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A 10 years Trend of Peptic Ulcer Disease and other Gastrointestinal Disorders in Northern Uganda
(East and Central African Journal of Surgery, 2016) Okello, T.R.; Ogwang, D.M; Pecorella, I.
The changing trend of GI disorders has not been expounded in our setting, there is need to examine the extent to which major endoscopically diagnosed upper GI disorders have changed in the last 10 years (2005 to 2015). Methods: This was a retrospective study in which endoscopically diagnosed GI disorders of Jan-Jun 2005 were compared with 2015 (10 years) for the same period Results: In the 10 years (2005 to 2015), the prevalence of peptic ulcer disease (PUD) reduced from 9.6% to 2.9% (P value 0.000), followed by esophageal varices from 10.3% to 4.0%, and duodenitis from 3.2% to 0.7% respectively. Gastritis increased from 18.4% to 48.2% (P value 0.000), followed by cancer esophagus from 3.2% to 5.1%. Conclusion: As the prevalence of PUD decreases in our community, gastritis increases hence patients with upper GI symptoms tend to suffer gastritis thus clinicians should focus on treating gastritis and eradication of Helicobacter pylori.
A 10-year retrospective study of lung cancer in Uganda
(BioMed Central Ltd, 2022-02) Bogere, Naghib; Bongomin, Felix; Katende, Andrew; Omaido, Blair Andrew; Namukwaya, Elizabeth; Mayanja-Kizza, Harriet; Walusansa, Victoria
Abstract Background Lung cancer is a leading cause of cancer-related deaths in Uganda. In this study, we aimed to describe the baseline characteristics and survival of patients with lung cancer at the Uganda Cancer Institute (UCI). Methods We retrospectively reviewed medical records of all patients with a histological diagnosis of lung cancer registered at UCI between January 2008 and August 2018. Data on demographic, clinical, and treatment characteristics, and vital status were abstracted and analyzed. Patients with undocumented vital status on the medical records were contacted through phone calls. We determined survival as time from histological diagnosis to death. The Kaplan-Meier survival analysis was performed to estimate the median survival time and the 5-year overall survival rate. Results Of the 207 patients enrolled, 56.5% (n = 117) were female, median age was 60 years (range: 20–94), 78.7% (n = 163) were never-smokers and 18 (8.7%) were living with HIV. Presumptive anti-tuberculosis treatment was given to 23.2% (n = 48). Majority had non-small cell lung cancer (96.6%, n = 200) with 74.5% (n = 149) adenocarcinoma and 19% (n = 38) squamous cell carcinoma. All had advanced (stage III or IV) disease with 96.1% (n = 199) in stage IV. Chemotherapy (44.9%, n = 93) and biological therapy (34.8%, n = 72) were the commonest treatments used. Overall survival at 6 months, 1-, 2- and 5-years was 41.7, 29.7, 11.8, and 1.7%, respectively. The median survival time of 4.4 months was not statistically significantly different between participants with NSCLC or SCLC (4.5 versus 3.9 months, p = .335). Conclusion In Uganda, adenocarcinoma is the predominant histologic subtype of lung cancer and patients are predominantly females, and non-smokers. Patients present late with advanced disease and poor overall survival. Public awareness should be heightened to facilitate early detection and improve outcomes.
