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Background/Aims Danger signs are indicators of complications easily recognised by non-clinical personnel that may occur during pregnancy, childbirth or in the postpartum period. Some maternal deaths can be attributed to a lack of information about postnatal danger signs. Most studies on knowledge of danger signs have investigated groups of participants with mixed parities, meaning there is limited research on knowledge among first-time mothers. The aim of this study was to determine first-time mothers’ knowledge of postnatal danger signs and associated factors in Uganda. Methods This was a cross-sectional study that recruited 358 primigravidas. Data on knowledge of postnatal danger signs and the participants’ obstetric and sociodemographic factors were collected through interviewer-administered questionnaires. A multivariable logistic regression model was used to determine factors associated with knowledge of postnatal danger signs. Results Of the 358 participants, 63.4% could name at least one postnatal danger sign. Factors associated with knowledge of postnatal danger signs were having secondary or tertiary education (P=0.002), attending more than four antenatal care visits (PConclusions There is insufficient knowledge of postnatal danger signs among first-time mothers at Tororo General Hospital. First-time mothers require health education as they lack experience and knowledge of danger signs. The use of media sources to convey health information should be strengthened in the healthcare system.

Evidence-based quality care is essential for reducing the high burden of maternal and newborn mortality and morbidity in sub-Saharan Africa. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers. We assessed midwifery care providers’ childbirth and immediate newborn competencies as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire assessing knowledge, and skills drills observations assessing skills and behaviours in the 16 ALERT maternity wards. A total of 302 participants took part in the knowledge assessment and 113 skills drills were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. More than half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn in the skills drills assessment, while higher scores were achieved in active management of the third stage of labour. The assessment also suggested a lack of involvement of women in decision-making, illustrated by the failure to encourage women to ask questions and failing to report clinical findings back to them. Participants furthermore indicated a lack of support from their managers, supervision and access to education and training resources. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly furthermore related to the structural and operational facility characteristics including continuing professional development. Investment and actioning on these findings are needed when developing and designing pre-service and in-service training to ensure women, newborns and families have access to evidence-based and quality midwifery care when needed.Trial registrationPACTR202006793783148—June 17th, 2020.

IntroductionA stillbirth is the death of a baby before or during birth and accounts for about 14 in every 1,000 births globally with the highest rates seen in Sub-Saharan Africa and South Asia. Stillbirth prevention and bereavement care following stillbirth remains a challenge, particularly in Low-Middle Income Countries (LMiC). One approach to improvement is the prioritisation of women/family-centred care. However, there are a large variety of outcomes measured in stillbirth studies and consensus on the outcomes that matter most to women and families is often lacking, which can impact on the ability to make informed decisions about improved care practices. To help mitigate this problem, a core outcome set (COS) has been developed for stillbirth prevention and another COS has recently been finalised for care after stillbirth. Despite the majority of stillbirths occurring in LMiC involvement in these studies is ‘tokenistic’ and therefore the outcomes may not reflect the needs of parents or communities in these settings. The aim is to develop standard sets of outcomes for use in all interventional studies for stillbirth prevention and bereavement care using participants from predominantly Sub-Saharan Africa and South Asia, where the burden of stillbirth is highest.Methods/DesignThis study will involve three stages in the development of the COS: (1) a list of outcomes will be identified from multiple sources, specifically existing reviews of outcomes and a targeted qualitative literature review of studies that have interviewed parents who have experienced stillbirth and healthcare professionals working in this field across Sub-Saharan Africa and South Asia. (2) The list of outcomes will first be reviewed by in-country leads and scored by multiple stakeholder groups in a real-time online Delphi survey. (3) The results of the Delphi will be summarised and discussed at a face-to-face or virtual consensus meeting with representation from all stakeholder groups.DiscussionAs well as improving the consistency of outcomes for future research in an LMiC setting, these COS will harmonise with the existing COS in this field developed in a high income setting. The final output will be a global ‘meta-COS’, a recommended set of outcomes that can be used in stillbirth research worldwide.

