27 results on '"Nakakeeto, Margaret"'
Search Results
2. Setting research priorities to improve global newborn health and prevent stillbirths by 2025.
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Yoshida, Sachiyo, Martines, José, Lawn, Joy E, Wall, Stephen, Souza, Joăo Paulo, Rudan, Igor, Cousens, Simon, neonatal health research priority setting group, Aaby, Peter, Adam, Ishag, Adhikari, Ramesh Kant, Ambalavanan, Namasivayam, Arifeen, Shams Ei, Aryal, Dhana Raj, Asiruddin, Sk, Baqui, Abdullah, Barros, Aluisio Jd, Benn, Christine S, Bhandari, Vineet, Bhatnagar, Shinjini, Bhattacharya, Sohinee, Bhutta, Zulfiqar A, Black, Robert E, Blencowe, Hannah, Bose, Carl, Brown, Justin, Bührer, Christoph, Carlo, Wally, Cecatti, Jose Guilherme, Cheung, Po-Yin, Clark, Robert, Colbourn, Tim, Conde-Agudelo, Agustin, Corbett, Erica, Czeizel, Andrew E, Das, Abhik, Day, Louise Tina, Deal, Carolyn, Deorari, Ashok, Dilmen, Uğur, English, Mike, Engmann, Cyril, Esamai, Fabian, Fall, Caroline, Ferriero, Donna M, Gisore, Peter, Hazir, Tabish, Higgins, Rosemary D, Homer, Caroline Se, Hoque, DE, Irgens, Lorentz, Islam, MT, de Graft-Johnson, Joseph, Joshua, Martias Alice, Keenan, William, Khatoon, Soofia, Kieler, Helle, Kramer, Michael S, Lackritz, Eve M, Lavender, Tina, Lawintono, Laurensia, Luhanga, Richard, Marsh, David, McMillan, Douglas, McNamara, Patrick J, Mol, Ben Willem J, Molyneux, Elizabeth, Mukasa, GK, Mutabazi, Miriam, Nacul, Luis Carlos, Nakakeeto, Margaret, Narayanan, Indira, Olusanya, Bolajoko, Osrin, David, Paul, Vinod, Poets, Christian, Reddy, Uma M, Santosham, Mathuram, Sayed, Rubayet, Schlabritz-Loutsevitch, Natalia E, Singhal, Nalini, Smith, Mary Alice, Smith, Peter G, Soofi, Sajid, Spong, Catherine Y, Sultana, Shahin, Tshefu, Antoinette, van Bel, Frank, Gray, Lauren Vestewig, Waiswa, Peter, Wang, Wei, Williams, Sarah LA, Wright, Linda, Zaidi, Anita, Zhang, Yanfeng, Zhong, Nanbert, Zuniga, Isabel, and Bahl, Rajiv
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neonatal health research priority setting group ,Public Health and Health Services - Abstract
BackgroundIn 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025.MethodsWe used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.ResultsNine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.ConclusionThese findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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- 2016
3. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
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Yoshida, Sachiyo, Martines, José, Lawn, Joy E, Wall, Stephen, Souza, Joăo Paulo, Rudan, Igor, Cousens, Simon, Aaby, Peter, Adam, Ishag, Adhikari, Ramesh Kant, Ambalavanan, Namasivayam, Arifeen, Shams EI, Aryal, Dhana Raj, Asiruddin, Sk, Baqui, Abdullah, Barros, Aluisio JD, Benn, Christine S, Bhandari, Vineet, Bhatnagar, Shinjini, Bhattacharya, Sohinee, Bhutta, Zulfiqar A, Black, Robert E, Blencowe, Hannah, Bose, Carl, Brown, Justin, Bührer, Christoph, Carlo, Wally, Cecatti, Jose Guilherme, Cheung, Po–Yin, Clark, Robert, Colbourn, Tim, Conde–Agudelo, Agustin, Corbett, Erica, Czeizel, Andrew E, Das, Abhik, Day, Louise Tina, Deal, Carolyn, Deorari, Ashok, Dilmen, Uğur, English, Mike, Engmann, Cyril, Esamai, Fabian, Fall, Caroline, Ferriero, Donna M, Gisore, Peter, Hazir, Tabish, Higgins, Rosemary D, Homer, Caroline SE, Hoque, DE, Irgens, Lorentz, Islam, MT, de Graft–Johnson, Joseph, Joshua, Martias Alice, Keenan, William, Khatoon, Soofia, Kieler, Helle, Kramer, Michael S, Lackritz, Eve M, Lavender, Tina, Lawintono, Laurensia, Luhanga, Richard, Marsh, David, McMillan, Douglas, McNamara, Patrick J, Mol, Ben Willem J, Molyneux, Elizabeth, Mukasa, GK, Mutabazi, Miriam, Nacul, Luis Carlos, Nakakeeto, Margaret, Narayanan, Indira, Olusanya, Bolajoko, Osrin, David, Paul, Vinod, Poets, Christian, Reddy, Uma M, Santosham, Mathuram, Sayed, Rubayet, Schlabritz–Loutsevitch, Natalia E, Singhal, Nalini, Smith, Mary Alice, Smith, Peter G, Soofi, Sajid, Spong, Catherine Y, Sultana, Shahin, Tshefu, Antoinette, van Bel, Frank, Gray, Lauren Vestewig, Waiswa, Peter, Wang, Wei, Williams, Sarah LA, Wright, Linda, Zaidi, Anita, Zhang, Yanfeng, Zhong, Nanbert, Zuniga, Isabel, and Bahl, Rajiv
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Public Health ,Health Sciences ,Infant Mortality ,Preterm ,Low Birth Weight and Health of the Newborn ,Pediatric ,Prevention ,Perinatal Period - Conditions Originating in Perinatal Period ,Reproductive health and childbirth ,Good Health and Well Being ,neonatal health research priority setting group ,Public Health and Health Services ,Public health - Abstract
BackgroundIn 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025.MethodsWe used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.ResultsNine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.ConclusionThese findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
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- 2015
4. Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study
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Tann, Cally J., Webb, Emily L., Lassman, Rachel, Ssekyewa, Julius, Sewegaba, Margaret, Musoke, Margaret, Burgoine, Kathy, Hagmann, Cornelia, Deane-Bowers, Eleanor, Norman, Kerstin, Milln, Jack, Kurinczuk, Jennifer J., Elliott, Alison M., Martinez-Biarge, Miriam, Nakakeeto, Margaret, Robertson, Nicola J., and Cowan, Frances M.