A 10-Year Risk of Cardiovascular Disease among Patients with Severe Mental Illness at Mbarara Regional Referral Hospital, Southwestern Uganda
(BioMed Research International, 2020) Agaba, David Collins; Migisha, Richard; Lugobe, Henry Mark; Katamba, Godfrey; Ashaba, Scholastic
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Patients with severe mental illness (SMI) are at a higher risk for developing CVD and have a higher risk for harboring factors related to CVD. In addition to the effects of antipsychotic medications, unhealthy lifestyle factors, such as poor diet, inadequate physical activity, cigarette smoking, and sedentary behaviors, are known to be risk factors that may contribute to poor cardiovascular health in patients with SMI. Early identification of individuals at elevated risk of CVD is essential so that dietary and lifestyle modifications or pharmacological interventions can be prescribed to alleviate the risk of cardiovascular disease. The objective of the study was to determine the 10-year risk of cardiovascular disease among patients with severe mental illness at Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a cross-sectional study at the outpatient mental health clinic of Mbarara Regional Referral Hospital, between October 2018 and March 2019. We used the Globorisk CVD risk score to estimate the 10-year risk of CVD among patients with SMI, using the online Globorisk calculator. Participants were then assigned to one of three categories depending on their 10-year CVD risk score: <3% (low), 3–10% (intermediate), and >10% (high). We calculated the risk scores of 125 participants aged 40-74 years. Most of the participants were female 75 (60%), had a diagnosis of bipolar disorder 75 (60%), and had mental illness for ≥10 years 57 (46%). Eighty five percent (85%) of the participants had intermediate to high 10-year risk of CVD (64% with intermediate and 21% with high risk). The average risk score was significantly higher in males compared to females, 8.82% versus 6.43%, p = 0:016. We detected a high 10-year risk of CVD in a significant proportion of patients with SMI in southwestern Uganda. We recommend lifestyle modifications and pharmacological interventions to reverse risk or delay progression to CVD in this patient population.
2353.Distance and Time to Clinic Are Associated with Increased Risk of Detectable HIV-1 Viral Load at a Peripheral Health Center in Rural Western Uganda
(US: Oxford University Press., 2022) Hendren, Cate; Ndizeye, Ronnie; Mumbere, Nobert; Rubinstein, Rebecca J.; Baguma, Emma; Muhindo, Rabbison; Goel, Varun; Ntaro, Moses; Siedner, Mark; Mulogo, Edgar
Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV) and reduces HIV transmission. While availability and efficacy of ART have improved in sub-Saharan Africa (SSA), access remains a challenge. Travel burden, measured as travel time, distance, and cost, has been posited as a potential barrier to ART. For example, a previous study at a large, urban referral center in Uganda showed GPS-measured distance was associated with clinic absenteeism. However, others suggest that PLHIV are willing to travel farther for HIV care because of stigma or for higher quality care. Less is known about the effect of travel burden in rural settings where transportation infrastructure is sparse, and there are few transportation options. Therefore, the objective of this study funded by the IDSA GERM Program was to explore potential associations between distance- and time-to-clinic in a highland area of rural western Uganda with HIV outcomes including viral suppression.
2D-Discrete Fourier Transform: Generalization of the MIA-QSAR strategy in molecular modeling
(Chemometrics and Intelligent Laboratory Systems, 2015) Barigye, Stephen J.; Freitas, Matheus P.
Adequate alignment of chemical structure images with respect to the basic scaffold in a series of chemical compounds constitutes an indispensable requirement for constructing multivariate images (MVIs) and subsequent molecular modeling using the Multivariate Image Analysis applied to Quantitative Structure–Activity Relationship (MIA-QSAR) approach. However, up to the moment, this alignment procedure has been manually performed, based on subjective ocular precision. The 2D-Discrete Fourier Transform (2D-DFT) is introduced as a strategy for creating a common base to construct MVIs for chemical structures using their magnitude spectra. The utility of magnitude spectra in QSAR studies has been evaluated through models for the antimalarial, anticancer and trichomonicidal activity of a series of 2, 5-diaminobenzophenone, 4-phenylpyrrolocarbazole and benzimidazole derivatives, respectively, yielding satisfactory results comparable to superior to those reported in the literature. It is anticipated that this strategy should enable the application of the MIA-QSAR approach to structurally diverse datasets other than a series of congeneric datasets.
3D Nerve Cell Cultures and Complex Physiological Relevance
(Drug Discovery Today, 2018) Cheng, Xin; Ndyabawe, Kenneth; Asthana, Amish; Kisaalita, William S.
The field of tissue engineering has not yet provided knowledge on which a consensus for the complex physiological relevance (CPR) of neuronal cultures could be established. The CPR of 3D neuronal cultures can have a profound impact on the drug discovery process through the validation of in vitro models for the study of neuropsychiatric and degenerative diseases, as well as screening for neurotoxicity during drug development. Herein, we assemble evidence in support of the potential of [Ca 2+] i oscillation frequency as a CPR outcome that can demonstrate the in vivo-like behavior of 3D cultures and differentiate them from 2D monolayers. We demonstrate that [Ca 2+] i oscillation frequencies in 2D cultures are significantly higher than those found in 3D cultures, and provide a possible molecular explanation.
