ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This stud... more ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.DesignProspective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.SettingSix referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.ResultsPercentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and incre...
The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1... more The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1%) is higher than the global estimate (18.5%). Soroti district tops Teso (a region with highest adolescent childbearing rate nationally) in adolescent childbearing. Adolescent repeat childbearing (ARC) is associated with poor health outcomes, increased risk of stillbirth, maternal and child mortality, thus a public health concern. The factors associated with, and the burden, of ARC remains unknown in Soroti district. Consequently, interventions which combat ARC in Soroti district have not been informed by empirical data. This study determined the proportion of adolescent mothers with, and factors associated with, repeat childbirth among adolescent mothers in Soroti district.We conducted a cross-sectional study involving mixed methods of data collection. Interviewer-administered structured interviews were conducted amongst 422 adolescent mothers.Demographic and socio-economic data of resp...
Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access ... more Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access to and utilization of self care-oriented family planning (FP) methods. We assessed current contraceptive use, contraception decision-making processes and interest in self care-oriented contraception among adolescent girls and young women (AGYW) in Uganda. Methods: This secondary analysis used cross-sectional data from 2109 sexually-active AGYW aged 10-24 years obtained from a national survey conducted in September 2020. AGYW were asked if they had ever used or were currently using any FP method. Current contraceptive users were asked about who made the decision to use contraception in general and the specific FP methods that they were currently using in particular (i.e. respondent, partner, respondent and partner, or provider); those who made the decision to use contraception on their own were considered to have had contraception decision-making autonomy. We used a modified multivariable...
The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1... more The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1%) is higher than the global estimate (18.5%). Soroti district tops Teso (a region with highest adolescent childbearing rate nationally) in adolescent childbearing. Adolescent repeat childbearing (ARC) is associated with poor health outcomes, increased risk of stillbirth, maternal and child mortality, thus a public health concern. The explanations to the high prevalence of repeat childbirth in Soroti district remain unknown. We conducted a phenomenological study where theoretical saturation was achieved with 3 focus group discussions; each comprised of 8 respondents. The questions posed focused on modified socio-ecological model regarding the factors associated with repeat childbirth. These included; perceived individual factors of repeat childbirth, factors related to the sexual partner of the adolescent mother, adolescent mother’s family related factors and factors related to the peers...
BackgroundAt 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has... more BackgroundAt 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has 126 outpatient therapeutic care (OTC) sites for managing children with severe acute malnutrition.Local problemCure rate (CR) in OTC in Karamoja remains below the international standard of over 75%. The study aimed at increasing the CR in 10 OTC sites in Karamoja, from 74.1% to >75% in 13 months.MethodsThe study commenced in July 2018, up to September 2019, in purposively selected health facilities in six districts in Karamoja. Quality improvement (QI) methods per the Ministry of Health QI Framework were applied. QI teams (QITs) tracked the outcome of the tested changes for 13 months. χ2tests were used to assess the intrafacility and interdistrict association in CR.InterventionInstitute for Health Improvement (IHI) (2003) improvement model was applied in this collaborative. QITs conducted root cause analysis of CR gaps, which guided them in the development of improvement aims, changes...
Much of the methodological literature on rapid qualitative analysis describes processes used by a... more Much of the methodological literature on rapid qualitative analysis describes processes used by a relatively small number of researchers focusing on one study site and using rapid analysis to replace a traditional analytical approach. In this paper, we describe the experiences of a transnational research consortium integrating both rapid and traditional qualitative analysis approaches to develop social theory while also informing program design. Research was conducted by the Innovations for Choice and Autonomy (ICAN) consortium, which seeks to understand how self-injection of the contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC) can be implemented in a way that best meets women's needs, as defined by women themselves. Consortium members are based in Kenya, Uganda, Malawi, Nigeria, and the United States. Data for the ICAN study was collected in all four countries in sub-Saharan Africa. In order to both illuminate social phenomena across study sites and inform...
