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Item 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 JxxAbstract 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.Item Combining a guided self-help and brief alcohol intervention to improve mental health and reduce substance use among refugee men in Uganda: a cluster-randomized feasibility trial(Cambridge University Press, 2024-11) Greene, M. Claire; Andersen, Lena S; Leku, Marx R; Au, Teresa; Akellot, Josephine; Upadhaya, Nawaraj; Odokonyero, Raymond; White, Ross; Ventevogel, Peter; Garcia-Moreno, Claudia; Tol, Wietse AAbstract Evidence on the effectiveness and implementation of mental health and psychosocial support (MHPSS) interventions for men in humanitarian settings is limited. Moreover, engagement and retention of men in such interventions has been challenging. Adaptations may therefore be required to improve the appropriateness and acceptability of these interventions for men. This study conducted formative research and examined the feasibility of combining an MHPSS intervention, Self-Help Plus, with a brief intervention to reduce harmful alcohol use among refugee men in Uganda. We conducted a cluster randomized feasibility trial comparing the combined alcohol intervention and Self-Help Plus, Self-Help Plus alone and enhanced usual care. Participants were 168 South Sudanese refugee men in Rhino Settlement who reported moderate or high levels of psychological distress. Session attendance was adequate: all sessions had at least 69% of participants present. Participant outcome measures, including symptoms of psychological distress, functional impairment, self-defined problems, depressive symptoms, post-traumatic stress symptoms, overall substance use risk, substance specific risk (alcohol, cannabis, stimulants and sedatives) and well-being, were sensitive to change. A combined approach to addressing mental health and alcohol use appears feasible among men in refugee settings, but further research is needed to examine the effectiveness of combined interventions among men.Item The prevalence of occupational-related low back pain among working populations in sub-saharan Africa: a systematic review and meta-analysis(2024-10) Atalay, Yibeltal Assefa; Gebeyehu, Natnael Atnafu; Gelaw, Kelemu AbebeWork-related musculoskeletal disorders represent a major public health problem, contributing significantly to the global burden of disability-adjusted life years and affecting the quality of life of all population groups. The main problem in most musculoskeletal disorders is low back pain. Therefore, our study aims to identify the overall prevalence of work-related low back pain among the working population in sub-Saharan Africa. Research published between 2010 and 2023 in English, conducted in Sub-Saharan Africa was included in this systematic review and meta-analysis. Using Boolean logic operators and targeted keywords, we searched for publications on a number of electronic databases (Web of Science, PubMed, Google Scholar, African Journals Online (AJOL), and Science Direct). The Joanna Briggs Institute Critical Appraisal techniques were utilized to conduct a quality assessment of the papers and ascertain their relevance to the study. The degree of heterogeneity among the included studies, the 95% confidence interval, and the pooled prevalence were estimated using a random effects model. Sensitivity studies were carried out to determine the causes of heterogeneity and the impact of outliers. In this study, a total of 970 articles were retrieved, and 35 studies were included in the systematic review and meta-analysis. The overall estimated pooled prevalence of low back pain among the working population in sub-Saharan Africa was (55.05% [95% CI: 49.34, 60.76]). Based on a sub-group analysis by countries, the higher pooled prevalence of low back pain was found in Uganda at (61.48% [95% CI: 40.39, 82.57]), while the lower pooled prevalence of low back pain was in Ghana at (34.48% [95% CI: 17.96, 51.01]). This systematic review and meta-analysis found that 55.05% of the included study participants experienced low back pain in the previous years. Therefore, it is recommended that policymakers incorporate and enhance strategies for the prevention and management of low back pain within the health system management guidelines of each country.Item Participatory research with youth with disabilities: Experiences from sub-Saharan Africa(African Online Scientific Information Systems (Pty) Ltd t/a AOSIS, 2024-10) Bannink Mbazzi, Femke; Hameed, Shaffa; Ganle, John K; Shakespeare, Tom; Polack, SarahBackground: Disability inclusive youth research, involving youth with disabilities in the design, implementation and dissemination of study data, is still limited in Africa.Objectives: To describe and reflect on the experiences of involving youth with disabilities in an exploratory research study, focused on disability-inclusive education and employment in 7 African countries.Method: 12 youths with different impairments, aged 18 to 35, were employed as researchers in Ethiopia, Ghana, Kenya, Nigeria, Rwanda, Senegal and Uganda. Youth researchers contributed to the data collection and analysis of interviews with 210 youth with disabilities. 