3D structure design and simulation for efficient particles capture: The influence of nanofiber diameter and distribution
(Materials Today Communications, 2020) Wu, Jiajun; Akampumuza, Obed; Liu, Penghong; Qin, Xiaohong
Software simulation is a convenient and efficient way to design and check different air filter structures with high efficiency and low pressure drop. In this work, nanofiber filters of different diameters ranging from 100 to 900 nm were designed to check their influence on filtration efficiency, pressure drop and quality factor (QF). Slip-flow effect of air molecules was considered on the surface of single fiber. Then, filters with different diameter distributions were constructed to study the filtration efficiency discrepancy when the filter thickness and porosity were kept equal. With a rotation of the filters composed of nanofibers of 500 nm in diameter in the computational domain, the filtration efficiency and QF increased steadily. The simulation results were partially verified by electrospun cellulose acetate nanofiber filter, and meanwhile provide with new insights into the filter structure design of high filtration efficiency with low pressure drop.
50 Gb/s DMT and 120 Mb/s LTE signal transmission over 5 km of optical fiber using a silicon photonics transceiver
(In Integrated Photonics Research, Silicon and Nanophotonics, 2018) Rahim, Abdul; Abbasi, Amin; Shahin, Mahmoud; Sequeira André, Nuno; Richter, André; Kerrebrouck, Joris Van; Van Gasse, Kasper; Katumba, Andrew; Moeneclaey, Bart; Yin, Xin; Morthier, Geert; Baets, Roel; Roelkens, Gunther
Next-generation passive optical networks will require the use of low-cost, high-performance transceivers to cope with the increasing bandwidth demands for emerging applications such as fixed-mobile convergence for 5G. Silicon photonics is widely acknowledged as a technology that can provide manufacturing of low-cost photonic integrated circuits by using existing CMOS fabrication infrastructure. Intensity modulation/direct detection solutions can reach 100 Gb/s per wavelength, but require high-speed electronics and photonics, which adversely affects the cost. An alternative approach is to use advanced multi-carrier modulation schemes, such as Discrete Multi-Tone (DMT), a real-valued Orthogonal Frequency Division Multiplexing (OFDM) scheme. This technique uses Digital Signal Processing (DSP) to relax electrical and optical bandwidth requirements on the transmitter and receiver side. It promises high spectral efficiency and granularity, higher tolerance to fiber impairments and channel adaptation through flexible multi-level / multi-carrier coding [1]. DMT transmission at 100 Gb/s and even 4x100 Gb/s using modest bandwidth (~ 20 GHz) electronic and optical components has already been demonstrated [2-4]. Despite requiring computationally more expensive DSP compared to single carrier baseband schemes (e.g., OOK, PAM), DMT’s added advantage is that it allows transmission of a mobile data signal within its bandwidth using the same optical transceiver [5]. In this work we demonstrate the combined transmission of a Long Term Evolution (LTE) 4G mobile communication signal (at 3.48 GHz carrier frequency) and a 50 Gb/s DMT signal using a directly modulated InP-on-Silicon Distributed Feedback (DFB) laser. Direct modulation is poised to provide low power consumption and a reduced number of optical components in the transceiver. On the receiver side, a silicon-waveguide-coupled germanium photodiode (GeSi-PD) with a co-designed trans-impedance amplifier (TIA) is used and its performance is compared with a commercial III-V photodiode and TIA.