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- 2018
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5. Newborn survival in Uganda: a decade of change and future implications
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Mbonye, Anthony K, Sentongo, Miriam, Mukasa, Gelasius K, Byaruhanga, Romano, Sentumbwe-Mugisa, Olive, Waiswa, Peter, Sengendo, Hanifah Naamala, Aliganyira, Patrick, Nakakeeto, Margaret, Lawn, Joy E, and Kerber, Kate
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- 2012
6. Heritability Analysis of Cytokines as Intermediate Phenotypes of Tuberculosis
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Stein, Catherine M., Guwatudde, David, Nakakeeto, Margaret, Peters, Pierre, Elston, Robert C., Tiwari, Hemant K., Mugerwa, Roy, and Whalen, Christopher C.
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- 2003
7. Elevated serum IL-10 is associated with severity of neonatal encephalopathy and adverse early childhood outcomes
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Pang, Raymand, primary, Mujuni, Brian M., additional, Martinello, Kathryn A., additional, Webb, Emily L., additional, Nalwoga, Angela, additional, Ssekyewa, Julius, additional, Musoke, Margaret, additional, Kurinczuk, Jennifer J., additional, Sewegaba, Margaret, additional, Cowan, Frances M., additional, Cose, Stephen, additional, Nakakeeto, Margaret, additional, Elliott, Alison M., additional, Sebire, Neil J., additional, Klein, Nigel, additional, Robertson, Nicola J., additional, and Tann, Cally J., additional
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- 2021
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8. Child Healthcare Workers in Resource-Limited Areas Improve Health with Innovative Low-Cost Projects
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Duncan, Burris, Mandalakas, Anna, Staton, Donna, Anders, Bron, Kurbasic, Mirzada, Nakakeeto, Margaret, Mustafa, Ghulam, Reyes, Alex, and Evangelista, Doris
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- 2012
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9. Pilot randomized trial of therapeutic hypothermia with serial cranial ultrasound and 18-22 month follow-up for neonatal encephalopathy in a low resource hospital setting in uganda: study protocol
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Costello Anthony, Elbourne Diana, Nyombi Natasha, Allen Elizabeth, Acolet Dominique, Hagmann Cornelia F, Robertson Nicola J, Jacobs Ian, Nakakeeto Margaret, and Cowan Frances
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Medicine (General) ,R5-920 - Abstract
Abstract Background There is now convincing evidence that in industrialized countries therapeutic hypothermia for perinatal asphyxial encephalopathy increases survival with normal neurological function. However, the greatest burden of perinatal asphyxia falls in low and mid-resource settings where it is unclear whether therapeutic hypothermia is safe and effective. Aims Under the UCL Uganda Women's Health Initiative, a pilot randomized controlled trial in infants with perinatal asphyxia was set up in the special care baby unit in Mulago Hospital, a large public hospital with ~20,000 births in Kampala, Uganda to determine: (i) The feasibility of achieving consent, neurological assessment, randomization and whole body cooling to a core temperature 33-34°C using water bottles (ii) The temperature profile of encephalopathic infants with standard care (iii) The pattern, severity and evolution of brain tissue injury as seen on cranial ultrasound and relation with outcome (iv) The feasibility of neurodevelopmental follow-up at 18-22 months of age Methods/Design Ethical approval was obtained from Makerere University and Mulago Hospital. All infants were in-born. Parental consent for entry into the trial was obtained. Thirty-six infants were randomized either to standard care plus cooling (target rectal temperature of 33-34°C for 72 hrs, started within 3 h of birth) or standard care alone. All other aspects of management were the same. Cooling was performed using water bottles filled with tepid tap water (25°C). Rectal, axillary, ambient and surface water bottle temperatures were monitored continuously for the first 80 h. Encephalopathy scoring was performed on days 1-4, a structured, scorable neurological examination and head circumference were performed on days 7 and 17. Cranial ultrasound was performed on days 1, 3 and 7 and scored. Griffiths developmental quotient, head circumference, neurological examination and assessment of gross motor function were obtained at 18-22 months. Discussion We will highlight differences in neonatal care and infrastructure that need to be taken into account when considering a large safety and efficacy RCT of therapeutic hypothermia in low and mid resource settings in the future. Trial registration Current controlled trials ISRCTN92213707
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- 2011
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10. Early Childhood Outcomes After Neonatal Encephalopathy in Uganda: A Cohort Study
