Objective There is a dearth of published data on the vitamin D status of the Ugandan population; the objective of the study was to determine the prevalence of vitamin D deficiency among pregnant women in Uganda and its associations with maternal characteristics and adverse foetal-maternal outcomes.Study design and setting We conducted a cross-sectional study on pregnant women admitted to a tertiary referral hospital in Kampala, Uganda for delivery during the study period from July to December 2023.Participants The study was conducted on 351 pregnant women aged ≥18 years who consented to participate in the study, who had a single intrauterine pregnancy and a gestational age greater than 26 weeks, and who delivered at St. Francis Hospital, Nsambya. We excluded pregnant women admitted to the hospital longer than 1 week before delivery; pregnant women with self-reported pre-existing kidney diseases, liver diseases, or gut or malabsorption disorders and pregnant women with severe pregnancy-unrelated comorbidities requiring intensive care unit admission before delivery.Interventions Maternal venous blood was collected at admission, and serum 25-hydroxy-vitamin D (25(OH)D) was measured by an electrochemiluminescence binding assay.Primary and secondary outcome measures Maternal sociodemographic characteristics and obstetric-medical factors, and adverse maternal and foetal outcomes were captured by using a data collection form. The data were analysed by logistic regression analysis at the univariate, bivariate and multivariate levels.Results The prevalence of vitamin D deficiency, defined as a serum 25(OH)D concentration less than 20 ng/mL, was 40.2%. This was seen more among the Muslims (OR 2.4, 95% CI 1.33 to 4.43, p value 0.004), members of the Banyankore tribe (OR 2.1, 95% CI 1.02 to 4.36, p value 0.043) and primigravidae (OR 0.6 for women with parity of 1–4 compared with primigravidity, 95% CI 0.36 to 0.94, p value 0.028). Among adverse maternal outcomes, vitamin D deficiency was associated with hypertensive disorders in pregnancy (OR 2.4, 95% CI 1.16 to 4.10, p value <0.001), in particular gestational hypertension (OR 2.2, 95% CI 1.21 to 4.94, p value 0.014), and pre-eclampsia/eclampsia/haemolysis, elevated liver enzymes and low platelets syndrome (OR 2.9, 95% CI 1.45 to 6.08, p value 0.003), with increased preterm birth (OR of 4.0, 95% CI 1.78 to 10.84, p value<0.001) and with delivery of babies with low birth weight (OR 4.2, 95% CI 2.63 to 13.62, p value 0.001).Conclusions The study found a high prevalence (40.2%) of vitamin D deficiency among pregnant women delivering at St. Francis Hospital, Nsambya. Additionally, vitamin D deficiency was linked with adverse maternal and foetal outcomes such as hypertensive disorders in pregnancy, preterm birth and low birth weight.

# Background Low- and middle-income countries, particularly in the African region in-country distribution and determinants of infertility are understudied. In this study, we aimed to estimate the prevalence, regional distribution, and determinants of infertility in Uganda to inform programming. # Methods We estimated the prevalence of primary and secondary infertility among women aged 20-49 years using data from the three rounds of the Uganda Demographic and Health Survey 2006, 2011, and 2016, and compared the differences across geographic regions. We pooled data sets for all three years and conducted logistic regression to identify factors associated with infertility. # Results We included 16,537 women aged 20-49 years for analysis of primary infertility and 12,628 for secondary infertility. The overall prevalence of infertility (pooled across the three surveys was 6.4%. The prevalence of primary infertility was 1.4% (95% Confidence interval, CI=1.0-1.8), 0.7% (95% CI=0.5-1.0) and 0.8% (95% CI=0.6-1.0) in 2006, 2011 and 2016, respectively. The prevalence of secondary infertility was 7.4% (95% CI=6.5-8.4), 6.9% (95% CI=5.9-8.0) and 7.1% (95% CI=6.4-7.9) in 2006, 2011, and 2016 respectively. The prevalence of primary infertility was similar across regions. Secondary infertility was highest in the Central (7.9%, 95% CI= 6.1-10.3, in 2016) and Northern regions (7.4%, 95% CI=6.1-8.9, in 2016). In all survey years, women with higher education had lower odds of secondary infertility compared to women with no education (adjusted odds ratio, aOR=0.54, 95% CI=0.35-0.83; *P* \< 0.001). # Conclusions Our results suggest that the prevalence of primary infertility is similar across regions, whereas secondary infertility varies by region, with higher prevalence in Central and Northern regions. More research is required to understand the drivers behind the variation of secondary infertility across regions to inform policy and decision making.