72 Weeks Post-Partum Follow-Up of Dolutegravir Versus Efavirenz Initiated in Late Pregnancy (DolPHIN-2): An Open-Label, Randomised Controlled Study
(The Lancet HIV, 2022) Malaba, Thokozile R.; Nakatudde, Irene; Kintu, Kenneth; Reynolds, Helen; Mrubata, Megan; Seden, Kay; Twimukye, Adelline; Hodel, Eva Maria; Wang, Duolao; Byamugisha, Josaphat; Bokako, Sharon; Waitt, Catriona
Late initiation of antiretrovirals in pregnancy is associated with increased risk of perinatal transmission and higher infant mortality. We report the final 72-week postpartum results for efficacy and safety of dolutegravir-based compared with efavirenz-based regimens in mothers and infants. DolPHIN-2 was a randomised, open-label trial. Pregnant women in South Africa and Uganda aged at least 18 years, with untreated but confirmed HIV infection and an estimated gestation of at least 28 weeks, initiating antiretroviral therapy in third trimester were eligible for inclusion. Eligible women were randomly assigned (1:1) to receive either dolutegravir-based (50 mg dolutegravir, 300 mg tenofovir disoproxil fumarate, and either 200 mg emtricitabine in South Africa or 300 mg lamivudine in Uganda) or efavirenz-based (fixed dose combination 600 mg tenofovir disoproxil fumarate plus either emtricitabine in South Africa or lamivudine in Uganda) therapy. The primary efficacy outcome was the time to a viral load of less than 50 copies per mL measured at 6, 12, 24, 48, and 72 weeks postpartum with a Cox model adjusting for viral load and CD4 cell count. Safety endpoints were summarised by the number of women and infants with events. This trial is registered with ClinicalTrials.gov, NCT03249181. Between Jan 23 and Aug 15, 2018, 280 women were screened for inclusion, of whom 268 (96%) women were randomly assigned: 133 (50%) to the efavirenz group and 135 (50%) to the dolutegravir group. 250 (93%; 125 [50%] in the efavirenz group and 125 [50%] in the dolutegravir group) women were included in the intention-to-treat analysis of efficacy. Median time to viral load of less than 50 copies per mL was 4·1 weeks (IQR 4·0–5·1) in the dolutegravir group compared with 12·1 weeks (10·7–13·3) in the efavirenz group (adjusted hazard ratio [HR] 1·93 [95% CI 1·5–2·5]). At 72 weeks postpartum, 116 (93%) mothers in the dolutegravir group and 114 (91%) in the efavirenz group had a viral load of less than 50 copies per mL. Of 57 (21%) mothers with a severe adverse event, three (2%) in the dolutegravir group and five (4%) in the efavirenz group were related to the drug (dolutegravir drug-related events were one woman each with suicidal ideation, suicide attempt, herpes zoster meningitis; efavirenz drug-related events were one woman each with suicide attempt and liver cirrhosis, and three people with drug-induced liver injury). Of 136 (56%) infants in whom severe adverse events were recorded, none were related to the study drugs. In addition to the three infant HIV infections detected at birth in the dolutegravir group that have been previously reported, an additional transmission in the efavirenz group occurred during breastfeeding despite optimal maternal viral suppression and serial negative infant tests in the first year of life. Dolutegravir was safe and well tolerated, supporting updated WHO treatment recommendations in pregnant and breastfeeding women. Infant HIV transmissions can occur during breastfeeding despite persistently undetectable maternal viral load highlighting the need for continued infant testing.
8-Year Follow-up of a Maternal Education Trial in a Low-Resource Setting
(Pediatrics, 2024-04) Kakwangire, Paul; Muhoozi, K. M. Grace; Ngari, Moses; Matovu, Nicholas; Westerberg, Cecilie Ane; Iversen, Ole Per; Atukunda, Prudence
OBJECTIVES: Nutrition and stimulation interventions promote early childhood development, but little is known about their long-term benefits in low- and middle-income countries. We conducted a follow-up study of a cluster-randomized maternal education trial performed in children aged 6 to 8 months to assess the sustainability of developmental benefits after 8 years. METHODS: The education intervention lasted 6 months and consisted of nutrition, hygiene, sanitation, and child stimulation aspects. We assessed child processing and cognitive abilities using the Kaufman Assessment Battery for Children Second Edition (KABC-II) and attention and inhibitory control using the Test of Variables of Attention after 8 years. The original trial included 511 mother-child pairs (intervention, n 5 263; control, n 5 248), whereas in the current study, 361 (71%; intervention, n 5 185; control, n 5 176) pairs were available for analyses. RESULTS: The intervention group scored higher than the controls (all P < .001) on all 5 KABC-II subscales and on the KABC-II global score (mean difference: 14; 95% confidence interval, 12–16; P < .001). For all 5 Test of Variables of Attention variables, the intervention group scored higher than the controls on both the visual and auditory tasks (all P < .05). Because the intervention was delivered as a package, a limitation is that we cannot pinpoint the individual contribution of each component (nutrition, hygiene, and stimulation) to the developmental benefits. CONCLUSIONS: The intervention group consistently scored markedly higher on both neuropsychological tests. Thus, even 8 years after the original maternal education intervention, the developmental benefits that we observed at child age of 1, 2, and 3 years, were sustained.