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Tann, Cally J, Webb, Emily L, Lassman, Rachel, Ssekyewa, Julius, Sewegaba, Margaret, Musoke, Margaret, Burgoine, Kathy, Hagmann, Cornelia; https://orcid.org/0000-0003-2647-9809, Deane-Bowers, Eleanor, Norman, Kerstin, Milln, Jack, Kurinczuk, Jennifer J, Elliott, Alison M, Martinez-Biarge, Miriam, Nakakeeto, Margaret, Robertson, Nicola J, Cowan, Frances M, Tann, Cally J, Webb, Emily L, Lassman, Rachel, Ssekyewa, Julius, Sewegaba, Margaret, Musoke, Margaret, Burgoine, Kathy, Hagmann, Cornelia; https://orcid.org/0000-0003-2647-9809, Deane-Bowers, Eleanor, Norman, Kerstin, Milln, Jack, Kurinczuk, Jennifer J, Elliott, Alison M, Martinez-Biarge, Miriam, Nakakeeto, Margaret, Robertson, Nicola J, and Cowan, Frances M
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Background Neonatal encephalopathy (NE) is a leading cause of global child mortality. Survivor outcomes in low-resource settings are poorly described. We present early childhood outcomes after NE in Uganda. Methods We conducted a prospective cohort study of term-born infants with NE (n = 210) and a comparison group of term non-encephalopathic (non-NE) infants (n = 409), assessing neurodevelopmental impairment (NDI) and growth at 27-30 months. Relationships between early clinical parameters and later outcomes were summarised using risk ratios (RR). Findings Mortality by 27-30 months was 40·3% after NE and 3·8% in non-NE infants. Impairment-free survival occurred in 41·6% after NE and 98·7% of non-NE infants. Amongst NE survivors, 29·3% had NDI including 19·0% with cerebral palsy (CP), commonly bilateral spastic CP (64%); 10·3% had global developmental delay (GDD) without CP. CP was frequently associated with childhood seizures, vision and hearing loss and mortality. NDI was commonly associated with undernutrition (44·1% Z-score < - 2) and microcephaly (32·4% Z-score < - 2). Motor function scores were reduced in NE survivors without CP/GDD compared to non-NE infants (median difference - 8·2 (95% confidence interval; - 13·0, - 3·7)). Neonatal clinical seizures (RR 4.1(2.0-8.7)), abnormalities on cranial ultrasound, (RR 7.0(3.8-16.3), nasogastric feeding at discharge (RR 3·6(2·1-6·1)), and small head circumference at one year (Z-score < - 2, RR 4·9(2·9-5·6)) increased the risk of NDI. Interpretation In this sub-Saharan African population, death and neurodevelopmental disability after NE were common. CP was associated with sensorineural impairment, malnutrition, seizures and high mortality by 2 years. Early clinical parameters predicted impairment outcomes.
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- 2018
11. Perinatal risk factors for neonatal encephalopathy: an unmatched case-control study
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Tann, Cally J, Nakakeeto, Margaret, Willey, Barbara A, Sewegaba, Margaret, Webb, Emily L, Oke, Ibby, Mutuuza, Emmanuel Derek, Peebles, Donald, Musoke, Margaret, Harris, Kathryn A, Sebire, Neil J, Klein, Nigel, Kurinczuk, Jennifer J, Elliott, Alison M, and Robertson, Nicola J
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Male ,Brain Diseases ,Term Birth ,Infant, Newborn ,Infant ,Infant, Newborn, Diseases ,Logistic Models ,Risk Factors ,Pregnancy ,Neonatal Encephalopathy ,Case-Control Studies ,Humans ,Original Article ,Uganda ,Female ,Infection - Abstract
OBJECTIVE: Neonatal encephalopathy (NE) is the third leading cause of child mortality. Preclinical studies suggest infection and inflammation can sensitise or precondition the newborn brain to injury. This study examined perinatal risks factor for NE in Uganda. DESIGN: Unmatched case-control study. SETTING: Mulago National Referral Hospital, Kampala, Uganda. METHODS: 210 term infants with NE and 409 unaffected term infants as controls were recruited over 13 months. Data were collected on preconception, antepartum and intrapartum exposures. Blood culture, species-specific bacterial real-time PCR, C reactive protein and placental histology for chorioamnionitis and funisitis identified maternal and early newborn infection and inflammation. Multivariable logistic regression examined associations with NE. RESULTS: Neonatal bacteraemia (adjusted OR (aOR) 8.67 (95% CI 1.51 to 49.74), n=315) and histological funisitis (aOR 11.80 (95% CI 2.19 to 63.45), n=162) but not chorioamnionitis (aOR 3.20 (95% CI 0.66 to 15.52), n=162) were independent risk factors for NE. Among encephalopathic infants, neonatal case fatality was not significantly higher when exposed to early neonatal bacteraemia (OR 1.65 (95% CI 0.62 to 4.39), n=208). Intrapartum antibiotic use did not improve neonatal survival (p=0.826). After regression analysis, other identified perinatal risk factors (n=619) included hypertension in pregnancy (aOR 3.77), male infant (aOR 2.51), non-cephalic presentation (aOR 5.74), lack of fetal monitoring (aOR 2.75), augmentation (aOR 2.23), obstructed labour (aOR 3.8) and an acute intrapartum event (aOR 8.74). CONCLUSIONS: Perinatal infection and inflammation are independent risk factors for NE in this low-resource setting, supporting a role in the aetiological pathway of term brain injury. Intrapartum antibiotic administration did not mitigate against adverse outcomes. The importance of intrapartum risk factors in this sub-Saharan African setting is highlighted.
