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Item Malaria Diagnosed in an Urban Setting Strongly Associated with Recent Overnight Travel: A Case–Control Study from Kampala, Uganda(The American journal of tropical medicine and hygiene, 2020-08-24) Arinaitwe, Emmanuel; Mpimbaza, Arthur; Nankabirwa, Joaniter I.; Asiimwe, Alan; Staedke, Sarah G.Malaria is frequently diagnosed in urban Kampala, despite low transmission intensity. To evaluate the association between recent travel out of Kampala and malaria, we conducted a matched case–control study. Cases were febrile outpatients with a positive malaria test; controls were febrile outpatients with a negative test. For every two cases, five controls were selected, matching on age. Data were collected on recent overnight travel out of Kampala (past 60 days), destination and duration of travel, and behavioral factors, including sleeping under an insecticide-treated net (ITN) during travel. From July to August 2019, 162 cases and 405 controls were enrolled. The locations of residence of cases and controls were similar. More controls were female (62.7% versus 46.3%, P < 0.001). Overall, 158 (27.9%) participants reported recent overnight travel. Travelers were far more likely to be diagnosed with malaria than those who did not travel (80.4% versus 8.6%, OR 58.9, 95% CI: 23.1–150.1, P < 0.001). Among travelers, traveling to a district not receiving indoor residual spraying of insecticide (OR 35.0, 95% CI: 4.80–254.9, P < 0.001), no ITN use (OR 30.1, 95% CI: 6.37–142.7, P < 0.001), engaging in outdoor activities (OR 22.0, 95% CI: 3.42–141.8, P = 0.001), and age < 16 years (OR 8.36, 95% CI: 2.22–56.2, P = 0.03) were associated with increased odds of malaria. Kampala residents who traveled overnight out of the city were at substantially higher risk of malaria than those who did not travel. For these travelers, personal protection measures, including sleeping under an ITN when traveling, should be advocated.Item An EarlyMorning Sputum Sample Is Necessary for the Diagnosis of Pulmonary Tuberculosis, Even withMore Sensitive Techniques: A Prospective Cohort Study among Adolescent TB-Suspects in Uganda(Tuberculosis research and treatment, 2012-12-04) Ssengooba, Willy; Kateete, David P.; Mboowa, Gerald; Joloba, Moses L.The World Health Organization (WHO) recommends collection of two sputum samples for tuberculosis (TB) diagnosis, with at least one being an early morning (EM) using smear microscopy. It remains unclear whether this is necessary even when sputum culture is employed. Here, we determined the diagnostic yield from spot and the incremental yield from the EM sputum sample cultures among TB-suspected adolescents from rural Uganda. Sputum samples (both spot and early-morning) from 1862 adolescents were cultured by the Lowenstein-Jensen (LJ) and Mycobacterium Growth Indicator Tube (MGIT) methods. For spot samples, the diagnostic yields for TB were 19.0% and 57.1% with LJ and MGIT, respectively, whereas the incremental yields (not totals) of the early-morning sample were 9.5% and 42.9% (P < 0.001) with LJ and MGIT, respectively. Among TB-suspected adolescents in rural Uganda, the EM sputum culture has a high incremental diagnostic yield. Therefore, EM sputum in addition to spot sample culture is necessary for improved TB case detection.Item Utilization of Youth Friendly Reproductive Health Services among Secondary School Youths in Fort Portal Municipality, Western Uganda: School Based Cross Sectional Study(Saudi Journal of Nursing and Health Care, 2018-12-30) Irumba, Pauline; Munguiko, Clement; Miruka, Conrad OndiekiYouth often face difficulties in accessing sexual and reproductive health services. The main aim this study was to determine the utilization of youth friendly reproductive health services among secondary school going youths of Fort portal Municipality and ascertain factors that influence use of these services. A cross sectional descriptive study was conducted on 250 secondary school youths in Fortportal Municipality. Sample size was determined by using Kish Leslie’s formula. Clustered sampling method was used to choose two (2) schools from each division of Fort portal Municipality; then respondents selected by consecutive sampling method. Data was analyzed using SPSS V.22. About half (53.2%) of the respondents were females and most of the study respondents (85.6%) were adolescents. Almost a third of the respondents (39.2%) were sexually active with 67.3 percent of them having unprotected sex. The study revealed that more than three quarters (79.2%) of the youths were poor users of youth friendly reproductive health services with sex education as the most utilized service (88.4%) and the least being use of contraceptives (20.3%). Age and availability of the services were the main determinants of utilization of these services. Adolescents utilized Youth friendly reproductive health services more than fellow older youths (P; 0.023 and P; 0.033 respectively). Availability of some Youth friendly reproductive health services in schools and health facilities influenced their utilization (P; 0.001 and P;0.013 respectively).Youth friendly reproductive health services are under-utilized by secondary school going youths. Youth friendly healthcare clinics should be operational in all schools and health facilities.Item Safety and Efficacy of the PrePex Device for Rapid Scale-Up of Male Circumcision for HIV Prevention in Resource-Limited Settings(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2011-12-05) Bitega, Jean Paul MD, MMed (Surgery),* , MD,* MD,† MD, MPH,‡ and; Ngeruka, Muyenzi