A case for urban liveability from below: exploring the politics of water and land access for greater liveability in Kampala, Uganda
(Research Sqaure, 2019) Nastar, Maryam; Isoke, Jennifer; Kulabako, Robinah; Silvestri, Giorgia
Improving urban liveability and prosperity is commonly set as a priority in urban development plans and policy around the world. Several annual reports produced by international consulting firms, media, and global agencies rank the liveability of cities based on a set of indicators, to represent the quality of life in these cities. The higher is the ranking, the more liveable is the city. In this paper, we argue that such quantitative approaches to framing and addressing urban liveability challenges leave little room to reflect on people's experiences of this liveability, which cannot be expressed through numbers. To illustrate our argument, we draw on empirical evidence of urban liveability challenges in access to water and land in Kampala, the capital city of Uganda, ranked recently as the most liveable East African city by various global agencies and media outlets. By showing that increasing the number of water connections does not guarantee improved access to water and sanitation in the long run, first, we demonstrate how urban liveability challenges are tightly linked with land-title issues in the city. Second, we highlight the political game-playing between the central government, the opposition, the traditional leadership, and the slum dwellers in governance processes of service delivery. Finally, by arguing that urban liveability can be enhanced by broadening political participation in city development planning, we discuss some of the strategies that can be used by communities to make collective claims towards improving their quality of life and the environment.th cities related poor air quality to specific health outcomes such as asthma or lung cancer.
A case of forensic genomics in Uganda reveals animal ownership and low exotic genetic introgression in indigenous cattle
(Veterinary Medicine and Science, 2023-09-19) Masembe, Charles; Benda, Kirungi Katali; Opoola, Oluyinka; Ndinawe, Ruth Pamela; Beine, Peter; Mukiibi, Robert
The cattle industry contributes to Uganda's agricultural output. It faces challenges that include theft and parentage ascertainment. These challenges can benefit from recent molecular genomics and bioinformatics technologies. We employed genomic analyses to establish potential ownership of a group of nine cattle that were being claimed by two farmers in Uganda. We investigated the genetic relationship of Ugandan cattle with regional indigenous breeds as well as exotic breeds that are currently present in Uganda. In addition, we investigated regions that are likely to be under selection in the Ugandan cattle. Hair samples were collected from seven and two animals from farmers A and B, respectively. They were genotyped for 53,218 Single Nucleotide Polymorphism markers. To establish genetic relationships between the sampled animals, we performed genomic analyses including, principal component analysis (PCA), hierarchical clustering analysis and identity by state/descent. We also performed admixture and runs of homozygosity analyses to assess the ancestry composition and identify regions potentially under selection in Ugandan cattle, respectively. The seven animals from Farmer A were genetically close to each other but showed minimal relationship with the disputed animals. The two animals from Farmer B were genetically distant from each other but showed greater similarity to four of the disputed animals. Four of the disputed animals showed great dissimilarity from the animals of both farmers. Comparison of these with the reference breeds revealed minimal European exotic genetic introgression into these animals, but rather high similarity to the Sheko. Results also revealed high homozygosity in the major histocompatibility complex regions. Our results demonstrate the use of currently available genomic tools to empirically establish the ownership of cattle; these could be scaled up as a resourceful and viable tool that could be employed to support conflict resolution where reliable livestock identification is unavailable.