24 youth advisors with disabilities formed two youth advisory groups (YAG) of 12 advisors each in the regional hub countries Ghana and Uganda. The YAGs met 4 times during the project and contributed to the study design, data collection, data analysis and dissemination activities. In addition, 4 workshops were held with the Ugandan YAG to develop a participatory film.Results: Together with the youth participants, we reflected on the experiences of involving youth with disabilities and conducting research with, by and on youth with disabilities. We highlighted ethics and safeguarding, recruitment and representation, exploring experiences and data quality, participatory dissemination, accessibility, capacity building and networking as key areas of consideration and benefit in this project.Conclusion: Participatory research with youth with disabilities is feasible, enriching, and key to inclusive research that informs education and employment policy and practices.Contribution: Lessons learned from youth involvement in a disability inclusive research programme, focused on education and employment in 7 African countries.Item Irrational acts: Maternal death, women’s agency, and the obligation to care in Uganda(PubMed, 2024-04-21) Boyd, LydiaFollowing the recommendation of the WHO in the mid-2000s, the Ugandan government banned traditional birth attendants (TBAs) and encouraged all women to give birth in biomedical clinics. Yet in rural Luuka district, about half of women still give birth at home or with the assistance of lay providers. This article examines women's healthcare behavior to better understand decisions that are characterized as irrational by officials, in particular women's choices to delay care, move between providers, and defer health decisions to others. Building on anthropological interest in the relationality of care, this article explores how women compel the care of others, especially under conditions of healthcare scarcity and in contexts outside clinical settings. A focus on the gendered nature of kin-based care provides insight into how acts often characterized as irrational can be modes of action for women in ways that exceed a policy focus on healthcare choice and autonomy.Item Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic reviews protocol(BMJ Publishing Group LTD, 2024-10) Aremu, Abdulmujeeb Babatunde; Afolabi, Ismail Bamidele; Awunor, Nyemike Simeon; Sumayah, Nakitende; Mujeeb, Salaam; Mahjub, Atiku SaadTeenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. More than 90% of these live births are estimated to occur in developing countries. The objective of this review is to estimate the prevalence of teenage pregnancy and its associated factors in Uganda. This review protocol will be registered with the PROSPERO database and will be designed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. A literature search will be conducted in PubMed, African Journals OnLine, Science Direct and Google Scholar in December 2023. Observational studies that report the prevalence of teenage pregnancy will be included. Studies will be assessed for the risk of bias in duplicate. The data will be pooled using random-effects models to estimate the prevalence of teenage pregnancy, with a 95% CI and I statistic capturing heterogeneity. This review will not require ethical approval. The findings from the data synthesis will be published in relevant peer-reviewed journals and conferences targeting adolescent and reproductive health. CRD42023486460. MEDLINEItem Feasibility of a Guided Self-Help Intervention to Reduce Psychological Distress in South Sudanese Refugee Women in Uganda(World Psychiatry, 2018-06-20) Tol A. Wietse, Jura Augustinavicius, Leku R. Marx, Adaku Alex, Mark van OmmerenImplementing evidence-based psychological interventions in low-resource refugee settings is challenging, because of the need for an extensive workforce of trainers, supervisors and facilitators1,2. Self-Help Plus (SH1) was developed by the World Health Organization (WHO) as a tool potentially applicable in those settings. SH1 is a guided self-help intervention consisting of five audio-recorded sessions and an illustrated self-help manual. It can be provided to large groups (20 to 30 participants) and facilitated by lay helpers with minimal training. It aims to reduce psychological distress in people with a range of common mental disorders and subthreshold symptoms. It is based on acceptance and commitment therapy, a third wave cognitive behavioral therapy focused on enhancing psychological flexibility.Item Translation, Adaptation, and Pilot of a Guided Selfhelp Intervention to Reduce Psychological Distress in South Sudanese Refugees in Uganda(Global Mental Health, 2018-03-29) Tol. A.W, Augustinavicius J., Adaku A., Leku R.M., García-Moreno C., van Ommeren M.In this period of unprecedented levels of displacement, scalable interventions are needed to address mental health concerns of forced migrants in low-resource settings. This paper describes the adaptation and piloting of a guided, multi-media, self-help intervention, Self-Help Plus (SH+), which was developed to reduce psychological distress in large groups of people affected by adversity. Using a phased approach that included community consultations, cognitive interviewing, facilitator training, pilot implementation, and a qualitative process evaluation, we adapted SH+ for use among South Sudanese refugees in a refugee settlement in northern Uganda.Item Improving Mental Health and Psychosocial Wellbeing in Humanitarian Settings: Reflections on Research Funded through R2HC(Conflict and Health, 2020-10-30) Wietse A. Tol, Alastair Ager, Marx R. Leku, Samuel Likindikoki, Kevin Savage, Melissa Harper Shehadeh, Mark van OmmerenMajor knowledge gaps remain concerning the most effective ways to address mental health and psychosocial needs of populations affected by humanitarian crises. The Research for Health in Humanitarian Crisis (R2HC) program aims to strengthen humanitarian health practice and policy through research. As a significant portion of R2HC’s research has focused on mental health and psychosocial support interventions, the program has been interested in strengthening a community of practice in this field. Following a meeting between grantees, we set out to provide an overview of the R2HC portfolio, and draw lessons learned. In this paper, we discuss the mental health and psychosocial support-focused research projects funded by R2HC; review the implications of initial findings from this research portfolio; and highlight four remaining knowledge gaps in this field. Between 2014 and 2019, R2HC funded 18 academic-practitioner partnerships focused on mental health and psychosocial support, comprising 38% of the overall portfolio (18 of 48 projects) at a value of approximately 7.2 million GBP. All projects have focused on evaluating the impact of interventions. In line with consensus-based recommendations to consider a wide range of mental health and psychosocial needs in humanitarian settings, research projects have evaluated diverse interventions. Findings so far have both challenged and confirmed widely-held assumptions about the effectiveness of mental health and psychosocial interventions in humanitarian settings. They point to the importance of building effective, sustained, and diverse partnerships between scholars, humanitarian practitioners, and funders, to ensure long-term program improvements and appropriate evidence-informed decision making. Further research needs to fill knowledge gaps regarding how to: scale-up interventions that have been found to be effective (e.g., questions related to integration across sectors, adaptation of interventions across different contexts, and optimal care systems); address neglected mental health conditions and populations (e.g., elderly, people with disabilities, sexual minorities, people with severe, pre-existing mental disorders); build on available local resources and supports (e.g., how to build on traditional, religious healing and community-wide social support practices); and ensure equity, quality, fidelity, and sustainability for interventions in real-world contexts (e.g., answering questions about how interventions from controlled studies can be transferred to more representative humanitarian contexts).Item Cross border population movements across three East African states: Implications for disease surveillance and response(Public Library of Science, 2024-10) King, Patrick; Wanyana, Mercy Wendy; Mayinja, Harriet; Nakafeero Simbwa, Brenda; Zalwango, Marie Gorreti; Owens Kobusinge, Joyce; Migisha, Richard; Kadobera, Daniel; Kwesiga, Benon; Et.alThe frequent population movement across the five East African Countries poses risk of disease spread in the region. A clear understanding of population movement patterns is critical for informing cross-border disease control interventions. We assessed population mobility patterns across the borders of the East African states of Kenya, Uganda, and Rwanda. In November 2022, we conducted Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), and participatory mapping. Participants were selected using purposive sampling and a topic guide used during interviews. Key informants included border districts (Uganda and Rwanda) and county health officials (Kenya). FGD participants were identified from border communities and travellers and these included truck drivers, commercial motorcyclists, and businesspersons. During KIIs and FGDs, we conducted participatory mapping using Population Connectivity Across Borders toolkits. Data were analysed using thematic analysis approach using Atlas ti 7 software. Different age groups travelled across borders for various reasons. Younger age groups travelled across the border for education, trade, social reasons, employment opportunities, agriculture and mining. While older age groups mainly travelled for healthcare and social reasons. Other common reasons