Introduction: In Uganda, 12% of the audited maternal deaths occur among teenagers. The prevalence... more Introduction: In Uganda, 12% of the audited maternal deaths occur among teenagers. The prevalence and factors associated with teenage pregnancy in health facilities is not well documented. We determined the prevalence and factors associated with teenage pregnancy in Mbale Regional Referral Hospital. Materials and Methods: We conducted a cross sectional study between July and September 2019.We consecutively enrolled and collected information from 427 respondents. Associated factors were determined using logistic regression, a P-value < 0.05. Results: The prevalence of teenage pregnancy was 20.6% [95% CI : (17.0% - 24.7%)]. Rural residence [(AOR: 2.8 (1.08 – 7.09)], primary level of education [(AOR: 9.57 (3.48 – 26.3)], unhappy feelings about the current pregnancy [(AOR: 3.57(1.05 – 12.15)], primiparity [(AOR: 21.05 (7.36 – 60.15)] increased the likelihood of teenage pregnancy. While, history of ever use of contraceptives [(AOR: 0.32 (0.12 – 0.84)], age at coitarche [(AOR: 0.68 (0....
IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which we... more IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic.MethodsMixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting.ResultsWe identified three periods: first wave, slow period and second wave. The first wa...
IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal healt... more IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic.MethodsMixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting.ResultsThr...
What is the prevalence and factors associated with teenage pregnancy in Mbale regional referral a... more What is the prevalence and factors associated with teenage pregnancy in Mbale regional referral and teaching hospital?
Introduction Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban... more Introduction Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women. Methods We estimated the percentage of women 20–24 years at each of the six Uganda Demographic and Health Surveys (1988/89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years (“adolescent childbirth”), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey. Results Among these women, 67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively. Between 1988/89 to 2000/01, there was no evidence of change (+ 2.6% point (pp), p = 0.170), unlike between the 2000/01 and 2016 surveys when a significant declin...
ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This stud... more ObjectivesThe COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes.DesignProspective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave.SettingSix referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda.Participants22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels.ResultsPercentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and incre...
The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1... more The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1%) is higher than the global estimate (18.5%). Soroti district tops Teso (a region with highest adolescent childbearing rate nationally) in adolescent childbearing. Adolescent repeat childbearing (ARC) is associated with poor health outcomes, increased risk of stillbirth, maternal and child mortality, thus a public health concern. The factors associated with, and the burden, of ARC remains unknown in Soroti district. Consequently, interventions which combat ARC in Soroti district have not been informed by empirical data. This study determined the proportion of adolescent mothers with, and factors associated with, repeat childbirth among adolescent mothers in Soroti district.We conducted a cross-sectional study involving mixed methods of data collection. Interviewer-administered structured interviews were conducted amongst 422 adolescent mothers.Demographic and socio-economic data of resp...
Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access ... more Background: Reproductive autonomy is a key ingredient in driving the agenda for increased access to and utilization of self care-oriented family planning (FP) methods. We assessed current contraceptive use, contraception decision-making processes and interest in self care-oriented contraception among adolescent girls and young women (AGYW) in Uganda. Methods: This secondary analysis used cross-sectional data from 2109 sexually-active AGYW aged 10-24 years obtained from a national survey conducted in September 2020. AGYW were asked if they had ever used or were currently using any FP method. Current contraceptive users were asked about who made the decision to use contraception in general and the specific FP methods that they were currently using in particular (i.e. respondent, partner, respondent and partner, or provider); those who made the decision to use contraception on their own were considered to have had contraception decision-making autonomy. We used a modified multivariable...
The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1... more The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1%) is higher than the global estimate (18.5%). Soroti district tops Teso (a region with highest adolescent childbearing rate nationally) in adolescent childbearing. Adolescent repeat childbearing (ARC) is associated with poor health outcomes, increased risk of stillbirth, maternal and child mortality, thus a public health concern. The explanations to the high prevalence of repeat childbirth in Soroti district remain unknown. We conducted a phenomenological study where theoretical saturation was achieved with 3 focus group discussions; each comprised of 8 respondents. The questions posed focused on modified socio-ecological model regarding the factors associated with repeat childbirth. These included; perceived individual factors of repeat childbirth, factors related to the sexual partner of the adolescent mother, adolescent mother’s family related factors and factors related to the peers...