Leon; Hategekimana, Theobald; Asiimwe, Anita; Binagwaho, AgnesTo assess the safety and efficacy of the PrePex device for nonsurgical circumcision in adult males as part of a comprehensive HIV prevention program in Rwanda. Single-center 6-week noncontrolled study in which healthy men underwent circumcision using the PrePex device, which employs fitted rings to clamp the foreskin, leading to distal necrosis. In the first phase of the study, the feasibility of the procedure was tested on 5 subjects in a sterile environment; in the main phase, an additional 50 subjects were circumcised in a nonsterile setting by physicians or a nurse. Outcome measures included the rate of successful circumcision, time to complete healing, pain, and adverse events. In the feasibility phase, all 5 subjects achieved complete circumcision without adverse events. In the main phase, all 50 subjects achieved circumcision with 1 case of diffuse edema after device removal, which resolved with minimal intervention. Pain was minimal except briefly during device removal (day 7 after placement in most cases). The entire procedure was bloodless, requiring no anesthesia, no suturing, and no sterile settings. Subjects had no sick/absent days associated with the procedure. Median time for complete healing was 21 days after device removal. There were no instances of erroneous placement and no mechanical problems with the device. The PrePex device was safe and effective for nonsurgical adult male circumcision without anesthesia or sterile settings and may be useful in mass circumcision programs to reduce the risk of HIV infection, particularly in resource-limited settings.Item Rapid Assessment of an African District Health System : Test of a Planning Tool(The International Journal of Health Planning and Management, 1993) Nordberg, Erik; Oganga, Hezron; Kazibwe, Sam; Onyango, JaredOccasional rapid health care system assessments are potentially useful for planning, for monitoring health care systems development over time, and for comparing health systems in different areas. With the decentralization of health sector management, for example in Kenya, there is a growing need of such assessments at district and sub-district levels. Can rapid assessments be conducted at affordable cost at these levels? What variables and methods are feasible? This paper reports on a rapid health system assessment conducted in rural Kenya during 1991. It required the completion at each health facility of a self-administered questionnaire which included questions on resources, health care programmes, management, service output, and prominent problems. It also included interviews with officers in charge of each health institution in the sub-district and an examination of records and reports available at each facility The paper presents the range of issues addressed, the indicators used, the methods applied, the problems encountered, the costs of the assessment, and a small selection of the findings. We conclude that the assessment model is manageable at district level with modest planning and analysis support from central level. Field staff need more precise instructions for completion of the questionnaire, and more population-based estimates need to be calculated. Reassessment taking place every 3–5 years should be adequate for monitoring the process of change in the local health care system.Item Fiscal space for the immunisation program in Zambia– an efficiency analysis approach(BMC Research Notes, 2024-06-03) Chompolola, Abson; Simuyemba, Moses Chikoti; Asiimwe, Gilbert; Masiye, FelixThe immunisation programme in Zambia remains one of the most effective public health programmes. Its financial sustainability is, however, uncertain. Using administrative data on immunisation coverage rate, vaccine utilisation, the number of health facilities and human resources, expenditure on health promotion, and the provision of outreach services from 24 districts, we used Data Envelopment Analysis to determine the level of technical efficiency in the provision of immunisation services. Based on our calculated levels of technical efficiency, we determined the available fiscal space for immunisation. Out of the 24 districts in our sample, 9 (38%) were technically inefficient in the provision of immunisation services. The average efficiency score, however, was quite high, at 0.92 (CRS technology) and 0.95 (VRS technology). Based on the calculated level of technical efficiency, we estimated that an improvement in technical efficiency can save enough vaccine doses to supply between 5 and 14 additional districts. The challenge, however, lies in identifying and correcting for the sources of technical inefficiency.Item Immuno‑diagnosis of Mycobacterium tuberculosis in sputum, and reduction of timelines for its positive cultures to within 3 h by pathogen‑specific thymidylate kinase expression assays(BMC Research Notes, 2017-08-08) Wayengera, Misaki; Mwebaza, Ivan; Bayiyana, Alice; Joloba , Moses L.Laboratory diagnosis of Tuberculosis (TB) is traditionally based on microscopy and or culture. Microscopy is however, only sensitive to a specified degree of bacillary load not present in HIV co-infected persons. Traditional cultures of Mycobacterium tuberculosis (M. tb), on the other hand, take weeks to read—thereby delaying the critical decision whether or not, to treat. Although nucleic acids amplification tests (NAATS) applied directly on sputum or cultures can increase the sensitivity for TB diagnosis among those with HIV co-infection as well as reduce time-lines for positive culture detection, they do not