Background: Unwanted and mistimed pregnancies are postulated to affect the utilization of maternal health services particularly among adolescent girls and young women (AGYW). We investigated the association between pregnancy wantedness and utilization of maternal health services by AGYW in Uganda. Methods: We analyzed data from the 2011 and 2016 Uganda Demographic and Health Surveys among women whose most recent live birth in each survey’s 5-year recall period was their first birth and who were ≤ 24 years old at the time of their first birth. The outcome variables for this study included utilization of antenatal care (ANC) (categorized as “optimal” if ≥ 4 visits or “poor” if < 4 visits), health facility delivery (yes/no), utilization of postnatal care (PNC) (yes/no), and utilization of the continuum of all three maternal health services (fully utilized and partially utilized). The main independent variable was pregnancy wantedness, categorized as wanted at the time of conception versus unwanted (wanted later or not wanted at all). Data were analyzed using STATA 14. We performed descriptive analysis and logistic regression (bivariate and multivariable) for each survey separately. Results: We included a total of 741 (in 2011) and 1,828 (in 2016) AGYW (10 to 24 years at the time of their first live birth). The percentage of them that said their first pregnancy was unwanted was 42.0% in 2011 and 45.9% in 2016. In 2011, AGYW with unwanted pregnancies were less likely to utilize optimal ANC compared to those who wanted their pregnancies (AOR=0.64, 95%CI=0.43-0.96). Additionally, pregnancy wantedness was associated with utilization of the continuum of maternal health services in 2011 (AOR = 0.63, CI = 0.40 - 0.99). In 2016, pregnancy wantedness was not significantly associated with ANC utilization (AOR 0.93, CI = 0.73 - 1.17). There was no association between pregnancy wantedness and delivery in a health facility or utilization of PNC in both surveys (p-value >0.05). Conclusion: Our results showed that although pregnancy wantedness was associated with utilization of ANC and the continuum of maternal health services in 2011. However, in 2016, pregnancy wantedness was not associated with the utilization of any maternal health services.

Purpose:Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Methods: Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Results: Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Conclusion: Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.

BackgroundAlthough reproductive failure after cancer treatment in children and young adults has been extensively described in high-income countries, there is a paucity of data in low-income settings. In addition, patient, parent, or health worker experiences, perspectives, and attitudes toward the risk of reproductive failure among young cancer patients in these settings are unknown. This study will describe the extent of reproductive morbidity associated with cancer treatment among childhood and young adult cancer survivors in Uganda. In addition, we aim to explore the contextual enablers and barriers to addressing cancer treatment-related reproductive morbidity in Uganda.MethodsThis is an explanatory sequential mixed-method study. The quantitative phase will be a survey among childhood and young adult cancer survivors recruited from the Kampala Cancer Registry (KCR). The survey will utilize a Computer Assisted Telephone Interview (CATI) platform on a minimum of 362 survivors. The survey will obtain information on self-reported reproductive morbidity and access to oncofertility care. The qualitative phase will use grounded theory to explore contextual barriers and enablers to addressing reproductive morbidity associated with cancer treatment. The quantitative and qualitative phases will be integrated at the intermediate and results stage.ConclusionResults from this study will inform the development of policy, guidelines, and programs supporting reproductive health among childhood and young adult cancer survivors.

Background: Despite a plethora of literature on barriers to addressing future fertility in childhood cancer survivors, the data are not representative of limited middle-income settings. Unique and context-specific factors may influence addressing future fertility care among childhood cancer survivors in Uganda. This study aimed to explore the experiences, attitudes, and perceptions of parents on their interactions with health providers about future fertility, as part of their child's cancer survivorship.Methods: Using grounded theory, semistructured interviews were conducted with parents of children diagnosed with cancer, <18 years of age, and not in the induction or consolidation phases of treatment. Transcripts were thematically analyzed.Results: A total of 20 participants were interviewed, with the majority identifying as female (n = 18). The global theme that arose was the importance of shared decision-making, and the key themes encompassing this were as follows: (1) importance of accurate information, (2) respect of autonomy, and (3) engagement and psychosocial support.Conclusion: In Uganda, parents of children with cancer value a multifaceted approach to satisfactory decision-making within the context of oncofertility.

Abstract Background: Human Chorionic Gonadotropin (hCG) is secreted by the embryo as early as the first week of life. Several studies have proven the potential of a single serum β hCG level, at 12 to 14 days after embryo transfer, to predict pregnancy outcomes after In vitro fertilization. However, these studies show significant heterogeneity, with paucity of data from African populations. This study aimed to evaluate the prognostic value of a serum β-hCG level cut off, 12 days after embryo transfer, on predicting livebirth among Ugandan women. Methods: A Retrospective cross-sectional study. 337 fresh IVF cycles with serum β-hCG ≥5 mIU/mL, at 12 days after embryo transfer, were eligible. We abstracted participant characteristics, IVF cycle characteristics, livebirth, clinical pregnancy, and ongoing pregnancy data from each eligible cycle. We utilized the Youden index metric and the maximize_boot_metric method to link serum β-hCG levels to outcome data and determine the optimal cut off values. Results:The optimal serum β-hCG cut off value for predicting livebirth was 437.42mIU/ml with a corresponding sensitivity and false positive rate of 72% and 31% respectively. The cut-offs for clinical and ongoing pregnancy, were 239.58 mIU/ml and 353.66 mIU/ml respectively. These corresponded with a sensitivity of 83% and 77% respectively, and a false positive rate of 27% and 33% respectively. The serum β-hCG cut off had a poor discriminatory performance for predicting live birth but moderate performance for predicting clinical and ongoing pregnancies. Conclusion: A single serum β-hCG 12 days after cleavage embryo transfer has poor discriminatory performance in predicting live birth, albeit performing modestly in predicting clinical pregnancy and ongoing pregnancy among Uganda women.

Aims: Hyperglycaemia in pregnancy (HIP) is a major determinant of maternal and offspring adverse outcomes, but there are little data from sub-Saharan Africa.This study examined the burden and risk factors of HIP in Uganda. Materials and Methods:We collected data sociodemographic, anthropometric and clinical data from approximately 4000 pregnant women attending antenatal clinics in Uganda.Oral glucose tolerance test performed at 24-28 weeks gestation to screen for hyperglycaemia.Prevalence was defined as the number of participants diagnosed with HIP as a proportion of the total number of participants enrolled into the study, during the study period.Univariable and multivariable Poisson regression models were fitted to calculate prevalence ratios for association between risk factors and the outcome.Results: Using the 2013 WHO criteria, 8.5% (95% CI: 7.7-9.4%) of the women had HIP.In multivariable analyses, older maternal age (>30 years) and mid-gestation obesity were the key factors associated with hyperglyceamia; other factors, such as HIV infection, were less important. Conclusions:This study reveals a high prevalence of HIP in Uganda, with obesity an important contributor.Cost-effective interventions are urgently needed to mitigate this major health threat in Africa, where the rates of obesity are increasing.

Objective: This study aimed to evaluate the prognostic value of a serum β-hCG level cutoff, 12 days after embryo transfer, on predicting live births among Ugandan women. Methods: This is a retrospective cross-sectional study. Three hundred thirty-seven fresh IVF cycles with serum β-hCG ≥5 mIU/mL, at 12 days after embryo transfer, were eligible. We abstracted participant characteristics, IVF cycle characteristics, live birth, clinical pregnancy, and ongoing pregnancy data from each eligible cycle. We utilized the Youden Index metric and the maximize_boot_metric method to link serum β-hCG levels to outcome data and determine the optimal cutoff values. Results: The optimal serum β-hCG cutoff value for predicting live birth was 437.42 mIU/mL with a corresponding sensitivity and false positive rate of 72% and 31%, respectively. The cutoffs for clinical and ongoing pregnancy were 239.58 mIU/mL and 353.66 mIU/mL, respectively. These corresponded with a sensitivity of 83% and 77%, respectively, and a false positive rate of 27% and 33%, respectively. The serum β-hCG cutoff had poor discriminatory performance for predicting live births but moderate performance for predicting clinical and ongoing pregnancies. Conclusion: A single serum β-hCG 12 days after cleavage embryo transfer has poor discriminatory performance in predicting live birth, albeit performing modestly in predicting clinical pregnancy and ongoing pregnancy among Ugandan women.