for crossing the borders included religious and cultural matters. Respondents reported seasonal variations in the volume of travellers. Respondents reported using both official (4 Kenya-Uganda, 5 Rwanda-Uganda borders) and unofficial Points of Entry (PoEs) (14 Kenya-Uganda, 20 Uganda-Rwanda) for exit and entry movements on borders. Unofficial PoEs were preferred because they had fewer restrictions like the absence of health screening, and immigration and customs checks. Key destination points (points of interest) included: markets, health facilities, places of worship, education institutions, recreational facilities and business towns. Twenty-eight health facilities (10- Lwakhakha, Uganda, 10- Lwakhakha, Kenya, and 8- Cyanika, Uganda) along the borders were the most commonly visited by the travellers and border communities. Complex population movement and connectivity patterns were identified along the borders. These were used to guide cross-border disease surveillance and other border health strategies in the three countries. Findings were used to revise district response and preparedness plans by strengthening community-based surveillance in border communities. PubMedItem Revisiting immunity versus exposure in schistosomiasis: A mathematical modelling study of delayed concomitant immunity(Oxford University Press, 2024-10) Milne, Gregory C; Oettle, Rebecca C; Whittaker, Charles; Kabaterine, Narcis B; Basáñez, Maria-Gloria; Webster, Joanne P; Walker, Martin; Wilson, ShonaAbstract The relative contributions of exposure versus acquired immunity to the epidemiology of human schistosomiasis has been long debated. While there is considerable evidence that humans acquire partial immunity to infection, age- and sex-related contact patterns with water bodies contaminated with infectious cercarial schistosome larvae also contribute to typical epidemiological profiles of infection. Here, we develop a novel schistosome transmission model that incorporates both partially protective ‘delayed concomitant’ acquired immunity—stimulated by dying worms—and host age- and sex-dependent patterns of exposure. We use a contemporary Bayesian approach to fit the model to historical individual data on exposure to infectious cercaria, eggs per gram of faeces (epg), and immunoglobulin E (IgE) antibodies specific to Schistosoma mansoni Tegumental-Allergen-Like protein 1 (SmTAL1) collected from a highly endemic community in Uganda, estimating the relative contributions of exposure and acquired immunity. We find that model variants incorporating or omitting delayed concomitant immunity describe equally well the age- and sex-specific immunoepidemiological patterns observed before intervention and 18 months after treatment. Over longer time-horizons, we find that acquired immunity creates subtle differences in immunoepidemiological profiles during routine mass drug administration that may confer resilience against elimination. We discuss our findings in the broader context of the immunoepidemiology of schistosomiasis.Item Utilization of mobile surgical units to address surgical needs in remote African communities: a narrative review(BioMed Central Ltd, 2024-10) Mugisha, Nadine; Uwishema, Olivier; Noureddine, Rawan; Ghanem, Laura; Manoel, Agnes Zanotto; Shariff, SanobarIntroduction Accessing surgical care is of profound significance that face remote African communities due to insufficient healthcare means and infrastructure. Deploying mobile surgical units (MSUs) have present a potential solution to underserved populations in rural Africa to address said issues. The aim of this narrative review is to examine the role of MSU utilization in remote African communities to meet surgical needs and evaluate how this has affected healthcare provision. Methods To identify studies focusing on the dissemination of MSUs in remote African communities covered countries such as Uganda, Kenya, Tanzania, Nigeria, and Ethiopia, and we employed a plethora of electronic search databases including PubMed/Medline, Google Scholar, Scopus and other relevant literature sources. Inclusion criteria were studies on MSUs in remote African communities, while exclusion criteria involved non- African or urban-focused studies. Results This review highlights that the current literature depicts that application of MSUs bring a positive impact in providing timely and quality surgical care to remote African communities. Frequent interventions, such as minor surgeries, obstetric procedures, and major trauma control, have been performed on MSUs. In settings with shortages of human resources and clinical equipments, these units have improved patient outcomes, reduced healthcare disparities, and increased access to emergency surgical care. While challenges such as financial constraints and surgical sustainability have been noted, the need for interdisciplinary collaboration and the advantages of MSU deployment often help mitigate these obstacles. Conclusion A lack of surgical care for individuals living in remote African domiciles may be addressed via MSU application. Through