replace the need for smear microscopy and culture. We have previously proposed the M. tb DNA-synthetic enzyme thymidylate kinase (aka TMKmt) as an organism-specific growth and proliferation biomarker to reduce time-lines for detection of positive TB cultures. In this study, we explored the secretory levels of TMKmt in M. tb cultures and sputum, towards improving the overall laboratory diagnosis of TB. Modelling of TMKmt secretion in vitro was done by cloning, expressing and SDS-PAGE/MALDI-TOF detection of purified recombinant TMKmt in E. coli. TMKmt expression profiling in M. tb was done by qRT-PCR assay of related messenger ribonucleic acids (mRNA) and TMKmt antigen detection by Enzyme linked Immuno-absorbent Assay (EIA) among cultures of a pathogenic wild-type Ugandan strain (genotype 1) alongside the H37Rv laboratory strain. Owing to the high-load of pathogen in-culture, direct EIA on limiting dilutions of sputum were done to examine for assay sensitivity. A rise in TMKmt antigen levels was observed at 3 h post-innoculation among in vitro cultures of E. coli. The 1st of several cyclic spikes in TMKmt mRNA and antigen levels were detected at 2.5 h among in vitro cultures of the pathogenic wild-type Ugandan isolate alongside the laboratory M. tb strain. TMKmt antigen was detected up to between 1 × 10−4–1 × 10−5 (containing 10 and 1 CFUs/ml) dilutions of a microscopically designated 1+ (est. Acid Fast Bacillary load of 1 × 105) patient sample. Detection of TMKmt expressed mRNA and Ag offers us opportune for instant diagnosis of M. tb in sputum, and reduction of timelines for positive pathogen detection in cultures to within 3 h.Item Enablers of and barriers to ART adherence among female sex workers in mid‑western Uganda: a qualitative study(AIDS Research and Therapy, 2025-01-08) Apuulison, David Friday; Nabawanuka, Brenda; Muhoozi, Michael; Asiimwe, Moses; Rubaihayo, JohnFemale sex workers (FSWs) in Uganda experience numerous barriers to antiretroviral therapy (ART) adherence. We used the planned behavior theory to help explore the enablers and barriers to ART adherence among FSWs. Understanding the barriers to ART adherence may help contribute to the development of interventions to improve ART adherence among the FSWs. A descriptive qualitative study was conducted in Fort portal City. We conducted 30 in-depth interviews among FSWs who had been taking ART for at least six months. Furthermore, six key informant interviews were conducted with healthcare workers and leaders of the FSWs initiative. Data collection lasted for two months. Thematic deductive analysis was applied to analyse the data through the lens of the theory of planned behavior. The attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including perceived benefits of ART, and experiencing positive outcomes from taking ART were seen to enable its adherence. Subjective norms such as social support, disclosure of HIV status, seeing others take ART, and aspirations of longer life enabled ART adherence. Taking ART in the morning, responsive and respectful healthcare workers, and availability of food/basic needs facilitated compliance with ART adherence. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV, lack of social support, gender-based violence, non-disclosure, stigma, and abandonment hindered the use of ART among FSWs. Socio-economic constraints (e.g., food scarcity), and occupation-related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations) were the additional barriers to ART adherence. ART adherence among FSWs was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these barriers in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSWs.Item Impact of different mosquito collection methods on indicators of Anopheles malaria vectors in Uganda(Malaria journal, 2022-12-19) Mawejje, Henry Ddumba; Asiimwe, Jackson R.; Kyagamba, Patrick; Staedke, Sarah G.Methods used to sample mosquitoes are important to consider when estimating entomologic metrics. Human landing catches (HLCs) are considered the gold standard for collecting malaria vectors. However, HLCs are labour intensive, can expose collectors to transmission risk, and are difficult to implement at scale. This study compared alternative methods to HLCs for collecting Anopheles mosquitoes in eastern Uganda. Between June and November 2021, mosquitoes were collected from randomly selected households in three parishes in Tororo and Busia districts. Mosquitoes were collected indoors and outdoors using HLCs in 16 households every 4 weeks. Additional collections were done indoors with prokopack aspirators, and outdoors with pit traps, in these 16 households every 2 weeks. CDC light trap collections were done indoors in 80 households every 4 weeks. Female Anopheles mosquitoes were identified morphologically and Anopheles gambiae sensu lato were speciated using PCR. Plasmodium falciparum sporozoite testing was done with ELISA. Overall, 4,891 female Anopheles were collected, including 3,318 indoors and 1,573 outdoors. Compared to indoor HLCs, vector density (mosquitoes per unit collection) was lower using CDC light traps (4.24 vs 2.96, density ratio [DR] 0.70, 95% CIs 0.63–0.77, p < 0.001) and prokopacks (4.24 vs 1.82, DR 0.43, 95% CIs 0.37–0.49, p < 0.001). Sporozoite rates were similar between indoor methods, although precision was limited. Compared to outdoor HLCs, vector density was higher using pit trap collections (3.53 vs 6.43, DR 1.82, 95% CIs 1.61–2.05, p < 0.001), while the sporozoite rate was lower (0.018 vs 0.004, rate ratio [RR] 0.23, 95% CIs 0.07–0.75, p = 0.008). Prokopacks collected a higher