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Assessment of quality of care among in-patients with postpartum haemorrhage and severe pre-eclampsia at st. Francis hospital nsambya : a criteria-based audit
(BMC pregnancy and childbirth, 2017) Lumala, Alfred; Sekweyama, Peter; Abaasa, Andrew; Lwanga, Humphrey; Byaruhanga, Romano
The maternal mortality ratio of Uganda is still high and the leading causes of maternal mortality are postpartum haemorrhage (PPH), severe pre-eclampsia and eclampsia. Criteria-based audit (CBA) is a way of improving quality of care that has not been commonly used in low income countries. This study aimed at finding out the quality of care provided to patients with these conditions and to find out if the implementation of recommendations from the audit cycle resulted in improvement in quality of care. Methods This study was a CBA following a time series study design. It was done in St. Francis Hospital Nsambya and it involved assessment of adherence to standards of care for PPH, severe pre-eclampsia and eclampsia. An initial audit was done for 3 consecutive months, then findings were presented to health workers and recommendations made; we implemented the recommendations in a subsequent month and this comprised three interventions namely continuing medical education (CME), drills and displaying guidelines; a re-audit was done in the proceeding 3 consecutive months and analysis compared adherence rates of the initial audit with those of the re-audit. Results Pearson Chi-Square test revealed that the adherence rates of 7 out of 10 standards of care for severe pre-eclampsia/eclampsia were statistically significantly higher in the re-audit than in the initial audit; also, the adherence rates of 3 out of 4 standards of care for PPH were statistically significantly higher in the re-audit than in the initial audit. Conclusion The giving of feedback on quality of care and the implementation of recommendations made during the CBA including CME, drills and displaying guidelines was associated with improvements in the quality of care for patients with PPH, severe pre-eclampsia and eclampsia.
COVID-19 vaccination status and associated factors among patients presenting with COVID-19-like symptoms in Uganda
(Vaccine, 2025) Kusemererwa, Sylvia; Ankunda, Violet; Ongaria, Terry A.; Abaasa, Andrew; Kakande, Ayoub; Ssemwanga, Deogratius; Kimbugwe, Geofrey; Nayiga, Bernadette; Bosa, Henry K.; Driwale, Alfred; Yonas, T. Woldemariam; Kisakye, Annet; James, Humphreys; Archibald, K. Worwui; Sandra, Cohuet; Mwenda, Jason M.; Alison, M. Elliott; Kaleebu, Pontiano; Ruzagira, Eugene
The emergence of new SARS-CoV-2 variants threatens the effectiveness of global vaccination campaigns. This study examines the vaccination status and associated factors among patients presenting with COVID-19-like symptoms at 19 healthcare facilities in Uganda. Materials and methods A cross-sectional analysis was conducted using data collected at health facilities to evaluate the effectiveness of COVID-19 vaccines in Uganda from March 2023 to March 2024. Participants were individuals aged 12 years and older with COVID-19-like symptoms who underwent a SARS-CoV-2 qPCR test within 10 days of symptom onset. The study involved obtaining informed consent, collecting medical and vaccination histories (confirmed using vaccination cards and Ministry of Health COVID-19 database), performing physical examinations, administering a questionnaire, and taking oral/nasopharyngeal swabs for SARS-CoV-2 qPCR testing. Vaccination coverage was defined as receiving at least one vaccine dose. Logistic regression was used to identify factors associated with vaccination status. Results Among 1398 participants enrolled (55.4 % female), the median age was 30.0 years (IQR: 24.0–41.0). Vaccination coverage, was 66.6 %. Residing in Wakiso district compared to the Capital, Kampala was associated with a higher likelihood of vaccination (adjusted odds ratio [aOR] = 1.4, 95 % CI: 1.0–1.8, p = 0.021). Frontline and healthcare workers were more likely to be vaccinated (aOR = 5.0, 95 % CI: 3.6–7.3, p < 0.001), as were individuals with a previous COVID-19 diagnosis (aOR = 2.4, 95 % CI: 1.6–3.9, p < 0.001). Conclusions Our results underscore the need for targeted public health messaging and support to promote vaccination, especially among non-healthcare workers. Addressing these gaps is crucial for maintaining high vaccination coverage and mitigating the impact of new SARS-CoV-2 variants on the population.
Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of Lake Victoria in Uganda : a randomized controlled trial
(BMC Health Services Research, 2022) Nanvubya, Annet; Wanyenze, Rhoda K.; Abaasa, Andrew; Nakaweesa, Teddy; Mpendo, Juliet; Kawoozo, Barbarah; Matovu, Francis; Nabukalu, Sarah; Omoding, Geoffrey; Kaweesi, Jed; Ndugga, John; Bagaya, Bernard; Chinyenze, Kundai; Price, Matt A.; Van Geertruyden, Jean Pierre
Family planning knowledge is poor and use is low in Ugandan fishing communities. We compared the effectiveness of enhanced family planning (FP) education with routine counselling on FP knowledge and use. Methods Individuals aged 15–49 years were randomly assigned to intervention or control arm. The intervention constituted enhanced FP education based on a simplified handout extracted from the WHO FP guidance tool called, “Family planning: A global handbook for FP providers” which participants took home for additional reading. The control arm constituted FP counselling following Uganda Ministry of Health guidelines. FP knowledge score and contraceptive prevalence rate (CPR) were compared between trial arms at baseline and at 12 months. Negative binomial regression models were used to estimate the effect of the intervention on FP knowledge and use. Results Overall, 1410 participants were screened to enrol 1004 (502 per study arm, 48.5% women). Subsequently, 384 (76.5%) and 383 (76.3%) completed the 12 months’ follow-up in the intervention and control arms respectively. At baseline, a median FP knowledge score of 8 and a < 70% FP knowledge score was observed for all participants with a CPR of 36.8%. At month-12, the median FP knowledge score improved in both arms, higher in the intervention arm than the control arm (46 vs 30; p < 0.001). In the intervention arm, 304 (79.2%) had a score of ≥70 compared with 21 (5.5%) in the control arm (p < 0.001). In the negative binomial regression model, the change in FP knowledge score was 47% higher in the intervention arm than in the control arm (score ratio: 1.47, 95%CI: 1. 43-1.51, p < 0.001). The change in CPR was 16% higher in the intervention arm than in the control arm (Prevalence ratio: 1.16, 95%CI: 1.01-1.34, p < 0.040). Interpretation Enhanced FP education using a simplified FP education handout was more effective in increasing FP knowledge and use compared to routine FP counselling for people living in fishing communities. Innovative FP education interventions are recommended for improving FP knowledge and optimizing uptake in remote-rural settings where literacy levels are low.
Factors Associated with Consistent Condom Use in Ugandan Fishing Communities' Cohort
(PAMJ-One Health, 2022) Nakazibwe, Hope Grania; Muturi-Kioi, Vincent; Abaasa, Andrew; Kibengo, Freddie; Hughes, Peter; Price, Matt
fishing communities continue to face a heavy burden of HIV-infection. Access to HIV prevention methods remains problematic. Provision of affordable interventions such as condoms can help, but there is limited information on consistent condom use and associated factors among members of fishing communities around Lake Victoria. we promoted and provided free condoms to HIV negative fisherfolks enrolled in a longitudinal observational cohort between 2012 and 2017 in Uganda. We defined consistent condom use as a participant self-reporting 100% condom use while having sex with a new sexual partner. in total 615 persons were analysed. Of these 63 (10.2%) reported consistent condom use. Being male, Muslim and mobile were independently associated with high consistent condom use while having sex under influence of alcohol and having genital discharge or sores were associated with low use. findings suggest low consistent condom use, calling for attention to barriers to consistent condom use.
