title: Individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda.
abstract: BACKGROUND
  Obstructed labour is still a major cause of maternal morbidity and mortality and of adverse outcome for newborns in low-income countries. The aim of this study was to investigate the role of individual and health facility factors and the risk for obstructed labour and its adverse outcomes in south-western Uganda.
  
  
  METHODS
  A review was performed on 12,463 obstetric records for the year 2006 from six hospitals located in south-western Uganda and 11,180 women records were analysed. Multivariate logistic regression analyses were applied to control for probable confounders.
  
  
  RESULTS
  Prevalence of obstructed labour for the six hospitals was 10.5% and the main causes were cephalopelvic disproportion (63.3%), malpresentation or malposition (36.4%) and hydrocephalus (0.3%). The risk of obstructed labour was statistically significantly associated with being resident of a particular district [Isingiro] (AOR 1.39, 95% CI: 1.04-1.86), with nulliparous status (AOR 1.47, 95% CI: 1.22-1.78), having delivered once before (AOR 1.57, 95% CI: 1.30-1.91) and age group 15-19 years (AOR 1.21, 95% CI: 1.02-1.45). The risk for perinatal death as an adverse outcome was statistically significantly associated with districts other than five comprising the study area (AOR 2.85, 95% CI: 1.60-5.08) and grand multiparous status (AOR 1.89, 95% CI: 1.11-3.22). Women who lacked paid employment were at increased risk of obstructed labour. Perinatal mortality rate was 142/1000 total births in women with obstructed labour compared to 65/1000 total births in women without the condition. The odds of having maternal complications in women with obstructed labour were 8 times those without the condition. The case fatality rate for obstructed labour was 1.2%.
  
  
  CONCLUSIONS
  Individual socio-demographic and health system factors are strongly associated with obstructed labour and its adverse outcome in south-western Uganda. Our study provides baseline information which may be used by policy makers and implementers to improve implementation of safe motherhood programmes.
authors: Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, CRC, Entrance 72, 205 02 Malmo, Sweden. jerome.kabakyenga@med.lu.se
authors: Jerome K
authors: JK
authors: Kabakyenga
authors: Per-Olof
authors: PO
authors: Östergren
authors: Eleanor
authors: E
authors: Turyakira
authors: Peter K
authors: PK
authors: Mukasa
authors: Karen Odberg
authors: KO
authors: Pettersson
mesh_terms: D000293:Adolescent; D000328:Adult; D004420:Dystocia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006268:Health Facilities; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control; D008427:Maternal Health Services; D008507:Medically Underserved Area; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult