Browsing by Author "Jacob Eperu"

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    Attitudes and Perceptions of Health Workers Towards Immediate Postpartum Family Planning at Soroti Regional Referral Hospital: A Qualitative Study
    (2026-08-21) Jacob Eperu; Enid Kawala Kagoya; Laila Nalubega; John Michael Okusa; Anitah Birungi; Abudu Rahuman Ssekabira; James Kateregga; Samuel Okello; Ronald Opito; Clement Munguiko; Clare Nankinga; Josephine Namujju; Alice Collete Alum; Joseph Atukwatse; Safina Akello; David Aderu
    Introduction: Unintended pregnancy among married women remains a great health burden in LMICs. Having successfully completed child birth, the World health organization guides that woman wait for not less than two to three years before attempting another pregnancy to reduce health risks for the mother and the baby. Whereas much is known about client related factors contributing to the low uptake of immediate postpartum family planning (IPPFP), little is known about health care workers (HCWs). This study sought to explore health workers’ attitudes and perceptions toward IPPFP at Soroti Regional Referral Hospital (SRRH). Methods: Sixteen (16) HCWs from the Department of Obstetrics and Gynecology at SRRH participated in this exploratory qualitative study. Purposive sampling was employed for recruitment. Data were collected through in-depth interviews and analyzed using hybrid thematic analysis to generate codes and themes. Results: Thematic analysis involving 16 study participants revealed that attitudes toward IPPFP were shaped by four major themes: willingness to provide services, professional experience, client influences, and provider Fears. Whereas many healthcare workers expressed willingness to offer IPPFP a majority reported conditional readiness dependent on training, availability of equipment, and adequate skills. Providers with prior exposure demonstrated greater confidence. The study is reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ). Perceptions were driven by three major themes: Perceived benefits, Barriers and Mutual aid. Participants highlighted several benefits of IPPFP, including prevention of unintended pregnancies, improved birth spacing, reduced missed opportunities for family planning, and enhanced maternal and child wellbeing. However, this study reveals previously undocumented system-level barriers such as only a few HCWs being trained, stock-outs, workload, and limited policy support, alongside sociocultural challenges including myths, misconceptions, religious beliefs, and the need for partner approval. Limited social support was also reported, although organizations such as JHPIEGO and Marie Stopes were recognized for supporting training and service delivery. Conclusion: Although linked to several considerations, most HCWs demonstrated positive attitudes toward IPPFP. This study reveals previously undocumented system-level barriers which must be addressed to enhance HCWs’ knowledge, confidence, and attitudes toward providing IPPFP services.
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    Clinical, Sonographic and Biochemical Profiles of Patients with a Mainz II Pouch Urine Diversion in Rural Uganda. A Case Series
    (2025-05-24) Ronald Opito; David Aderu; Joseph Epodoi; Denise Apolot; Ritah Kiconco; Richard Mpango; Jacob Eperu; Fred Kirya
    Background: Mainz II pouch urinary diversion is an alternative surgery for patients with an incurable vesicovaginal fistula (VVF). We report six (6) cases of patients who had incurable VVF and were offered Mainz II pouch surgery at Soroti Regional Referral Hospital, between 2009 and 2018 and followed up in 2023. Methods: A retrospective review of charts of 6 patients who were offered Mainz II pouch procedure and a cross-sectional assessment of their biochemical, sonographic and clinical profiles five (5) or more years after the procedure at Soroti Regional Referral Hospital were done. All case notes of patients who underwent the Mainz II procedure between 2009 and 2018 were retrieved from the registry and each patient profiled using a standard data abstraction tool. Results: The ages of the six participants ranged between 16 and 65 years at the time of the procedure. Four of the 6 participants had lived with the fistula for less than 10 years. Four participants had only one delivery and the other 2 had five and six deliveries. All the participants had lived with the Mainz II pouch urine diversion for at least five years (5–14 years). One participant (1/6) had hypertension (BP=161/101). Most participants reported nocturnal incontinence. Sonographic findings revealed one-sided mild vesi coureteral reflux with loss of corticomedullary differentiation in two participants (2/6). One of six (1/6) patients had severe vesicoureteral reflux grade 4. The commonest metabolic disorders were compensated metabolic acidosis (4/6). Conclusion: The Mainz II pouch procedure remains a viable option for managing incurable obstetric fistulas. However, the prevalence of metabolic complications, including acidosis and renal impairment, underscores the need for routine biochemical and sonographic monitoring to ensure optimal long-term patient outcomes. Keywords: Mainz II pouch, vesicovaginal fistula, urinary diversion, acidosi