Purpose: To establish the extent of self-reported reproductive failure associated with cancer treatment, and attitudes toward fertility among adolescent and young adult (AYA) cancer survivors in Uganda. Methods: A registry-based computer-assisted telephone interview survey was conducted in Uganda. The survey population were survivors of childhood, adolescent and early adulthood cancers diagnosed between 2007 and 2018. The survey explored fertility outcomes, experiences of oncofertility and fertility attitudes of AYA cancer survivors. Results: Thirty-four (female = 14 and male = 20) interviews were completed. Survivors were 18-35 years of age. The median age at cancer diagnosis was 23.5 for females and 17.5 for males. Kaposi's sarcoma contributed to 44% of primary cancer diagnoses. All the survivors had received chemotherapy alone or in combination with other modalities and 79% of survivors had not received satisfactory information about future fertility before cancer treatment. Twenty one percent of males and 46% females met the criteria for infertility and 60% of these had met this criterion after their cancer diagnosis. Eighty two percent wanted to raise a biologically related child. Forty seven percent would be dissatisfied with their lives if they were unable to have a child or additional children. Conclusion: AYA cancer survivors in this low-resource setting reported reproductive failure, despite a strong fertility desire. Information and counseling provided on therapy-related problems before cancer treatment was insufficient and reinforces the need to build capacity for oncofertility resources within the region.

Abstract Background: Human Chorionic Gonadotropin (hCG) is secreted by the embryo as early as the first week of life. Several studies have proven the potential of a single serum β hCG level, at 12 to 14 days after embryo transfer, to predict pregnancy outcomes after In vitro fertilization. However, these studies show significant heterogeneity, with paucity of data from African populations. This study aimed to evaluate the prognostic value of a serum β-hCG level cut off, 12 days after embryo transfer, on predicting livebirth among Ugandan women. Methods: A Retrospective cross-sectional study. 337 fresh IVF cycles with serum β-hCG ≥5 mIU/mL, at 12 days after embryo transfer, were eligible. We abstracted participant characteristics, IVF cycle characteristics, livebirth, clinical pregnancy, and ongoing pregnancy data from each eligible cycle. We utilized the Youden index metric and the maximize_boot_metric method to link serum β-hCG levels to outcome data and determine the optimal cut off values. Results: The optimal serum β-hCG cut off value for predicting livebirth was 437.42mIU/ml with a corresponding sensitivity and false positive rate of 72% and 31% respectively. The cut-offs for clinical and ongoing pregnancy, were 239.58 mIU/ml and 353.66 mIU/ml respectively. These corresponded with a sensitivity of 83% and 77% respectively, and a false positive rate of 27% and 33% respectively. The serum β-hCG cut off had a poor discriminatory performance for predicting live birth but moderate performance for predicting clinical and ongoing pregnancies. Conclusion: A single serum β-hCG 12 days after cleavage embryo transfer has poor discriminatory performance in predicting live birth, albeit performing modestly in predicting clinical pregnancy and ongoing pregnancy among Uganda women.

Aims The study aims to evaluate the strength of fasting versus post-load glucose levels in predicting adverse outcomes in women with hyperglycaemia in pregnancy (HIP). Methods Women attending antenatal clinics in urban and peri-urban Uganda had oral glucose tolerance test between 24 and 28 weeks of gestation to screen for HIP, and were followed up to collect data on maternal and neonatal outcomes. Univariable and multivariable Poisson regression models were used to estimate the relative risk adverse outcome associated with fasting hyperglycaemia alone post-load hyperglycaemia alone, or elevation of both fasting and post-load glucose levels. Results We included 3206 participants in the final analysis. HIP was associated with increased risk of Caesarean section, large for gestaional age babies, and neonatal intensive care admission. The risk was highest (2.54-fold compared to normal glycaemic women) when both FBG and post-load glucose levels were elevated. After adjustment for potential confounders, having elevated post-load glucose alone was not associated with increased risk of any of the outcomes, but elevated FBG alone increased the risk of Caesarian section by 1.36-fold. Conclusion Fasting hyperglycemia appears to be more strongly associated with adverse pregnancy outcomes than post-load hyperglycaemia, but the risk is even higher in women with elevation of both fasting and post-load glucose levels.

BACKGROUND:The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recent evidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations.OBJECTIVE:This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity.STUDY DESIGN:This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks' gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization's criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used.RESULTS:Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36-5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20-2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74-3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17-3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16-2.30).CONCLUSION:Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity.

Abstract Background Hyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women. Methods A prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Results Two hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM. Conclusion HIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.

