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. Sociodemographic 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: 1.2343.72] 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 middleincome 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.
Conclusion. Translation of nurses’ knowledge into practice is possible if barriers like staff
shortage, pressure relieving devices provision, and risk assessment tools are addressed at
Mulago
Programme Implications: The nurse training schools and universities need to examine their
curricula to address issues related to pressure ulcers prevention and treatment. Hospitals also
need to devote more resources to prevent and manage pressure ulcers. Professional bodies
should also provide continuous nursing education (CNE) and continuous medical education
(CME) to staffs about pressure ulcers.
At the completion of the presentation the participants will
1. Appreciate the seriousness of pressure ulcers and the importance of prevention
2. Find out the level of knowledge of the sampled nurses about pressure ulcers
3. Consider the possible interventions to increase nurse’s knowledge, change their practice
skills, and encourage hospitals to provide more resources especially for prevention.
School/ Community Health: Section 3
A Comparative Study Of Sexual Behaviour Of Vaccinated And Non Vaccinated Girls
Against Human Papilloma Virus in Two Districts Of Uganda
Christine Nimwesiga, Karen Drake, Florence Mirembe
Vaccines to prevent certain types of human papillomavirus (HPV) and associated cancers are
recommended for routine use among young women. National representative reports of
vaccine uptake have not explored the relationship between HPV vaccine initiation and
various sexual behaviors. Reduction of cervical cancer morbidity/mortality relies on
prevention and early detection of human papillomavirus (HPV). This study examined sexual
behavior of vaccinated girls against HPV, fears related to sexual life among vaccinated girls
against HPV vaccination, and the relationship between knowledge of HPV vaccine and girls’
sexual behaviors.
Theory of Reasoned Action (TRA) which proposes that attitudes about protective action,
perceptions of what others would think about this (subjective norms), and behavioral control
would be important predictors of sexual behavior guided the study. A cross-sectional survey
of a random sample (n = 768) was used to study sexual behaviors of both vaccinated and nonvaccinated girls (12-18 years) against HPV. Multistage sampling was used to select schools
and within each school random sampling was used to identify girls. Questionnaires were used
to obtain information from study participants.
The study found no difference in sexual behaviors of vaccinated girls and non-vaccinated
girls. In the study 25 girls were already sexually active and none had used condom.
Vaccinated girls said they would recommend the vaccine to colleagues while the nonvaccinated girls said they were willing to take the vaccine if offered without a cost. The girls
in both groups reported that HPV vaccine did not promote sexual activity but a significant
proportion of non-vaccinated girls did not know. Perhaps this was because they had no
knowledge of HPV vaccine. In this study HPV vaccination did not promote sexual behavior
among vaccinated girls and knowledge about HPV vaccine was not found to be related to
girls’ sexual behaviors.
In view of the study findings, there is need to educate girls about sexual and reproductive
health issues to help them understand dangers related to sexually transmitted infections
especially HPV. Programs to improve adolescent sexual and reproductive health should
include dimensions of parental involvement that may strengthen the program’s specific
behavior change goals.
At the completion of the presentation the participants will
1. Give a realistic judgment on the new vaccine and appreciate that what has been said
about the vaccine is not true.
2. Get up-to-date information about the new vaccine such that they can be able to give
informed advice to the community.
3. Make suggestions to policy makers during policy formulations and implementation
of HPV vaccination in the whole country
Perceived Risk of HIV Infection, Associated Factors, and Sexual Behaviors of
Secondary School Students in Uganda
Charles Peter Osingada, Caroline Nabasirye, Sara Groves, Tom Denis Ngabirano
Introduction: HIVAIDS remains a major public health problem in Uganda. About 4% of
individuals aged 15-24 years are living with HIV. Few studies have examined HIV risk
perception among adolescents in Uganda even though 56.1% the population comprises
individuals aged 18 years and below.
Methods: We conducted a cross-sectional study among 379 secondary school students using
multi-stage sampling techniques. Data was collected using an interviewer administered
questionnaire. Descriptive and logistic regression analyses were done.
