebolo, Francis Pebalo; Atim, Pamela Okot; Okot, Godfrey Smart; Nantale, Ritah; Aloyo, Judith; Kitara, David Lagoro
Background: The WHO and the US. CDC documented that facemask-wearing in public situations is one of the most important prevention measures that can limit the acquisition and spread of COVID-19. Considering this, WHO and US. CDC developed guidelines for using facemasks in public settings. This study aimed to determine correlates and prevalence of facemask wearing during COVID-19 pandemic among adult population of Northern Uganda. Methods. We conducted a cross-sectional study on five hundred and eighty-seven adult population of northern Uganda. A single stage stratified, and systematic sampling methods were used to select respondents from twenty four Acholi subregion’s health facilities. Data was collected in a face-to-face questionnaire interview with an internal validity of Cronbach's α=0.72. A local IRB approved the study, and Stata 18 was used for data analysis at multivariable Poisson regression with a p-value set at ≤0.05. Results: The most substantial findings from this study were the high prevalence of face mask-wearing in public among respondents [88.7%,95%CI:86%-91%]. At a multivariable Poisson regression analysis, we found that obese respondents were 1.12 times more likely to wear facemasks than those who were not, [adjusted Interval Rates Ratios, aIRR=1.12,95%CI:1.04-1.19;p<0.01], and respondent who agreed to the lockdown measures were 1.23 times more likely to wear facemasks during COVID-19 pandemic than those who did not, [aIRR=1.23, 95%CI:1.07- 1.41;p<0.01]. Other sociodemographic characteristics such as sex, age, occupation, level of education, religion, tribes, marital status, nationality, race, and comorbidities were not statistically significant at 95% Confidence Intervals. Conclusion: The most significant findings from this study were the high prevalence of face mask-wearing among adult community members in northern Uganda. The correlates of facemask wearing in public were the obese and respondents who agreed with the presidential directives on the lockdown measures. Although this was within acceptable prevalence rates, the strict enforcement of face mask-wearing by security forces raised concerns among many community members and human rights advocates. We recommend more studies on communities' perspectives on the challenges and benefits of facemask-wearing during the COVID-19 pandemic.
Factors associated with utilization of standard days method of family planning among market vendors in Gulu City
(PAMJ Clinical Medicine., 2021-12-09) Acire, Robin; Acidri, Philip; Angolere, Pasquale; Pebalo, Francis Pebolo
Introduction: standard days method (SDM) is a family planning method in which users avoid unprotected sexual intercourse during cycle days 8 through 19. Its efficacy is 95% and 88% in perfect and typical use respectively when used among women whose cycles are between 26-32 days. Classified as a modern contraceptive, can be used to bridge the gap brought by fear of side effects, cost, cultural and religious opposition to the modern hormonal method. The study, therefore, seeks to look at the factors associated with choosing or continuing to use SDM as a method of family planning in the Gulu City main market. Methods: this was a cross-sectional analytical study among women of reproductive age in Gulu main. Results: a total of 248 women were included in the final analysis. Women who heard about SDM, understand their menstrual cycle, believe in a high possibility of conception within their cycle, have very good thoughts and good thoughts about the method were more likely to choose or continue using the method; P-values 0.061, 0.08, 0.002,0.001 and, 0.001 respectively. Recommendation to use the method was a positive predictor for using the method, P-value <0.001, meanwhile, some knowledge and little knowledge about the method were negative predictive factors for using SDM, P-values 0.038 and 0.020 respectively. Conclusion: intervention aimed at improving knowledge about SDM among the population may help increase use of SDM to reduce incidences of unintended pregnancies and meet contraceptive unmet needs among women not comfortable using the modern hormonal contraceptives.