Objective: To determine whether hyperglycaemia in the gestational diabetes (GDM) range independently predicts adverse pregnancy outcomes in Uganda. Design: Prospective observational cohort study. Setting:Five major hospitals in urban/semi-urban central Uganda. Sample:237 women with gestational diabetes, 2,641 normoglycaemic controls. Methods:Women were screened with oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Cases of GDM were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, prenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Participants with diabetes in pregnancy (DIP) were excluded from the analysis. Outcomes:Primary outcomes: Birthweight large for gestational age (LGA; >90th centile) and perinatal death. Secondary outcomes: Caesarean delivery, preterm birth <37 weeks, umbilical cord c-peptide concentration >90th centile (>1.35 mcg/L), and neonatal admission. Results:Women with GDM had a median of only two glucose measurements recorded in third trimester, and only one fifth received therapeutic management (mostly metformin, one participant received insulin). GDM was not independently associated with LGA (adjusted odds ratio, aOR 1.12; 95% CI 0.81-1.56) or perinatal death (aOR 0.66; 95% CI 0.26-1.66), but increased the risk of Caesarean delivery. Mid-gestational BMI of >30kg/m2 was strongly associated with LGA, and mean arterial pressure >90 mmHg was the strongest predictor of perinatal death. Conclusions:Even without active management, GDM was not associated with large birthweight or perinatal death in this population. Interventions that target blood pressure and obesity are likely to be more beneficial in improving LGA and perinatal mortality, than management of GDM. Funding:Medical Research Council Keywords:Gestational diabetes, Africa

Background The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. Methods A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. Results Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18–0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14–0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08–1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. Conclusion Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.

Partner support is very important in alleviating the burden of infertility related stress and although understudied, partner coping patterns also play a key role in the other partner’s ability to cope with the infertility experience which eventually affects treatment outcomes. Very few studies more so in a low to middle income setting, explore the psychological and social aspects of infertility in men. There is a need for a deeper understanding into men’s perceptions, expectations and challenges of fertility treatment in our low resource setting. To explore men’s perceptions, expectations, challenges and experiences during IVF treatment among men in a low resource setting. A qualitative research design was utilised. The study was conducted at life sure fertility and gynaecology centre. The study participants were men participating in the IVF cycles. They were selected purposefully by maximum variation sampling. All the interviews took place on the day of enrolment for treatment and inductive content analysis was used to draw meaning from the transcripts. Ethical approval for the study will be sought from Nsambya Hospital IRB/REC. Seven major themes arose, and these included: (1) Societal influence on IVF treatment experience; (2) Social support during IVF treatment; (3) Feeling insignificant; (4) Financial burden; (5) IVF as an emotional bridge; (6) Inadequate sensitization; (7) Fear of treatment failure. Men’s experiences during IVF treatment were negatively affected by the society’s perceptions of IVF treatment and infertility, cost of treatment, perceived men’s involvement and insufficient knowledge about the IVF process. However, spouse and friends’ support helped with coping and the IVF treatment experience strengthened emotional bonds.

2014 with the complaint of vaginal discharge for three days without other symptoms.At that time, she reported that she was asleep when she suddenly felt her bed wet.The fluid was coming from the vagina, it was clear, not blood stained, not mucoid and odorless.It was not associated with abdominal pains, fever or other genito-urinary symptoms.There was no history of trauma.The ultrasound scan done on 30th June 2014 indicated a single live fetus at 22weeks with severe oligohydramnios.The AFI was 3cm, Urinalysis was normal.She stayed in the hospital under conservative management of bed rest, pad checks and 48hourly Complete blood counts.She was later discharged at 23.6Weeks of amenorrhea on erythromycin 500mg every 6hrs for 5days and was scheduled to attend the High risk antenatal clinic.She was counselled on the danger signs and what to lookout for.She continued to have on and off mild drainage of liquor without any other symptoms for the next two months.She had three antenatal visits at hospital after discharge and serial ultra sound scans monthly which showed reduced liquor.She was given one dose of malaria prophylaxis, and hematinics.She did not continue with any oral antibiotics after stopping the erythromycin.She also abstained from sexual intercourse during the entire period.Three days prior to the re-admission, she developed progressive dull lower abdominal pain with a vaginal discharge but no bleeding.She had normal micturition habits, no fever, and no history of trauma.This is what prompted her to come to hospital otherwise she had planned to return when she is at term. Review of other systems did not reveal significant findings Past obstetric historyThe previous four pregnancies were all carried to term with no major antenatal concerns.The first was delivered by spontaneous vaginal delivery at Mulago hospital in 2001 and is alive.The second was delivered by assisted breech delivery in 2005.The neonate was asphyxiated and died after one hour.The third was delivered by EmCS due to fetal distress in 2009.The neonate died after 48hours.The fourth pregnancy was also delivered by EmCS in Nsambya hospital due to failed trial of labor in 2012.The birth weight was 3.0kg with good outcome.