Results: One hundred ninety one (49.6%) of the respondents perceived themselves to be at
risk of contracting HIV, 174 (45.9%) had ever had sex and over 80% had first sexual
encounter at 16 years or less. Only 49% of respondents who had sex within 12 months used a
condom. Female gender (COR 0.52, 95% CI 0.35-0.79) and not having taken an HIV test
(COR 0.51, 95% CI 0.33-0.78) were negatively associated with perceived risk of contracting
HIV. Being older than 17 years (COR 1.9, 95% CI 1.22-2.96), knowing someone who died of
HIV (COR 2.16, 95% CI 1.30-3.58), early sexual debut (COR 2.26, 95% CI 1.22-4.19), and
having ever had sex (COR 1.88, 95% CI 1.25-2.83) were all positively associated with
perceived risk of contracting HIV. With multivariate analysis, only knowledge of someone
who died of HIV (AOR 16, 95% CI 1.49-171.97) remained statistically significant.
Conclusion: Risky sexual behaviors, such as not using condoms, having multiple sexual
partners and having sex after drinking alcohol are widespread among secondary school
students in Wakiso Town council. Therefore, there is a need to design and implement school
based HIV risk reduction programs with specific information about primary prevention and
the use of condoms. These findings call for new school based sexual risk reduction
interventions to modify the sexual behaviors of youth in school.
At the completion of the presentation the audience will
1. Understand the importance of studying the adolescent age group’s HIV knowledge
and behavior concerning sex in an effort to stop the spread of the disease.
2. Be aware of the HIV risk perception of the Ugandan adolescent studied
3. Appreciate the importance of designing and implementing an appropriate HIV risk
reduction programs for the adolescents
Factors Hindering Continuation Of Paediatric HIV/AIDS Care Utilization
At Uganda Cares-Masaka Municipality.
Judith Owokuhaisa
Study objective: To identify factors hindering continuation of paediatric HIV/AIDS care
utilization. Care providers were interviewed to see if they impacted why children didn’t
continue at Uganda Cares.
Methodology: The study was a cross sectional quantitative design. Data was collected from
care providers (9) and care takers (57) using a structured questionnaire and analysed using
SPSS, (version 17.0).
Findings: Most of the caretaker respondents were aged above 45 years (53%) and 65%
peasant farmers. Stigma hindered the continuation of pediatric HIV care utilization (100%)
and 87% cited that transport was a constraint to continue utilizing. To determine knowledge
about importance of continuation the respondents stated radios were the most common source
of information on pediatric HIV infection. The respondents (80%) were not willing to
disclose if their child was HIV positive, and 70% stated it was duet o fear of stigma and
discrimination. Half of the caretaker respondents knew their child would be on ART for their
lifetime.
Of the health worker respondents, 99% revealed that on average 120 children attended the
HIV/AIDS pediatric clinic every week. Majority of health workers (78%) said that they felt
exhausted at the end of the clinic day.
Conclusion: Insufficient knowledge on paediatric HIV, stigma and discrimination, and lack
of transport were caretaker related factors that hindered continuation of paediatric HIV care
utilization. Work load and inadequate knowledge regarding provision of paediatric HIV care
were health facility related factors that hindered continuation of paediatric HIV/AIDS care
utilization at Uganda Cares–Masaka district.
At the completion of the presentation the audience will
1. Understand why HIV positive children enrol in care do not continue
2. Identify factors that health workers identified that made continuation difficult for the
children
3. Appreciate the recommendation on how to improve continuation rates
Perceived threat of Hepatitis B infection and barriers to vaccination among MUST
Students and Health Providers at MRRH
Valence Mfitumukiza, Heather Wopat
For health care workers (HCW), exposure to blood and body fluid carries a risk of both HIV
and hepatitis B infection. Pre-existing HIV infection reduces clearance of hepatitis B after
exposure and increases the risk of liver-related complications in hepatitis B infected
individuals. In addition, people infected with HIV are less likely to produce antibodies
against hepatitis B when they are vaccinated. The impact of hepatitis B infection on HIV
progression is unclear, but co-infection is an indication for ART in patients who would
otherwise not be treated for HIV. In Uganda, researchers have reported exceptionally high
exposure to blood and body fluids by HCW, with 67.8% reporting at least one exposure. Two
thirds of those had more than one exposure, but few reported it to the institution. Health care
students are even less likely to have received the vaccine, yet they are more likely to receive
exposure during patient care with either a needle stick or splash, and even less likely to report
it. The prevalence of hepatitis B in the general population of Uganda has been estimated at
10%. The estimated prevalence of HIV is 7.2 %. In the absence of an effective vaccination
against HIV, preventing hepatitis co-infection is essential in maintaining the health of
exposed HCW.
