Nsambya Hospital

Blended oxygen has been shown to reduce severe retinopathy of prematurity (ROP) incidence worldwide, and more recently in Uganda. Although it has been established that ROP-driven visual impairment has a substantial societal burden and that screening and treatment programs are cost-effective in low- and middle-income countries, there is limited evidence for the economic impact of prevention with appropriate oxygen management equipment (OME) in these regions. We performed a cost-utility analysis of OME implementation comparing variations ranging between most and least favorable values. Disability-adjusted life years (DALYs) were calculated with a 3% discount rate. Calculations assumed a 62.1% incidence of visual impairment in untreated severe ROP and a disability weight of 0.184 for severe visual impairment due to ROP. One set of OME costs between $677.50-$1,844.11 USD in Uganda. We found that the cost to prevent one case of ROP-driven severe visual impairment in Uganda ranges from $25.55-$543.99, with a base case (best estimate) of $168.92 per case averted. This reflects 5.18 DALYs averted over the 58-year average Ugandan lifespan and a cost of $4.97-$104.98 to avert one DALY, with a base case of $32.60 per DALY averted. In comparison, prevention of malaria via mosquito net distribution was estimated in a 2020 meta-analysis to cost $50 for every DALY averted. The high-end estimate is roughly 10% of the annual gross domestic product per capita ($1,002.30). Therefore, OME is a cost-effective means to prevent severe visual impairment among infants in Uganda. Implementation of OME in Uganda would also reflect a clear ethical and humanitarian success.

Neonatal units can be stressful for pre-term infants at a time of rapid brain growth and plasticity, which may contribute to poorer developmental outcomes. Environmental modification to protect against negative sensory experiences and provide positive caregiver stimuli is the standard of care, but little is known about practices in low-income settings. We aimed to determine knowledge and practice relating to developmentally-supportive-care in Uganda. A quantitative survey on knowledge and practice of developmentally-supportive-care was conducted with 135 health workers in four neonatal units. In addition, observations of practices and sound measurements were conducted. Only 36% of respondents reported that stress, and 21% that parental interaction can affect brain development, and knowledge of stress reduction was limited. 84% of respondents reported actions to protect infants from excessive light in their unit, 33% from excessive sound, and 69% from sleep disruption. The main perceived benefit of family involvement in care was to reduce parental stress levels (67%), with infection risk perceived as the main negative (71%). Workers at the largest volume facility had the lowest knowledge and practice, with wide variations across facilities. All units had sound readings over recommended levels. Knowledge and practice of DSC in this setting were low and needs to be improved to ensure that pre-terms in this setting both survive and thrive.

<title>Abstract</title> <bold>Background</bold> : Globally, about 26% of women experience maternal near miss (MNM) events during pregnancy or childbirth. MNM events are a crucial indicator for evaluating maternal health services and achieving SDG3 which aims to reduce maternal mortality. The study aimed to determine the predictors of MNM among postnatal mothers at Hoima Regional Referral Hospital. <bold>Methodology:</bold> Study design was cross sectional with a quantitative research approach. Using Cochran’s (1977) formula for sample size computation 289 respondents were assessed and sociodemographic, obstetric and other health related data collected from August to September 2025. Statistical analysis involved chi squares, and logistic regressions through SPSS version 27. P values &lt; 0.05 were considered significant. Ethical approval was obtained from the research ethics committee of Uganda Martyrs University. Other ethical principles like informed consent, anonymity were accordingly upheld. <bold>Results</bold> : Of the assessed mothers, 113/289 (39.1%) were near miss. Underlying causes of maternal near miss were obstetric hemorrhage 54/113 (47.8%), pregnancy‑related infections 30/113 (26.5%), hypertensive disorders 15/113 (13.3%) and other conditions 14/113 (12.3%). Modifiable factors that significantly predicted maternal near miss included having four or fewer ANC visits during pregnancy (AOR = 2.01, [CI: 1.11-3.98], p = 0.047), whereas non modifiable factors that significantly predicted maternal near miss included severe post-partum hemorrhage (AOR = 18.95, [CI: 5.26-68.21], p &lt; 0.001), severe pre-eclampsia (AOR = 4.32, [CI: 3.33-5.57], p &lt; 0.001), sepsis AOR = 5.28, [CI: 7.45-12.22], p = &lt; 0.001) and delivery from the hospital (AOR = 0.23, [CI: 0.08-0.71], p = 0.010). <bold>Conclusion</bold> : The result highlights critical need for targeted intervention to address these leading causes, improve referral system and enhance care for high-risk mothers to eventually reduce the incidence of MNM.