Healthcare providers’ attitude towards abortion service provision in Gulu city, Northern Uganda
(International Journal of Sexual and reproductive Health care, 2022-06-07) Pebolo, Pebalo Francis; Obol, James Henry; Auma, Grace Anna
Background: Although induced abortion is legally allowed on various grounds in several sub-Saharan African countries, health care providers in these countries often persist in viewing induced abortion as immoral. Providers’ attitudes may confl ict with the national abortion law or their personal and or religious values. Abortion services are severely restricted and highly contentious in Uganda. This study, therefore, is aimed at determining attitudes among healthcare providers on induced abortion service provision in Gulu City. Procedures: A cross-section survey was conducted among health workers about attitudes toward induced abortion between September and November 2019 using a modified abortion attitudinal score. The study was conducted in the Hospitals and Health centers in Gulu City, in Northern Uganda, the participants were drawn from Public, Private non-for-profi t faith-based, Private for Profi t and, Private non-for-profi t Non-Government Organisation health centers. Findings: A total of 252 health care providers were surveyed. The mean attitudinal score for generally in support, generally not in support, conditional in support,personal attitude, and beliefs against and toward abortion provision were 2.80, 2.71, 2.86, 3.239, and 3.35 respectively. Factors that were positively associated with general support included age 40 years and above; and being employed in private non-for-profi t non-governmental health facilities, with coeffi cients of 0.85 and 0.67 respectively.Factors that were positively associated with conditional support were; age 40years or above; being employed in a non for profi t non-governmental health facility; private for-profi t and private not-for-profi t faith-based health facilities coeffi cients 0.55, 0.54, 0.40, and 0.37 respectively. However, being a born-again Christian was negatively associated with general support for induced abortion provision. Conclusion: Healthcare providers’ attitude is an important element in the provision of quality stigma-free post-abortion care services. A clear national effort to improve post-abortion and comprehensive abortion care training should include value clarifi cation and attitude transformation among all healthcare providers.
“I Use Strawberry Flavoured Condoms during My Periods”:
(MDPI, 2023-08-28) Bongomin, Felix; Kibone, Winnie; Pebalo, Francis Pebolo; Laker, Fiona Gladys; Okot, Jerom; Kaducu, Felix Ocaka; Madraa, Grace; Labongo Loum, Constantine Steven; Awor, Silvia; Napyo, Agnes; Musoke, David; Ouma, Simple
Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging healthrisk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population
Invasive Fungal Diseases in Africa:
(MDPI, 2022-11-22) Bongomin, Felix; Ekeng, Bassey E.; Kibone, Winnie; Nsenga, Lauryn; Olum, Ronald; Itam-Eyo, Asa; Ngouanom Kuate, Marius Paulin; Pebolo, Francis Pebalo; Davies, Adeyinka A; Manga, Musa; Ocansey, Bright; Kwizera, Richard; Baluku, Joseph Baruch
Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
Is the 14% cesarean section rate in Gulu Regional Referral Hospital justifiable?
(. PAMJ Clinical Medicine, 2021-03-26) Pebolo, Francis Pebalo; Baguma, Steven; Auma, Anna Grace
Worldwide, cesarean section (CS) rates haveincreased tremendously in recent years, especially among high-income countries, raising concernsabout the over-utilization of CS without added benefits, and in the sub-Saharan African region, therate is at its lowest (7.3%). In Uganda, the CS rate stands at 6% and is seen to be higher (11%) among first-order births indicating a high incidence of primary CS. Despite the low rate of CS in Uganda,there are massive gaps in the provision of obstetric procedure with some women receiving unnecessary surgeries, and the facility-based CS rate is projected to increase to 32% by end of 2021. Notwithstanding the increasing facility rates of CS, Gulu Regional Referral Hospital (GRRH) rate has remained low in the years 2017-2019, with lower levels maternal mortality ratio and fresh stillbirths´ rates compared to the national average. Prolonged labor is one of the commonest indications for primary CS accounting for more than 50% among nulliparous women and this is linked to progress of labor usually measured using cervical dilatation. World Health Organization (WHO) recommended a change in cervical dilatation from 4cm to 5cm as a threshold for the active phase of the first stage of labor, as away to reduce unnecessary labor intervention including the CS. Lack of standard reporting tools such as the WHO Robson´s ten group classification in Uganda make comparisons of CS rate between/within facility/facilities worrisomely difficult.