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- 2017
12. Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study
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Tann, Cally J, Nakakeeto, Margaret, Hagmann, Cornelia, Webb, Emily L, Nyombi, Natasha, Namiiro, Flaviah, Harvey-Jones, Kelly, Muhumuza, Anita, Burgoine, Kathy, Elliott, Alison M, Kurinczuk, Jennifer J, Robertson, Nicola J, Cowan, Frances M, University of Zurich, and Tann, Cally J
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1114 Paediatrics And Reproductive Medicine ,610 Medicine & health ,2735 Pediatrics, Perinatology and Child Health ,10027 Clinic for Neonatology ,Pediatrics - Abstract
BACKGROUND: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury. METHODS: Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans
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- 2016
13. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial
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Kerber, Kate, Peterson, Stefan, Waiswa, Peter, Lawn, Joy E., Sankoh, Osman, Claeson, Mariam, Pariyo, George, Kallander, Karin, Akuze, Joseph, Namazzi, Gertrude, Ekirapa-Kiracho, Elizabeth, Sengendo, Hanifah, Aliganyira, Patrick, Okuga, Monica, Kemigisa, Margaret, Namutamba, Sarah, Timša, Līga, Marrone, Gaetano, Ekirapa, Elizabeth, Nakakeeto, Margaret, Nakibuuka, Victoria K., Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, Ajeani, Judith, Byaruhanga, Romano N., Tetui, Moses, Forsberg, Birger C., Hanson, Claudia, Kiguli, Juliet, Namusoko, Sarah, Nalwadda, Christine K., Guwatudde, David, Sitrin, Deborah, Guenther, Tanya, Sharma, Srijana, Ashish, KC, Rubayet, Sayed, Bhadra, Subrata, Ligowe, Reuben, Chimbalanga, Emmanuel, Sewell, Elizabeth, and Moran, Allisyn
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neonatal mortality ,newborn health ,essential newborn care ,Newborn Health in Uganday ,care-seeking ,maternal health ,neonatal ,community health worker ,private health care ,community health workers ,kangaroo mother care ,formative research ,antenatal care ,newborn ,sociocultural influences ,postnatal care ,community-based ,Uganda ,traditional birth attendants ,public health care ,postnatal ,birth preparedness ,health policy ,Newborn Health in Uganda ,home visit ,postpartum depression ,health system strengthening ,newborn care ,qualitative ,stillbirth ,referral ,Special Issue: Newborn Health in Uganda ,maternal care ,pregnancy ,pregnancy loss ,randomised controlled trial - Abstract
Background Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design The Uganda Newborn Study (UNEST) was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs) were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth) to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care). Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively). Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively). Half (49.6%) of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in the control arm (p, Background There is a lack of literature on how to adapt new evidence-based interventions for maternal and newborn care into local health systems and policy for rapid scale-up, particularly for community-based interventions in low-income settings. The Uganda Newborn Study (UNEST) was a cluster randomised control trial to test a community-based care package which was rapidly taken up at national level. Understanding this process may help inform other studies looking to design and evaluate with scale-up in mind. Objective This study aimed to describe the process of using evidence to design a community-based maternal and newborn care package in rural eastern Uganda, and to determine the dissemination and advocacy approaches used to facilitate rapid policy change and national uptake. Design We reviewed UNEST project literature including meeting reports and minutes, supervision reports, and annual and midterm reports. National stakeholders, project and district staff were interviewed regarding their role in the study and perceptions of what contributed to uptake of the package under evaluation. Data related to UNEST formative research, study design, implementation and policy influence were extracted and analysed. Results An advisory committee of key players in development of maternal and newborn policies and programmes in Uganda was constituted from many agencies and disciplines. Baseline qualitative and quantitative data collection was done at district, community and facility level to examine applicability of aspects of a proposed newborn care package to the local setting. Data were summarised and presented to stakeholders to adapt the intervention that was ultimately tested. Quarterly monitoring of key activities and events around the interventions were used to further inform implementation. The UNEST training package, home visit schedule and behaviour change counselling materials were incorporated into the national Village Health Team and Integrated Community Case Management packages while the study was ongoing. Conclusions Designing interventions for national scale-up requires strategies and planning from the outset. Use of evidence alongside engagement of key stakeholders and targeted advocacy about the burden and potential solutions is important when adapting interventions to local health systems and communities. This approach has the potential to rapidly translate research into policy, but care must be taken not to exceed available evidence while seizing the policy opportunity., Background Community health workers (CHWs) have been employed in a number of low- and middle-income countries as part of primary health care strategies, but the packages vary across and even within countries. The experiences and motivations of a multipurpose CHW in providing maternal and newborn health have not been well described. Objective This study examined the perceptions of community members and experiences of CHWs around promoting maternal and newborn care practices, and the self-identified factors that influence the performance of CHWs so as to inform future study design and programme implementation. Design Data were collected using in-depth interviews with six local council leaders, ten health workers/CHW supervisors, and eight mothers. We conducted four focus group discussions with CHWs. Respondents included 14 urban and 18 rural CHWs. Key themes explored included the experience of CHWs according to their various roles, and the facilitators and barriers they encounter in their work particular to provision of maternal and newborn care. Qualitative data were analysed using manifest content analysis methods. Results CHWs were highly appreciated in the community and seen as important contributors to maternal and newborn health at grassroots level. Factors that positively influence CHWs included being selected by and trained in the community; being trained in problem-solving skills; being deployed immediately after training with participation of local leaders; frequent supervision; and having a strengthened and responsive supply of services to which families can be referred. CHWs made use of social networks to identify pregnant and newly delivered women, and were able to target men and the wider family during health education activities. Intrinsic motivators (e.g. community appreciation and the prestige of being ‘a doctor’), monetary (such as a small transport allowance), and material incentives (e.g. bicycles, bags) were also important to varying degrees. Conclusions There is a continued role for CHWs in improving maternal and newborn care and linking families with health services. However, the process for building CHW programmes needs to be adapted to the local setting, including the process of training, deployment, supervision, and motivation within the context of a responsive and available health system., Background Promotion of birth preparedness and raising awareness of potential complications is one of the main strategies to enhance the timely utilisation of skilled care at birth and overcome barriers to accessing care during emergencies. Objective This study aimed to investigate factors associated with birth preparedness in three districts of eastern central Uganda. Design This was a cross-sectional baseline