Background Stillbirth is an extremely traumatic and distressing experience for parents, with profound and long-lasting negative impacts. Cultural beliefs and practices surrounding death vary considerably across different contexts and groups, and are a key influence on individual experiences, impacting grief, adjustment, and support needs. Few studies have explored cultural influences surrounding stillbirth in an African context. This study explored the influence of cultural beliefs and practices on the experiences of bereaved parents and health workers after stillbirth in urban and rural settings in Kenya and Uganda. Methods A qualitative descriptive study design was employed. Face to face interviews were conducted with parents (N = 134) who experienced a stillbirth (≤ 1 year) and health workers (N = 61) at five facilities in Uganda and Kenya. Interviews were conducted in English or the participants’ local language, audio-recorded and transcribed verbatim. Analysis was conducted using descriptive thematic analysis. Results Commonalities in cultural beliefs and practices existed across the two countries. Three main themes were identified: 1) Gathering round, describes the collective support parents received from family and friends after stillbirth. 2)‘It is against our custom’ addresses cultural constraints and prohibitions impacting parents’ behaviour and coping in the immediate aftermath of the baby’s death. 3) ‘Maybe it’s God’s plan or witchcraft’ summarises spiritual, supernatural, and social beliefs surrounding the causes of stillbirth. Conclusions Kinship and social support helped parents to cope with the loss and grief. However, other practices and beliefs surrounding stillbirth were sometimes a source of stress, fear, stigma and anxiety especially to the women. Conforming to cultural practices meant that parents were prevented from: holding and seeing their baby, openly discussing the death, memory-making and attending the burial. The conflict between addressing their own needs and complying with community norms hindered parents’ grief and adjustment. There is an urgent need to develop culturally sensitive community programmes geared towards demystifying stillbirths and providing an avenue for parents to grieve in their own way.

Background We aim to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care. Methods Using an explanatory sequential mixed method design we will employ three methods (i) a survey will be conducted using self-administered questionnaires assessing knowledge, (ii) skills drills assessing basic intrapartum skills and attitudes, using an observation checklist and (iii) Focus Group Discussions (FGDs) to explore midwifery care providers’ experiences and perceptions of in-service training. All midwifery care providers in the study facilities are eligible to participate in the study. For the skills drills a stratified sample of midwifery care providers will be selected in each hospital according to the number of providers and, professional titles and purposive sampling will be used for the FGDs. Descriptive summary statistics from the survey and skills drills will be presented by country. Conventional content analysis will be employed for data analysis of the FGDs. Discussion We envision comparative insight across hospitals and countries. The findings will be used to inform a targeted quality in-service training and quality improvement intervention related to provision of basic intrapartum care as part of the ALERT project. Trial registration: PACTR202006793783148—June 17th, 2020.

Objective To explore parents' lived experiences of care and support following stillbirth in urban and rural health facilities. Design Qualitative, interpretative, guided by Heideggerian phenomenology. Setting Nairobi and Western Kenya, Kampala and Central Uganda. Sample A purposive sample of 75 women and 59 men who had experienced the stillbirth of their baby (≤1 year previously) and received care in the included facilities. Methods In-depth interviews, analysed using Van Manen's reflexive approach. Results Three main themes were identified; parents described devastating impacts and profound responses to their baby's death. Interactions with health workers were a key influence, but poor communication, environmental barriers and unsupportive facility policies/practices meant that needs were often unmet. After discharge, women and partners sought support in communities to help them cope with the death of their baby but frequently encountered stigma engendering feelings of blame and increasing isolation. Conclusions Parents in Kenya and Uganda were not always treated with compassion and lacked the care or support they needed after the death of their baby. Health workers in Kenya and Uganda, in common with other settings, have a key role in supporting bereaved parents. There is an urgent need for context and culturally appropriate interventions to improve communication, health system and community support for African parents. Tweetable abstract Health-system response and community support for parents after stillbirth in Kenya and Uganda are inadequate.