Medical Education Technology in Resource-Limited Settings
(intechopen, 2024) Pebalo Francis Pebolo; Ayikoru Jackline; Maxwell Opwonya; Raymond Otim; Felix Bongomin
The integration of information and communication technology (ICT) in medical education is crucial to meet the evolving needs of the global population and ensure competency among healthcare trainees. In low- and middle-income countries (LMICs), where resources are limited, leveraging advanced ICTs has the potential to revolutionize medical education by promoting student-centred learning through asynchronous and distributed access. The recent introduction of artificial intelligence (AI) = in medical education has transformed learning into a personalized experiences, virtual simulations, and real-time feedback. Our experience with use of simple technology in Uganda serves as a prime example of how innovative technologies are being utilized to enhance medical education in a LMICs setting. Our experience in the implementation of interactive displays in simulation training and the establishment of low-cost content production studio has significantly improved trainings and learnings. By integrating these technologies closer to the learning environment, students can access information before or after interacting with their teachers, engage in higher cognitive activities, and stimulate problem-solving skills. The success of these initiatives demonstrates their potential for adoption to elevate the quality of medical education in LMICs. Embracing ICT in medical training not only bridges educational gaps but also fosters inclusive and equitable access to resources in LMICs.
Perceptions of COVID-19 vaccination among different adult age group populations in Northern Uganda. A cross-sectional study.
(Research squares, 2022-07-14) Oloya, Johnson Nyeko; Baguma, Steven; Okot, Christopher; Alema, Nelson Onira; Acullu, Denis; Ochula, Denis; Atim, Pamela; Olwedo, Patrick Odong; Okot, Smart Godfrey; Pebolo, Francis Pebalo; Freddy Wathum Drinkwater Oyat, Freddy Wathum Drinkwater; Ikoona, Eric Nzirakaindi; Aloyo, Judith; Oballim, Lawence; Kitara, David Lagoro
Introduction: Although COVID-19 first spread slowly in the African continent, confirmed virus cases have risen steadily since March 2020. The rapid spread of SARS-CoV-2 can be attributed to its numerous characteristics, including its high transmissibility, asymptomatic persons’ ability to shed the virus, vast numbers of asymptomatic persons, or mild symptoms but with the ability to transmit the virus, new variants, and super-spreading events. Poor public health practices,disbeliefs, myths, and misconceptions about the virus and its origin in many African communities are the other reasons for its rapid spread. This study aimed to determine the perceptions of the adult population in northern Uganda on the COVID-19 vaccine acceptance, disaggregated by age groups. Methods: A cross-sectional study was conducted between March and April 2022 to assess COVID-19 vaccine acceptance among seven hundred and twentythree adult populations selected randomly from the nine districts of the Acholi sub-region. A five-point Likert scale with responses categorized as Strongly Agree, "SA," Agree, "A," Neutral, "N," Disagree, "DA," and Strongly Disagree, "SD" was used to assess participants' acceptance of the COVID-19 vaccines. Ethical approval was obtained from a local IRB, and SPSS version 20.0 was used to perform multivariable logistic regression to identify factors associated with vaccine acceptance. A p-value less than 0.05 was considered significant. Results: The most significant finding was that COVID-19 vaccine acceptance among the adult population in northern Uganda disaggregated by age groups was not statistically significant (χ2=3.956; p=0.142). COVID-19 vaccine acceptance among the age groups was associated with trust in the information from the mainstream media χ2=20.105; p=0.000; Government of Uganda χ2=19.900; p=0.028 and social media 10.745; p=0.030. The independent predictors on perceptions of the COVID-19 vaccine acceptance among age groups were; Participants strongly agreed on its importance to protect them from the virus AoR=4.99;95% CI:1.626-15.337;p=0.005; Agreed that the vaccine would protect them from the virus AoR=3.44;95%CI:1.225-9.650;p=0.019; strongly agreed that the side effects of the vaccine would stop them from receiving the vaccine AoR=0.330; 95%CI:0.125-0.856; p=0.023; They were neutral on whether the side effects of the COVID-19 vaccine would stop them from getting a COVID-19 jab AoR= 0.320; 95%CI:0.108-0.952;p=0.027; would not accept to pay for the COVID-19 vaccine AoR=0.280;95%CI:0.093-0.866; p=0.027; Agreed that children could take a COVID-19 vaccine AoR= 0.260; 95%CI:0.105-0.626;p=0.003; Strongly agreed that children could return to school before the COVID-19 vaccination AoR= 2.330; 95%CI:1.103-4.916;p=0.027; and agreed that children could return to school before taking COVID-19 vaccines AoR= 3.320; 95%CI:1.225-9.014;p=0.018. Conclusion: COVID-19 vaccine acceptance among the study population disaggregated by age group was not significant despite the disinformation and misinformation in the Ugandan media. The independent determinants of COVID-19 vaccine acceptance were the importance of the vaccine in protecting against the virus, that the vaccine’s side effects could stop them from taking the vaccine, and that children could take the COVID-19 jab but could return to school before taking the COVID-19 jab. The fear of family members contracting the virus and self-isolation when infected contributed significantly to the COVID-19 vaccine acceptance among participants in northern Uganda. There is a need for health managers to engage, sensitize and mobilize the population by addressing concerns about long-term and immediate side effects to increase the COVID-19 vaccine uptake in this community.