The government is required by law to provide the hepatitis B vaccine to HCW and health
science students, but supplies are insufficient. In 2010, only 6.2 % of HCW polled had
received a single dose. The Mbarara University Nurse Student Association initiated a
hepatitis B immunization program for health science students and for staff at Mbarara
Regional Referral Hospital. At the time of immunization, those receiving the vaccine were
asked to complete a voluntary questionnaire. The study was approved by Institutional Review
Board of Mbarara University of Science and Technology. Of the 577 staff and students
immunized, 391 completed the survey. This presentation will report perceived seriousness
and risk of acquiring this disease by HCW and students. It will also identify precautions staff
and students currently take to prevent exposure and barriers for not initiating or completing
the vaccine schedule.
At the completion of the presentation the audience will
1. Understand the serious risk for exposure to blood borne pathogens the health care
workers and student experience daily in the government referral hospitals in Uganda
2. Appreciate the barriers health care workers and students have to receiving mandated
Hepatitis B vaccine.
3. Recognize the knowledge students and staff have about the disease and how they protect
themselves in the clinical wards.
Maternal and Child Health II: Session 4
The Practice Of Traditional Rituals And Customs In New-borns By Mothers In
Selected Villages In Southwest Uganda
Florence Beinempaka, Basil Tibanyendera, Fortunate Atwine,
Teddy Kyomuhangi, Noni E MacDonald
Background: Globally neonatal mortality has dropped from 32 to 22/1000 live births but in
Africa has remained above 30. Continuation of traditional pregnancy/birth rituals may put
some mothers/neonates at risk. The Ankole region of Uganda has a population of 8 million,
and approximately 10,000 live referral hospital births annually. However, most babies are
born at home in their villages, since women avoid going to the hospital unless complications
occur. The purpose of this study was to determine what potentially harmful traditional
pregnancy/birth rituals were practiced in Ankole region in order to develop Village Health
Team mitigation strategies.
Methods: Ten villages were randomly selected to participate in focus group discussions
(FGD) on traditional pregnancy/ birth customs. For each village FGD, 8 to 12 people were
purposively selected with VHT help. Sessions were recorded, transcribed verbatim, analysed
qualitatively for study thematic areas including pregnancy, new born baby, umbilical cord,
placenta-all categories with specific traditional rituals and customs.
Results: A total of 67 women and 37 men participated. They noted that child bearing in
Kinyankore culture was held in high esteem, sacred, and shrouded in mystery. The following
potential risky traditional pregnancy/ birthing rituals were described:
During pregnancy: Herbs are orally ingested and vaginally inserted to cleanse the
unborn baby through to term i.e. infection risk
Post delivery: Handling and disposal of the placenta as if it is another living baby, risk
of post delivery infection of much handled placenta with transfer back to mother or baby.
For the new-born: 1) The new-born’s head is moulded on “borning” fire; 2) The
mother’s first milk is prohibited so given other fluids i.e. potentially contaminated
liquids; 3) Cord care: cutting baby’s cord with a reed; 4) adding mother’s or friend’s spit
and/or materials such as dust, herbs, cow-dung powder and/or soot to the cord/stump to
encourage healing, i.e. infection risk: 4) For babies born in a health facility, traditional
rituals are practiced when the baby goes to the village.
Conclusion: Many Ankole traditional pregnancy/birth customs contravene World Health
Organization recommended health care practices. VHTs need to understand these traditions
to provide better maternal/neonatal care in their villages.
1. At the end of the presentation the participants will
2. Value the maternal and new-born customs associated with the Ankole tribe and
understand the negative health consequences
3. Identify practices that the VHT’s can initiate to change some of the local customs to
keep babies healthy and prevent morbidity and mortality
4. Understand the type of information that is essential to teach health care students to
prevent dangerous practices in the Ankole villages
Quality Improvement In Nursing Care Saving Mothers Giving Life
Using Pre-packed Emergency Kits.
Anita Babukiika
Background: The concept of Quality Improvement (QI) started way back in 2010 for
Kyenjojo district. The District QI Committee was formed and projects were identified which
were basically ART related and then spread to maternal child health using quality
improvement framework.
For the 2012 project the interest was in maternal mortality. The Kyenjojo district population
had 415,900 people. The expected number of women getting pregnant would be 5%,
translating to 20,795. The estimated number of deliveries would be 20,171.