BackgroundAt 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has... more BackgroundAt 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has 126 outpatient therapeutic care (OTC) sites for managing children with severe acute malnutrition.Local problemCure rate (CR) in OTC in Karamoja remains below the international standard of over 75%. The study aimed at increasing the CR in 10 OTC sites in Karamoja, from 74.1% to >75% in 13 months.MethodsThe study commenced in July 2018, up to September 2019, in purposively selected health facilities in six districts in Karamoja. Quality improvement (QI) methods per the Ministry of Health QI Framework were applied. QI teams (QITs) tracked the outcome of the tested changes for 13 months. χ2tests were used to assess the intrafacility and interdistrict association in CR.InterventionInstitute for Health Improvement (IHI) (2003) improvement model was applied in this collaborative. QITs conducted root cause analysis of CR gaps, which guided them in the development of improvement aims, changes...
Much of the methodological literature on rapid qualitative analysis describes processes used by a... more Much of the methodological literature on rapid qualitative analysis describes processes used by a relatively small number of researchers focusing on one study site and using rapid analysis to replace a traditional analytical approach. In this paper, we describe the experiences of a transnational research consortium integrating both rapid and traditional qualitative analysis approaches to develop social theory while also informing program design. Research was conducted by the Innovations for Choice and Autonomy (ICAN) consortium, which seeks to understand how self-injection of the contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC) can be implemented in a way that best meets women's needs, as defined by women themselves. Consortium members are based in Kenya, Uganda, Malawi, Nigeria, and the United States. Data for the ICAN study was collected in all four countries in sub-Saharan Africa. In order to both illuminate social phenomena across study sites and inform...
Introduction: In Uganda, 12% of the audited maternal deaths occur among teenagers. The prevalence... more Introduction: In Uganda, 12% of the audited maternal deaths occur among teenagers. The prevalence and factors associated with teenage pregnancy in health facilities is not well documented. We determined the prevalence and factors associated with teenage pregnancy in Mbale Regional Referral Hospital. Materials and Methods: We conducted a cross sectional study between July and September 2019.We consecutively enrolled and collected information from 427 respondents. Associated factors were determined using logistic regression, a P-value < 0.05. Results: The prevalence of teenage pregnancy was 20.6% [95% CI : (17.0% - 24.7%)]. Rural residence [(AOR: 2.8 (1.08 – 7.09)], primary level of education [(AOR: 9.57 (3.48 – 26.3)], unhappy feelings about the current pregnancy [(AOR: 3.57(1.05 – 12.15)], primiparity [(AOR: 21.05 (7.36 – 60.15)] increased the likelihood of teenage pregnancy. While, history of ever use of contraceptives [(AOR: 0.32 (0.12 – 0.84)], age at coitarche [(AOR: 0.68 (0....
IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which we... more IntroductionReferral hospitals in sub-Saharan Africa are located in crowded urban areas, which were often epicentres of the COVID-19 pandemic. This paper prospectively assesses how maternal healthcare was provided in six referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the COVID-19 pandemic.MethodsMixed-methods design using three data sources: (1) qualitative data from repeated rounds of semi-structured interviews conducted between July 2020 and February 2021 with 22 maternity skilled heath personnel (SHP) on perceptions of care provision; (2) quantitative monthly routine data on caesarean section and labour induction from March 2019 to February 2021; and (3) timeline data of COVID-19 epidemiology, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on timeline analysis, and triangulated during reporting.ResultsWe identified three periods: first wave, slow period and second wave. The first wa...
IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal healt... more IntroductionIn sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic.MethodsMixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019–February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020–February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting.ResultsThr...
What is the prevalence and factors associated with teenage pregnancy in Mbale regional referral a... more What is the prevalence and factors associated with teenage pregnancy in Mbale regional referral and teaching hospital?
Introduction Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban... more Introduction Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women. Methods We estimated the percentage of women 20–24 years at each of the six Uganda Demographic and Health Surveys (1988/89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years (“adolescent childbirth”), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey. Results Among these women, 67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively. Between 1988/89 to 2000/01, there was no evidence of change (+ 2.6% point (pp), p = 0.170), unlike between the 2000/01 and 2016 surveys when a significant declin...
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Papers by Dinah Amongin