Background: Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents’ needs. However, very few studies have explored health worker’s experiences in these settings.\ud Aim: To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda.\ud Methods: Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda,\ud were interviewed. Data were analysed following Van Manen’s reflexive approach.\ud Results: Three main themes summarised participants’ experiences: ‘In the mud and you learn to swim in it’ reflected a perceived of lack of preparation; skills were gained through experience and often without adequate support. The emotional and psychological impacts including sadness, frustration, guilt and shame were summarised in ‘It’s bad, it’s a sad experience’. Deficiencies in organisational culture and support, which entrenched blame, fear and negative behaviours were encapsulated in Nobody asks ‘how are you doing?’.\ud Conclusion: Health workers in Kenya and Uganda were deeply sensitive to the impacts of stillbirth for women and families, and often profoundly and personally affected. Care and psychological support were acknowledged as often inadequate. Interventions to support improved bereavement care in sub-Saharan Africa need to target increasing health worker knowledge and awareness and also embed supportive organisational cultures and processes.

Background: Contraceptive adherence is the current and consistent use of a contraceptive method as prescribed by a health worker or family planning provider so as to prevent pregnancy. Globally, adherence is lowest among adolescents. This has greatly contributed to the high burden of adolescent pregnancies. Adherence and reasons for discontinuation among refugee adolescents are poorly understood. The aim of this study was to determine the rates and predictors of adherence to modern contraceptives among female refugee adolescents in northern Uganda.Methods: A prospective single cohort study, nested into a randomised controlled trial (RCT) assessing the effect of peer counselling on acceptance of modern contraceptives. The RCT was conducted among female refugee adolescents in Palabek refugee settlement, northern Uganda. The study involved 272 new starters of modern contraceptives who were followed up for six months from May 2019 to January 2020. The outcome was measured at one, three and six months after receiving a contraceptive method. Data was analysed using STATA version 14.0.Results: Adherence rates were low and reduced over time. By the end of the six months, only 44% of the participants were using a contraceptive method. The commonest reasons for non-adherence were side effects and partner prohibition. Participants using long acting reversible contraceptives (LARC) were more likely to adhere compared to those who were using short acting reversible contraceptives (SARC) (OR: 3.37, 95% CI: 1.914-5.937, p=Conclusion: Adherence to modern contraceptives was low, leaving adolescents at risk of unintended pregnancies. Participants using LARC were more likely to adhere than those using SARC. Interventions addressing fear of side effects and partner prohibition should be studied and implemented to enable adherence to modern contraceptives.

Strengthening the capacity of midwives and nurses in low- and middle-income countries to lead research is an urgent priority in embedding and sustaining evidence-based practice and better outcomes for women and newborns during childbearing. International and local travel restrictions\ud and physical distancing resulting from the COVID-19 pandemic has compromised the delivery of many existing programmes and challenged international partnerships working in maternal and newborn heath to adapt rapidly. In this paper, we share the experiences of a midwife-led research partnership between Kenya, Malawi, Tanzania, Uganda, UK, Zambia and Zimbabwe in sustaining and enhancing capacity strengthening activities remotely in this period. Whilst considerable challenges arose, and not all were overcome, collectively we gained new insights and important learning which have shifted perspectives and will impact future design and delivery of learning programmes.\ud Keywords: Capacity-strengthening, midwifery, nursing, sub-Saharan Africa, COVID-19, global health

Background Birth asphyxia is one of the leading causes of intrapartum stillbirth and neonatal mortality worldwide. We sought to explore the experiences of health care workers in managing foetal distress and birth asphyxia to gain an understanding of the challenges in a low-income setting. Methods We conducted in-depth interviews with 12 midwives and 4 doctors working in maternity units from different health facilities in Northern Uganda in 2018. We used a semi-structured interview guide which included questions related to; health care workers’ experiences of maternity care, care for foetal distress and birth asphyxia, views on possible preventive actions and perspectives of the community. Audio recorded interviews were transcribed verbatim and analysed using inductive content analysis. Results Four categories emerged: (i) Understanding of and actions for foetal distress and birth asphyxia including knowledge, misconception and interventions; (ii) Challenges of managing foetal distress and birth asphyxia such as complexities of the referral system, refusal of referral, lack of equipment, and human resource problems, (iii) Expectations and blame from the community, and finally (iv) Health care worker’ insights into prevention of foetal distress and birth asphyxia. Conclusion Health care workers described management of foetal distress and birth asphyxia as complex and challenging. Thus, guidelines to manage foetal distress and birth asphyxia that are specifically tailored to the different levels of health facilities to ensure high quality of care and reduction of need for referral are called for. Innovative ways to operationalise transportation for referral and community dialogues could lead to improved birth experiences and outcomes.

Background: In Uganda, perinatal mortality is 38 per 1000 pregnancies. One-third of these deaths are due to birth asphyxia. Adequate fetal heart rate (FHR) monitoring during labor may detect birth asphyxia but little is known about monitoring practices in low resource settings. Objective: To explore FHR monitoring practices among health workers at a public hospital in Northern Uganda. Methods: A sequential explanatory mixed methods study was conducted by reviewing 251 maternal records and conducting 11 interviews and two focus group discussions with health workers complemented by observations of 42 women in labor until delivery. Quantitative data were summarized using frequencies and percentages. Content analysis was used for qualitative data. Results: FHR was assessed in 235/251 (93.6%) of records at admission. Health workers documented the FHR at least once in 175/228 (76.8%) of cases during the first stage of labor compared to observed 17/25 (68.0%) cases. Median intervals between FHR monitoring were 30 (IQR 30–120) minutes in patients’ records versus 139 (IQR 87–662) minutes according to observations. Observations suggested no monitoring of FHR during the second stage of labor but records indicated monitoring in 3.2% of cases. Reported barriers to adequate FHR monitoring were inadequate number of staff and monitoring devices, institutional challenges such as few beds, documentation problems and perceived non-compliant women not reporting for repeated checks during the first stage of labor. Health workers demonstrated knowledge of national FHR monitoring guidelines and acknowledged that practice was different. Conclusions: When compared to national and international guidelines, FHR monitoring is sub-optimal in the studied setting. Approximately one in four women was not monitored during the first stage of labor. Barriers to appropriate FHR monitoring included shortage of staff and devices, institutional challenges and mother’s negative attitudes. These barriers need to be addressed in order to reduce neonatal mortality.

Introduction: Disrespectful and undignified care during childbirth is a global challenge, particularly in less developed countries. Despite the increase in health facility births, women continue to suffer from disrespect and abuse during childbirth. This practice counters the efforts to encourage women to deliver in health facilities by a skilled birth attendant as a strategy to reduce maternal and neonatal mortality. The purpose of the study was to explore midwives' understanding of respectful maternity care and observe how their practice conforms to this concept. Methods: We conducted a qualitative study combining one-on-one interviews and observation methods of data collection. In-depth interviews were conducted with 17 midwives and 20 observations were done. Audio-recorded data were later transcribed verbatim and analyzed using the content analysis method. Observation data was summarized into a table 2 below.Results: Midwives understood respectful maternity care (RMC) as treating women with respect, dignity, politeness, providing information to clients, and ensuring privacy and confidentiality. However, there was a discrepancy between their understanding of RMC and what they practiced. They also lacked an in-depth understanding of the domains of RMC. Conclusion: There is a need to strengthen midwife's knowledge and skills to enable them to provide respectful maternity services. We recommend in-service training and mentoring to equip midwives with knowledge and skills to offer RMC. Also, RMC should be integrated into pre-service curricula for midwifery and nursing training in Uganda. Furthermore, efforts should be put in to strengthen health systems, and support healthcare providers to provide RMC. More research is needed into locally relevant solutions to promote respectful maternity care.