A case of toxoplasmic encephalitis in a patient on cancer chemotherapy in Uganda
(African Journals Online (AJOL), 2025-01-11) Mitala, Yekosani; Atwine, Raymond; Birungi, Abraham; Ambaru, Jacinta; Kuraishi, Baluku; Sekitene, Semei; Nuwagira, Edwin
Background: Reactivation of central nervous system (CNS) toxoplasmosis can be caused by immunosuppression (ISS) of any kind. However, anti-cancer chemotherapy combined with human immunodeficiency virus (HIV) induced ISS results in an atypical presentation that is fatal. Case presentation: A 46 years old man with a well-controlled infection of the human immunodeficiency virus presented with generalized tonic-clonic seizures following the second dose of anti-cancer chemotherapy for esophageal cancer. His brain's computerized tomography (CT) scan showed enlarged ventricles with no space-occupying lesions. Cerebrospinal fluid (CSF) smears stained with hematoxylin and eosin (H&E) revealed numerous bradyzoites and tachyzoites consistent with central nervous system toxoplasmosis. Conclusion: With a double burden of cancer and Human immunodeficiency virus (HIV) infection in low-income countries, this case raises awareness about the atypical presentation of CNS toxoplasmosis reactivation among patients on cancer chemotherapy.
A century of human-induced environmental changes and the combined roles of nutrients and land use in Lake Victoria catchment on eutrophication
(Science of the Total Environment, 2022) Njagi, Dennis M.; Joyanto, Routh; Odhiambo, Moses; Luo, Chen; Laxmi, Gayatri Basapuram; Olago, Daniel; Val, Klump; Curt, Stager
Lake Victoria, a lifeline for millions of people in East Africa, is affected by anthropogenic activities resulting in eutrophication and impacting the aquatic life and water quality. Therefore, understanding the ongoing changes in the catchment is critical for its restoration. In this context, catchment and lake sediments are important archives in tracing nutrient inputs and their dominant sources to establish causality with human activities and productivity shifts. In this study, we determine the 1) changes in concentrations of total organic carbon (TOC), black carbon (BC), total nitrogen (TN), C/N ratio, and phosphorous (P) fractions in catchment sediments and the open lake, 2) distribution of diatom population in the lake, and 3) land use and land cover changes in the catchment. The distribution of TOC, BC, TN, C/N, and P correlate while showing spatial and temporal variations. In particular, the steady increase in BC confirms atmospheric inputs from anthropogenic activities in the catchment. However, lake sediments show more variations than catchment-derived sediments in geochemical trends. Notably, the catchment has undergone dramatic land use changes since the 1960s (post-independence). This change is most evident in satellite records from 1985 to 2014, which indicate accelerated human activities. For example, urban growth (666–1022%) and agricultural expansion (23–48%) increased sharply at the expense of a decline in forest cover, grassland, and woodlands in the catchment. Cities like Kisumu and Homa Bay expanded, coinciding with rapid population growth and urbanization. Consequently, nutrient inputs have increased since the 1960s, and this change corresponds with the divergence of diatom communities in the lake. In addition, the transition to Nitzschia and cyanobacteria mark increasing cultural eutrophication in the lake. The geochemical trends and statistical data support our inference(s) and provide insights into urban development and agriculture practices, which propelled increased nutrients from the catchment and productivity shifts in the lake.