High HIV prevalence and associated factors in a remote community in the Rwenzori region of Western Uganda
(Infectious Disease Reports, 2010) Rubaihayo, John; Akib, Surat; Mughusu, Ezekiel; Abaasa, Andrew
In Uganda, previous studies have shown a tremendous decline in HIV prevalence over the past two decades due to changes in sexual behavior with a greater awareness of the risks involved. However, studies in Fort-Portal municipality, a rural town in Western Uganda, continued to show a persistent high HIV prevalence despite the various interventions in place. We conducted a study to establish the current magnitude of HIV prevalence and the factors associated with HIV prevalence in this community. This cross-sectional study was conducted between July and November 2008. Participants were residents of Fort-Portal municipality aged 15–49 years. A populationbased HIV sero-survey and a clinical review of prevention of mother to child HIV transmission (PMTCT) and voluntary counseling and HIV Testing (VCT) records were used to collect quantitative data. An inteviewer administered structured questionnaire was used to collect qualitative data on social deographics, risk behaviour and community perceptions. Focus group discussions (FGDs) and in-depth interviews provided supplementary data on community perceptions. Logistic regression was used in the analysis. The overall HIV prevalence in the general population was 16.1% [95% CI; 12.5–20.6]. Prevalence was lower among women (14.5%; 95% CI; 10.0–19.7) but not significantly different from that among men (18.7%; 95% CI; 12.5–26.3) (χ2 =0.76, P=0.38). Having more than 2 sexual partners increased the odds of HIV by almost 2.5 times. None or low education and age over 35 years were independently associated with HIV prevalence (P<0.05). Most participants attributed the high HIV prevalence to promiscuity/multiple sexual partners (32.5%), followed by prostitution (13.6%), alcoholism (10.1%), carelessness (10.1%), poverty (9.7%), ignorance (9.5%)), rape (4.7%), drug abuse (3.6%) and others (malice/malevolence, laziness, etc.) (6.2%). Although there was a slight decline compared to previous reports, the results from this study confirm that HIV prevalence is still high in this community. In order to prevent new infections, the factors mentioned above need to be addressed, and we recommend that education aimed at changing individual behavior should be intensified in this community.
Reduced susceptibility to pyrethroid insecticide treated nets by the malaria vector Anopheles gambiae s.l. in western Uganda
(Malaria Journal, 2008-05-28) Rubaihayo, John; Tukesiga, Ephraim; Abaasa, Andrew
Pyrethroid insecticide-treated mosquito nets are massively being scaled-up for malaria prevention particularly in children under five years of age and pregnant mothers in sub-Saharan Africa. However, there is serious concern of the likely evolution of widespread pyrethroid resistance in the malaria vector Anopheles gambiae s.l. due to the extensive use of pyrethroid insecticide-treated mosquito nets. The purpose of this study was to ascertain the status of pyrethroid resistance in An. gambiae s.l. in western Uganda. Wild mosquitoes (1–2 days old) were exposed in 10 replicates to new nets impregnated with K-othrine (Deltamethrin 25 mg/m2), Solfac EW50 (Cyfluthrin 50 mg/m2) and Fendona 6SC (Cypermethrin 50 mg/m2) and observed under normal room temperature and humidity (Temperature 24.8°C–27.4°C, Humidity 65.9–45.7). A similar set of mosquitoes collected from the control area 80 km away were exposed to a deltamethrin 25 mg/m2 impregnated net at the same time and under the same conditions. The 10-year mean KDT50 and mortality rates for each of the three pyrethroid insecticides were compared using the Student t-test. A significant increase in the mean knockdown time (KDT50) and mean mortality rate were observed in almost all cases an indication of reduced susceptibility. The overall results showed a four-fold increase in the mean knockdown time (KDT50) and 1.5-fold decrease in mortality rate across the three pyrethroid insecticides. There was a significant difference in the 10-year mean KDT50 between deltamethrin and cyfluthrin; deltamethrin and cypermethrin, but no significant difference between cyfluthrin and cypermethrin. The 10-year mean difference in KDT50 for mosquitoes exposed to deltamethrin from the control site was significantly different from that of mosquitoes from the intervention site (p<0.05, t=3.979, 9df). The 10-year mean difference in mortality rate between deltamethrin (84.64%); cyfluthrin (74.18%); cypermethrin (72.19%) and the control (90.45%) showed a significant decline in mortality across all the three insecticides. Generally the results showed a trend of increase in mosquito resistance status with cross-resistance against all the three pyrethroid insecticides. This study reveals for the first time the development of pyrethroid resistance in An. gambiae s.l. in Western Uganda. It is therefore strongly recommended that the impact of this development on malaria control efforts be closely monitored and alternative fabric treatments be considered before this problem curtails community wide implementation of this malaria control strategy in Uganda.