Background: Working women often feel unable to practise exclusive breastfeeding if they return to work early. Expressing breast milk is an option to ensure exclusive breastfeeding. Aims: The aim of this study was to explore the working mothers' knowledge, perceptions and breast milk expression practices. Methods: A descriptive cross-sectional study design was used to administer a structured questionnaire to 217 working breastfeeding mothers attending the postnatal clinic at Mulago Hospital, Uganda. Simple random sampling was used to select women who consented before completing the questionnaire. Data was analysed using descriptive statistics. Findings: The respondents (79.3%) were knowledgeable about breast milk expression but only a few knew about the storage and use of expressed breast milk. Breast milk expression was not practised by most of the mothers (73.7%), and the majority (64.5%) did not like to express breast milk, raising doubts on acceptability, hygiene and safety. Chi-square (χ2) tests showed an association between breast milk expression and level of education (χ2=5.595; P=0.018), occupation (χ2=4.678, P=0.031), infant feeding practices (χ2=9.617; P=0.002), knowledge (χ2=16.97; P2=13.772; PConclusions: The results highlighted important knowledge gaps about breast milk expression. There is a need to design and implement interventions to sensitise and support women to express breast milk for continued exclusive breastfeeding.

Background: Although it is a cost effective tool in labour management, the partograph is not always used appropriately. The aim of this audit was to assess the initiation and completion of the partograph for women in labour at Mulago Hospital. Methods: A criteria-based audit was conducted, using patients’ files and delivery records from February to May 2016. A checklist was used to gather data and descriptive statistics computed. Findings: Of 7170 files, 256 (3.57%) had the partograph initiated. The recording of maternal wellbeing was low. For example, pulse was recorded in 20% of cases and blood pressure in 35%. Recording of vaginal examination results was 90% on admission but reduced to 57% in the first stage of labour. Similarly, recording of fetal heart rate in the first stage of labour was 62%. Conclusions: Partograph initiation was unacceptably low. Maternal well-being documentation was generally low compared to the set standard. There is need to strengthen the use of a partograph to improve care during labour

Background/aims Intimate partner violence during pregnancy is associated with adverse health outcomes for mothers and their unborn babies. Whereas the literature on intimate partner violence in the general population is extensive, little is known about this type of violence among pregnant teenagers, especially in resource-limited settings. This study aimed to determine the prevalence and factors associated with intimate partner violence among pregnant teenagers attending antenatal care clinics in Lira District, northern Uganda. Methods This was a cross-sectional study of 310 pregnant teenagers attending antenatal care clinics at the Lira Regional Referral Hospital and Ogur Health Center IV. Eligible teenagers were recruited consecutively until the required sample size was accrued. Data were collected using a structured questionnaire. Intimate partner violence was determined using the Revised Conflict Tactile Scale 2. Logistic regression analysis was performed to identify factors associated with violence during pregnancy, while considering potential confounding factors. Results The overall prevalence of intimate partner violence among pregnant teenagers was 40.6%. The prevalence of psychological violence was 37.1%, sexual assault was 29%, and physical violence was 24.8%. Partner alcohol intake (odds ratio=5.00, P=0.000); polygamy (odds ratio=2.80, P=0.001) and the inability of the teenage mother to make major decisions in the home (odds ratio=2.42, P=0.006) were independently associated with intimate partner violence during pregnancy. Conclusions Approximately 4 in 10 pregnant teenagers in Lira district, northern Uganda experienced intimate partner violence. This is higher than has been reported in the general population of pregnant women in Uganda. Intimate partner violence screening and counselling should be part of the routine antenatal care package.

