Browsing by Author "Otim, Tom Charles"

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    The Effectiveness of Post-Operative Pain Regime in C-Section Mothers, Lira Regional Referral Hospita
    (IAR J. Med Ser, 2023) Oyella, Pamela; Okidi, Ronald; Ogena, Jonathan; Acire, Robin; Otim, Tom Charles; Okello, Tom Richard
    Purpose: This study sought to explore the effectiveness of pain management in post-caesarian section mothers in Lira Regional Referral hospital Methods: Using a descriptive cross sectional design, data was collected from 110 randomly selected mother who underwent Caesarian section delivery in Lira regional referral hospital for a period of 2months. An interviewer administered questionnaire was used to collect data as well as review of patients’ charts to discern the analgesic drug given to the post C-section mother in the first 24hrs. Findings: Out of the 110 participants who had C-section within the study period, 65.5% suffered excruciating pain, 30.9% got severe pain and 3.6% experienced moderate pain. None of the patients who suffered excruciating pain was given strong opioids like morphine, pethidine but they were instead treated with weak opioid like tramadol (67.6%) or NSAIDs (19.7%). Those with severe pain were treated predominantly with weak opioids (58.8%), although 14.7% received strong opioids. Overall, only 79.1% of the C-section mothers reported the got effective pain control Conclusion Most mothers who undergo CS at LRRH suffer either excruciating pain or severe pain, despite that, the commonly used analgesia in Post-Operative Pain Management at the facility are weak opioids and NSAIDs irrespective of whether a mother is suffering excruciating or severe pain. Effective pain control after C-section at LRRH is achieved in only79.1%.
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    Obstetric Referrals to a Tertiary Hospital in Northern Uganda - A One Year Experience
    (Jemds.com, 2020) Nionzima, Elizabeth; Otim, Tom Charles
    BACKGROUND Delay in referral adversely affects maternal and neonatal outcome. We wanted to review the obstetric referrals, source of referrals, appropriateness of referrals and document the maternal and perinatal outcomes in a tertiary hospital in northern Uganda. METHODS This is a secondary data analysis from case records. A descriptive study of 780 eligible obstetric referrals, with ≥28 week’s gestation, referred to the hospital for a period of 12 months were analysed with SPSS version 23. RESULTS Obstetric referrals accounted for 16.3% (780/4799) of the total admissions in 2018, 43.8% were from CEMNOC sites and 32.3% from HC IVs, while 57% from without Lira District, showing lacunae in the emergency obstetric care given at the HC IV levels and the districts hospital in the region. Majority or 93.5% (729) were intrapartum admissions and 98.1% (715) of these had labour outcome recorded, showing the nature of referrals. Most common diagnosis at referral was labour or complications of labour and only 4.6% had other diagnoses. The diagnoses at the time of admission were normal labour (31.0%); obstructed labour (25.1%); prolonged labour (7.1%). About 29.9% presented with more than one medical/obstetric complications, and the most common one was obstructed labour, preeclampsia, IUFD and previous caesarean section scars. The outcome of the referred cases included 45.1% (327) vaginal delivery (either spontaneous or augmented), 54.4% (396) caesarean section, 0.5% (4) Caesarean hysterectomy, 3.1% (24) transferred out undelivered, 1.2% (09) missing outcome while the 3.6% (28) with medical conditions were managed and discharged. There were ten (10) maternal deaths among the referrals, during the study period and 3 were due to obstetric haemorrhage; and behind these there were many near misses which would provide valuable information on the quality of care at the peripheral facilities. 80.4% (627) were live babies, 10.5% (82) were FSB/MSB and 10% had APGAR score ≤5 at 5 minutes of birth while 13.2% were of low birth weight. CONCLUSIONS A wide spectrum of complicated and uncomplicated obstetric cases was referred to this hospital and majority were unjustifiable as majority of the referred conditions could be managed at the lower CEMONC sites. Unavailability of Comprehensive Emergency Obstetric Care (CEMONC) was the most common reason for referrals, even where infrastructure and human resource where known to be available. Most common diagnosis at the time of referral was prolonged/obstructed labour. Even today, obstetric haemorrhage is the leading cause of maternal mortality while prolonged/obstructed labour contributed to the high neonatal mortality. KEY WORDS Obstetric Referrals, Maternal, Outcome, Foetal Outcome, Referral Sites, Tertiary
