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Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients’ records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother’s negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality. [ABSTRACT FROM AUTHOR]

The side effects of antiretroviral (ARV) medications negatively impact patients' quality of life and adherence to treatment. This study describes the burden of side effects from ARV treatment as experienced by a sample of HIV/AIDS patients and identifies the personal strategies they used to cope with the side effects. A total of 166 participants were recruited from a non-governmental HIV/AIDS clinic in Entebbe, Uganda. Most of the participants (76%) were females and the mean age of the sample was 38 years. Although the participants had taken ARV medications for an average period of nine months, a large proportion (76%) could not name the medications they were taking. The mean side-effects burden for the participants was five side effects. The most common adverse effects reported were tiredness, nightmares, mood swings, nausea, poor appetite, insomnia, vomiting and dizziness. The main strategies the patients used for coping with the side effects were those categorised under information-seeking, social-support seeking and positive-emotion-focused coping. However, 27% of the participants reported non-adherence to their ARV medications as a strategy to cope with the side effects. The findings show a significant relationship between the side-effects burden and a patient's age (r = 0.530, p ≤ 0.01) and level of education (r = 0.394, p ≤ 0.01). The findings indicate that in the short term after initiating ARV treatment most patients are able to cope with the high burden of side effects through appropriate strategies, but a sizable portion will fail to cope appropriately and thus resort to non-adherence. Clinicians should assist patients with continuous health education and counselling that focuses on appropriate strategies to cope with the side effects of ARVs in order to buffer the negative impact of HIV treatment on patients' adherence and quality of life. [ABSTRACT FROM AUTHOR]