The objective for this QI was to reduce maternal mortality by 50% in one year (2012-2013).
Program description: Nurses and Midwives were trained on quality improvement initiative
developed by the Ministry of Health. The training covered four principals of QI: client focus,
use of data, systems and processes, and team work. Introduction of documentation journals,
the 5’s model (sort, set, shine, standardize, sustain), and the PFSA cycle (plan, do, study, act)
were also introduced. Regular follow-ups were done at the facilities and learning sessions
were conducted by different health units bi-monthly to share innovations and best practices.
Lessons learned: Reduced maternal mortality by 30% in 1 year due to preventable obstetric
and gynaecological complications
Nurses put up emergency packs in their facilities to manage obstetric complications
There was Increase in partograph use and reduced PPH.
Conclusion: Quality improvement should be included in pre-service training of nurses in
order to improve on their skill and attitude towards work. This will help have a positive
outlook towards the nursing profession.
At the completion of the presentation the audience will
1. Understand the concept of quality improvement as implemented in this project
2. Appreciate the interventions that significantly decreased maternal mortality
3. Think about ways to include QI in their practice as professional nurses
Mothers’ Perceptions Towards Husbands’ Presence During Childbirth:
A Case Study At Mbarara Regional Referral Hospital
Kevin Bwongyezibwa
Men have been redefined as a valuable emotional and moral support in the labour ward, thus
emerged the significance and new meaning, on the paternal involvement in labour and
childbirth. Therefore, the MOH (2001) Strategic plan advocates for men involvement in
reproductive health. However, no study was done to find out how mothers feel about the
presence of their husbands during childbirth, hence the reason for this study.
This descriptive qualitative study on mothers’ perceptions towards the presence of their
husbands during childbirth was conducted in Mbarara Regional Referral Hospital. It aimed at
assessing mothers’ perceptions towards the presence of their husbands during childbirth and
exploring how mothers would want their husbands to be involved. Participants were selected
using purposive sampling method. Data was generated through discussions. Three focus
group discussions each having eight (8) mothers were conducted. The in- depth interview
guide was used to generate information about participants’ views on their perceptions
towards the presence of their husbands during childbirth. Data was analyzed using qualitative
analytic procedures. Themes or recurring regularities were searched.
Three main themes emerged from the study; active involvement, limited involvement and no
involvement. Witness and support were primary reasons mothers wanted their husbands’
presence during childbirth. While mothers wanted their husbands to be present and actively
involved during childbirth, some mothers opposed the idea of husband’s presence during
childbirth. Feeling that husband’s presence during childbirth was shameful. On how mothers
would want their husbands to be involved during childbirth, three themes emerged; active
support, limited support and no involvement. Majority of mothers wanted their husbands to
provide active assistance to them during childbirth. Although mothers’ perceptions split along
three themes, all the participants wanted to have an option. Therefore, provision of facilities
and trainings for husband’s presence during childbirth is recommended. However, emphasis
must be put in place to provide an option for mothers. Furthermore, the mothers’
confidentiality must always be taken into account in designing such services.
At the completion of the presentation the audience will
1. Understand actions nurses can take to improve the quality of maternal care involving the
husband in that care.
2. Appreciate the feelings mother have about the presence of their husband during childbirth
3. Understand the need for options for the women when it comes to the husband’s
involvement during childbirth.
Knowledge of malaria prevention among pregnant women
Betty Kinkuhaire
Introduction: Malaria continues to be the most dreadful human parasitic infection in the
world today of which the majority of the cases are in the Sub Saharan Africa. Pregnancy
increases susceptibility to malaria by causing suppression of immune systems and placental
cell mediated immune response, leading to sequestration of plasmodium in the placenta.
Malarial infection during pregnancy has been seen to cause substantial risk to mother, her
fetus and the new born. With these aspects in mind, this study was conducted in order to
explore knowledge regarding malaria disease prevention among pregnant women.
Methodology: A descriptive qualitative study design was used. A convenient sampling
method was employed to recruit 24 pregnant participants from the antenatal clinic. A total of
3 focus group discussions were conducted with 8 participants in each to group.