Introduction: The COVID-19 pandemic severely disrupted maternal, neonatal, and child health (MNCH) services in Uganda. In response, digital health tools were rapidly adopted as one of the strategies to restore service delivery. However, the experiences of MNCH professionals implementing these adaptations remain underexplored. This study aimed to explore how MNCH professionals in Uganda experienced the digital tools adaptations made to restore MNCH services during the pandemic. Methods: This qualitative study involved seven in-depth interviews with MNCH professionals in Kampala, Uganda. Participants were purposively sampled based on their direct involvement in digital health adaptations during the pandemic. Data were analysed using qualitative content analysis to explore both manifest and latent meanings in participants’ experiences. Results: One overarching theme emerged: Experiencing digitalisation as a paradox between promise and practice. This was supported by two sub-themes: realising multi-dimensional gains of digitalisation and recognising digitalisation as only ‘part of the puzzle’, and six categories. The results explored how digital tools improved work-life balance, collaboration, and service continuity, they also exposed infrastructural and socioeconomic barriers, particularly in rural and low-income settings. Conclusions: Digital health innovations offer valuable support for MNCH service delivery during public health emergencies. However, their effectiveness is limited by structural inequities and digital exclusion. This underscores the need for context-sensitive strategies that balance technological innovation with persistent structural and clinical realities.

The International Federation of Gynecology and Obstetrics (FIGO) Committee on Health Systems Strengthening and Respectful Care recognizes the detrimental effects of disrespectful and abusive practices within maternity care on maternal and neonatal health outcomes. In response, the committee advocates for the implementation of strategic, evidence‐based interventions aimed at safeguarding women from substandard and disrespectful treatment during pregnancy, childbirth, and the postpartum period. This statement presents FIGO's recommendations for adopting respectful maternity care into health systems. The proposed policy interventions and clinical strategies are designed to foster compassionate, person‐centered, and culturally competent care, thereby contributing to improved maternal and perinatal outcomes globally.

ABSTRACTObjective To identify modifiable intensive care unit factors associated with outcomes among patients receiving invasive mechanical ventilation in a low-income setting.Methods This prospective, multicenter, registry-embedded observational study has two components: a prospective registry-based cohort assessing patient- and care-process-related factors and a cross-sectional intensive care unit survey evaluating organizational structure. Functional intensive care units in Uganda will be included. Patients aged ≥ 15 years old requiring invasive mechanical ventilation will be enrolled. Patients extubated within 48 hours, transferred after > 24 hours, and imminent early death will be excluded. Primary outcomes will include 28-day intensive care unit mortality, intensive care unit length of stay, and mechanical ventilation duration. Tracheostomy-related outcomes will be explored in a pre-planned sub-study. Factors potentially associated with outcomes will be categorized into non-modifiable and potentially modifiable factors. Non-modifiable factors will include patient-related factors like age, comorbidities, and illness severity; potentially modifiable factors include processes of care (e.g., sedation levels) and intensive care unit organizational structure (e.g., staffing patterns). Multilevel multivariable logistic regression models will assess association outcomes. Survival analysis (Kaplan-Meier curves) will explore mortality trends. Confounders will be identified using directed acyclic graphs.Results (anticipated findings) This study will generate high-quality data on modifiable intensive care unit factors associated with ventilated patient outcomes in low-resource settings.Conclusion This is Uganda’s first registry-embedded, multicenter intensive care unit study to systematically potentially modifiable factors associated with ventilated patient outcomes. This study will provide evidence-based insights to optimize critical care management in low- and middle-income countries by leveraging real-time intensive care unit registry data.

ABSTRACTIntroductionNeurodevelopmental delay has been reported among preterm infants who survive beyond the neonatal period. However, there is paucity of data regarding neurodevelopmental outcomes in preterm infants in Africa, including Uganda.ObjectivesThis study aimed at determining the prevalence and factors associated with neurodevelopment delay (NDD) in preterm infants aged 6 to 24 months of adjusted gestation age.MethodsA cross-sectional study was conducted among 206 preterm infants, aged between 6 and 24 months of adjusted gestation age in the preterm follow up clinics at St. Francis Hospital Nsambya and Mulago Specialized Women and Neonatal Hospital in Kampala-Uganda from 1stJanuary 2021 to 1stJanuary 2022.ResultsThe prevalence of NDD was 13.6% (28/206), with social delay comprising 12.1% (25/206), fine motor delay 11.7% (24/206), language delay 10.7% (22/206) and gross motor delay 7.8% (16/206). Factors associated with NDD included microcephaly [aPR=6.2, CI: 2.6-33.5, P=0.0002], severe acute malnutrition (SAM) [aPR=4.6, CI: 1.87-12.56, P=0.021], incomplete immunization [aPR=2.8, CI: 1.23-4.76, P=0.013], neonatal sepsis [aPR=3.8, CI: 1.1-9.3, P=0.026], neonatal hypoglycemia [aPR=6.2, CI: 1.8-16.4, P=0.002], lack of caretaker social support [aPR=8.3, CI: 2.43-37.9, P=0.002] and families with more than 5 children [aPR=6.8, CI: 2.24-22.7, P=0.002]ConclusionsThe 13.6% prevalence of NDD is noteworthy, with the social and fine motor domains affected most. Modifiable factors like malnutrition, lack of caretaker social support and incomplete immunization should be screened and addressed to reduce NDD among preterm infants in Uganda.