Background: Intimate partner violence (IPV) during pregnancy is associated with adverse health outcomes for the mother and her unborn baby. Whereas the literature on IPV in the general population is extensive, little is known about IPV among pregnant teenagers especially in resource limited settings. This study determined the prevalence and factors associated with IPV among pregnant teenagers attending antenatal care clinics (ANC) in Lira District, Northern Uganda. Methods: This was a cross-sectional study of 310 pregnant teenagers attending ANC at Lira regional referral hospital and Ogur health center IV. Eligible teenagers were recruited consecutively until the required sample size was accrued. Data was collected using a structured questionnaire. IPV was determined using the Revised Conflict Tactile Scale (CTS2) screening tool. Logistic regression analysis was performed to identify factors associated with IPV during pregnancy while considering potential confounding factors. Results: The overall prevalence of IPV among pregnant teenagers was 40.6% [95% CI: 35.13-46.34]. The prevalence of psychological violence was 37.1%, [95% CI: 31.70-42.74]; sexual assault 29%, [95% CI: 24.04-34.43] and physical violence was 24.8%, [95% CI: 20.13-30.04]. Partner alcohol intake (OR=5.00, 95%CI: 2.87-8.71, P =0.000); polygamy (OR=2.80, 95%CI: 1.49-5.23, p=0.001); and inability to make major decision in the home by the teenage mother (OR=2.42, 95%CI: 1.29-4.54: P=0.006); were independently associated with IPV during pregnancy. Conclusion: About 4 in 10 of pregnant teenagers in Lira district, Northern Uganda experience IPV. This is higher than what has been reported in the general population of pregnant women in Uganda. Teenagers were more likely to experience IPV if they were in a polygamous relationship, were unable to make major decisions in the home and had an alcoholic partner. IPV screening and counselling should be part of the routine antenatal care package. Key words; Intimate partner violence, teenage pregnancy, factors associated.

Introduction: Preterm birth, a leading cause of neonatal mortality accounts for 35 percent of all neonatal deaths worldwide. Uganda's high preterm birth rate of 13.6 per 1000 live births ranks 28th in the world. Efforts at reducing these pre-term births must entail interventions that target any associated risk factors. This study therefore aimed at identifying and describing the risk factors for preterm births among mothers delivering in Mulago Hospital. Methods: This was a case control study among postpartum women in Mulago Hospital. Ninety nine women with preterm newborns were recruited as cases and 193 with full term babies were the controls. A semi-structured questionnaire was used to collect data. Data was entered into Epidata version 3.1 and exported to STATA 11 for univariate analysis and multivariate analysis by logistic regression. Results: Risk factors for preterm birth included maternal height less than 1.5 meters (OR 131.08 (20.35-844.02)), rural residence (OR 6.56(2.68-16.10)) and failure to attend antenatal care clinic (OR 8.88(1.44-54.67)). Pregnancy related risk factors included PPROM (OR 287.11(49.26-1673.28)), antepartum haemorrhage (OR 7.33(1.23-43.72)) and preeclampsia/eclampsia (OR 16.24(3.11-84.70)). Conclusion: Preterm birth is more likely to occur in women of short stature, living in rural areas and those who do not attend antenatal care clinic. The preterm birth risk is higher for women who get PPROM, APH and preeclampsia/eclampsia in pregnancy. Early recognition and management of these high risk conditions among pregnant women may lead to a reduction in preterm birth rates. Keywords: Preterm birth, postpartum, risk factors, newborn, Uganda

Male involvement in pregnancy and labour care has been shown to improve maternal and newborn outcomes. Nevertheless, it continues to be low, especially in low income countries. Several interventions have been suggested for supporting male involvement in reproductive health and maternity care, but no assessment has been made in terms of their effectiveness. The objective of this review was to summarise and evaluate the current evidence related to male partner involvement in maternal health. Three databases were searched electronically. This review included two randomised controlled trials and two observational studies. Two interventions emerged from the review: facility-based couple health education and workplace-based health education. These interventions showed positive outcomes regarding the presence of partners during antenatal visits, postpartum visits, childbirth, and the initiation of breastfeeding within one hour of birth among others. More rigorous research is needed into strategies for, and the effect of, including men in maternal and newborn health.