A Century of Water–Socioecological Dynamics and Evolutionary Stages in Lake Victoria Basin, East Africa
(MDPI AG, 2025-04) Zhang, Xinxin;; Wang, Mengyuan;; Jin, Shiying ;; Kimirei, Ismael A.;; Gao, Qun
Understanding the feedback relationships and evolutionary stages of water–socioecological systems (W-SESs) is crucial for achieving sustainable development in basins. This study focuses on the Lake Victoria Basin (LVB) in East Africa, where population growth, rapid urbanization, and developing industrialization have intensified water resource supply–demand conflicts, leading to socioecological issues such as water environmental degradation and ecological conflicts. The objective of this research is to develop a theoretical framework for the Lake Victoria Basin W-SESs (LVB-WSESs) based on the SES framework, identify the main drivers and critical nodes in the evolution of the LVB-WSESs, analyze the root causes of water–society–ecology conflicts, and explore the feedback relationships and evolutionary stages of the LVB-WSESs over the past century. To achieve this, we employed an integrated qualitative and quantitative analysis of historical data combined with tipping point detection to systematically assess the dynamics of the LVB-WSESs. Our findings show that, under the drivers of climate change (with a 1 °C increase in annual temperature since 1920s), population growth (a six-fold increase since 1920s), economic development, land-use change, urbanization, and species invasion, the basin’s demand for water resources, water environments, and aquatic ecosystems has continually increased, leading to the gradual degradation and imbalance of the basin’s ecological functions. The evolution of the LVB-WSESs can be divided into five stages against the historical backdrop of societal transitions from colonial to independent democratic systems: the stable resource utilization period, the slow environmental change period (1920s–1960s), the rapid environmental imbalance period (1960s–1990s), the transition period from environmental imbalance to protection (1990s–2015), and the reconstruction period of socioecological equilibrium. This study not only enhances understanding of the long-term dynamics of the LVB-WSESs but also provides practical implications for sustainable water management in similar basins globally. It enriches the local practice of global sustainable development theories, providing new theoretical perspectives and case references for future watershed sustainable management. By identifying critical drivers and evolutionary stages, our findings can inform policy decisions and interventions to mitigate socioecological conflicts and achieve basin-level sustainability. Publicly Available Content Database
A clinical score for identifying active tuberculosis while awaiting microbiological results: Development and validation of a multivariable prediction model in subSaharan Africa
(PLoS Med, 2020) Yeonsoo, Baik; Hannah, M. Rickman; Colleen, F. Hanrahan; Lesego, Mmolawa; Peter, J. Kitonsa; Tsundzukana, Sewelana; Nalutaaya, Annet; Emily, A. Kendall; Limakatso, Lebina; Neil, Martinson; Katamba, Achilles; David, W. Dowdy
Background In highly resource-limited settings, many clinics lack same-day microbiological testing for active tuberculosis (TB). In these contexts, risk of pretreatment loss to follow-up is high, and a simple, easy-to-use clinical risk score could be useful. Methods and findings We analyzed data from adults tested for TB with Xpert MTB/RIF across 28 primary health clinics in rural South Africa (between July 2016 and January 2018). We used least absolute shrinkage and selection operator regression to identify characteristics associated with Xpert-confirmed TB and converted coefficients into a simple score. We assessed discrimination using receiver operating characteristic (ROC) curves, calibration using Cox linear logistic regression, and clinical utility using decision curves. We validated the score externally in a population of adults tested for TB across 4 primary health clinics in urban Uganda (between May 2018 and December 2019). Model development was repeated de novo with the Ugandan population to compare clinical scores. The South African and Ugandan cohorts included 701 and 106 individuals who tested positive for TB, respectively, and 686 and 281 randomly selected individuals who tested negative. Compared to the Ugandan cohort, the South African cohort was older (41% versus 19% aged 45 years or older), had similar breakdown of biological sex (48% versus 50% female), and had higher HIV prevalence (45% versus 34%). The final prediction model, scored from 0 to 10, included 6 characteristics: age, sex, HIV (2 points), diabetes, number of classical TB symptoms (cough, fever, weight loss, and night sweats; 1 point each), and >14-day symptom duration. Discrimination was moderate in the derivation (c-statistic = 0.82, 95% CI = 0.81 to 0.82) and validation (c-statistic = 0.75, 95% CI = 0.69 to 0.80) populations. A patient with 10% pretest probability of TB would have a posttest probability of 4% with a score of 3/10 versus 43% with a score of 7/10. The de novo Ugandan model contained similar characteristics and performed equally well. Our study may be subject to spectrum bias as we only included a random sample of people without TB from each cohort. This score is only meant to guide management while awaiting microbiological results, not intended as a community-based triage test (i.e., to identify individuals who should receive further testing). Conclusions In this study, we observed that a simple clinical risk score reasonably distinguished individuals with and without TB among those submitting sputum for diagnosis. Subject to prospective validation, this score might be useful in settings with constrained diagnostic resources where concern for pretreatment loss to follow-up is high.
