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Asiki G.,Karolinska Institutet | Asiki G.,Medical Research Council Uganda Virus Research Council | Baisley K.,London School of Hygiene and Tropical Medicine | Newton R.,Medical Research Council Uganda Virus Research Council | And 7 more authors.
BMC Pregnancy and Childbirth | Year: 2015

Objective: Community based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods. Methods: Within a general population cohort, between 1996 and 2013, women aged 15-49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012-13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome. Results: One third of women reported an adverse pregnancy outcome; 10.8 % (abortion = 8.4 %, stillbirth = 2.4 %) by method 1 and 8.5 % (abortion = 7.2 %, stillbirth = 1.3 %) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity. Discussion: Both methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates. Conclusion: Strategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions. © 2015 Asiki et al.


PubMed | Medical Research Council Uganda Virus Research Council, Karolinska Institutet and London School of Hygiene and Tropical Medicine
Type: | Journal: BMC pregnancy and childbirth | Year: 2015

Community based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods.Within a general population cohort, between 1996 and 2013, women aged 15-49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012-13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome.One third of women reported an adverse pregnancy outcome; 10.8% (abortion = 8.4%, stillbirth = 2.4%) by method 1 and 8.5% (abortion = 7.2%, stillbirth = 1.3%) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity.Both methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates.Strategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions.


PubMed | Medical Research Council Uganda Virus Research Council and Karolinska Institutet
Type: Journal Article | Journal: Acta paediatrica (Oslo, Norway : 1992) | Year: 2016

Accurately estimating child mortality in rural communities in Africa with poor vital registration is a challenge. We aimed to estimate mortality rates and risk factors for children under five years old in rural Uganda.Age-specific mortality rates were estimated using the synthetic cohort life-table technique for 10 118 children under the age of five years, between 2002 and 2012. Calendar year-specific hazard rates were calculated using five-year moving averages, and risk factors were explored by Cox regression.The mortality rate was 92 per 1000 newborn infants from birth to five years, based on a total of 256 deaths. It was 40 for boys and 23 for girls in the neonatal period and 68 for boys and 42 for girls up to the age of one year. A substantial decline in mortality from 2002 to 2012 was observed between the ages of 28 days and 11 months. Multivariate analysis demonstrated that mortality increased with decreasing child age, home delivery, human immuno-deficiency virus in the child, a birth interval of less than one year, having an unmarried mother and a maternal parity of more than four.Under-five mortality rates in rural Uganda are driven by maternal factors.

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