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Purpose: To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS). Methods: A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. The annual proportions for the ischemic and iatrogenic fistula over the study period were compared. A sub group analysis of women with genitourinary fistula delivered by CS was done to determine the factors associated with iatrogenic fistula. Multivariable log binomial regression was performed to determine the independent risk factors. Results: There were 521 women who presented with genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). The proportions of iatrogenic fistulae increased from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (OR = 5.8; 95% CI: 2.1– 15.4), Repeat CS (OR = 4.1; 95% CI: 1.8– 9.3), CS performed by an intern doctor (OR = 4.8; 95% CI: 1.5– 15.5) and CS done at a Health Centre IV (OR = 4.5; 95% CI: 1.2– 16.7). Conclusion: The magnitude of the iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula. The risk factors for iatrogenic fistula following CS are grandmultiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is a need for continuous training and supervision of lower cadre doctors involved in CS to reduce on the rising trend of iatrogenic fistula. [ABSTRACT FROM AUTHOR]

Background Ureterovaginal fistulae usually follow iatrogenic injury to the ureter during pelvic surgery. This manifests as urine incontinence and results in serious psychosocial effects on women. Ureterovaginal fistulae unlike vesicovaginal fistulae present challenges in diagnosis and management especially in resource-constrained settings. Objective The objective of this study is to describe the magnitude, etiology, diagnosis, management, and outcomes of iatrogenic ureterovaginal fistula in Uganda over a 12-year period. Methods A retrospective review of charts for women who had fistula repair at four fistula repair centers in Uganda from 2010 to 2021 was conducted. The diagnosis of ureterovaginal fistula was made clinically using a history of leakage of urine through the vagina following a pelvic surgery, a negative methylene blue dye test, and a three-swab test. All women were managed using open transvesical ureteral reimplantation with or without a Boari flap. The outcome of surgery was successful fistula repair with urine continence and was determined at two months post-surgery. Results Overall, 477 women were managed for genitourinary fistulae during the study period. Approximately one in every 10 women with genitourinary fistula had an iatrogenic ureterovaginal fistula (n=47, 9.8%). The mean age of women with ureterovaginal fistula was 31.9 (SD: ±11.8) years. The majority of ureterovaginal fistulae (n=33, 70.7%) followed cesarean sections done at general hospitals (n=22, 46.8%) by medical officers (n=32, 68.1%). Clinical assessment was accurate in diagnosing ureterovaginal fistula. Successful fistula repair was achieved in 45 (95.7%) cases. Conclusion Iatrogenic ureterovaginal fistulae are common in Uganda, and most follow cesarean section performed at lower-level health facilities by medical officers. In resource-limited settings where advanced diagnostic techniques are not available or not affordable, simple stepwise clinical evaluation is effective in making a diagnosis. Open ureteral reimplantation with or without a Boari flap has a high successful repair rate., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kajabwangu et al.)

Introduction: Each year, millions of teenagers in low-resource areas experience unintended pregnancies, many of which result in childbirth. These pregnancies often carry an increased risk of negative perinatal outcomes., Objectives: The study determined the prevalence and factors associated with adverse perinatal outcomes among teenagers delivering at a tertiary referral hospital in southwestern Uganda., Methods: This cross-sectional study was carried out in the Department of Obstetrics and Gynecology. We consecutively included all teenagers (13-19 years) in the postnatal ward who delivered. Descriptive statistics were used to summarize demographic and outcome data, and multivariable logistic regression analysis was used to identify factors associated with adverse perinatal outcomes., Results: Overall, 327 participants were enrolled. The mean age was 18.4 (SD 1.1) years, while the mean number of antenatal care (ANC) visits attended was 4.6 (SD 1.9). Less than half delivered by cesarean 136 (41.6%) and 16 (4.9%) were HIV seropositive. Approximately 140 (42.8%) participants had adverse perinatal outcomes, including neonatal death (7, 2.1%), APGAR score at five minutes <7 (44, 13.5%), or low birth weight <2.5 kg (52, 15.9%). ANC attendance was mildly protective against adverse perinatal outcomes (aOR 0.91 (95% CI 1.14, 3.01), p=0.03). Feeling indifferent toward the pregnancy was associated with increased odds of one or more adverse perinatal outcomes compared to feeling happy about the pregnancy (aOR 3.39 (95% CI 1.11, 10.37), p=0.02). Participants with a history of prior miscarriage had increased odds of adverse perinatal outcomes (aOR 9.03 (95% CI 2.45, 25.53), p=0.04)., Conclusions: Nearly half of teenagers experienced adverse perinatal outcomes, and a history of prior miscarriage was a significant risk factor for adverse perinatal outcomes, while ANC was protective. Prospective cohort studies to explore the newborn and child developmental outcomes among children born to teenage mothers are also recommended., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board of Mbarara University of Science and Technology and the Uganda National Council of Science and Technology issued approval 09/05-17 and UNCST HS967ES. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ngonzi et al.)

