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Puerperal sepsis remains one of the leading causes of maternal mortality and morbidity in Uganda. This study assessed the prevalence and factors associated with puerperal sepsis among postpartum women at Fort portal Regional Referral Hospital located in western Uganda. A cross-sectional design was employed in the study. We conducted a records review of the patient files of 180 postnatal mothers who were admitted at Fort Portal Regional Referral Hospital from 20 February, 2024 to 01 April, 2024. A data abstraction checklist was used to collect data from participant files based on strict inclusion and exclusion criteria. Data was entered in Microsoft Excel and exported to STATA17 for data analysis. Descriptive analysis and logistic regression analysis were performed to determine the prevalence of puerperal sepsis and determinants. Bivariate and multivariate logistic regression analysis was conducted for significant factors presented as Adjusted Odds Ratios (aOR) at p ≤ 0.05. The median age of participants was 25.5 years (1QR = 20-30) and the majority (77%) had primary education. The prevalence of postnatal sepsis was 24%. Duration of hospital stay [aOR=2.30; 95%CI (1.552-3.398); p=<0.001], history of antepartum hemorrhage [aOR=29.09; 95% CI (1.182-716.38); p = 0.039] and Anemia [aOR=0.01; 95% CI (0.001-0.218); p = 0.004] were identified as factors associated with puerperal sepsis among postnatal women upon multivariate logistic regression. Puerperal sepsis was common in our setting. This study found that mode of delivery, duration of hospital stay, anemia, and Antepartum hemorrhage, were the determining factors contributing to puerperal sepsis, infection prevention measures during cesarean sections, and reducing the length of hospital stay would prove to be beneficial in the prevention of sepsis.

Puerperal sepsis remains one of the leading causes of maternal mortality and morbidity in Uganda. This study assessed the prevalence and factors associated with puerperal sepsis among postpartum women at Fort portal Regional Referral Hospital located in western Uganda. A cross-sectional design was employed in the study. We conducted a records review of the patient files of 180 postnatal mothers who were admitted at Fort Portal Regional Referral Hospital from 20 February, 2024 to 01 April, 2024. A data abstraction checklist was used to collect data from participant files based on strict inclusion and exclusion criteria. Data was entered in Microsoft Excel and exported to STATA17 for data analysis. Descriptive analysis and logistic regression analysis were performed to determine the prevalence of puerperal sepsis and determinants. Bivariate and multivariate logistic regression analysis was conducted for significant factors presented as Adjusted Odds Ratios (aOR) at p [less than or equal to] 0.05. The median age of participants was 25.5 years (1QR = 20-30) and the majority (77%) had primary education. The prevalence of postnatal sepsis was 24%. Duration of hospital stay [aOR=2.30; 95%CI (1.552-3.398); p=<0.001], history of antepartum hemorrhage [aOR=29.09; 95% CI (1.182-716.38); p = 0.039] and Anemia [aOR=0.01; 95% CI (0.001-0.218); p = 0.004] were identified as factors associated with puerperal sepsis among postnatal women upon multivariate logistic regression. Puerperal sepsis was common in our setting. This study found that mode of delivery, duration of hospital stay, anemia, and Antepartum hemorrhage, were the determining factors contributing to puerperal sepsis, infection prevention measures during cesarean sections, and reducing the length of hospital stay would prove to be beneficial in the prevention of sepsis.

Introduction Female sex workers (FSWs) in Uganda experience numerous barriers to antiretroviral therapy (ART) adherence. We used the planned behavior theory to help explore the enablers and barriers to ART adherence among FSWs. Understanding the barriers to ART adherence may help contribute to the development of interventions to improve ART adherence among the FSWs. Materials and methods A descriptive qualitative study was conducted in Fort portal City. We conducted 30 in-depth interviews among FSWs who had been taking ART for at least six months. Furthermore, six key informant interviews were conducted with healthcare workers and leaders of the FSWs initiative. Data collection lasted for two months. Thematic deductive analysis was applied to analyse the data through the lens of the theory of planned behavior. Findings The attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including perceived benefits of ART, and experiencing positive outcomes from taking ART were seen to enable its adherence. Subjective norms such as social support, disclosure of HIV status, seeing others take ART, and aspirations of longer life enabled ART adherence. Taking ART in the morning, responsive and respectful healthcare workers, and availability of food/basic needs facilitated compliance with ART adherence. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV, lack of social support, gender-based violence, non-disclosure, stigma, and abandonment hindered the use of ART among FSWs. Socio-economic constraints (e.g., food scarcity), and occupation-related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations) were the additional barriers to ART adherence. Conclusion ART adherence among FSWs was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these barriers in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSWs.