proportion of Anopheles funestus (75.0%) than indoor HLCs (25.8%), while pit traps collected a higher proportion of Anopheles arabiensis (84.3%) than outdoor HLCs (36.9%). In this setting, the density and species of mosquitoes collected with alternative methods varied, reflecting the feeding and resting characteristics of the common vectors and the different collection approaches. These differences could impact on the accuracy of entomological indicators and estimates of malaria transmission, when using the alternative methods for sampling mosquitos, as compared to HLCs.Item Molecular epidemiology of Panton- Valentine Leukocidin-positive community-acquired methicillin resistant Staphylococcus aureus isolates in pastoral communities of rural south western Uganda(BMC infectious diseases, 2017-01-05) Asiimwe, Benon B.; Baldan, Rossella; Trovato, Alberto; Daniela, M. CirilloThe emergence of multidrug resistant Staphylococcus aureus strains, including methicillin resistant (MRSA), is a global concern. Treatment of bacterial infections in Uganda’s health care settings is largely empirical, rarely accompanied by laboratory confirmation. Here we show the burden, characteristics of MRSA and epidemiology of Panton-Valentine Leukocidin (PVL) positive strains in asymptomatic carriers in pastoral households of south-west Uganda. Nasal swabs from 253 participants were cultured following standard methodology. MRSA strains were identified by detection of the mecA gene and SCCmec typing, and PVL genes detected by PCR. Pulsed Field Gel Electrophoresis (PFGE) was done to evaluate possible transmission patterns. Spa typing of PVL positive isolates was done to study the epidemiology of virulent strains in this setting. S. aureus was isolated in 29% (n = 73) of the participants, of which 48 were MRSA by mecA typing. PVL-encoding genes were found in 49.3% (n = 36) of the 73 isolates, of which 25 were also mecA positive. Among the PVL negative strains (n = 37), 62.2% (n = 23) carried the mecA gene. The most common SCCmec type was V, detected in 39 (18 PVL positive and 21 PVL negative) isolates. PFGE clustered 21/36 (58.3%) PVL positive isolates divided in four pulsotypes and 18/37 (48.6%) PVL negative isolates divided in eight pulsotypes. The most prevalent Spa types were t318 (26.5%, n = 9) and t645 (20.6%, n = 7); while other common Spa types were t11656 (n = 3), t127 (n = 3) and t355 (n = 3). The study shows a high prevalence of community acquired (CA)-MRSA, and PVL-positive isolates with two predominant spa types in rural Uganda, further complicating infection control strategies in these underprivileged communities.Item Identifying indigenous practices for cultivation of wild saprophytic mushrooms: responding to the need for sustainable utilization of natural resources(Journal of ethnobiology and ethnomedicine, 2019) Wendiro, Deborah; Wacoo, Alex P.; Wise, GrahamDue to increasing pressure on natural resources, subsistence agriculture communities in Uganda and Sub-Saharan Africa are experiencing increasingly restricted access to diminishing natural resources that are a critical requirement of their livelihoods. Previously, common-pool resources like forests and grasslands have been either gazetted for conservation or leased for agriculture, the latter in particular for large-scale sugarcane production. Satisfying the increasing consumer demand for grassland or forestry products like wild mushrooms as food or medicine, requires innovative ethno-biological and industry development strategies to improve production capacity, while easing the pressure on diminishing natural resources and averting ecosystems degradation. Methods: This case study addresses traditional knowledge systems for artisanal mycoculture to identify cultivation practices that enhance sustainable utilization of natural resources. Multi-scalar stakeholder engagement across government and community sectors identified artisanal mushroom producers across five districts in Uganda. Focus groups and semi-structured interviews characterized artisanal production methods and identified locally used substrates for cultivation of different mushroom species. Results: Artisanal practices were characterized for the cultivation of six wild saprophytic mushroom species including Volvariella speciosa (akasukusuku), two Termitomyces sp. (obunegyere and another locally unnamed species), Agaricus sp. (ensyabire) and Agrocybe sp. (emponzira), and one exotic Pleurotus sp. (oyster) that are used as food or medicine. The substrates used for each species differed according to the mushroom’s mode of decomposition, those being the following: tertiary decomposers such as those growing under rotting tree stumps or logs from forestry activity like the Agrocybe sp. known as emponzira which grows in forests, thickets, or near homesteads where big logs of hardwood have been left to rot. Also pieces of firewood are chipped off whenever need arises thus providing fuel; secondary decomposers growing on naturally composted grass associated with termites like the Termitomyces sp. known as obunegyere growing in protected sites in gardens, composted cattle manure for Agaricus sp. known as ensyabire in the kraal area where cattle manure is plenty, composted maize cobs for a locally unnamed Agaricus sp. on heaped cobs placed near homesteads; and primary decomposers growing on waste sorghum from brewing the traditional alcoholic drink, muramba for Pleurotus sp. (oyster), and banana and spear grass residue from banana juice processing like the Volvariella speciosa known as akasukusuku because it is associated with the banana