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Quantifying mpox transmission and control: A regional analysis of vaccination strategies in East Africa
(Elsevier B.V, 2025-03) Rabiu, Musa;; Fagbemigun, Bosede;; Fadugba, Sunday ;; Shatalov, Michael;; Malesela, Kekana;; Adeniji, Adejimi
Africa is home to the endemic mpox disease, especially in the tropical rain-forest regions of Central and West Africa. Although it is mostly found in the Democratic Republic of the Congo, reports of it have also come from other neighboring African nations. To understand the dynamics of mpox, we studied its spread in Burundi, Uganda, Rwanda, Congo, and Kenya before and after the implementation of interventions. Using a Bayesian framework, a simple mathematical model of Susceptible-Infected-Recovered type was calibrated and fitted to the 2022 mpox data covering the period before the introduction of intervention strategies. The model was then re-stratified to incorporate key epidemiological features, including vaccination with imperfect efficacy, partial immunity, exposure, and demographics. The transmission of mpox varied throughout East Africa, with Uganda exhibiting the highest basic reproduction number = 2.51, suggesting the possibility of a rapid spread. Despite having the highest initial infection count and the lowest (1.23), Congo may have had delayed detection. The moderate values (1.35 and 1.88) in Rwanda and Burundi have implications for prompt intervention to control epidemics. Transmission and vaccination rates have a non-linear relationship with the thresholds required to contain mpox outbreaks. Our model shows that in high-transmission settings, substantially higher vaccination coverage (exceeding 80 % at an effectiveness of 70 %) is required to reduce the control reproduction number below unity, whereas in moderate-transmission contexts, coverage above 40 % may suffice. These quantitative thresholds provide actionable guidance for tailoring vaccination strategies to different epidemiological conditions. In particular, sustained vaccination strategies that achieve coverage above the threshold predicted by our model (approximately 80 %) can guarantee mpox eradication, even in situations with strong transmission rates. While real-world complexities such as heterogeneous risk groups and behavioral factors may affect outcomes, these findings shed light on potential quantitative thresholds and provide a foundation for more detailed, population-specific modeling of mpox interventions.
Community health worker–facilitated telehealth for moderate–severe hypertension care in Kenya and Uganda: A randomized controlled trial
(Public Library of Science, 2025-06-05) Hickey, Matthew D.;; Owaraganise, Asiphas;; Ogachi, Sabina ;; Sang, Norton;; Wafula, Erick M.;; Kabami, Jane;; Sutter, Nicole;; Temple, Jennifer;; Muiru, Anthony;; Chamie, Gabriel;; Kakande, Elijah;; Petersen, Maya L.;; Balzer, Laura B.;; Havlir, Diane V.;; Kamya, Moses R.;; Ayieko, James
Hypertension is underdiagnosed and undertreated in sub-Saharan Africa. Improving hypertension treatment within primary health centers can improve cardiovascular disease outcomes; however, individuals with moderate-severe hypertension face additional barriers to care, including the need for frequent clinic visits to titrate medications. We conducted a pilot study to test whether a clinician-driven, community health worker (CHW)-facilitated telehealth intervention would improve hypertension control among adults with severe hypertension in rural Uganda and Kenya.BACKGROUNDHypertension is underdiagnosed and undertreated in sub-Saharan Africa. Improving hypertension treatment within primary health centers can improve cardiovascular disease outcomes; however, individuals with moderate-severe hypertension face additional barriers to care, including the need for frequent clinic visits to titrate medications. We conducted a pilot study to test whether a clinician-driven, community health worker (CHW)-facilitated telehealth intervention would improve hypertension control among adults with severe hypertension in rural Uganda and Kenya.We conducted a pilot randomized controlled trial (RCT) of hypertension treatment delivered via telehealth by a clinician (adherence assessment, counseling, decision-making) and facilitated by a CHW in the participant's home, compared to clinic-based hypertension care (NCT04810650). We recruited adults ≥40 years with BP ≥ 160/100 mmHg at household screening by CHWs, with no restrictions by HIV status. After initial evaluation at the clinic, participants were randomized to telehealth or clinic-based hypertension follow-up. Randomization assignment was not blinded, except for the study statistician. All participants were treated using standard country guideline-based antihypertensive drugs. The primary outcome was hypertension control at 24 weeks (BP < 140/90 mmHg). We also assessed hypertension control at 48 weeks. In intention-to-treat analyses, we compared outcomes between randomized arms with targeted minimum loss-based estimation using sample-splitting to select optimal adjustment covariates (candidates: age, sex, baseline hypertension severity, and country). We screened 2,965 adults ≥40 years, identifying 266 (9%) with severe hypertension and enrolling 200 (98 telehealth arms, 102 clinic arms). Participants were 67% women, median age of 62 years (Q1-Q3 51-72); 14% with HIV. Week 24 blood pressure was measured in 96/99 intervention and 99/102 control participants; week 24 hypertension control was 77% in telehealth and 51% in clinic arms (risk difference (RD) 26%, 95% confidence interval (CI) [14%, 38%], p < 0.001). Week 48 hypertension control was 86% in telehealth and 44% in clinic arms (RD 42%, 95% CI [30%, 53%], p < 0.001). Three participants died (telehealth: 2, clinic: 1); all deaths were unrelated to the study interventions. Our study was limited by its small sample size, although findings are strengthened by being conducted in three primary health centers across two countries.METHODS AND FINDINGSWe conducted a pilot randomized controlled trial (RCT) of hypertension treatment