Risk factors for Crimean-Congo Haemorrhagic Fever (CCHF) virus exposure in farming communities in Uganda
(Journal of Infection, 2022) Atim, Stella A.; Ashraf, Shirin; Ademun, Anna R.; Nakayiki, Teddy; Balinandi, Stephen; Nakanjako, Gladys; Abaasa, Andrew; Odongo, Steven; Esau, Martin; Kaleebu, Pontiano; Lutwama, Julius J.; Masembe, Charles; Lambe, Teresa; Tweyongyere, Robert
Crimean-Congo Haemorrhagic Fever (CCHF) is an emerging human-health threat causing sporadic outbreaks in livestock farming communities. However, the full extent and the risks associated with exposure of such communities has not previously been well-described. We collected blood samples from 800 humans, 666 cattle, 549 goats and 32 dogs in districts within and outside Ugandan cattle corridor in a cross-sectional survey, and tested for CCHFV-specific IgG antibodies using Enzyme-Linked Immunosorbent Assays. Sociodemographic and epidemiological data were recorded using structured questionnaire. Ticks were collected to identify circulating nairoviruses by metagenomic sequencing. CCHFV seropositivity was in 221/800 (27·6%) in humans, 612/666 (91·8%) in cattle, 413/549 (75·2%) in goats and 18/32 (56·2%) in dogs. Human seropositivity was associated with livestock farming (AOR=5·68, p<0·0001), age (AOR=2·99, p=0·002) and collecting/eating engorged ticks (AOR=2·13, p=0·004). In animals, seropositivity was higher in cattle versus goats (AOR=2·58, p<0·0001), female sex (AOR=2·13, p=0·002) and heavy tick infestation (>50 ticks: AOR=3·52, p=0·004). CCHFV was identified in multiple tick pools of Rhipicephalus appendiculatus.
Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross sectional study
(Sexually transmitted infections, 2019) Namale, Gertrude; Kamacooko, Onesmus; Bagiire, Daniel; Mayanja, Yunia; Abaasa, Andrew; Kilembe, William; Price, Matt; Ssemwanga, Deogratius; Lunkuse, Sandra; Nanyonjo, Maria; Ssenyonga, William; Mayaud, Philippe; Newton, Rob; Kaleebu, Pontiano; Seeley, Janet
We assessed the prevalence and risk factors associated with virological failure among female sex workers living with HIV on antiretroviral therapy (ART ) in Kampala, Uganda. Methods We conducted a cross-sectional study between January 2015 and December 2016 using routinely collected data at a research clinic providing services to women at high risk of STIs including HIV. Plasma samples were tested for viral load from HIVseropositive women aged ≥18 years who had been on ART for at least 6 months and had received adherence counselling. Samples from women with virological failure (≥1000 copies/mL) were tested for HIV drug resistance by population-based sequencing. We used logistic regression to identify factors associated with virological failure. Results Of 584 women, 432 (74%) with a mean age of 32 (SD 6.5) were assessed, and 38 (9%) were found to have virological failure. HIV resistance testing was available for 78% (28/38), of whom 82.1% (23/28) had at least one major drug resistance mutation (DRM), most frequently M184V (70%, 16/23) and K103N (65%, 15/23). In multivariable analysis, virological failure was associated with participant age 18–24 (adjusted OR (aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART nonadherence (aOR=2.6, 95% CI 1.2 to 5.8) and baseline CD4+ T-cell count ≤350 cells/mm3 (aOR=3.1, 95% CI 1.4 to 7.0). Conclusions A relatively low prevalence of virological failure but high rate of DRM was found in this population at high risk of transmission. Younger age, self-reported ART non-adherence and low CD4+ T-cell count on ART initiation were associated with increased risk of virological failure.
Trends of Reported HIV Sexual Risk Behaviour and HIV Incidence among Fisherfolk in Uganda Receiving Clinic-based Routine HIV Counseling and Testing
(AIDS Research and Human Retroviruses, 2014) Mushabe Bahemuka, Ubaldo; Abaasa, Andrew; Ruzagira, Eugene; Mukasa Kibengo, Freddie; Ndibazza, Juliet; Asiki, Gershim; Mulondo, Jerry; Andrew Price, Matthew; Fast, Patricia; Kamali, Anatoli
HIV counseling and testing (HCT) has been shown to reduce HIV risk behavior and is central to HIV prevention programs. We investigated risk behavior and HIV incidence trends in a fisherfolk cohort on Lake Victoria, Uganda. HIV negative volunteers aged 18–49 years, at high risk of HIV infection and willing to undergo HCT were enrolled. At every quarterly visit, they received HCT. Condoms and STI treatment were also provided. Risk behavior data on alcohol consumption before sex, multiple or new sex partners, condom use and exchange of gifts for sex in the past 3 months were collected at baseline and every 6 months for 2 years. We fitted multilevel logistic regression models to investigate the trends.

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