Word Count 117 Nurses increasingly form global health partnerships through academic and voluntary organizations that are designed to improve health outcomes. Many such partnerships are funded for specific time periods and have short or long term goals to achieve during the partnership. Other partnerships are sustained for longer periods of time through the efforts of partners committed to their joint work. The case example of the Health Volunteers Overseas (HVO) Nursing Education partnership in Kampala Uganda demonstrates key components of partnerships that promote sustainability of programs. This case example is analyzed using literature that reports partnership models to identify those factors that have led to sustainability. Additionally, both objective and subjective program outcomes are reported. Recommendations for further evaluation are included.

Background. Birth asphyxia is the leading cause of neonatal mortality in Kenya. Quality care during neonatal resuscitation (NR) can contribute to a reduction in neonatal mortality related to birth asphyxia by 30 percent. This study assessed the quality of care (QoC) during NR for newborns with birth asphyxia. Methods. Direct observations of 138 newborn resuscitations were done in labor ward and maternity theatre. Twenty-eight healthcare providers were observed 3–5 times using a structured checklist. Descriptive and inferential statistics were calculated and quality of care scores computed. Ordered logistic regression model identified HCPs characteristics associated with the QoC scores during NR. Results. Overall QoC scores were good for airway clearance (83%). Suctioning in meconium presence (40%) was poorly performed. Years of experience working in maternity were associated with good drying/stimulation (β = 1.86, P=0.003, CI = 0.626–3.093) and airway maintenance (β = 1.887, P=0.009, CI = 0.469–3.305); nurses were poor compared to doctors during initial bag and mask ventilation (β = −2.338, P=0.05, CI = −4.732–0.056). Conclusion. Key steps in NR are poorly performed during drying and warmth, airway maintenance in meconium presence, and ventilation. Mentorship with periodic refresher training can improve the care provided during NR.

In Uganda, the prevalence of non-adherence to antiretroviral therapy (ART) by HIV/AIDS patients remains high and sometimes this is blamed on patients' religious behavior. A descriptive design was used to examine the relationship between religiosity and ART adherence in a sample of 220 patients attending a HIV/AIDS clinic in a Ugandan public hospital. Participants who self-identified as Pentecostal and Muslim had the highest percentage of members with high religiosity scores and ART adherence. Among Muslim participants (34), 82% reported high religiosity scores and high levels of ART adherence. Of the fifty Pentecostals participants, 96% reported high religiosity scores and 80% reported high levels of ART adherence. Correlation analysis showed a significant relationship between ART adherence and religiosity (r = 0.618, P ≤ 0.01). Therefore, collaboration between religious leaders and HIV/AIDS healthcare providers should be encouraged as one of the strategies for enhancing ART adherence.

To eliminate mother to child transmission of HIV, existing interventions might need to be scaled-up and rigorously implemented. One of the strategies to reduce vertical transmission of HIVis the 4-6weeks daily single oral dose ofNevirapine (NVP) or Zidovidinerecommended for newbornsto HIV positive mothers. Maternal optimal adherence to these anti-retroviral prophylaxis regimens is imperative to prevention of vertical transmission of HIV. Limited studies investigated maternal adherence to infant’s NVP prophylaxis regimen and associated factors. This study examined the level and factors influencing maternal adherence to infant’s NVPprophylaxis regimenat six weeks of age. Maternal adherence to infant’s NVP regimen was defined as dispensation of 95% of the total daily single dose of NVPsuspension to infants at 6 weeks of age. Maternal adherence, socio-demographic and psychosocial factors were measured using a pre-tested questionnaire. Bivariate analysis and binary logistic regression model were used to determine the level and factors influencing maternal adherence to infant’s NVP regimen respectively. Results showed that 77% of the mothers had optimal adherence. Maternal age ≥ 20 years and believe in the effectiveness of NVP in prevention of vertical transmission of HIV were associated with increased likelihood of adherence to infants NVP regimen (OR 6.18; 95% CI: 1.64-23.24) and (OR 12.69; 95% CI 3.07-52.44) respectively.In conclusion maternal maturity and perceived benefits of NVP seems to be important positive drivers of optimal adherence. This suggests the importance of considering psychosocial and demographic characteristics of mothers in policy and intervention designing.