study involving 2,010 women from Iganga [community health worker (CHW) strategy], Buyende (vouchers for transport and services), and Luuka (standard care) districts who had delivered within the past 12 months. ‘Birth prepared’ was defined as women who had taken all of the following three key actions at least 1 week prior to the delivery: 1) chosen where to deliver from; 2) saved money for transport and hospital costs; and 3) bought key birth materials (a clean instrument to cut the cord, a clean thread to tie the cord, cover sheet, and gloves). Logistical regression was performed to assess the association of various independent variables with birth preparedness. Results Only about 25% of respondents took all three actions relating to preparing for childbirth, but discrete actions (e.g. financial savings and identification of place to deliver) were taken by 75% of respondents. Variables associated with being prepared for birth were: having four antenatal care (ANC) visits [adjusted odds ratio (ORA)=1.42; 95% confidence interval (CI) 1.10–1.83], attendance of ANC during the first (ORA=1.94; 95% CI 1.09–3.44) or second trimester (ORA=1.87; 95% CI 1.09–3.22), and counselling on danger signs during pregnancy or on place of referral (ORA=2.07; 95% CI 1.57–2.74). Other associated variables included being accompanied by one's husband to the place of delivery (ORA=1.47; 95% CI 1.15–1.89), higher socio-economic status (ORA=2.04; 95% CI 1.38–3.01), and having a regular income (ORA=1.83; 95% CI 1.20–2.79). Women from Luuka and Buyende were less likely to have taken three actions compared with women from Iganga (ORA=0.72; 95% CI 0.54–0.98 and ORA=0.37; 95% CI 0.27–0.51, respectively). Conclusions Engaging CHWs and local structures during pregnancy may be an effective strategy in promoting birth preparedness. On the other hand, if not well designed, the use of vouchers could disempower families in their efforts to prepare for birth. Other effective strategies for promoting birth preparedness include early ANC attendance, attending ANC at least four times, and male involvement., Background In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs. Conclusion Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities., Background In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p, Background Stillbirths do not register amongst national or global public health priorities, despite large numbers and known solutions. Although not accounted in statistics – these deaths count for families. Part of this disconnect is that very little is known about the lived experiences and perceptions of those experiencing this neglected problem. Objective This study aimed to explore local definitions and perceived causes of stillbirths as well as coping mechanisms used by families affected by stillbirth in rural eastern Uganda. Design A total of 29 in-depth interviews were conducted with women who had a stillbirth (14), men whose wives experienced a stillbirth (6), grandmothers (4), grandfathers (1), and traditional birth attendants (TBAs) (4). Participants were purposively recruited from the hospital maternity ward register, with additional recruitment done through community leaders and other participants. Data were analysed using content analysis. Results Women and families affected by stillbirth report pregnancy loss as a common occurrence. Definitions and causes of stillbirth included the biomedical, societal, and spiritual. Disclosure of stillbirth varies with women who experience consecutive or multiple losses, subject to potential exclusion from the community and even the family. Methods for coping with stillbirth were varied and personal. Ritual burial practices were common, yet silent and mainly left to women, as opposed to public mourning for older children. There were no formal health system mechanisms to support or care for families affected by stillbirths. Conclusion In a setting with strong collective ties, stillbirths are a burden borne by the affected family, and often just by the mother, rather than the community as a whole. Strategies are needed to address preventable stillbirths as well as to follow up with supportive services for those affected., Background The first week of life is the time of greatest risk of death and disability, and is also associated with many traditional beliefs and practices. Identifying sick newborns in the community and referring them to health facilities is a key strategy to reduce deaths. Although a growing area of interest, there remains a lack of data on the role of sociocultural norms and practices on newborn healthcare-seeking in sub-Saharan Africa and the extent to which these norms can be modified. Objective This study aimed to understand the community's perspective of potential sociocultural barriers and facilitators to compliance with newborn referral. Method In this qualitative study, focus group discussions (n=12) were conducted with mothers and fathers of babies aged less than 3 months. In addition, in-depth interviews (n=11) were also held with traditional birth attendants and mothers who had been referred by community health workers to seek health-facility-based care. Participants were purposively selected from peri-urban and rural communities in two districts in eastern Uganda. Data were analysed using latent content analysis. Results The community definition of a newborn varied, but this was most commonly defined by the period between birth and the umbilical cord stump falling off. During this period, newborns are perceived to be vulnerable to the environment and many mothers and their babies are kept in seclusion, although this practice may be changing. Sociocultural factors that influence compliance with newborn referrals to seek care emerged along three sub-themes: community understanding of the newborn period and cultural expectations; the role of community health actors; and caretaker knowledge, experience, and decision-making autonomy. Conclusion In this setting, there is discrepancy between biomedical and community definitions of the newborn period. There were a number of sociocultural factors that could potentially affect compliance to newborn referral. The widely practised cultural seclusion period, knowledge about newborn sickness, individual experiences in households, perceived health system gaps, and decision-making processes were facilitators of or barriers to compliance with newborn referral. Designers of newborn interventions need to address locally existing cultural beliefs at the same time as they strengthen facility care., Background Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda. Objective This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices. Design Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable – home visit from a community health worker (CHW) during pregnancy (0, 1–2, 3+) – and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education. Results There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices. Conclusion Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of increasing facility delivery rates to ensure that all babies benefit from these practices.
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- 2015
14. Strengthening health facilities for maternal and newborn care : experiences from rural eastern Uganda
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Namazzi, Gertrude, Waiswa, Peter, Nakakeeto, Margaret, Nakibuuka, Victoria K, Namutamba, Sarah, Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, Ajeani, Judith, Peterson, Stefan, Byaruhanga, Romano N, Namazzi, Gertrude, Waiswa, Peter, Nakakeeto, Margaret, Nakibuuka, Victoria K, Namutamba, Sarah, Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, Ajeani, Judith, Peterson, Stefan, and Byaruhanga, Romano N
- Abstract
BACKGROUND: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. OBJECTIVE: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. DESIGN: This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. RESULTS: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of
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- 2015
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15. Perinatal risk factors for neonatal encephalopathy: an unmatched case-control study.