delivering fundamental surgical services directly to underserved populations, MSUs may potentially prevent disabilities, save countless lives, and enhance overall health outcomes in African remote communities. To guarantee the long-term feasibility and sustainability of MSU programs in Africa, however, more funding must be allocated to infrastructure, supplies, and relevant education. Keywords: Surgical care, Healthcare, Mobile surgical units, Remote African communitiesItem Epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection within the context of repeated mass drug administration in rural Uganda: a population-based, cross-sectional study(Elsevier Ltd, 2024-10) Anjorin, Seun; Nabatte, Betty; Mpooya, Simon; Tinkitina, Benjamin; Opio, Christopher K; Kabatereine, Narcis B; Chami, Goylette FWHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis. We examined 1442 households randomly sampled from 38 villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834 individuals aged 5–90 years using ultrasound and image patterns C–F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household. Between Jan 6 and Feb 3, 2022, 342 (12·1%) of participants were diagnosed with periportal fibrosis. By Kato-Katz microscopy, 1229 (43·4%) of 2834 participants were infected. 1863 (65·7%) of 2834 participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834 participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from 5–25 years, non-linearly increased from 26–45 years, attenuated or remain unchanged from 46–60 years, and steadily decreased past 60 years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood. WHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management. NDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council.Item Building locally anchored implementation science capacity: the case of the adolescent HIV implementation science alliance-supported local iS alliances(Frontiers Media S.A, 2024-10) Vorkoper, Susan; Agot, Kawango; Dow, Dorothy E; Mbizvo, Michael; Mugo, Cyrus; Sam-Agudu, Nadia A; Semitala, Fred C; Zanoni, Brian C; Sturke, RachelBackgroundThe Fogarty International Center-led Adolescent HIV Implementation Science Alliance (AHISA) supports region-/country-specific implementation science (IS) alliances that build collaborations between research, policy, and program partners that respond to local implementation challenges. AHISA supported the development of seven locally-led IS alliances: five country-specific (i.e., Kenya, South Africa, Tanzania, Uganda, and Zambia), one in Central and West Africa, and one with youth researchers. This article outlines the aims, activities, and outcomes of local alliances, demonstrating how they enhance sustainable IS activities to address local challenges.MethodsWe conducted a desk review of each alliance's funding applications, reports, and data from the initial findings of a larger AHISA evaluation. The review analyzes common approaches, highlights their local relevance, and summarizes initial outcomes.ResultsThe local alliances have a common goal: to expand implementation of successful interventions to improve adolescent HIV. We identified four overarching themes across the local alliances’ activities: capacity building, priority setting, stakeholder engagement, and knowledge dissemination. Research capacity building activities include long-term mentorship between junior and senior researchers and short-term training for non-research partners. Setting priorities with members identifies local research needs and streamlines activities. Alliances incorporate substantial engagement between partners, particularly youth, who may serve as leaders and co-create activities. Dissemination shares activities and results broadly.ConclusionLocal IS alliances play a key role in building sustainable IS learning and collaboration platforms, enabling improved uptake of evidence into policy and programs, increased IS research capacity, and shared approaches to addressing implementation challenges.Item Epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection within the context of repeated mass drug administration in rural Uganda: a population-based, cross-sectional study(Elsevier Ltd, 2024-10) Anjorin, Seun; Nabatte, Betty; Mpooya, Simon; Tinkitina, Benjamin; Opio, Christopher K; Kabatereine, Narcis B; Chami, Goylette FWHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis.BACKGROUNDWHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis.We examined 1442 households randomly sampled from 38 villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834 individuals aged 5-90 years using ultrasound and image patterns C-F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household.METHODSWe examined 1442 households randomly sampled from 38 villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834 individuals aged 5-90 years using ultrasound and image patterns C-F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household.Between Jan 6 and Feb 3, 2022, 342 (12·1%) of 2834 participants were diagnosed with periportal fibrosis. By Kato-Katz microscopy, 1229 (43·4%) of 2834 participants were infected. 