In settings where home birth rates are high, prenatal distribution of misoprostol has been advocated as a strategy to increase access to uterotonics during the third stage of labor to prevent postpartum hemorrhage (PPH). Our objective was to project the potential cost-effectiveness of this strategy in Uganda from both governmental (the relevant payer) and modified societal perspectives. To compare prenatal misoprostol distribution to status quo (no misoprostol distribution), we developed a decision analytic model that tracked the delivery pathways of a cohort of pregnant women from the prenatal period, labor to delivery without complications or delivery with PPH, and successful treatment or death. Delivery pathway parameters were derived from the Uganda Demographic and Health Survey. Incidence of PPH, treatment efficacy, adverse event and case fatality rates, access to misoprostol, and health resource use and cost data were obtained from published literature and supplemented with expert opinion where necessary. We computed the expected incidence of PPH, mortality, disability adjusted life years (DALYs), costs and incremental cost effectiveness ratios (ICERs). We conducted univariate and probabilistic sensitivity analyses to examine robustness of our results. In the base-case analysis, misoprostol distribution lowered the expected incidence of PPH by 1.2% (95% credibility interval (CrI): 0.55%, 1.95%), mortality by 0.08% (95% CrI: 0.04%, 0.13%) and DALYs by 0.02 (95% CrI: 0.01, 0.03).” and “ICERs were US$181 (95% CrI: 81, 443) per DALY averted from a governmental perspective, and US$64 (95% CrI: -84, 260) per DALY averted from a modified societal perspective [corrected]. Prenatal distribution of misoprostol is potentially cost-effective in Uganda and should be considered for national-level scale up for prevention of PPH.

The diagram shows the impact of the 10 most influential parameters on the incremental cost per DALY averted from a modified societal perspective. https://doi.org/10.1371/journal.pone.0152955.g002 thumbnail Download: * PPT PowerPoint slide * PNG larger image * TIFF original image Fig 4. The dashed red line represents the lower threshold of willingness to pay per DALY averted (one times the GDP of Uganda) and the solid red line represents the higher threshold of willingness to pay per DALY averted (three times the GDP of Uganda). https://doi.org/10.1371/journal.pone.0152955.g003 thumbnail Download: * PPT PowerPoint slide * PNG larger image * TIFF original image Fig 5. The dashed red line represents the lower threshold of willingness to pay per DALY averted (one times the GDP of Uganda) and the solid red line represents the higher threshold of willingness to pay per DALY averted (three times the GDP of Uganda). https://doi.org/10.1371/journal.pone.0152955.g004 Supporting Information Showing 1/1:

Puerperal sepsis remains one of the leading causes of maternal mortality and morbidity in Uganda. This study assessed the prevalence and factors associated with puerperal sepsis among postpartum women at Fort portal Regional Referral Hospital located in western Uganda. A cross-sectional design was employed in the study. We conducted a records review of the patient files of 180 postnatal mothers who were admitted at Fort Portal Regional Referral Hospital from 20 February, 2024 to 01 April, 2024. A data abstraction checklist was used to collect data from participant files based on strict inclusion and exclusion criteria. Data was entered in Microsoft Excel and exported to STATA17 for data analysis. Descriptive analysis and logistic regression analysis were performed to determine the prevalence of puerperal sepsis and determinants. Bivariate and multivariate logistic regression analysis was conducted for significant factors presented as Adjusted Odds Ratios (aOR) at p [less than or equal to] 0.05. The median age of participants was 25.5 years (1QR = 20-30) and the majority (77%) had primary education. The prevalence of postnatal sepsis was 24%. Duration of hospital stay [aOR=2.30; 95%CI (1.552-3.398); p=<0.001], history of antepartum hemorrhage [aOR=29.09; 95% CI (1.182-716.38); p = 0.039] and Anemia [aOR=0.01; 95% CI (0.001-0.218); p = 0.004] were identified as factors associated with puerperal sepsis among postnatal women upon multivariate logistic regression. Puerperal sepsis was common in our setting. This study found that mode of delivery, duration of hospital stay, anemia, and Antepartum hemorrhage, were the determining factors contributing to puerperal sepsis, infection prevention measures during cesarean sections, and reducing the length of hospital stay would prove to be beneficial in the prevention of sepsis.