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Tann, Cally J., Margaret Nakakeeto, Willey, Barbara A., Sewegaba, Margaret, Webb, Emily L., Oke, Ibby, Mutuuza, Emmanuel Derek, Peebles, Donald, Margaret Musoke, Harris, Kathryn A., Sebire, Neil J., Klein, Nigel, Kurinczuk, Jennifer J., Elliott, Alison M., Robertson, Nicola J., Nakakeeto, Margaret, and Musoke, Margaret
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CHILD mortality ,HYPERTENSION in pregnancy ,FETAL monitoring ,POLYMERASE chain reaction ,BRAIN diseases ,NEONATAL diseases ,DURATION of pregnancy ,RESEARCH funding ,LOGISTIC regression analysis ,CASE-control method - Abstract
Objective: Neonatal encephalopathy (NE) is the third leading cause of child mortality. Preclinical studies suggest infection and inflammation can sensitise or precondition the newborn brain to injury. This study examined perinatal risks factor for NE in Uganda.Design: Unmatched case-control study.Setting: Mulago National Referral Hospital, Kampala, Uganda.Methods: 210 term infants with NE and 409 unaffected term infants as controls were recruited over 13 months. Data were collected on preconception, antepartum and intrapartum exposures. Blood culture, species-specific bacterial real-time PCR, C reactive protein and placental histology for chorioamnionitis and funisitis identified maternal and early newborn infection and inflammation. Multivariable logistic regression examined associations with NE.Results: Neonatal bacteraemia (adjusted OR (aOR) 8.67 (95% CI 1.51 to 49.74), n=315) and histological funisitis (aOR 11.80 (95% CI 2.19 to 63.45), n=162) but not chorioamnionitis (aOR 3.20 (95% CI 0.66 to 15.52), n=162) were independent risk factors for NE. Among encephalopathic infants, neonatal case fatality was not significantly higher when exposed to early neonatal bacteraemia (OR 1.65 (95% CI 0.62 to 4.39), n=208). Intrapartum antibiotic use did not improve neonatal survival (p=0.826). After regression analysis, other identified perinatal risk factors (n=619) included hypertension in pregnancy (aOR 3.77), male infant (aOR 2.51), non-cephalic presentation (aOR 5.74), lack of fetal monitoring (aOR 2.75), augmentation (aOR 2.23), obstructed labour (aOR 3.8) and an acute intrapartum event (aOR 8.74).Conclusions: Perinatal infection and inflammation are independent risk factors for NE in this low-resource setting, supporting a role in the aetiological pathway of term brain injury. Intrapartum antibiotic administration did not mitigate against adverse outcomes. The importance of intrapartum risk factors in this sub-Saharan African setting is highlighted. [ABSTRACT FROM AUTHOR]- Published
- 2018
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16. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda
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Namazzi, Gertrude, primary, Waiswa, Peter, additional, Nakakeeto, Margaret, additional, Nakibuuka, Victoria K., additional, Namutamba, Sarah, additional, Najjemba, Maria, additional, Namusaabi, Ruth, additional, Tagoola, Abner, additional, Nakate, Grace, additional, Ajeani, Judith, additional, Peterson, Stefan, additional, and Byaruhanga, Romano N., additional
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- 2015
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17. Prevalence of Bloodstream Pathogens Is Higher in Neonatal Encephalopathy Cases vs. Controls Using a Novel Panel of Real-Time PCR Assays
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Tann, Cally J., primary, Nkurunziza, Peter, additional, Nakakeeto, Margaret, additional, Oweka, James, additional, Kurinczuk, Jennifer J., additional, Were, Jackson, additional, Nyombi, Natasha, additional, Hughes, Peter, additional, Willey, Barbara A., additional, Elliott, Alison M., additional, Robertson, Nicola J., additional, Klein, Nigel, additional, and Harris, Kathryn A., additional
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- 2014
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18. The Uganda Newborn Study (UNEST) : an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial
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Waiswa, Peter, Peterson, Stefan S., Namazzi, Gertrude, Ekirapa, Elizabeth Kiracho, Naikoba, Sarah, Byaruhanga, Romano, Kiguli, Juliet, Kallander, Karin, Tagoola, Abner, Nakakeeto, Margaret, Pariyo, George, Waiswa, Peter, Peterson, Stefan S., Namazzi, Gertrude, Ekirapa, Elizabeth Kiracho, Naikoba, Sarah, Byaruhanga, Romano, Kiguli, Juliet, Kallander, Karin, Tagoola, Abner, Nakakeeto, Margaret, and Pariyo, George
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Background: Reducing neonatal-related deaths is one of the major bottlenecks to achieving Millennium Development Goal 4. Studies in Asia and South America have shown that neonatal mortality can be reduced through community-based interventions, but these have not been adapted to scalable intervention packages for sub-Saharan Africa where the culture, health system and policy environment is different. In Uganda, health outcomes are poor for both mothers and newborn babies. Policy opportunities for neonatal health include the new national Health Sector Strategic Plan, which now prioritizes newborn health including use of a community model through Village Health Teams (VHT). The aim of the present study is to adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and to evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda. Methods/Design: Through formative research around evidence-based practices, and dialogue with policy and technical advisers, we constructed a home-based neonatal care package implemented by the responsible VHT member, effectively a Community Health Worker (CHW). This CHW was trained to identify pregnant women and make five home visits - two before and three just after birth - so that linkages will be made to facility care and targeted messages for home-care and care-seeking delivered. The project is improving care in health units to provide standardized care for the mother and the newborn in both intervention and comparison areas. The study is taking place in a new Demographic Surveillance Site in two rural districts, Iganga and Mayuge, in Uganda. It is a two-arm cluster randomized controlled design with 31 intervention and 32 control areas (villages). The comparison parishes receive the standard care already being provided by the district, but to the intervention villages are added a system for CHWs to visit the mother five times in her home during
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- 2012
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19. The Uganda Newborn Study (UNEST): an effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities - study protocol for a cluster randomized controlled trial
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Waiswa, Peter, primary, Peterson, Stefan S, additional, Namazzi, Gertrude, additional, Ekirapa, Elizabeth Kiracho, additional, Naikoba, Sarah, additional, Byaruhanga, Romano, additional, Kiguli, Juliet, additional, Kallander, Karin, additional, Tagoola, Abner, additional, Nakakeeto, Margaret, additional, and Pariyo, George, additional
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- 2012
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20. Therapeutic hypothermia for birth asphyxia in low-resource settings: a pilot randomised controlled trial
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Robertson, Nicola J, Nakakeeto, Margaret, Hagmann, Cornelia, Cowan, Frances M, Acolet, Dominique, Iwata, Osuke, Allen, Elizabeth, Elbourne, Diana, Costello, Anthony, and Jacobs, Ian
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- 2008
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21. Comparison of Maternal Milk (Breastmilk) Expression Methods in an African Nursery
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Slusher, Tina M., primary, Slusher, Ida L., additional, Keating, Elizabeth M., additional, Curtis, Beverly A., additional, Smith, Eleanor A., additional, Orodriyo, Elizabeth, additional, Awori, Sussane, additional, and Nakakeeto, Margaret K., additional
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- 2012
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22. Pilot randomized trial of therapeutic hypothermia with serial cranial ultrasound and 18-22 month follow-up for neonatal encephalopathy in a low resource hospital setting in uganda: study protocol
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Robertson, Nicola J, primary, Hagmann, Cornelia F, additional, Acolet, Dominique, additional, Allen, Elizabeth, additional, Nyombi, Natasha, additional, Elbourne, Diana, additional, Costello, Anthony, additional, Jacobs, Ian, additional, Nakakeeto, Margaret, additional, and Cowan, Frances, additional
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- 2011
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23. Neuropsychological benefits of computerized cognitive rehabilitation training in Ugandan children surviving cerebral malaria and children with HIV
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Boivin, Michael J, primary, Bangirana, Paul, additional, Tomac, Rachelle, additional, Parikh, Sujal, additional, Opika-Opoka, Robert, additional, Nakasujja, Noeline, additional, Nakakeeto, Margaret, additional, John, Chandy, additional, and Giordani, Bruno, additional
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- 2008
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24. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda.