1863 (65·7%) of 2834 participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834 participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from age 5 years to age 25 years, non-linearly increased from age 26 years to age 45 years, attenuated or remained unchanged from age 46 years to age 60 years, and steadily decreased past 60 years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood.FINDINGSBetween Jan 6 and Feb 3, 2022, 342 (12·1%) of 2834 participants were diagnosed with periportal fibrosis. By Kato-Katz microscopy, 1229 (43·4%) of 2834 participants were infected. 1863 (65·7%) of 2834 participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834 participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from age 5 years to age 25 years, non-linearly increased from age 26 years to age 45 years, attenuated or remained unchanged from age 46 years to age 60 years, and steadily decreased past 60 years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood.WHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management.INTERPRETATIONWHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management.NDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council.FUNDINGNDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council. MEDLINE - AcademicItem Global landscape of nicotine and tobacco products additives policies(BMJ Publishing Group Ltd, 2024-10) Oliveira da Silva, Andre Luiz; Bialous, StellaIntroductionProduct design is a key tobacco industry strategy to recruit consumers and hinder cessation. An important technology in tobacco product design is the use of additives including those that create characterising flavours, that is, flavours that are perceived by taste and or smell by the user. To curb youth use, many countries are implementing policies to limit the use of flavours and other additives in tobacco products. This paper reviews the global landscape of tobacco additives policies including those focusing only on flavouring additives, updating a previous review.MethodsWe gathered additives policy data from available online sources of tobacco control policies including parties’ reports to the WHO Framework Convention on Tobacco Control (where WHO refers to World Health Organization), the website Tobacco Control Laws, government websites, searches with the Google search engine and consultations with the WHO to ensure comprehensiveness of the assessment. The policies were classified according to their objective and characteristics: Labelling regulations, sales bans and tobacco product design regulations. We classified and organised the regulations according to their stated intent.ResultsWe found that 62 countries had tobacco products’ additives-related regulations at the regional, national or subnational levels. Most of these regulations focused on flavouring additives especially bans on the selling, importing and manufacturing tobacco products with characterising flavours.ConclusionsThe data demonstrate various global policies addressing additives and/or flavours and a range of definitions of additives and flavours. Establishing common definitions and standards could facilitate cooperation between countries and regions.Item Enhancing the implementation and integration of mHealth interventions in resource-limited settings: a scoping review(BioMed Central Ltd, 2024-10) Tumuhimbise, Wilson; Theuring, Stefanie; Kaggwa, Fred; Atukunda, Esther C; Rubaihayo, John; Atwine, Daniel; Sekandi, Juliet N; Musiimenta, AngellaAlthough mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions. We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions. We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged. The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings. MEDLINEItem Tuberculosis-related deaths at a tertiary hospital in Zambia: Insights into the prevalence and associated factors(Public Library of Science, 2024-10) Siame, Lukundo; Chembe, Eemmanuel; Muchaili, Lweendo; Hamooya, Benson M; Masenga, Sepiso KTuberculosis (TB) mortality remains a significant public health concern globally. This study aimed to determine the prevalence of tuberculosis-related deaths and associated factors among patients at Livingstone University Teaching Hospital (LUTH) Chest Clinic, Zambia. We conducted a retrospective cross-sectional study among 694 individuals (507 adult and 187 children) diagnosed with drug susceptible TB disease between January 1, 2021, and December 31, 2022. Demographic and clinical information were collected from medical records using a data collection form. Multivariable logistic regression was used to determine factors associated with TB-related death. Statistical significance was set at p < 0.05. STATA version 15 was used for all data analysis. The prevalence of TB-related death among adults (above 19 years old) was 18.4% (n = 93) whereas that in children (below 19 years old) was 7.0% (n = 187). Living with HIV (AOR 1.75, 95% CI 1.00-3.08, p = 0.049) was positively associated with TB-related death among the