Background; Episiotomy, an obstetric procedure introduced into practice without any clear scientific evidence showing its benefits, became almost a procedure performed on all parturient women. Recently, a liberal episiotomy has been discouraged and WHO recommends an episiotomy rate of about 10% or less. The procedure substantially increases the risk of anal sphincter damage, improper wound healing, hematoma, infections, and perineal pain. The study was aimed at investigating the prevalence and factors associated with episiotomy among primiparous parturients in Mulago National Referral. Methods:A cross-sectional study using a researcher administered questionnaires was conducted in Hospital Obstetrics and Gynecological Department in February and March 2018. Two hundred forty-nine participants were systematically recruited on the first postnatal day after meeting the inclusion criteria and the socio-demographic and obstetric characteristics were recorded. Logistic regression was used to determine the factors associated with the occurrences of episiotomy. Results:The prevalence of episiotomy was 73% (181/249) (CI 67-78). Mothers whose second stage of labor lasted between; 31-60 minutes were 3.6 times more likely to be made an episiotomy, (CI; 1.66-7.86, p=0.001), the odds further doubles if the second stage of labor was prolonged, lasting 60 minutes or greater OR=7.2 (CI; p=0.015). Episiotomy was also found to be associated with gestational age above 37 weeks OR=1.8 (CI; 1.28-2.40 p<0.001). Conclusion:The prevalence of episiotomy among primiparous is high yet higher episiotomy rates are associated with increasing morbidities and lack of benefits. The factors associated with episiotomy practice were gestational age above 37 weeks and prolonged second stage.

Abstract Background: Rwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital.Methods: A concurrent mixed method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using structured questionnaire and in-depth interview respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data.Results: The prevalence for PPIUCD use was 28.1% , women who had normal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95%CI=2.017-6.507 compared to those who had cesarean section; women who received PPIUCD counselling during antenatal period were more likely to use PPIUCD ((AOR 2.072, 95%CI=1.018-4.218) as compared to those who didn’t receive any form of counselling ; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95%CI= 1.485-4.492);as compared to those who didn’t receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95%CI=1.472-3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477-2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative, health education of mothers and partners on PPIUCD, training of health care providers and availability of supplies to provide PPIUCD influenced use of PPIUCD.Conclusion: The acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers and availability of supplies to provide PPIUCD influenced use PPIUCD.

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BackgroundThere is a growing number of adolescents and young adults with HIV who require transfer of care from pediatric/ adolescent clinics to adult ART clinic. Currently, adolescents are largely in the care of pediatricians; but as they grow, they transition to adult HIV clinics. The purpose of this study was to explore the facilitators and barriers of transitioning among adolescents from adolescent clinics to adult ART clinics.MethodAn explorative qualitative approach was utilised for this study. Eighteen focus group discussions were held in nine health facility with (191) adolescents and young people in order to capture their experiences, barriers and facilitators regarding transitioning to adult clinics. The focus group discussions were audio recorded and transcribed. The Silences Framework using thematic approach guided the analysis.Results The key emerging issues were: Care provided in the adolescent clinics, Unfriendly adults, stigma and discrimination, Congestion and long waiting time, health providers in adult clinics were barriers to transitioning. Moving as a cohort, Transition preparation, care in clinics, positive living, support from the guardian and Young adolescent program Support (YAPS) could facilitate readiness and transitioning.ConclusionAdolescents and young people expressed fear to transition to adult clinics mainly because of the perceived better care provided in adolescent clinic, thus constituting a barrier to smooth transition A range of individual, social and health system and services-related factors hindered transitioning. Expectation of transitioning as a group, assurance of similar care as in the adolescent clinic, and guarantees of confidentiality, privacy and autonomy in decision-making for care were perceived as facilitators. There is need to strengthen implementation of age-appropriate care and individualized case management during care transition at all health facilities. Furthermore, the findings suggest the need to create supportive family, peer, and healthcare environments for adolescent transition.

Introduction Many HIV infected adolescents require transfer of care from paediatric/ adolescent clinics to adult ART clinics. Transition is beset with factors that hinder or facilitate the process, thereby raising ethical challenges of the transition process. Decisions made regarding therapy, such as when and how to transition to adult HIV care, should consider ethical benefits and risks. Understanding and addressing ethical challenges in the healthcare transition could ensure a successful transition. The purpose of this study was to analyse the ethical challenges of transitioning HIV care for adolescents into adult HIV clinics. Method We conducted 18 focus group discussions among 191 adolescents attending 9 different health facilities in Uganda. We explored facilitators and barriers regarding adolescent transitioning to adult HIV clinics. Thematic data analysis was used to analyze the data. The Silences Framework guided the data analysis and interpretation. The principles of Bioethics and the four-boxes ethics framework for clinical care (Patient autonomy, Medical indications, Context of care and Quality of life) were used to analyze the ethical issues surrounding the transition to adult HIV care. Results The key emerging ethical issues were: reduced patient autonomy; increased risk of harm from stigma and loss of both privacy and confidentiality; unfriendly adult clinics induce disengagement and disruption of the care continuum; patient preference to transition as a cohort; and contextual factors are critical to successful transition. Conclusion The priority outcomes of the healthcare transition for adolescents should address ethical challenges of the healthcare transition to ensure retention in HIV care, facilitate long-term self-care, provide ongoing holistic healthcare and support in order to promote health and wellbeing, and build trust in the healthcare system. Identifying what facilitates successful transitions, and the gaps that interventions can target, may ensure HIV-infected youth remain healthy across the healthcare transition.