Background: Sub-Saharan Africa has a high abortion case-fatality rate, and most of these maternal deaths are due to hemodynamic instability which results from hemorrhage, especially in cases of incomplete abortion. Timely identification and management of hemodynamic instability is an important strategy for addressing the morbidity and mortality associated with incomplete abortion. This study, therefore, aimed at determining the prevalence and factors associated with hemodynamic instability among women presenting with incomplete abortion at Mbarara Regional Referral Hospital (MRRH). Methods: We conducted a cross-sectional study at the gynaecology ward of MRRH from January 2024 to April 2024. We consecutively enrolled women with incomplete abortion and collected data on socio-demographic, abortion- and medical-related factors, and measured their blood pressure and heart rate at admission. Obstetric shock index (OSI), the ratio of the heart rate to systolic blood pressure, was used as a measure of haemodynamic stability. A participant whose OSI was [greater than or equal to] 0.9 was considered haemodynamically unstable. We performed a modified Poisson regression analysis to determine the factors associated with hemodynamic instability. Results: A total of 137 women with incomplete abortion were enrolled in this study with a mean age of 26.3 ([+ or -]5.93) years. The majority of the participants had first-trimester abortions (65.7%), were married (70.8%), and were from rural areas (60.0%). The prevalence of hemodynamic instability was 41.6% (95% CI: 33.6-50.1). At multivariable regression analysis, gestation age [greater than or equal to] 13 weeks (aPR 1.67, 95% CI: 1.12-2.49) and post-abortion infection (aPR 1.75, 95% CI: 1.18-2.60) were significantly associated with hemodynamic instability. Conclusion: Approximately two in every five women with incomplete abortion at MRRH were hemodynamically unstable at admission during the study period. Women with second trimester abortion and those with post-abortion infection are more likely to present with hemodynamic instability. We recommend strengthening routine assessment and management of hemodynamic instability among women with incomplete abortion. Keywords: incomplete abortion, hemodynamic instability, obstetric shock index, post-abortion infection

Sub-Saharan Africa has a high abortion case-fatality rate, and most of these maternal deaths are due to hemodynamic instability which results from hemorrhage, especially in cases of incomplete abortion. Timely identification and management of hemodynamic instability is an important strategy for addressing the morbidity and mortality associated with incomplete abortion. This study, therefore, aimed at determining the prevalence and factors associated with hemodynamic instability among women presenting with incomplete abortion at Mbarara Regional Referral Hospital (MRRH). We conducted a cross-sectional study at the gynaecology ward of MRRH from January 2024 to April 2024. We consecutively enrolled women with incomplete abortion and collected data on socio-demographic, abortion- and medical-related factors, and measured their blood pressure and heart rate at admission. Obstetric shock index (OSI), the ratio of the heart rate to systolic blood pressure, was used as a measure of haemodynamic stability. A participant whose OSI was ≥0.9 was considered haemodynamically unstable. We performed a modified Poisson regression analysis to determine the factors associated with hemodynamic instability. A total of 137 women with incomplete abortion were enrolled in this study with a mean age of 26.3 (±5.93) years. The majority of the participants had first-trimester abortions (65.7%), were married (70.8%), and were from rural areas (60.0%). The prevalence of hemodynamic instability was 41.6% (95% CI: 33.6-50.1). At multivariable regression analysis, gestation age ≥13 weeks (aPR 1.67, 95% CI: 1.12-2.49) and post-abortion infection (aPR 1.75, 95% CI: 1.18-2.60) were significantly associated with hemodynamic instability. Approximately two in every five women with incomplete abortion at MRRH were hemodynamically unstable at admission during the study period. Women with second trimester abortion and those with post-abortion infection are more likely to present with hemodynamic instability. We recommend strengthening routine assessment and management of hemodynamic instability among women with incomplete abortion.