adult patients while being on a family based direct observation therapy (DOT) plan was negatively associated with TB-related death both among adults and among children, (AOR 0.24, 95% CI 0.13-0.45, p <0.001) and (AOR 0.2, 95% CI 0.03-0.99, p = 0.039) respectively. This study found a high TB-related mortality rate, both among adults and children, exceeding the national target of 5% and it was significantly associated with HIV status and DOT plan. There is therefore a need to enhance strategies aimed at reducing TB-related deaths, especially among those living with HIV.Tuberculosis (TB) mortality remains a significant public health concern globally. This study aimed to determine the prevalence of tuberculosis-related deaths and associated factors among patients at Livingstone University Teaching Hospital (LUTH) Chest Clinic, Zambia. We conducted a retrospective cross-sectional study among 694 individuals (507 adult and 187 children) diagnosed with drug susceptible TB disease between January 1, 2021, and December 31, 2022. Demographic and clinical information were collected from medical records using a data collection form. Multivariable logistic regression was used to determine factors associated with TB-related death. Statistical significance was set at p < 0.05. STATA version 15 was used for all data analysis. The prevalence of TB-related death among adults (above 19 years old) was 18.4% (n = 93) whereas that in children (below 19 years old) was 7.0% (n = 187). Living with HIV (AOR 1.75, 95% CI 1.00-3.08, p = 0.049) was positively associated with TB-related death among the adult patients while being on a family based direct observation therapy (DOT) plan was negatively associated with TB-related death both among adults and among children, (AOR 0.24, 95% CI 0.13-0.45, p <0.001) and (AOR 0.2, 95% CI 0.03-0.99, p = 0.039) respectively. This study found a high TB-related mortality rate, both among adults and children, exceeding the national target of 5% and it was significantly associated with HIV status and DOT plan. There is therefore a need to enhance strategies aimed at reducing TB-related deaths, especially among those living with HIV.Item Understanding menstrual factors associated with poor mental health among female secondary school students in Uganda: a cross-sectional analysis(BioMed Central Ltd, 2024-10) Ssesanga, Titus; Thomas, Katherine A; Nelson, Kate Andrews; Oenen, Evaline; Kansiime, Catherine; Lagony, Stephen; Enomut, Jonathan R; Mayanja, Yunia; Weiss, Helen AThere is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda. We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders. Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001). This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority. Trial registration: ISRCTN 45461276. Registered on 16 September 2021.Item Depression, anxiety, psychological distress, and perceived social support among Ugandan palliative care providers during the COVID-19 pandemic(Cambridge University Press, 2024-10)Abstract Objectives To identify the prevalence of depression, anxiety, and psychosocial distress among Ugandan palliative care providers during the COVID-19 pandemic, measure providers’ perceived levels of social support, and identify factors affecting a provider’s likelihood of being depressed, anxious, distressed, or perceiving various levels of social support. Methods Data was collected from 123 palliative care providers using an online survey. Depression, anxiety, and psychological distress were measured using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Self-Reporting Questionnaire, respectively. Information on perceived level of social support was gathered through the Multidimensional Scale of Perceived Social Support. The survey also asked about mental health resources available to providers at their place of work and what resources are still needed. Results Participants ranged in age, gender, religion, marital status, clinical position, and years of experience in palliative care. Results indicate that 20% of respondents show signs of moderate to severe depression, 14% show signs of moderate to severe anxiety, and 33% show signs of psychological distress. Additionally, 50% of respondents reported a low total level of social support. Depression, anxiety, and psychological distress scores were all negatively correlated with perceived social support scores. Over 50% expressed a desire for additional mental health resources at their place of work. Significance of results In 2021–2022, the severity of depression, anxiety, and psychological distress varied among palliative care providers in Uganda, with some experiencing moderate to severe mental health effects. Higher degrees of depression, anxiety, and psychological distress were correlated with lower levels of perceived social support, highlighting the importance of social support during times of crisis. The results highlight a desire for improved access to mental health resources and will help providers and organizations provide better support and better prepare for future crises.