plantation locally known in the Luganda language as olusuku and is usually heaped under ficus trees. Management practices also varied based on mode of decomposition and other ecological requirements such as the following: zero tillage and minimal disturbance in areas where obunegyere grow, heaping banana and spear grass residues under the cool ficus trees which also keep them away from banana stump that may cause infestation with nematodes and insects. Even within the generic practices accessibility by the users is critical for example placing logs near homes where children can use them to play, they can be used as fire wood and to even get off-season mushroom as household waste water can make the mushrooms grow. Conclusions: Our description of artisanal mycoculture methods that respond to conservation and utilization pressures, demonstrates the value of addressing traditional knowledge to improve ethno-biology and mycoculture industry practice. Traditional communities engage in multiple technological and organizational innovations and practices for sustainability and in the case of mushroom production to conserve the environment and culture, ensure variety, food and nutrition security, and income. The results of this study present opportunities to preserve ecosystem quality while developing an artisanal mycoculture system. They have also identified aspects of artisanal mycoculture that most urgently require further ethno-biological study and industry development. Future research and industry development can utilize the result of this study to boost artisanal production of wild saprophytic mushrooms in Sub-Saharan countries, for food or medicinal consumption, and environment conservation. Further development of production efficiencies in context with sustainable natural resource management is recommendedItem Development and validation of the ISARIC 4C Deterioration model for adults hospitalised with COVID-19: a prospective cohort study(The Lancet Respiratory Medicine, 2021-04-24) Gupta, Rishi K.; Harrison, Ewen M.; Ho, Antonia; Smeden, Maarten vanPrognostic models to predict the risk of clinical deterioration in acute COVID-19 cases are urgently required to inform clinical management decisions. We developed and validated a multivariable logistic regression model for in-hospital clinical deterioration (defined as any requirement of ventilatory support or critical care, or death) among consecutively hospitalised adults with highly suspected or confirmed COVID-19 who were prospectively recruited to the International Severe Acute Respiratory and Emerging Infections Consortium Coronavirus Clinical Characterisation Consortium (ISARIC4C) study across 260 hospitals in England, Scotland, and Wales. Candidate predictors that were specified a priori were considered for inclusion in the model on the basis of previous prognostic scores and emerging literature describing routinely measured biomarkers associated with COVID-19 prognosis. We used internal–external cross-validation to evaluate discrimination, calibration, and clinical utility across eight National Health Service (NHS) regions in the development cohort. We further validated the final model in held-out data from an additional NHS region (London).Item The Prevalence and Determinants of Stunting among Children 6 - 59 Months of Age in One of the Sub-Counties in the Rwenzori Sub-Region, Western Uganda(Open Journal of Nursing, 2020-04-24) Masereka, Enos Mirembe; Kiconco, Arthur; Katsomyo, Edson; Munguiko, ClementDespite being referred to as one of the country’s “food baskets”, 41% of children, 6 - 59 months of age in the Rwenzori sub-region, Western Uganda are stunted. Stunting is a form of chronic malnutrition in which children are short for their age. In this study, we established the prevalence and determinants of stunting in one of the sub-counties in this region. This was a cross-sectional descriptive study conducted in one of the sub-counties in the Rwenzori sub-region, Western Uganda from May 26th to June 26th, 2018. A total of 372 mothers and their children were recruited using systematic sampling. Data was collected using a questionnaire. Stunting was determined by taking child’s height or length and comparing it with child’s age. A child whose height or length for age index was less than −2 Standard Deviations (SD) was considered stunted. We used descriptive statistics to understand characteristics of mothers and multivariable logistic regression model to obtain the determinants of stunting. Data was analyzed using SPSS version 20. A total of 372 mothers and their children were included in this study; majority, 307 (83.0%) of the children were 6 - 24 months old and nearly half, 167 (44.9%) were stunted. We found that reserving food stock for use in the dry season (aOR = 0.23, CI = 0.08 - 0.62, p = 0.004), deworming children (aOR = 0.32, CI = 0.18 - 0.54, p = 0.001) and the family earning at least 10,000 Ushs (2.7USD) at the end of the month (aOR = 0.36, CI = 0.22 - 0.58, P = 0.001) were associated with no stunting. We found a high prevalence of stunting among children 6 - 59 months of age. We recommend enforcing ownership of food granary by households especially during dry season, support to de-worming programs targeting children below five years of age and establishing community based income generating livelihood projects.Item Sero-diagnosis of Active Mycobacterium tuberculosis Disease among HIV Co-infected Persons using Thymidylate Kinase based Antigen and Antibody Capture Enzyme Immuno-Assays(Mycobacterial diseases: tuberculosis & leprosy, 