Results: Data were transcribed, analysed and themes isolated. The findings of the study
revealed that participants were well informed about malaria disease prevention as evidenced
by data that reflected the three pronged approach recommended by the WHO and the MOH
regarding malaria disease prevention during pregnancy. These approaches included the use of
prophylaxis such as sulphur Pyremethium, use of bed nets treated with insecticide and
seeking early treatment of the disease. Further more participants mentioned environmental
hygiene as another preventive measure. Not all women understood the mosquito transfer of
the disease.
Conclusion: Although most women had some understanding of malarial prevention, some
participants had only a partial understanding of disease transmission. For example some
thought they could get malaria by drinking boiled water and that herbs could prevent it. This
partial understanding is a clear sign of a knowledge gap among some of the antenatal clients,
indicating that some of the women were still susceptible to malaria and its potential harm to
the fetus and newborn child.
At the completion of the presentation the audience will
1. Know that the antenatal clients have considerable awareness of preventive measures for
malaria.
2. Appreciate that some of the women in the antenatal clinic only had a partial
understanding of the transmission of the disease and were still susceptible to the disease
3. Recognize that the majority of the women at the antenatal clinic knew the importance of
preventing malaria for their health and baby’s health
Interventions to Provide Improved Patient Care: Session 5
Outcome of Pilot Hypertension Education Intervention with Ugandan
Nurses Working in Primary Care.
Godfrey Katende, Sara Groves, and Kathleen Becker
Non-communicable diseases (NCDs) pose a significant global burden in both developed and
developing countries. It is estimated that by 2025, 41.7% of males and 38.7% of females in
Sub-Saharan Africa will develop high blood pressure (HBP). This is particularly true in
Uganda with hypertensive prevalence rates estimated to range from 22.5% to 30.5%. Coupled
with low levels of detection, treatment and control, hypertension represents a Ugandan public
health crisis. An innovative WHO-ISH education program was adapted culturally and
focused on knowledge, skills and attitudes of nurses caring for hypertensive patients. Prepost intervention data was collected and analysed in which significant improvements were
noted on all the three outcome measures. Through collaborative care and teamwork, Ugandan
nurses can be guided in using evidence-based guidelines and protocols for improved nursing
care services and patients’ outcomes.
At the completion of the presentation, participants will
1. Appreciate the magnitude of hypertension disease burden in Uganda
2. Have knowledge of WHO-ISH education program and how it can be easily adaptable
in a low resource environment
3. Evaluate the visibility of the pilot project
Management of facility based patient transport services in Ankole sub region
John Boscow Barebereho
Background: Transport is not only an expensive resource, but is also critical to effective
health care delivery. A lack of transport and the poor use of existing vehicles can lead to
problems such as difficulties in referring patients between facilities. The study examined the
management of facility-based patient transport by health facilities in Ankole region. The
study was guided by four objectives; to establish the administrative practices; to find out the
performance frameworks used by different health facilities; To explore the existing
performance measures of different health facilities and to explore the challenges associated
with the management of patient transport services in Ankole sub region.
Method: The study used a descriptive survey design with both qualitative and quantitative
approaches. The study data were collected using a structured questionnaire, observation and
record check list. Data was collected from health unit staff and through records review.
Results: The findings showed that there is a positive, moderate and significant relationship
between health unit’s administrative practices R 0.38 (0.05), performance frameworks R 0.58
(p ≤ 0.05), performance measures R 0.68 (p ≤ 0.05) and respondents’ satisfaction with their
patient transport services. All health facilities’ leadership had some administrative practices
targeting proper patient transport services like meetings, allocation of staff, vehicle
maintenance scheduling and controls for vehicle use. There were varying performance
frameworks and measures from health facility to another as reported in this study. All health
facilities’ vehicles were aging with no plan for replacing them, vehicles were being used for
other purposes most of the time (70%), and were consequently un available most of the time,
guidelines for PTS were not available, No specific staff for PTS in most health units
nevertheless patients were being accompanied by qualified staff but untrained in basic life
saving skills, patient transportation records and reporting were rare, faced several challenges
in patient transport.
Conclusion: The study concluded that patient transport administrative practices, performance
frame works and performance measures are positively correlated with improvement of patient
transport services and are hence vital in patient safety and survival. They enable health
facilities and health providers to eliminate various errors thus promoting efficiency in patient
transport services’ management. There were challenges faced by health facilities in
management of patient transport services among others are; aging vehicles with limited
maintenance and inadequate resources for PTS.