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Namutamba, Sarah, Namazzi, Gertrude, Waiswa, Peter, Peterson, Stefan, Nakakeeto, Margaret, Nakibuuka, Victoria K., Byaruhanga, Romano N., Najjemba, Maria, Namusaabi, Ruth, Tagoola, Abner, Nakate, Grace, and Ajeani, Judith
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MEDICAL education ,CLINICAL competence ,HEALTH facilities ,PREMATURE infants ,MATERNAL health services ,ORGANIZATIONAL change ,POSTNATAL care ,QUALITY assurance ,RURAL conditions ,SELF-efficacy ,SUPERVISION of employees - Abstract
Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs. Conclusion: Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities. [ABSTRACT FROM AUTHOR]
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- 2015
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- View/download PDF
25. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
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Paul, Vinod, Zuniga, Isabel, Bose, Carl, English, Mike, Williams, Sarah L.A., Mol, Ben Willem J., Poets, Christian, Nacul, Luis Carlos, Souza, Joao Paulo, Molyneux, Elizabeth, Zaidi, Anita, Islam, Luhanga, Richard, Corbett, Erica, Waiswa, Peter, Joshua, Martias Alice, Kramer, Michael S., Clark, Robert, van Bel, Frank, McNamara, Patrick J., Smith, Peter G., Colbourn, Tim, Conde-Agudelo, Agustin, Marsh, David, Dilmen, Ugur, Esamai, Fabian, Soofi, Sajid, Deal, Carolyn, Khatoon, Soofia, Reddy, Uma M., Das, Abhik, Lawintono, Laurensia, Wall, Stephen, Nakakeeto, Margaret, Osrin, David, Keenan, William, Kieler, Helle, Asiruddin, Benn, Christine S., Lackritz, Eve M., Tshefu, Antoinette, Black, Robert E., Irgens, Lorentz, Lawn, Joy E., Cheung, Po-Yin, Higgins, Rosemary D., Bührer, Christoph, Sultana, Shahin, Ferriero, Donna M., Bhattacharya, Sohinee, Homer, Caroline S.E., Gray, Lauren Vestewig, Aryal, Dhana Raj, Aaby, Peter, de Graft-Johnson, Joseph, Rudan, Igor, Narayanan, Indira, Carlo, Wally, Zhong, Nanbert, Martines, José, Adhikari, Ramesh Kant, Lavender, Tina, Bahl, Rajiv, Hoque, Yoshida, Sachiyo, Bhandari, Vineet, Arifeen, Shams E.I., Olusanya, Bolajoko, Czeizel, Andrew E., Bhatnagar, Shinjini, Spong, Catherine Y., Cousens, Simon, Cecatti, Jose Guilherme, Zhang, Yanfeng, Sayed, Rubayet, Santosham, Mathuram, Ambalavanan, Namasivayam, Wang, Wei, Schlabritz-Loutsevitch, Natalia E., Wright, Linda, Singhal, Nalini, Bhutta, Zulfiqar A., Hazir, Tabish, Gisore, Peter, Fall, Caroline, Engmann, Cyril, McMillan, Douglas, Deorari, Ashok, Mutabazi, Miriam, Blencowe, Hannah, Day, Louise Tina, Brown, Justin, Mukasa, Adam, Ishag, Smith, Mary Alice, Baqui, Abdullah, and Barros, Aluisio J.D.
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2. Zero hunger ,1. No poverty ,3. Good health - Abstract
BackgroundIn 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.MethodsWe used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.ResultsNine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.ConclusionThese findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.