2017-05-31) Wayengera, Misaki; Mwebaza, Ivan; Nakimuli, Cynthia; Wampande, Eddie; Joloba, Moses L.Clinical and laboratory diagnosis of Active Tuberculosis (ATB) and latent Mycobacterium Tuberculosis (M. tuberculosis) infections (LTBI) among people living with HIV/AIDS (PLWHA) presents formidable challenges. In the past, WHO issued an advisory against the use of existing TB sero-diagnostics. Emerging evidence, however, points to a precision of TB sero-diagnostics based on secretory rather than structural M. tuberculosis antigens. We hypothesized that secretory levels of M. tuberculosis thymidylate kinase (TMKmt) can Designate ATBI from LTBI and no TB (NTB). Here, we report in-house validation studies of levels of TMKmt antigen (Ag) and host specific TMKmt antibody (Ab) amongst HIV +ve and HIV −ve participants. Direct TMKmt Ag and host specific IgG Ab detection EIAs were conducted on broadly consented, stored serum (N=281[Ag] vs. 214 [Ab] respective) samples stratified as either HIV +ve or HIV−ve ATB relative to LTBI and No TB. On one hand, UG-peptide 1 and its PAb-based EIAs accurately diagnosed ATB relative to LTBI and NTB among HIV +ve subjects {irrespectively: (a) Ag detection ATB=OD>0.490; 95% CI: 0.7446 to 0.8715 vs. LTBI=OD<0.490; 95% CI 0.4325 to 0.4829 vs. NTB=OD<0.26; 95% CI 0.1675 to 0.2567 and (b) TMKmt specific IgG detection ATB=OD>1.00; 95% CI 1.170 to 1.528 [HIV +ve] and 2.044 to 2.978 [HIV −ve] respectively vs. LTBI=OD<1.00; 95% CI 0.2690 to 0.6396 vs. NTB=OD<; 95% CI 0.1527 to 0.8751}. HIV −ve ATB presented with Ag levels greater than NTB and less than LTBI (i.e. ATB −ve=<0.490 ODs>0.26), but displayed better ant-TMKmt IgG responses (OD>2.00; 95% CI 2.044 to 2.978) relative to HIV +ve ATB (OD<1.600; 95% CI 1.170 to 1.528); suggesting a better control of M. tuberculosis-septicemia. On the other hand, UG-peptide 2 and its PAb-based EIAs did not demonstrate ATB diagnostic potential regardless of HIV sero-status, except towards designating NTB. TMKmt Ab and Ag detecting EIAs based on UG-peptide 1 and its derivative PAb can accurately demarcate ATB from LTBI and NTB among HIV +ve subjects.Item Functioning and Control of Phagocytosis(IntechOpen, 2023-03-23) Turyamuhika, Laban; Agaba, Bosco; Asiimwe, Moses; Musinguzi, Benson; Okek, ErickPhagocytosis is a very complex and versatile process that contributes to immunity through a series of events that is it’s sometimes referred to the Come and Eat me process. Due to the recognition ingestion and digestion then destruction. It’s also central to tissue homeostasis and remodeling by clearing dead cells. This ability of phagocytes to perform such diverse functions rests in large part on their vast repertoire of receptors. In this book chapter we looked at the processes used by phagocyte to perform there phagocytosis function. This is made possible by the binding of opsonins on the microbes like the C3b of the complement. This works as a chemo attractant to the phagocytes to come and initiate the process of eating. On recognition this microbe or dead cell interacts with the phagocyte with the help of a very big repertoire of receptors the microbe is engulfed with in the phagosome. As microbes interact with the phagocyte receptors a cascade of signaling events downstream that then activate phagocytosis. This membrane and cytoskeleton remodulation lead to the formation of pseudopods that cover the entire microbe forming a phagocytic cup which closes a few minutes to take up the microbe completely. The signal cascade is most known for the Fc receptor activities. Crosslinking of the Fc receptor on the surface of phagocyte activate phagocytosis and any other effector functions such as activation of the oxidative burst, degranulation, antibody dependent cell mediated cytotoxicity and activation of genes for cytokine/chemokine production that are beneficial in microbe destruction and initiation of inflammation. This starts once the interaction of phagocytes receptors and their ligands on the target microbes takes place appropriately. The phagocyte receptors will then aggregate to activate a series of pathways that regulate actin cytoskeleton which helps in the formation of a new vesicle which comes out of the membrane to enclose the microbe. In here a number of processes and stages take place all aimed at killing and denaturing the particle. They include early phagosome, intermediate phagosome, phagolysosome formation and the late phagosome all these participate in eliminating the phagocytized microbe. However with all the above phagocytic efficiency, some pathogens evade phagocytosis using different means and presence of certain capacities that facilitate evasion examples of organisms that evade phagocytosis include Mycobacterium tuberculosis, Listeria monocytogens Escherichia coli etc. all these use different means in evasion. Therefore the concept and science of Phagocytes used to be studied more to explore more pharmaceutical products based on the evasion mechanisms.Item The T2 Mycobacterium tuberculosis Genotype, Predominant in Kampala, Uganda, Shows Negative Correlation with Antituberculosis Drug Resistance(Antimicrobial agents and chemotherapy, 2014-06-12) Lukoye, Deus; Katabazi, Fred A.; Musisi, Kenneth; Cobelens, Frank G. J.Surveillance of the circulating Mycobacterium tuberculosis complex (MTC) strains in a given locality is important for understanding tuberculosis (TB) epidemiology. We performed molecular epidemiological studies on sputum smear-positive isolates that were collected for anti-TB drug resistance surveillance to establish the variability of MTC lineages with anti-TB drug resistance and HIV