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Objective: To explore pregnancy outcomes at a referral hospital in rural western Uganda.Methods: A retrospective study was undertaken using data for all deliveries at Virika Hospital, Fort Portal, Uganda, between July 1, 2009, and October 22, 2011. A detailed review of delivery logs was conducted. Categories were created for obstetric risk factors (e.g. grand multipara, history of hypertension), maternal delivery complications (e.g. eclampsia, hemorrhage), and neonatal complications (e.g. fetal distress, birth defects).Results: Overall, 4883 deliveries were included. Of the 517 neonates who did not survive, 430 (83.2%) had been stillborn. After controlling for parity, gestational age, obstetric risk factors, and neonatal complications, risk factors for stillbirth included maternal delivery complications (risk ratio [RR] 3.32, 95% confidence interval [CI] 2.34-4.71; P<0.001) and living 51-100km from the hospital (RR 3.37, 95% CI 2.41-4.74; P<0.001). Risk factors for neonatal death included neonatal complications (RR 5.79, 95% CI 2.49-13.46; P=0.001) and maternal delivery complications (RR 3.17, 95% CI 1.47-6.82; P=0.003).Conclusion: Qualified providers need to be deployed to rural areas of Uganda to facilitate the prompt identification and management of pregnancy, delivery, and neonatal complications. [ABSTRACT FROM AUTHOR]

While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53–0.96), sex work (aIRR = 1.38, 95%CI 1.01–1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16–2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17–2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence of maternal near-miss (MNM) and its associated risk factors in a community setting in Central Uganda.Methods: A cross-sectional research design employing multi-stage sampling collected data from women aged 15-49 years in Rakai, Uganda, who had been pregnant in the 3years preceding the survey, conducted between August 10 and December 31, 2013. Additionally, in-depth interviews were conducted. WHO-based disease and management criteria were used to identify MNM. Binary logistic regression was used to predict MNM risk factors. Content analysis was performed for qualitative data.Results: Survey data were collected from 1557 women and 40 in-depth interviews were conducted. The MNM prevalence was 287.7 per 1000 pregnancies; the majority of MNMs resulted from hemorrhage. Unwanted pregnancies, a history of MNM, primipara, pregnancy danger signs, Banyakore ethnicity, and a partner who had completed primary education only were associated with increased odds of MNM (all P<0.05).Conclusions: MNM morbidity is a significant burden in Central Uganda. The present study demonstrated higher MNM rates compared with studies employing organ-failure MNM-diagnostic criteria. These findings illustrate the need to look beyond mortality statistics when assessing maternal health outcomes. Concerted efforts to increase supervised deliveries, access to emergency obstetric care, and access to contraceptives are warranted. [ABSTRACT FROM AUTHOR]

Background: Although under-five (U5) mortality in Uganda has dropped over the past two decades, rates in urban slum neighborhoods remain high. As part of a broader verbal and social autopsy study of U5 deaths, this study explored the perspectives of volunteer community health workers, called Village Health Teams (VHTs), on why children under five in Kampala's informal settlements are still dying despite living in close proximity to nearby health facilities. Methods: This exploratory, qualitative study took place between January and March 2020 in the Rubaga division of Kampala, Uganda. VHTs from the slums of Kawaala and Nankulabye parishes, both located near a large government health center, were interviewed by a trained local interviewer to determine their perceptions of barriers to care-seeking and attribution for U5 childhood deaths. All interviews were audiotaped, transcribed into English, imported into NVivo V 12.0 and thematically analyzed using the Attride-Stirling framework. Results: 20 VHTs were interviewed, yielding two global themes, the first focusing on VHTs perceptions of their role in the community to promote positive health outcomes, and the second focusing on VHTs' perceptions of how prompt care-seeking is disincentivized. Within the latter theme, three inter-related sub-themes emerged: disincentives for care-seeking at the health system level, which can drive negative beliefs held by families about the health system, and in turn, drive incentives for alternative health behaviors, which manifest as "incentivized delays" to care-seeking. Discussion: This study illustrates VHT perspectives on the complex interactions between health system disincentives and the attitudes and behaviors of families with a sick child, as well as the reinforcing nature of these factors. Findings suggest a need for multi-pronged approaches that sensitize community members, engage community and health system leadership, and hold providers accountable for providing high-quality care. VHTs have enormous potential to foster improvement if given adequate resources, training, and support. [ABSTRACT FROM AUTHOR]

A case series of Ugandan women with fistula and other birth injuries suggested that the root causes included social, cultural, and system ‐ based factors. [ABSTRACT FROM AUTHOR]