The side effects of antiretroviral (ARV) medications negatively impact patients' quality of life and adherence to treatment. This study describes the burden of side effects from ARV treatment as experienced by a sample of HIV/AIDS patients and identifies the personal strategies they used to cope with the side effects. A total of 166 participants were recruited from a non-governmental HIV/AIDS clinic in Entebbe, Uganda. Most of the participants (76%) were females and the mean age of the sample was 38 years. Although the participants had taken ARV medications for an average period of nine months, a large proportion (76%) could not name the medications they were taking. The mean side-effects burden for the participants was five side effects. The most common adverse effects reported were tiredness, nightmares, mood swings, nausea, poor appetite, insomnia, vomiting and dizziness. The main strategies the patients used for coping with the side effects were those categorised under informationseeking, social-support seeking and positive-emotion-focused coping. However, 27% of the participants reported non-adherence to their ARV medications as a strategy to cope with the side effects. The findings show a significant relationship between the side-effects burden and a patientfs age (r = 0.530, p ≤ 0.01) and level of education (r = 0.394, p ≤ 0.01). The findings indicate that in the short term after initiating ARV treatment most patients are able to cope with the high burden of side effects through appropriate strategies, but a sizable portion will fail to cope appropriately and thus resort to non-adherence. Clinicians should assist patients with continuous health education and counselling that focuses on appropriate strategies to cope with the side effects of ARVs in order to buffer the negative impact of HIV treatment on patientsf adherence and quality of life.Keywords: adverse effects, compliance, HIV medication adherence, quality of life, east Africa, support servicesAfrican Journal of AIDS Research 2010, 9(3): 205–211

Background Partnerships and networking are important for an institution of higher learning like Makerere University College of Health Sciences (MakCHS) to be competitive and sustainable. Methods A stakeholder and sustainability analysis of 25 key informant interviews was conducted among past, current and potential stakeholders of MakCHS to obtain their perspectives and contributions to sustainability of the College in its role to improve health outcomes. Results The College has multiple internal and external stakeholders. Stakeholders from Uganda wanted the College to use its enormous academic capacity to fulfil its vision, take initiative, and be innovative in conducting more research and training relevant to the country’s health needs. Many stakeholders felt that the initiative for collaboration currently came more from the stakeholders than the College. External stakeholders felt that MakCHS was insufficiently marketing itself and not directly engaging the private sector or Parliament. Stakeholders also identified the opportunity for MakCHS to embrace information technology in research, learning and training, and many also wanted MakCHS to start leadership and management training programmes in health systems. The need for MakCHS to be more vigorous in training to enhance professionalism and ethical conduct was also identified. Discussion As a constituent of a public university, MakCHS has relied on public funding, which has been inadequate to fulfill its mission. Broader networking, marketing to mobilize resources, and providing strong leadership and management support to inspire confidence among its current and potential stakeholders will be essential to MakCHS’ further growth. MakCHS’ relevance is hinged on generating research knowledge for solving the country’s contemporary health problems and starting relevant programs and embracing technologies. It should share new knowledge widely through publications and other forms of dissemination. Whether institutional leadership is best in the hands of academicians or professional managers is a debatable matter. Conclusions This study points towards the need for MakCHS and other African public universities to build a broad network of partnerships to strengthen their operations, relevance, and sustainability. Conducting stakeholder and sustainability analyses are instructive toward this end, and have provided information and perspectives on how to make long-range informed choices for success.