26. Setting research priorities to improve global newborn health and prevent stillbirths by 2025
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Yoshida, Sachiyo, Martines, Jose, Lawn, Joy E, Wall, Stephen, Souza, Joao Paulo, Rudan, Igor, Cousens, Simon, Aaby, Peter, Adam, Ishag, Adhikari, Ramesh Kant, Ambalavanan, Namasivayam, El Arifeen, Shams, Aryal, Dhana Raj, Asiruddin, Sk, Baqui, Abdullah, Barros, Aluisio J.D., Benn, Christine S., Bhandari, Vineet, Bhatnagar, Shinjini, Bhattacharya, Sohinee, Bhutta, Zulfiqar A., Black, Robert E., Blencowe, Hannah, Bose, Carl, Brown, Justin, Buehrer, Christoph, Carlo, Wally, Cecatti, Jose Guilherme, Cheung, Po-Yin, Clark, Robert, Colbourn, Tim, Conde-Agudelo, Agustin, Corbett, Erica, Czeizel, Andrew E., Das, Abhik, Day, Louise Tina, Deal, Carolyn, Deorari, Ashok, Dilmen, Ugur, English, Mike, Engmann, Cyril, Esamai, Fabian, Fall, Caroline, Ferriero, Donna M., Gisore, Peter, Hazir, Tabish, Higgins, Rosemary D., Homer, Caroline S.E., Hoque, Dewan E., Irgens, Lorentz, Islam, Mohammad T., de Graft-Johnson, Joseph, Joshua, Martias Alice, Keenan, William, Khatoon, Soofia, Kieler, Helle, Kramer, Michael S., Lackritz, Eve M., Lavender, Tina, Lawintono, Laurensia, Luhanga, Richard, Marsh, David, McMillan, Douglas, McNamara, Patrick J., Mol, Ben Willem J., Molyneux, Elizabeth, Mukasa, Gelasius K., Mutabazi, Miriam, Nacul, Luis Carlos, Nakakeeto, Margaret, Narayanan, Indira, Olusanya, Bolajoko, Osrin, David, Paul, Vinod, Poets, Christian, Reddy, Uma M., Santosham, Mathuram, Sayed, Rubayet, Schlabritz-Loutsevitch, Natalia E., Singhal, Nalini, Smith, Mary Alice, Smith, Peter G., Soofi, Sajid, Spong, Catherine Y., Sultana, Shahin, Tshefu, Antoinette, van Bel, Frank, Gray, Lauren Vestewig, Waiswa, Peter, Wang, Wei, Williams, Sarah L.A., Wright, Linda, Zaidi, Anita, Zhang, Yanfeng, Zhong, Nanbert, Zuniga, Isabel, Bahl, Rajiv, Yoshida, Sachiyo, Martines, Jose, Lawn, Joy E, Wall, Stephen, Souza, Joao Paulo, Rudan, Igor, Cousens, Simon, Aaby, Peter, Adam, Ishag, Adhikari, Ramesh Kant, Ambalavanan, Namasivayam, El Arifeen, Shams, Aryal, Dhana Raj, Asiruddin, Sk, Baqui, Abdullah, Barros, Aluisio J.D., Benn, Christine S., Bhandari, Vineet, Bhatnagar, Shinjini, Bhattacharya, Sohinee, Bhutta, Zulfiqar A., Black, Robert E., Blencowe, Hannah, Bose, Carl, Brown, Justin, Buehrer, Christoph, Carlo, Wally, Cecatti, Jose Guilherme, Cheung, Po-Yin, Clark, Robert, Colbourn, Tim, Conde-Agudelo, Agustin, Corbett, Erica, Czeizel, Andrew E., Das, Abhik, Day, Louise Tina, Deal, Carolyn, Deorari, Ashok, Dilmen, Ugur, English, Mike, Engmann, Cyril, Esamai, Fabian, Fall, Caroline, Ferriero, Donna M., Gisore, Peter, Hazir, Tabish, Higgins, Rosemary D., Homer, Caroline S.E., Hoque, Dewan E., Irgens, Lorentz, Islam, Mohammad T., de Graft-Johnson, Joseph, Joshua, Martias Alice, Keenan, William, Khatoon, Soofia, Kieler, Helle, Kramer, Michael S., Lackritz, Eve M., Lavender, Tina, Lawintono, Laurensia, Luhanga, Richard, Marsh, David, McMillan, Douglas, McNamara, Patrick J., Mol, Ben Willem J., Molyneux, Elizabeth, Mukasa, Gelasius K., Mutabazi, Miriam, Nacul, Luis Carlos, Nakakeeto, Margaret, Narayanan, Indira, Olusanya, Bolajoko, Osrin, David, Paul, Vinod, Poets, Christian, Reddy, Uma M., Santosham, Mathuram, Sayed, Rubayet, Schlabritz-Loutsevitch, Natalia E., Singhal, Nalini, Smith, Mary Alice, Smith, Peter G., Soofi, Sajid, Spong, Catherine Y., Sultana, Shahin, Tshefu, Antoinette, van Bel, Frank, Gray, Lauren Vestewig, Waiswa, Peter, Wang, Wei, Williams, Sarah L.A., Wright, Linda, Zaidi, Anita, Zhang, Yanfeng, Zhong, Nanbert, Zuniga, Isabel, and Bahl, Rajiv
- Abstract
Yoshida, S., Martines, J., Lawn, J. E., Wall, S., Souza, J. P., Rudan, I., ... & Ambalavanan, N. (2016). Setting research priorities to improve global newborn health and prevent stillbirths by 2025. Journal of global health, 6(1), 010508. Available here.
27. Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study.
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Tann CJ, Nakakeeto M, Hagmann C, Webb EL, Nyombi N, Namiiro F, Harvey-Jones K, Muhumuza A, Burgoine K, Elliott AM, Kurinczuk JJ, Robertson NJ, and Cowan FM
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- Brain Injuries diagnostic imaging, Case-Control Studies, Echoencephalography, Female, Humans, Hypoxia physiopathology, Infant, Newborn, Ischemia physiopathology, Male, Referral and Consultation, Risk, Uganda, Brain diagnostic imaging, Brain Diseases diagnostic imaging, Ultrasonography
- Abstract
Background: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury., Methods: Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status., Results: Scans were performed at median age 11.5 (interquartile range (IQR): 5.2-20.2) and 8.4 (IQR: 3.6-13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98-9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61-6.95))., Conclusion: In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia-ischemia (HI). Early abnormalities were a significant predictor of death.
- Published
- 2016
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