Perceptions of COVID-19 vaccine among different adult age group populations in Northern Uganda: a cross-sectional study
(Journal of Global Health Reports., 2022-07-28) Kitara, David L; Baguma, Steven; Okot, Christopher; Acullu, Denis; Ochula, Denis; Okot, Pamela A; Odong, Patrick O; Okot, Smart G; Pebolo, Francis P; Oyat, Freddy W Drinkwater; Ikoona, Eric N; Alema, Nelson O; Oloya, Johnson N; Aloyo, Judith; Oballim, Lawence
Background: At the time when COVID-19 was declared a pandemic in March 2020, its spread in the African continent was slow. However, confirmed cases of the virus have since risen steadily over the years in the African continent for many reasons. This study aimed to determine factors associated with perceptions of COVID-19 vaccines among adult age-group populations in northern Uganda. Methods: We conducted this study as part of a larger study to determine factors associated with COVID-19 vaccine hesitancy/acceptance among 723 adult age-group populations selected by stratified and systematic sampling approaches from northern Uganda. We used a questionnaire with an internal validity of Cronbach’s α= 0.772. A five-point Likert scale, with responses categorized as strongly agree “SA”, agree “A”, neutral “N”, disagree “DA”, and strongly disagree “SD”, was used to assess participants’ perceptions on COVID-19 vaccines. A multivariable regression analysis was conducted with P-value set at <0.05. Results: Overall, 723 participated in the study with a mean age of 31.4 years (standard deviation,SD, +10.1). The majority 54.5% (n=394) were males. There were no significant differences in perceptions of COVID-19 vaccines among age-group populations (adjusted odds ratio, aOR=0.99, 95% confidence interval, CI=0.98-1.01). Key finding include: (i) it was important to take a COVID-19 vaccine (aOR=1.02, 95% CI=1.00-1.04); (ii) vaccines have unlikely unforeseen side effects (aOR=0.98, 95% CI=0.97-0.99); (iii) vaccines were unlikely being promoted for commercial gains (aOR=0.98, 95% CI=0.97-0.99); and children could take COVID-19 vaccines (aOR=1.02, 95% CI=1.00-1.03). Stratified by age-groups, the 20–29-year-old perceived COVID-19 vaccines developed in Uganda as unlikely safe and effective (aOR=0.59, 95% CI=0.35-0.97), and COVID-19 vaccines have likely unforeseen side-effects (aOR=2.1, 95% CI=1.3-3.6). While the ≥50-year-old group perceived that COVID-19 vaccines were unlikely being promoted for commercial gains (aOR=0.2, 95% CI=0.1-0.6). Conclusions: There were no substantial differences in perceptions on COVID-19 vaccines in adult age-group populations in northern Uganda. The determinants of COVID-19 vaccine perceptions were its importance against the virus; vaccines have unlikely unforeseen side-effects, and children could take it. Stratified by age-groups, some age-groups perceived COVID-19 vaccines developed in Uganda as unlikely safe and unlikely being promoted for commercial gains
Polycystic ovarian syndrome: diagnostic challenges in resource-poor settings (Ugandan perspectives)
(PAMJ Clinical Medicine., 2021-01-29) Pebolo, Francis Pebalo; Auma, Anna Grace; Alobo, Gasthony
Polycystic ovarian syndrome is the most common cause of anovulatory infertility accounting for up to 40% of the reasons for visiting a doctor. The Ugandan government has recognized infertility as a major problem affecting over five million people, yet polycystic ovarian syndrome is not included in the Ugandan Clinical Guidelines, hence it´s not part of the Uganda minimum healthcare package. Lack of guidelines means diagnosis is a challenge and many cases have delayed or no diagnosis. Early diagnosis is good for awareness of associated risks such as infertility, dysfunctional uterine bleeding,endometrial cancer, obesity, diabetes, dyslipidemia, hypertension, and cardiovascular diseases. Clinical laboratories are handy in the diagnosis as well as follow-up of PCOS cases and in most rural settings, these are lacking, confounded by the lack of skilled frontline workers such as gynecologists and reproductive endocrinologists
Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda:
(Sage Publications, 2023-08-14) Bongomin, Felix; Kibone, Winnie; Okot, Jerom; Ouma, Simple; Madraa, Grace; Ojara, Francis Williams; Musoke, David; Pebalo, Francis Pebolo
Background: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sexworkers in Gulu, Uganda. Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p<0.05 was considered statistically significant. Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range:24–32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with;regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11–6.35, p<0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32–35.77, p=0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI:1.49–4.35, p<0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43–7.74, p=0.005), and use of postexposure prophylaxis (PEP) in the past 12months (aPR: 0.31, 95% CI: 0.17–0.59,p<0.001). Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.
Prevalence and factors associated with episiotomy practice among primiparous women in mulago national referral hospital Uganda
(International Journal of Pregnancy & Child Birth, 2019-11-01) Pebolo, Pebalo Francis; Ajeani, Judith; Kaye Kabonge, Dan
Background; Episiotomy, an obstetric procedure introduced into practice without any clear scientific evidence showing its benefits, became almost a procedure performed on all parturient women. Recently, a liberal episiotomy has been discouraged and WHO recommends an episiotomy rate of about 10% or less. The procedure substantially increases the risk of anal sphincter damage, improper wound healing, hematoma, infections, and perineal pain. The study was aimed at investigating the prevalence and factors associated with episiotomy among primiparous parturients in Mulago National Referral. Methods: A cross-sectional study using a researcher administered questionnaires was conducted in Hospital Obstetrics and Gynecological Department in February and March 2018. Two hundred forty-nine participants were systematically recruited on the first postnatal day after meeting the inclusion criteria and the socio-demographic and obstetric characteristics were recorded. Logistic regression was used to determine the factors associated with the occurrences of episiotomy. Results: The prevalence of episiotomy was 73% (181/249) (CI 67-78). Mothers whose second stage of labor lasted between; 31-60 minutes were 3.6 times more likely to be made an episiotomy, (CI; 1.66-7.86, p=0.001), the odds further doubles if the second stage of labor was prolonged, lasting 60 minutes or greater OR=7.2 (CI; 1.46-35.64, p=0.015). Episiotomy was also found to be associated with gestational age above 37 weeks OR=1.8 (CI; 1.28-2.40 p<0.001). Conclusion: The prevalence of episiotomy among primiparous is high yet higher episiotomy rates are associated with increasing morbidities and lack of benefits. The factors associated with episiotomy practice were gestational age above 37 weeks and prolonged second stage.
Prevalence of Teenage Pregnancy and Associated Factors in Agago District, Uganda:
(Taylor & Francis, 2023-08-07) Okot, Christopher; Laker, Florence; Okwir Apio, Pamela; Madraa, Grace; Kibone, Winnie; Pebolo, Francis Pebalo; Bongomin, Felix
Background: Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. Wedetermined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13–17 years in Agago district,Uganda. Methods: We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13–17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semistructured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant. Results: A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7–100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5–71.9, p=0.02). Conclusion: The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.

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