Browsing by Author "Lilungulu, Athanase"
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Item The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania(South Sudan Doctors' Association (SOSDA), 2019) Sichone, Janeth Dickson; Lilungulu, Athanase; Ngwashemi, Secilia K.; Ngowi, AgathaIntroduction: Female Genital Mutilation (FGM) is widespread in Tanzania and poses a risk when women give birth. Objective: To determine the association between FGM and perineal injury among women in labour in Dodoma Methods: A matched case-control study of 364 randomly selected consenting women in labour was conducted in Dodoma Region between January 2017 and June 2018. Controls (no perineal injury) were matched to the cases (with perineal injury) based on maternal age at a ratio 2:1 making a sample of 243 controls and 121 cases. FGM and perineal injury was directly observed during labour using WHO guidelines. Data were analysed by using SPSS version 20 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted. The association between FGM and perineal injury was determined using chi-squared statistics. Results: Of the 364 women were investigated 40.4% (n=147) were circumcised and 59.6% (n=217) were not. There was a significant association between FGM and perineal injury (p=0.001). Conclusion: The FGM rate was high. FGM (total and Type II) was significantly associated with perineal injury.Item The effects of maternal body mass index on placental morphology and foetal birth weight: A study from Dodoma central region, Tanzania(South Sudan Doctors Association, 2019) Kiliopa, Elly O; Gesase, Peter Ainory; Lilungulu, AthanaseIntroduction: The placenta plays a pivotal role during pregnancy by being intimately connected to the mother and foetus. Objective: To determine the effects of maternal Body Mass Index (BMI) on placental morphology and foetal birth weight. Method: The placental samples were obtained with consent from 236 mothers with a singleton full term pregnancy and who had a live birth between January 2017 and June 2018. Statistics on maternal BMI, placental morphology and foetal birth weight were collected and analysed using SPSS version 20 for Window (SPSS Inc., Chicago, IL, USA). Results: The mean maternal BMI was 24.25 ± 131.605 and was positively correlated with the foetal birth weight (r=0.66; p<0.001), number of cotyledons (r=0.71, p<0.001), placental weight (r=0.50; p <0.001) and placental thickness (r=0.42; p<0.001). Conclusion: The study supports the hypothesis that maternal factors which are known to influence foetal growth, birth weight and neonatal body composition are also the determinants of the placental morphology. Therefore, all the parameters can be clinically used in the prediction of birth outcomeItem Incidence and predictors of maternal and perinatal mortality among women with severe maternal outcomes: A Tanzanian facility-based survey for improving maternal and newborn care(Hindawi, 2020) Mujungu, Simon; Lilungulu, Athanase; Bintabara, Deogratius; Chiwanga, Enid; Chetto, Paulo; Nassoro, MzeeIntroduction: Maternal and perinatal mortality is still a major public health challenge in Tanzania, despite the ongoing government efforts to improve maternal and newborn care. Among the contributors to these problems is the high magnitude of severe maternal outcomes (maternal near-miss). The current study, therefore, aimed to identify the magnitude and predictors of maternal and perinatal mortality among women with severe maternal outcomes admitted to Dodoma Regional Referral Hospital. Methods: A retrospective cross-sectional study was conducted from October 2015 to January 2016 at Dodoma Regional Referral Hospital in Dodoma City. All maternal deaths and maternal near-misses based on WHO criteria were included in this study. Three outcome variables have been identified: maternal mortality, perinatal mortality, and neonatal complications. To examine the predictors for the three predetermined outcome variables, the three logit models each containing unadjusted and adjusted findings were fitted. A P-value of less than 0.05 was considered indicative of statistically significant. Results: A total of 3600 pregnant women were admitted for obstetric reasons during the mentioned period. 140 of them were diagnosed with severe maternal outcomes; hence, they were included in this study. The severe maternal outcome incidence ratio was 40.23 per 1000 live births, the institutional maternal mortality ratio was 459.77 per 100000 live births, and the perinatal mortality rate was 10.83 per 1000 total births. Most of the maternal morbidity and mortality were due to direct causes in which postpartum hemorrhage and hypertensive disorders were the leading causes. In adjusted analysis, per-protocol management, maternal age, and mode of birth were predictors of maternal mortality, perinatal mortality, and neonatal complications, respectively. Conclusion: Establishing and strengthening obstetric ICUs will help reduce maternal mortality as the response time from the onset of obstetric complications, while the provision of high-quality care will be substantially reduced. Furthermore, the study recommends the regular provision of in-service refresher training to emphasize the practice and compliance of per-protocol case management through a team approach in order to reduce the burden of maternal and perinatal mortality in Tanzania.Item Maternal deaths due to obstetric haemorrhage in Dodoma Regional Referral Hospital, Tanzania(Hindawi, 2020) Nassoro, Mzee M.; Chiwanga, Enid; Lilungulu, Athanase; Bintabara, DeogratiusBackground. Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. +is study was carried out to analyse the circumstances that had caused these deaths. Methods. A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019was made. Results. A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grandmultiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12(52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). +e leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterineatony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)).Conclusion. Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. +e leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. +ere is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.Item Maternal mortality in Dodoma regional referral hospital, Tanzania(Hindawi Limited, 2020) Nassoro, Mzee M.; Chetto, Paul; Chiwanga, Enid; Lilungulu, Athanase; Bintabara, Deogratius; Wambura, JacquilineMaternal mortality has remained a challenge in Tanzania. The Tanzania Demographic and Health Survey 2015-16 has shown that the problem has been increasing despite various strategies instituted to curb it. It has been shown that most of the maternal deaths occurring in health facilities, whether direct or indirect, have other contributing factors. The objective of this study was to analyse causes and associated factors for maternal deaths in Dodoma Regional Referral Hospital (DRRH). A retrospective review of all files of the women who died in 2018 and were classified as maternal deaths. A total of 8722 women gave birth in DRRH, out of which 35 died and were confirmed as maternal deaths. The number of live births was 8404 making the maternal mortality ratio of 417 per 100,000 live births. The leading causes of maternal death were eclampsia (9), sepsis (6), ruptured uterus (5), and haemorrhage (5). The third-phase delay was the leading contributing factor to 19 maternal deaths. This includes delays in referral from another facility as well as delays in getting treatment at DRRH and inadequate skills of providers at both the referring facilities and DRRH. The first-phase and second-phase delays contributed to 7 and 6 deaths, respectively. Furthermore, poor antenatal care contributed to 2 deaths. Maternal mortality is still high in Dodoma Regional Referral Hospital. Eclampsia was the leading cause of maternal deaths in 2018 followed by sepsis and obstetric haemorrhage. Delays associated with health system factors (third-phase delay) contributed much more to maternal mortality than the first-phase delay. Mentorship programmes on management of obstetric complications need to be instituted in order to reduce maternal deaths in Dodoma Regional Referral Hospital.