Recommendation: The study recommends that health units should institute patient transport
information system to enable evidence based management and continuous quality
improvement. Strengthening and enforcement of administrative practices to improve the
management of patient transport services. Formulations by the ministry of health, a patient
transport services’ guidelines, regulations, performance frameworks and measures that will
help check the poor management, and standardization of Patient Transport Services.
At the completion of the presentation participants will
1. To further disseminate the findings of the study about management of health facility
based patient transport services to the nursing fraternity and all other stakeholders.
2. To share experiences about management of patient transport services in the rural health
facilities.
3. To advocate for the uptake of recommendations by all stakeholders in health services
delivery and management
Multidisciplinary leadership training for undergraduate Nursing students to improve
Uganda Health Care
J. Najjuma, S. Groves, S. Maling. G. Ruzaaza, G. Mugyenyi
Context: The leadership development program (LDP), a key component of Community
Based Education Research and Service, is a platform for embedding progressive
transformative leadership and research related medical education within Uganda. Nursing
students and other health science students in Mbarara University are equipped through this
program with leadership knowledge and skills and a positive attitude toward leadership by
employing interactive learner centred education techniques with opportunity to implement
these in inter professional teams of students in the community.
Objectives: The objective of this study was to evaluate the LDP program at Mbarara
University. This study was part of a mentorship program supported by MEPI-MESAU
(Medical education partnership initiative-Medical education services for all Ugandans) in
which students are funded to conduct supervised research
Methods: The program evaluation of the LDP used quantitative pre/post-test measures and
qualitative data from focus group discussions (FGD) to enrich the evaluation. Data was
collected from students before and after the one week leadership training course using the
same self administered questionnaire. Variables were then compared to evaluate the impact
of LDP. The four FGD were conducted post community placement.
Results: Prior to the intervention, only 14% of the health science students had ever attended a
leadership training session. There was significant change in participants’ skills on analysing
ideas, tasks or process (t = 4.190; p<0.001). Students reported changed attitude about rural
communities and teamwork. Students articulated the importance of implementing their new
leadership skills during the community placement in the focus groups.
Conclusion: Results showed that LDP was instrumental in increasing leadership skills of
nursing students that would be instrumental in the new era of nursing in Uganda.
At the completion of the presentation the audience will
1. Understand the importance of equipping nursing and other health science students with
knowledge, skills and attitudes in leadership
2. Appreciate how important it is to give nursing students opportunities for inter
professional teamwork.
3. To recognize the utility of giving nursing students an immediate opportunity to practice
the leadership skills learned
Incidence and predictors of pregnancy among women receiving HIV care and treatment
at a large urban facility in western Uganda
Jane Kabami, Francis Bajunirwe
Background: HIV infection has been associated with adverse pregnancy outcomes and
substantial mortality even in the early stages of the infection. Counselling is given to HIV
positive women to create awareness and to provide information on the consequences of
pregnancy in HIV infection. The purpose of this study was to determine the incidence of
pregnancy and factors that predict pregnancy among women of reproductive age and
receiving HIV care and treatment at a large urban center in western Uganda.
Methods: We conducted a retrospective cohort study using routine data at the Immune
Suppression Clinic of Mbarara Regional Referral Hospital located in Mbarara District,
western Uganda. The data was collected between January 2006 and June 2010 using a
standard clinic medical form adapted from the Open Medical Record system (Open-MRS)
which is an electronic Database. The primary outcome was incidence of pregnancy calculated
as number of pregnancies per 1000 woman years (WY). Data was analysed by calendar year
and year of enrolment into care and the Cox Proportional Hazards model to determine the
predictors of pregnancy.
Results: The overall incidence rate was 86 pregnancies per 1000 woman years. Incidence
increased significantly from 60 pregnancies per 1000 WY in 2006 to 118 pregnancies per
1000 WY in 2010 (p<0.001). Significant predictors for pregnancy were younger age (HR
9.96 95% CI 6.27-15.8), married (HR 2.03 95% CI 1.65-2.5) and single (HR 1.87 95% CI
1.3-2.7) compared to widowed or separated, lower income (HR 2.47 95% CI 1.42-4.33),
knowing the HIV status of the spouse (HR 1.95, 95%CI 1.16-3.29) compared to not knowing,
use of family planning (HR 0.20 95% CI 0.15- 0.26) was protective against pregnancy. The
survival probability declined as the study proceeded and 80% of women who had ever used
any family planning method were still not pregnant by the end of the follow up period
compared to about 60% among those who had never used family. Factors that did not show
any significant association included religion, WHO disease stage, ARV use, Disclosure status
of the woman, number of HIV positive children and CD4 cell count at enrolment
Conclusion: Incidence of pregnancy among HIV positive women is comparable to that in the
general population. Routine HIV care should integrate reproductive health needs for these
women. There is an increasing trend in incidence of pregnancy among HIV positive women
receiving care at Mbarara Hospital with no significant difference observed between HIV
positive and HIV negative.