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    Prophylactic antibiotics to reduce pelvic infection in women having miscarriage surgery – The AIMS (Antibiotics in Miscarriage Surgery) trial: study protocol for a randomized controlled trial
    (Trials, 2018) Lissauer, David; Wilson, Amie; Daniels, Jane; Middleton, Lee; Bishop, Jon; Hewitt, Catherine; Merriel, Abi; Weeks, Andrew; Mhango, Chisale; Mataya, Ronald; Taulo, Frank; Ngalawesa, Theresa; Chirwa, Agatha; Mphasa, Colleta; Tambala, Tayamika; Chiudzu, Grace; Mwalwanda, Caroline; Mboma, Agnes; Qureshi, Rahat; Ahmed, Iffat; Ismail, Humera; Gulmezoglu, Metin; Oladapo, Olufemi T.; Mbaruku, Godfrey; Chibwana, Jerome; Watts, Grace; Simon, Beatus; Ditai, James; Otim, Tom Charles; Acam, Jane-Frances; Ekunait, John; Uniza, Helen; Iyaku, Margaret; Anyango, Margaret; Zamora, Javier; Roberts, Tracy; Goranitis, Ilias; Desmond, Nicola; Coomarasamy, Arri
    Abstract Background: The estimated annual global burden of miscarriage is 33 million out of 210 million pregnancies. Many women undergoing miscarriage have surgery to remove pregnancy tissues, resulting in miscarriage surgery being one of the most common operations performed in hospitals in low-income countries. Infection is a serious consequence and can result in serious illness and death. In low-income settings, the infection rate following miscarriage surgery has been reported to be high. Good quality evidence on the use of prophylactic antibiotics for surgical miscarriage management is not available. Given that miscarriage surgery is common, and infective complications are frequent and serious, prophylactic antibiotics may offer a simple and affordable intervention to improve outcomes. Methods: Eligible patients will be approached once the diagnosis of miscarriage has been made according to local practice. Once informed consent has been given, participants will be randomly allocated using a secure internet facility (1:1 ratio) to a single dose of oral doxycycline (400 mg) and metronidazole (400 mg) or placebo. Allocation will be concealed to both the patient and the healthcare providers. A total of 3400 women will be randomised, 1700 in each arm. The medication will be given approximately 2 hours before surgery, which will be provided according to local practice. The primary outcome is pelvic infection 2 weeks after surgery. Women will be invited to the hospital for a clinical assessment at 2 weeks. Secondary outcomes include overall antibiotic use, individual components of the primary outcome, death, hospital admission, unplanned consultations, blood transfusion, vomiting, diarrhoea, adverse events, anaphylaxis and allergy, duration of clinical symptoms, and days before return to usual activities. An economic evaluation will be performed to determine if prophylactic antibiotics are cost-effective
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    Spontaneous rupture of bladder in puerperium
    (African Health Sciences, 2004) Wandabwa, Julius; Kiondo, Paul; Otim, Tom Charles
    Abstract Spontaneous rupture of bladder and extravasation of urine in the peritoneum without evidence of trauma is rare. This condition is an emergency. It presents in a unique way therefore, the diagnosis and treatment is usually delayed. This patient presented with an acute abdominal pain and oliguria. She had delivered normally eight days before re-admission. Investigations were done and an exploratory laparotomy was performed. There was a tear in the fundus of the bladder and the peritoneal cavity contained urine. Peritoneal lavage was done and the bladder was repaired in layers. She was put on continuous bladder drainage for three weeks followed by bladder training. The bladder resumed its normal function. Early diagnosis and appropriate management decreases the morbidity and mortality associated with this condition. African Health Sciences 2004; 4(2) 138-13