infection. Spoligotyping was performed to determine MTC phylogenetic lineages. We compared patients' MTC lineages with drug susceptibility testing (DST) patterns and HIV serostatus. Out of the 533 isolates, 497 (93.2%) had complete DST, PCR, and spoligotyping results while 484 (90.1%) participants had results for HIV testing. Overall, the frequency of any resistance was 75/497 (15.1%), highest among the LAM (34.4%; 95% confidence interval [CI], 18.5 to 53.2) and lowest among the T2 (11.5%; 95% CI, 7.6 to 16.3) family members. By multivariate analysis, LAM (adjusted odds ratio [ORadj], 5.0; 95% CI, 2.0 to 11.9; P < 0.001) and CAS (ORadj, 2.9; 95% CI, 1.4.0 to 6.3; P = 0.006) families were more likely to show any resistance than was T2. All other MTC lineages combined were more likely to be resistant to any of the anti-TB drugs than were the T2 strains (ORadj, 1.7; 95% CI, 1.0 to 2.9; P = 0.040). There were no significant associations between multidrug resistance and MTC lineages, but numbers of multidrug-resistant TB strains were small. No association was established between MTC lineages and HIV status. In conclusion, the T2 MTC lineage negatively correlates with anti-TB drug resistance, which might partly explain the reported low levels of anti-TB drug resistance in Kampala, Uganda. Patients' HIV status plays no role with respect to the MTC lineage distribution.Item Knowledge and Practices of Male Circumcision as an HIV/AIDS Prevention Measure among Males in Mbarara Municipality(Int J AIDS Res, 2018-09-25) A. Moses; K. Patience; K. ChristopherSince the beginning of the HIV/AIDS epidemic in the 1980’s, more than 60 million people have acquired the Human Immunodeficiency Virus and AIDS related illnesses have claimed nearly 20 million lives worldwide. The landmark randomized clinical trials (RCT) conducted in Orange Farm in South Africa, Rakai district in Uganda, Kisumu province in Kenya (demonstrated a reduction in HIV incidence among circumcised men. Uganda incorporated Medical Male Circumcision into the HIV prevention package in 2009 to enable improved provision of MC services in Uganda. This study mainly assessed the knowledge, attitudes and practices of Male Circumcision as an HIV/AIDS prevention measure among males in Mbarara Municipality. This cross-sectional study was conducted in July 2017 among 150 males aged between 18-49 years at Kamukuzi, Kakoba and Nyamitanga health centers in Mbarara municipality in Uganda. The study found that 58% of the respondents were circumcised. Respondents reported good knowledge on the benefits of male circumcision on HIV infection. For example, 86% of the respondents revealed that Circumcision of an HIV negative man reduces HIV risk. Majority of the respondents had positive attitudes towards male circumcision which could possibly explain the high prevalence of circumcision (58%). In fact, 43.3% and 70.7% revealed that circumcised men enjoy sex more than uncircumcised men and would recommend MC to their sons respectively. From this study, a high level of knowledge was found, particularly its potential to reduce the risk of HIV infection. Similarly, the respondents had good attitudes towards Male circumcision. Male Circirmcision is accepted on a large scale by males in Mbarara municipality as an HIV prevention strategy considering that this is not a traditionally circumcising communityItem Uptake of Intrauterine Contraception after Medical Management of First Trimester Incomplete Abortion : A Cross-sectional study in central Uganda(2024) Kayiga, Herbert; Looft-Trägårdh, Emelie; Cleeve, Amanda; Kakaire, Othman; Tumwesigye, Nazarius M.; Sekikubo, Musa; Rujumba, Joseph; Gemzell- Danielsson, Kristina; Byamugisha, JosaphatAlthough intrauterine devices (IUDs) are readily available in Uganda, their utilization remains low, including within post abortion care. The level and factors associated with uptake of post abortion IUDs are not well documented. We set out to determine the uptake and factors associated with uptake of post abortion IUDs after medical management of first trimester incomplete abortions in central Uganda. Methods Between February 2023 and September 2023, we conducted a cross-sectional study among women aged 15 to 49 years, who expressed interest in initiating post abortion intrauterine contraception and were managed with Misoprostol for first trimester incomplete abortions at five health facilities in central Uganda. Healthcare providers received extensive training in post abortion contraceptive counselling and service provision. Data from 650 participants were collected using interviewer administered questionnaires. The primary outcome was uptake of post abortion IUDs, defined as the actual insertion of the post abortion IUDs. Data were collected during a post abortion follow up visit. The determinants of post abortion IUD uptake were assessed using the modified poisson regression. Results The proportion of women who took up IUDs after medical management of first trimester abortion, was 370/650 (56.9%). Among the other available contraceptive choices, 121(18.6%) women opted for injectable Depo-Provera (DMPA), 116(17.9%) women opted for implants, 35(5.4%) women opted for oral contraceptive pills, five (0.8%) of the women opted for condoms, and three (0.5%) women for periodic abstinence. The mean age of the participants was (27.3 ± SD 1.8) years. A high proportion of the women in the study were; Catholics (32.3%), unemployed (52.6%), cohabiting with their partners (84.0%) and had given birth to 2-3 children (38.5%). A high proportion (56%) of IUD users, opted for the copper IUDs. The