Browsing by Author "Nahurira, Violah"

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    Refractory convulsive syncope in pregnancy: a rare presentation of Takayasu’s arteritis - a case report and literature review
    (African Health Sciences, 2021-06-02) Alobo, Gasthony; Nahurira, Violah; Omona, Venice; Bayo, Pontius; Olum, Sam
    Background: Neurological manifestation of Takayasu’s Arteritis (TA) in pregnancy presenting as convulsive syncope is extremely rare, and poses a serious diagnostic dilemma due to other vast causes of fits in pregnancy. Objective: We aimed to present and shed more light on a case of TA with convulsive syncope in pregnancy refractory to anticonvulsants for seven weeks, and review the literature on the management of TA in pregnancy. Case presentation: A gravida 4 para 3+0 at 28 weeks of amenorrhea presented with repeated episodes of the sudden loss of consciousness, followed by a fall and jerking of the limbs. These were refractory to anticonvulsants that she had used for seven weeks. Physical examination revealed undetectable pulse and blood pressure (BP) in the upper limbs but elevated BP in the lower limbs. Further investigations confirmed TA and she improved on steroids and antihypertensives. Conclusion: This case typically describes the unexpected presentation of TA with convulsive syncope. It calls for meticulous clinical assessment of epileptic seizures in pregnancy to avoid a late diagnosis of TA and its potential poor outcomes.
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    Septic shock, acute renal and liver failure following unsafe abortion using bitter leaves and wandering jew in northern Uganda: A case series
    (Clinical Case Reports, 2022) Alobo, Gasthony; Reverzani, Cristina; Nahurira, Violah; Sarno, Laura
    Unsafe abortion is a major problem in Uganda, being one of the leading causes of maternal morbidity and mortality. Abortions are performed mostly under unsafe conditions, by people without medical training. In rural areas in northern Uganda, women often resort to traditional providers, who use local herbs as abortion remedies, usually with adverse outcomes. Little is known about the biological properties of these herbs and their toxicity profile. Here, we present the case series of two women, of 31 and 24 years of age, who underwent unsafe abortion for unintended pregnancy by using herbal medicines, that is, Commelina Africana (wandering jew) and Vernonia amygdalina (bitter leaf), respectively. While the first case resulted in uterine necrosis and pelvic peritonitis, which required multiple surgical interventions and the use of reserve antibiotics, the second case resulted in liver and renal failure that led to the death of the patient. This case series describes the unusual severe toxicity of two herbal medicines that are frequently used to induce abortion in northern Uganda. It highlights possible associations of Commelina Africana (wandering jew) with uterine necrosis complicated by sepsis, and of Vernonia amygdalina (bitter leaf) with acute liver and renal failure.
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    Why women die after reaching the hospital: a qualitative critical incident analysis of the ‘third delay’ in postconflict northern Uganda
    (BMJ open, 2021) Alobo, Gasthony; Ochola, Emmanuel; Bayo, Pontius; Muhereza, Alex; Nahurira, Violah; Byamugisha, Josaphat
    Objectives To critically explore and describe the pathways that women who require emergency obstetrics and newborn care (EmONC) go through and to understand the delays in accessing EmONC after reaching a health facility in a conflict-affected setting. Design This was a qualitative study with two units of analysis: (1) critical incident technique (CIT) and (2) key informant interviews with health workers, patients and attendants. Setting Thirteen primary healthcare centres, one general private-not- for- profit hospital, one regional referral hospital and one teaching hospital in northern Uganda. Participants Forty-nine purposively selected health workers, patients and attendants participated in key informant interviews. CIT mapped the pathways for maternal deaths and near-misses selected based on critical case purposive sampling. Results After reaching the health facility, a pregnant woman goes through a complex pathway that leads to delays in receiving EmONC. Five reasons were identified for these delays: shortage of medicines and supplies, lack of blood and functionality of operating theatres, gaps in staff coverage, gaps in staff skills, and delays in the interfacility referral system. Shortage of medicines and supplies was central in most of the pathways, characterised by three patterns: delay to treat, back-and- forth movements to buy medicines or supplies, and multiple referrals across facilities. Some women also bypassed facilities they deemed to be non-functional. Conclusion Our findings show that the pathway to EmONC is precarious and takes too long even after making early contact with the health facility. Improvement of skills, better management of the meagre human resource and availing essential medical supplies in health facilities may help to reduce the gaps in a facility’s emergency readiness and thus improve maternal and neonatal outcomes.