Dr. Edrako Immaculate Grace is a Medical Officer who is currently a resident of Paediatrics and Child Health in the College of Health Science Makerere University.
She is interested and concerned about the most vulnerable people in the society. She previously worked for more than ten years with organizations like Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), German Development Service (DED) and African centre of torture victims where she served the children refugees and tortured victims. Edrako Immaculate defends these victims as expert witness in the human rights tribunal court in the course of standing for their rights.
She also worked in the Neonatal Intensive Care Unit where she was inspired to study Paediatrics and Child Health.She is passionate about making lasting difference for New Born Care, Child Health and the Child’s Rights.
Dissertation title: Short term outcomes of Term neonates delivered by Caesarean Section at Mulago Hospital, Uganda
Background: Uganda has the highest perinatal mortality rate in East Africa and is still short of the Millennium Development Goal (MDG) number four. Though there are many factors that account for this, it has been demonstrated in studies that cesarean section is protective in reducing perinatal morbidity and mortality. In Mulago National Referral hospital more than 90% cesarean section deliveries are done as an emergency. Emergency cesarean section is more likely to result in birth asphyxia and perinatal loss compared to elective cesarean and vaginal birth. The neonatal outcome of babies born by cesarean section at Mulago hospital is not known. This study describes the short term outcomes of full term neonates delivered by caesarean section and factors influencing the respective outcomes.
Methods: This was a prospective cohort study with a single arm carried out between August to December 2015 at the Mulago National Referral Hospital. All term neonates delivered by caesarean section and whose parents gave consent to participate were recruited into the study. Information regarding maternal medical, antenatal history, labor and birth outcomes was collected. The babies born were examined at birth and at five minutes for APGAR score, weight and physical examination. The babies were monitored for temperature, respiratory rate and random blood sugar at 6 hours and daily up to discharge or a maximum of seven days. The main outcomes were either a normal baby or a baby with any of the abnormal measurements or death. Data was entered using Epi-Data and analysed using STATA version 12. Results of the outcomes were presented as proportions and associated factors determined using multivariate analysis.
Results: A total of 305 live births participated in this study. Of this, 223 were well babies while 82 had atleast one abnormal neonatal outcome. The prevalence of poor outcome was 82/305, 27%. The commonest poor outcome was hypoglycemia (57/305, 19%) followed by birth asphyxia (39/305, 13%), respiratory distress (38/305, 12%) and hypothermia (6/305, 2%). The mortality was 4% (12/305). Mothers who had been referred for cesarean section were twice more likely to have babies with a poor outcome: Adjusted Odds Ratio (AOR) 2.74, 95% CI: 1.03 – 7.27, P=0.043. Emergency cesarean section, AOR 4.3, 95%CI: 1.25- 14.77, General anesthesia, AOR 12.75 95%CI: 1.63 – 99.59, P = 0.015 and antibiotic used in the third trimester AOR 4.75.95%CI,1.40-16.16. Delayed initiation of breastfeeding AOR, 23.05, 95%CI,11.85-44.82 was the only infant factor that was independently associated with a poor outcome.
Conclusion: One in four babies born by cesarean section had a poor outcome. The maternal factors that were independently associated with poor outcome were referral for caesarean, emergency cesarean section, general anesthesia and antibiotic used in the third trimester. Delayed initiation of breastfeeding was the only infant factor that was independently associated with a poor outcome.