post abortion IUD uptake was independently associated with religion- being a Pentecostal (Adjusted PR=2.49, CI= (1.19-5.23), p-value=0.016), monthly earning > one million Ugx (270 USD) (Adjusted PR=1.88, CI= (1.44-2.46), p-value<0.001), and staying <5 kilometres from the health facility (Adjusted PR=1.34, CI= (1.04-1.72), p-value=0.023). Women who were not cohabiting with their partners, were less likely to choose IUDs (Adjusted PR=0.59, CI= (0.44-0.79), p-value=0.001). Conclusion The uptake of IUDs among post abortion women was nearly 60% emphasizing the potential impacts of integrated contraceptive services in Post abortion care. The impact of comprehensive and updated training on post abortion contraceptive counselling is vital on the uptake of IUDs. Regardless of sociodemographic status, women seeking post abortion care in Uganda should be provided with high-quality integrated services by trained providers offering a range of contraceptive methods. Such efforts may not only prevent unintended pregnancies but also improve health equity across the country.Item Uptake of Intra-Uterine Contraceptive Devices ant its Associated Individual Factors Among Women Aged 15 – 45 Years Attending services at Bweyogerere Health Center III, Wakiso District, Central Uganda – A cross Sectional Study(Student’s Journal of Health Research Africa, 2025) Ssebunya, Joel C.; Namaasa, Aeron M.An Intra-Uterine Contraceptive Device (IUCD) is a reversible, long-acting, safe, and effective method of postponing childbirth for couples, but many women get unwanted pregnancies in fear of side effects associated with some methods. This study aimed at determining the uptake of IUCDs and its associated individual factors among women aged 15 – 45 years attending health services at Bweyogerere Health Center III, Wakiso District, Central Uganda. Methods This cross-sectional study involved 391 women aged 15 – 45 years, attending services at Bweyogerere Health Center III, who voluntarily consented to participate in the study and were selected using systematic random sampling. Data was collected using a structured questionnaire. The data was analyzed in SPSS v.21 using mean, frequencies, percentages, chisquare, and binary logistic regression. Participants provided written informed consent for participation. Ethical approval was sought from the College Research and Scientific Committee, and administrative clearance was obtained from the District Health Office and the Health Facility In-Charge. Results Data was collected from 391 participants with an average age of 26.2 years (S = 6.86) and 348 (89%) were married and 378 (96.65%) were employed with almost equal distribution in the highest education level attained as; 148 (37.9%) had primary or less, 141 (36.1%) secondary and 102 (26.7%) had a tertiary or higher qualification. The uptake of IUCD was 26.6% and was associated with participants’ age (aOR=0.271; p-value=0.000) and education level (aOR=90.090; p-value=0.000) as the significant individual factors. Conclusion The uptake of IUCDs among participants is 26.6%, which is low and is associated with one’s age and educational level as the significant individual factors. Recommendations Health workers need to provide targeted contraceptive methods that are tailored to clients’ characteristics, like age and educational background, to accelerate the uptake of methods like IUCDs.Item The level of antiretroviral therapy (ART) adherence among orphan children and adolescents living with HIV/AIDS: A systematic review and meta-analysis(PLoS One, 2024) Kamau, Stanley G.; Akatusasira, Rita; Namatovu, Angella; Kibet, Emmanuel; Ssekitto, Joseph M.; Mamun, Mohammed A.; Kaggwa, Mark M.Many children and adolescents living with HIV have ended up as orphans. Due to HIV taking away their parents leaves them deprived of their most important social network and support, which predisposes them to poor adherence to antiretroviral therapy (ART). Various studies have shown poor adherence to ART among orphaned children and adolescents. This systematic review and meta-analysis, therefore, aims to determine the level of ART adherence among orphaned children and adolescents living with HIV/AIDS. This PROSPERO registered review (CRD42022352867) included studies from PubMed, Google Scholar, Scopus, Web of Science, Africa Journal Online, and selected HIV/AIDS journals from data inception to June 01, 2022. We included articles published in all languages that report the prevalence of adherence to ART among children and adolescent orphans (single parent orphans and/or double orphans) living with HIV/AIDS. We excluded qualitative studies, case studies, opinion papers, and letters to editors. We used the random- effect model to calculate the pooled prevalence of ART adherence based on the highest prevalence provided by the various methods in a particular study. We used the Joanna Briggs Institute Appraisal tool for the prevalence study to evaluate for risk of bias in the included studies. The Egger’s test was used to assess small study effects. Out of 1087 publications identified from the various databases, six met the selection criteria. The included six studies had a total 2013 orphans living with HIV/AIDS. The pooled prevalence of ART adherence was 78�0% (95% Confidence Interval: 67.4–87.7; I2 =82.92%, p<0�001) and ranged between 7�6% and >95%, using one of the following methods: pill count, caregiver’s self-report, clinical attendance, and nevirapine plasma levels (above three μg/mL). The factors associated with adherence were pill burden, caregiver involvement, stunting, and caregiver relationship