At the completion of the presentation the audience will
1. Know the pregnancy incidence rates of HIV positive women in this study
2. Understand the factors that predict pregnancy among these HIV positive women
3. Grasp the importance of integrated reproductive health care for HIV positive women
Nursing Hospital Issues: Section 6
Nurses’ knowledge and practices related to pain assessment in critically ill patients
at Mulago National Hospital, Uganda.
Kizza, I.B., Kohi, T.W., & Nabirye, R.C.
Background: Critically ill patients experience moderate to severe acute pain. If inadequately
managed, acute pain leads to negative physiological and psychological sequelae including the
development of chronic pain syndromes. Optimal pain relief is reliant on nurses’ systematic
and consistent assessment, and regular documentation of pain. Research related to nurses’
knowledge and practices regarding pain assessment in the critical care setting remains
limited, Uganda inclusive. The study was designed to describe nurses’ knowledge, practices
and barriers related to pain assessment for critically ill patients at Mulago National Hospital.
Methodology: A descriptive cross-sectional study design was employed. Data was collected
using a semi-structured questionnaire from 170 nurses working in critical care settings. The
study was approved by IRBs at MUHAS, MakCHS and Mulago Hospital and consent sought
from participants.
Results: Age; < 30 yrs. (83.5%). Majority were females (95.9%) with unit experience < 2
years (46.5%) and nursing experience >10 years of (56.5%). Majorities had diploma level
(88.2%) and were at post operative (54.7%) unit. Ninety per cent of nurses assessed for pain
but few (4%) used pain assessment tools and almost a quarter (21%) of those who assessed
did not document findings. Knowledge deficiency on key pain assessment principles: 43.5%
did not know patients were the most accurate in rating their pain and 44% did not always
agree with patients’ pain ratings.
Barriers to pain assessment include; nursing workload (84.1%), lack of availability of
assessment tools (74.1%), lack of education on assessment tools (82.4%), lack of familiarity
with tools (78.2%) , lack of protocols and guidelines (74.1%), poor documentation (77.6%)
and poor communication of pain assessment priorities at the unit (74.7%).
Conclusion: Pain assessment is done by majority of nurses. However, objective tools are
minimally used. Nurses lack knowledge key pain assessment principles that can affect
practice with poor patient outcomes.
Recommendations: There is need of a multifaceted approach by Ministry of Health,
hospital leadership, nurse leaders, nursing council, clinical nurses and nurse-educators to
conduct a continuous professional education program on pain assessment and design
strategies to address the barriers. A mixed methods research exploring the actual practices is
recommended.
1. At the completion of the presentation the audience will
2. Understand the importance of pain assessment
3. Be able to list some of the barriers identified by the respondents in the study to assessing
pain and communicating outcome
4. Identify actions that nurses can take to maximize the skill and implementation of good
patient pain assessment
Improving The Quality of Nursing Documentation: an Action Research Study
E. Okaisu, F. Kalikwani, G. Wanyana, M. Coetzee
Background: Nursing documentation is a very important function of professional nursing
practice. Numerous barriers and challenges mean that the quality of documentation remains
poor in spite of several improvement efforts.
Objectives: The project set out to improve nurses’ documentation of their assessments at the
CURE Children’s Hospital in Uganda to enhance the quality of nursing practice.
Method: An Action Research methodology, using repeated cycles of planning, intervention,
reflection and modification, was used to establish a best practice approaches for improving
nurses’ efficacy in patient record documentation. In this way, the project evolved over time,
necessitating broader changes in hospital systems and processes to realise documentation
quality in the patient record.
Results: Training of staff alone was not sufficient to achieve the desired project goal.
Broader changes were necessary, including building a critical mass of staff with the necessary
competencies, along with continual education, documentation form redesign, changes in
nurse status mix and continuous leadership support.
