Browsing by Author "Migisha, Richard"

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    Adverse Maternal Outcomes and Associated Factors Among Mothers of Advanced Age delivering at a Tertiary Hospital, Southwestern Uganda: A Cross-Sectional Study.
    (Kabale University, 2024) Masembe, Sezalio; Migisha, Richard; Turyasingura, Godwin; Aheisibwe, Hillary; Nzabandora, Emmanuel; Lule, John C.
    Background Mothers of advanced age, defined as pregnant women aged≥35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. Methods. We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged≥35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, and medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We define adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery, and immediate post-partum events (obstructed labor, antepartum hemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum hemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. Results Out of 417 participants, most were aged 35–37 years (n=206; 49.4%), and had parity≥5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n=157, 95%CI: 33.1–42.4%). Common adverse maternal outcomes included caesarian delivery (23%) and obstructed labor (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labor (adjusted prevalence ratio [aPR]=1.95, 95%CI: 1.44–2.65), prolonged labor, lasting>12 h (aPR=2.86, 95%CI: 1.48–3.16), and chronic hypertension (aPR=2.01, 95%CI: 1.34–3.9). Conclusion Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labor, precipitate labor, and chronic hypertension were more likely to experience adverse outcomes. We recommend the implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.
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    Distribution of Candida Species Isolated from People Living with Human Immunodeficiency Virus With Oropharyngeal and Oral Candidiasis in Africa in the Era Of Universal Test and Treat Policy: A Systematic Review and Meta-Analysis.
    (Kabale University, 2024) Musinguzi, Benson; Obuku, Ekwaro A.; Mwesigwa, Alex; Migisha, Richard; Kinengyere, Alison Annet; Ndagire, Regina; Baguma, Andrew; Okek, Erick Jacob; Olum, Ronald; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
    Background The introduction of antiretroviral therapy (ART) and the implementation of the human immunodeficiency virus (HIV) universal test and treat (UTT) policy have led to a decline in the incidence of opportunistic infections. However, oropharyngeal and oral candidiasis remain prevalent and continue to pose challenges among people living with human immunodefciency virus (PLHIV) in Africa, indicating the need for a better understanding of the distribution of Candida species responsible for these infections. This systematic review and meta-analysis aimed to determine the distribution of Candida species isolated from PLHIV with oropharyngeal and oral candidiasis in Africa in the era of UTT policy. Methods The review followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted to identify eligible studies to be included in the meta-analysis and analyzed using a random effects model in STATA version 17. The risk of bias was assessed using the Joanna Briggs Institute quality assessment tool. Results Fourteen studies with 4281 participants were included in the review. Overall, 2095 Candida isolates were reported, 78.7% (1650/2095) of which were C. albicans, 19.6% (410/2095), non-albicans Candida (NAC), and 1.7% (35/2095) could not be identified to the Candida specific species level. The most prevalent NAC species were C. glabrate (26.3%), followed by C. tropicalis (24.9%), C. krusei (15.6%), C. parapsilosis (11%), and C. dubliniensis (6.3%). The pooled prevalence of oropharyngeal and oral candidiasis was 48% (95% CI 34–62%). The prevalence of oropharyngeal candidiasis was higher in the pre-UTT era, at 56% (95% CI 40–72%, p<0.001), than in the post-UTT era, at 34% (95% CI 10–67%, p<0.001). The risk of bias assessment revealed that 71.4% (10/14) of the included studies had a low risk of bias and that 28.6% (4/14) had a moderate risk of bias. Conclusions While C. albicans remains, the predominant species causing oropharyngeal and oral candidiasis among PLHIV in Africa, NAC species also contribute significantly to the infection burden. Despite ART and UTT policies, oropharyngeal candidiasis remains prevalent, emphasizing the need for targeted interventions.