Introduction: Many female teenagers in low-resource settings conceive, of which half are unplanned and end in many deaths in sub-Saharan Africa, accounting for the majority of the cases. Teenage pregnancy is associated sometimes with poor maternal, newborn, and child deaths., Objectives:  The aim of the study was to determine the prevalence, maternal obstetric outcomes, and factors associated with poor maternal obstetric outcomes among teenage mothers delivering at Mbarara Regional Referral Hospital., Methods:  This was a cross-sectional study carried out in a maternity ward at Mbarara Regional Referral Hospital, where 9,200 mothers deliver annually. All the women coming in for the delivery of their babies were consecutively approached for inclusion in the study. The women were enrolled in the post-delivery ward after delivery and interviewed with pretested questionnaires to capture the sociodemographic, obstetric, and medical profiles of the mothers. Factors were significant if the p - value was <0.05.  Results: Out of the 327 participants, the majority were rural dwellers (68.5%), married (75.8%), attained primary education (69.4%), had not used contraception (89%), and had had a planned pregnancy (63.3%). The prevalence of adverse maternal obstetrical events was 59.9%. The HIV-positive rate was 4.9%, and about half of the participants had delivered by cesarean section (41.6%). The participants' mean age was 18.4 years and SD 1.1. The mean number of antenatal care contacts attended was 4.59 and SD 1.9. The adverse maternal outcomes included episiotomy (30.9%), perineal tear (18.7%), premature rupture of membranes (10.1%), placenta abruption (5.2%), and pre-eclampsia/eclampsia (4%). Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants by 97% (adjusted odds ratio (aOR) (95% CI) of 0.03 (0.02-0.06), p-value<0.001). Having a prior history of a miscarriage was significantly associated with the occurrence of adverse maternal obstetrical events among the participants (aOR (95% CI) of 6.55 (1.46-29.42), p-value0.014)., Conclusions:  Slightly more than half of the teenage mothers had adverse maternal obstetrical outcomes, and a history of a miscarriage in previous pregnancies was significantly associated with adverse maternal obstetrical outcomes. Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants. Teenage mothers are at a high risk of adverse maternal obstetrical outcomes, and close antepartum and intrapartum surveillance is recommended., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board (IRB) of Mbarara University of Science and Technology and Uganda National Council of Science and Technology (UNCST) issued approval with approval numbers (MUST) 09/05-17 and HS967ES, respectively. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Joseph Ngonzi, Wilson Birungi, Onesmus Byamukama, Arnold Kamugisha, Josephine Asiimwe, Moses Ntaro, Grace Nambozi, Leevan Tibaijuka, and Charles Tushabomwe-Kazooba declare(s) a grant from UCoBS. The micro-research was funded by the MUST-IUC Partnership titled ‘University as a facilitator of community-based sustainable solutions to demographic challenges in southwestern Uganda’ hereafter referred to as UCoBS. This is a collaborative partnership project between Mbarara University of Science and Technology (MUST), Vrije Universiteit Brussel (Belgium) and other Flemish Higher Education Institutions funded by the Flemish Interuniversity Council (VLIR UOS) with Grant number UG2021UC043A105. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ngonzi et al.)

Introduction A large number of teenagers in low-resource settings experience pregnancy, with a significant number of these cases happening in sub-Saharan Africa. Teenage pregnancy is associated with unique physical and psychological experiences. Objective To explore the lived experiences of teenage mothers delivering at a tertiary referral hospital in southwestern Uganda. Methods This qualitative study used focus group discussions (FGDs) with teenage mothers in Kasese and Bundibugyo districts in Uganda. We purposively sampled 32 teenage mothers attending a tertiary referral hospital who had been pregnant at least once and had given birth. Sociodemographic information was obtained, and FGDs were conducted to capture the teenagers' experiences transitioning to motherhood. An inductive content analytic approach was used to analyze data.  Results The mean age of the participants was 18.4 (standard deviation [SD], 1.2) years, with the majority (22, 68.8%) being rural dwellers, married (23, 71.9%), unemployed (21, 65.6%), and having attained primary education (23, 71.9%). Teenage mothers' lived experiences were characterized by shattered dreams, concerns about changes in their body size and shape, abandonment and neglect by family members and spouses, considerations of terminating the pregnancy, forced early marriages, family stereotypes, and engaging in sex for survival. The process of transitioning to motherhood occurred along with resilience post-pregnancy and supportive environments from their loved ones, which enabled them to accept reality and care for their children. Conclusions The lived experiences of teenage mothers demonstrated social pressures, fear of abandonment, and poverty as major influences on their mindset and behavior. Further research to gain a comprehensive understanding of the challenges encountered by teenage mothers will aid the development of culturally appropriate strategies to reduce teenage pregnancy and improve perinatal outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Uganda National Council of Science and Technology issued approval HS967ES. Ethical clearance was obtained from the Institutional Review Board (IRB) of MUST 09/05-17 and Uganda National Council of Science and Technology (UNCST) HS967ES. We also followed the ethical principles outlined in the Declaration of Helsinki for medical research involving human subjects (‘World Medical Association Declaration of Helsinki,’ 2013). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ngonzi et al.)