Conclusion: Solutions to nursing challenges are complex and demand more holistic
approaches, with evidence-based practice at the foundation, involving changes in systems to
produce visible transformation in practice. The role of leadership in these efforts is vital.
At the completion of the presentation the audience will
1. Understand the importance of quality improvement in improving nurses’ written
documentation
2. Appreciate the use of the Action Research Methodology to establish a best practice
approach
3. Identify approaches to meet the project goal of improved nurses’ notes.
Occupational Stress, Job Satisfaction, And Job Performance Among
Hospital Nurses In Kampala, Uganda
Rose Chalo Nabirye
Occupational stress, a common occurrence among various professions worldwide, is regarded
as a major occupational health problem for healthcare professionals especially nurses.
Occupational stress has been reported to affect job satisfaction and job performance among
nurses, thus compromising nursing care and placing patients’ lives at risk. Stress is a complex
phenomenon resulting from the interaction between individuals and the environment.
Therefore, significant differences in occupational stress, job satisfaction and job performance
among nurses may exist due to different work settings.
The aims of the study were to: 1) examine the relationships between occupational stress, job
satisfaction and job performance among hospital nurses in Kampala City, Uganda; 2)
establish whether personal background characteristics affect the relationships between
occupational stress, job satisfaction and job performance; and 3) examine whether there is a
difference in levels of occupational stress, job satisfaction and job performance by type of
hospital.
A non-experimental correlational design was used in the study. A total of 333 nurses from
four hospitals completed the Nurse Stress Index, the Job Satisfaction Survey, and the SixDimensional Scale of Nurse Performance scales. Study findings demonstrated that there were
significant differences in levels of occupational stress, job satisfaction and job performance
between the public and private not-for- profit hospitals. Nurses in the public hospital reported
higher levels of occupational stress and lower levels of job satisfaction and performance.
There were significant negative relationships between occupational stress and job
performance and between occupational stress and job satisfaction. Nursing experience, type
of hospital, and number of children had a statistically significant relationship with
occupational stress, job satisfaction and job performance. Type of hospital (public versus
private), ward (obstetrics/gynecology versus other ward types), and job satisfaction were
significant predictors of self-rated quality of job performance. Job satisfaction was shown to
mediate the relationship between occupational stress and job performance.
Large scale studies were recommended to identify sources of occupational stress and factors
that enhance job satisfaction among hospital nurses in Uganda. Future research is needed to
examine best practices for human resource managers to improve nurse motivation, job
satisfaction and nurse performance in hospitals.
At the completion of the presentation the audience will
Barriers preventing nurses from documenting patient intervention outcomes at
Mbarara Hospital in Uganda
Jane Kasozi Namagga, Ruby K. Dunlap
Background. Patient care documentation is written or electronically generated information
about a client that describes the care or service provided to that client. It is an essential
component of professional nursing practice. Quality documentation is accurate, clear,
concise, complete and timely. The record of nursing actions and patient responses is used to
facilitate client care, serve as a financial and legal record, help in clinical research, and
support decision analysis. Accurate and complete nursing documentation has been
emphasized in nursing since the Florence Nightingale era in the mid-1800s.
Objective. This study was to explore barriers preventing nurses from documenting the
process and outcomes of nursing interventions.
Method. The study was qualitative in nature based on the Participatory Action Research
(PAR) design. The intent was to use the collective action of the emergency ward nurses,
through focus group discussions, to examine meaningfully ways to change nursing
documentation patterns. This design specifically sought to empower the participants through
the process of evaluating and reflecting on their own practices, then creating and
implementing a user friendly format for nursing documentation. Seven themes were
identified and analyzed using thematic content analysis: Recording patients’ interventions,
continuity of care, patient observations, communicating patient care among nurses,
challenges faced, nursing process, and self value. These were evident and consistent with all
three focus group discussions.
Conclusion. The quality of documentation is a reflection of the standard of nursing
professional practice and an indicator of the skilled and safe practitioner. Effective
documentation is essential to the coordination and continuity of care, and enables personnel
to support and complement one another’s services and avoid duplication and omissions in
care. For nurses to remain viable health care providers, they need to clearly and succinctly
present their unique approach to patient care in the clinical record through documentation.
Therefore Nursing documentation is not optional.
At the completion of the presentation the audience will
1. Describe challenges facing nursing care through documentation
2. Share barriers that are encountered while documenting patients’ care
3. Describe the importance of recording nursing care intervention outcomes.