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Background: Malaria during pregnancy contributes to significant perinatal morbidity and mortality, accounting for almost 25% of global maternal mortality. However, the epidemiology and risk factors for subclinical malaria among pregnant women living in refugee settlements is poorly understood., Objective: To determine the prevalence and predictors of subclinical malaria among pregnant women in refugee settlements in Northern Uganda., Design: We conducted a multi-center, cross-sectional study., Methods: The study was conducted between April and June 2023 and involved pregnant women aged 18-45 years attending routine antenatal care (ANC) at three health facilities serving refugee communities in Adjumani district, Uganda. We collected sociodemographic, environmental, maternal, and obstetric factors using a structured questionnaire. Both CareStart Malaria HRP-2/pLDH (Pf/Pan) combo rapid diagnostic test (RDT) and blood smear microscopy with 3% Giemsa staining were simultaneously performed on samples from each patient. Logistic regression analysis identified factors independently associated with subclinical malaria, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs)., Results: We enrolled 304 pregnant women, with a mean age of 25 years. In total, 68.8% ( n  = 209) had lived in the settlement for over 12 months, 25.7% ( n  = 78) were primigravida, and 1.0% ( n  = 3) were living with HIV. Malaria prevalence was 5.3% ( n  = 16) by RDT and 3.2% ( n  = 10; seven Plasmodium falciparum and three P. malariae ) by microscopy. Only 4 (25.0%) of the RDT-positive cases were also positive by microscopy (Cohen's kappa: 0.278-Fair agreement). All participants were asymptomatic. Factors associated with higher odds of subclinical malaria included primiparity (aOR: 2.79, 95% CI: 1.25-6.25, p  = 0.013), ⩾4 ANC visits (aOR: 2.41, 95% CI: 1.34-4.34, p  = 0.003), and residence in the settlement for less than 12 months (aOR: 2.54, 95% CI: 2.0-3.22, p  < 0.001). Living in the settlement for over 3 years, being primigravida, and being married were associated with 68%, 50%, and 68% lower odds of subclinical malaria, respectively (aOR: 0.32, 95% CI: 0.13-0.79, p  = 0.014; aOR: 0.50, 95% CI: 1.22-5.52, p  = 0.016; aOR: 0.32, 95% CI: 0.13-0.78, p  = 0.012)., Conclusion: Our study reveals the high prevalence of subclinical malaria among pregnant women in refugee settlements, particularly among primiparous women and recent arrivals. The poor agreement between RDT and microscopy suggests the need for dual screening in asymptomatic pregnant women., (© The Author(s), 2024.)

Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized., Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda., Design: We employed a cross-sectional study design., Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson's moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH., Results: We included 105 participants, most were primigravida ( n  = 100, 43%), aged 15-24 years ( n  = 100, 52%), with term gestation ( n  = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50-600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR -11,182.1-2226.7 ml). Visual estimation underestimated blood loss in 90% of cases ( n  = 100), and 21% ( n  = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r  = 0.1165; p  = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25-34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11-2.30, p  < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20-4.05, p  < 0.012)., Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resource-constrained settings, can significantly reduce the morbidity and mortality associated with PPH., Trial Registration: Not applicable., (© The Author(s), 2024.)