A cluster randomised trial to evaluate the effectiveness of household alcohol‑based hand rub for the prevention of sepsis, diarrhoea, and pneumonia in Ugandan infants (the BabyGel trial): a study protocol
(Trials, 2023-04-17) Chebet, Martin; Mukunya, David; Faragher, Eric Brian; Wandabwa, Julius; Weeks, Andrew
Infections are one of the leading causes of death in the neonatal period. This trial aims to evaluate if the provision of alcohol-based hand rub (ABHR) to pregnant women for postnatal household use prevents severe infections (including sepsis, diarrhoea, pneumonia, or death) among infants during the first three postnatal months.
A comparative study on the role of microcredit on agricultural production improvement among resource-poor rural women
(Frontiers, 2023-03) Namayengo, Muyonga Mayanja Faith; van Ophem, Johan A. C.; Antonides, Gerrit
The objective of the study was to compare agricultural investment and agricultural production of rural agrarian women in Uganda that had received microcredit to those that had not. A quasi-experimental was used to assess differences between performance indicators of agricultural enterprises for existing and incoming borrowers of Bangladesh Rural and Advancement Committee (BRAC) microfinance. Propensity score matching was used to ensure the comparability of the groups and to assess differences between existing borrowers and incoming borrowers, before they received their first loan. Results indicated that the major reason for borrowing was education of children. There was no difference in investment in agricultural production between the study groups. The existing borrowers had lower monetary value of all harvested crops and for maize and beans than the in-coming borrowers. Total number of animals owned, types of animals kept and reported monetary value for goats and local cattle were also less for existing borrowers than for in-coming borrowers. It was observed that the loan repayment protocols did not match income from agriculture. The results reveal a need to modify loan repayment protocols to address the latent period between agricultural investment and output. KEYWORDS Microcredit, agricultural production, resource-poor, rural women, propensity score match
A cross-sectional study of point-of-care lactate testing in integrated community care management (ICCM) for children with acute respiratory illness in rural uganda
(2024-11) Matte, Michael; Koyama, Natsumi; Giandomenico, Dana; Baguma, Emmanuel; Kibaba, Georget; Ntaro, Moses; Reyes, Raquel; Mulogo, Edgar M; Boyce, Ross M; Ciccone, Emily Jxx
Abstract Background Integrated community case management (iCCM) programs leverage lay village health workers (VHWs) to carry out the initial evaluation of children with common conditions including malaria, pneumonia and diarrhea. Therefore, it is imperative that VHWs are able to identify children who are critically ill and require referral to a health facility. Elevated venous lactate levels have been associated with severe illness and adverse health outcomes, including death. However, lactic acidosis may not be recognized in rural settings because it is not routinely measured outside of hospitals and research studies. Point-of-care lactate tests may help identify patients in need of a higher level of care and improve VHWs’ ability to make timely and appropriate referrals. Methods The study was a cross-sectional evaluation of children aged <5 y presenting to VHWs in rural southwestern Uganda with complaints of fever and cough. Demographics, clinical presentation, evaluation, management and disposition were recorded. VHWs were trained and instructed to perform lactate testing using a point-of-care assay in eligible participants. Results During the study period, 238 children were enrolled and completed an initial assessment. Of the 204 participants included in the analysis, 113 (55.4%) were female, and the median (IQR) age was 23 (9–36) months. Most participants, 139/200 (69.5%), had negative results on the malaria rapid diagnostic test. The median lactate level was 2.1 mmol/L; 12% (24/204) had a lactate ≥3.5 mmol/L and only nine participants (4.4%) had a lactate ≥5 mmol/L. Having a lactate level above either cut-off was not associated with the presence of danger signs at presentation. Conclusions Few children presenting with fever and cough to VHWs in western Uganda had elevated lactate levels. However, most of the children with elevated lactate levels did not otherwise satisfy established iCCM criteria based on physical examination findings for referral to a health facility. Therefore, while elevated lactate was not associated with danger signs in this small study, it is possible that there is under-recognition of severe illness using current iCCM guidelines.
A Description of Experiences of Women and Significant others in Accessing Comprehensive Healthcare in the First 1000 Days of Life Post-conception During COVID-19 in Rural Uganda
(BMC Pregnancy and Childbirth, 2022-09-28) Nakate, Mary-Grace; MacKay, Sean; Ndirangu-Mugo, Eunice
COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy may have been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance.

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