delivered via telehealth by a clinician (adherence assessment, counseling, decision-making) and facilitated by a CHW in the participant's home, compared to clinic-based hypertension care (NCT04810650). We recruited adults ≥40 years with BP ≥ 160/100 mmHg at household screening by CHWs, with no restrictions by HIV status. After initial evaluation at the clinic, participants were randomized to telehealth or clinic-based hypertension follow-up. Randomization assignment was not blinded, except for the study statistician. All participants were treated using standard country guideline-based antihypertensive drugs. The primary outcome was hypertension control at 24 weeks (BP < 140/90 mmHg). We also assessed hypertension control at 48 weeks. In intention-to-treat analyses, we compared outcomes between randomized arms with targeted minimum loss-based estimation using sample-splitting to select optimal adjustment covariates (candidates: age, sex, baseline hypertension severity, and country). We screened 2,965 adults ≥40 years, identifying 266 (9%) with severe hypertension and enrolling 200 (98 telehealth arms, 102 clinic arms). Participants were 67% women, median age of 62 years (Q1-Q3 51-72); 14% with HIV. Week 24 blood pressure was measured in 96/99 intervention and 99/102 control participants; week 24 hypertension control was 77% in telehealth and 51% in clinic arms (risk difference (RD) 26%, 95% confidence interval (CI) [14%, 38%], p < 0.001). Week 48 hypertension control was 86% in telehealth and 44% in clinic arms (RD 42%, 95% CI [30%, 53%], p < 0.001). Three participants died (telehealth: 2, clinic: 1); all deaths were unrelated to the study interventions. Our study was limited by its small sample size, although findings are strengthened by being conducted in three primary health centers across two countries.In this pilot, RCT, clinician-driven, CHW-facilitated telehealth for hypertension management improved hypertension control and reduced severe hypertension compared to clinic-based care. Telehealth focused on individuals with moderate-severe hypertension is a promising approach to improve outcomes among those with the highest risk for CVD.CONCLUSIONIn this pilot, RCT, clinician-driven, CHW-facilitated telehealth for hypertension management improved hypertension control and reduced severe hypertension compared to clinic-based care. Telehealth focused on individuals with moderate-severe hypertension is a promising approach to improve outcomes among those with the highest risk for CVD. MEDLINE - Academic
A case of blinding abdominal pain
(South African Medical Journal, 2011-07-02) Mutyaba, A. K.; Gardiner,E. C.; Murphy, S
A 12-year-old girl was admitted to hospital with a week's history of severe abdominal pain, distension and generalised weakness, and was managed for incomplete intestinal obstruction. Plain abdominal films were compatible with ileus, and ultrasound showed no ascites, no lymphadenopathy, and normal abdominal and pelvic organs. We saw her following the onset of new generalised tonic-clonic seizures. She was slightly obtunded with raised blood pressure (166/115 mmHg) and sinus tachycardia (130 bpm), apyrexial, and had mild psychomotor retardation and blindness with no light perception in either eye. Fundoscopy was normal. There was no meningism or sensorimotor deficit. Apart from a marginally low serum sodium level (131 mmol/l), the results of all biochemical and haematological investigations were normal. Inflammatory markers (c-reactive protein, erythrocyte sedimentation rate and procalcitonin) and cerebrospinal fluid assessment were normal.
Experiences of Child Sexual Abuse Survivors with formal Child Protection Systems: An indigenist perspective
(Journal of Comparative Social Work, 2025-07-08) Turyomurugyendo, Florence; Walakira, Eddy J.; Cecilie, Revheim; Twikirize, Janestic M.
Preventing abuse in childhood and providing services to the victims requires a comprehensive child protection framework. Even when the government of Uganda has made deliberate efforts to facilitate protection of children, research shows that their efforts have largely been inadequate. Adopting an indigenous perspective that centers the structural inequalities that inform social relationships in families, communities and the society rather than the individual is paramount. Thus, this study examined how indigenous child protection systems can be integrated to complement formal approaches in responding to child sexual abuse. This article presents experiences of five adult women from Luuka district, Uganda who experienced rape during their childhood. Narrative inquiry was used to explore survivors’ experiences. This information was complemented by information from social workers who were purposively selected and interviewed using a semi-structured interview guide. Thematic analysis was used to analyse the findings and four major themes relating to survivors’ experiences emerged from this study. Survivors reported challenges with investigations, access to justice, lack of protective shelter and challenges in accessing medical services. In addition to formal child protection systems, survivors utilised services from indigenous child protection systems which included; Local Council 1, community volunteers, social groups and savings groups. Indigenous practices based on mutual aid and community organising addressed broader welfare needs of survivors, including enabling them to access education, linkage to services and access to shelter. The social support provided through indigenous models involved multiple social welfare functions, and addressed different child protection needs. However, poverty at the household and community level limits the scalability of such approaches. Accessing formal child protection services was found to be costly for the survivors. The Informal Child Protection System is more accessible, offers comprehensive services and demonstrates to buffer the formal systems.
Diagnostic pattern of mental, neurological and substance use disorders at primary health care facilities in Uganda
(International Journal of Mental Health Systems, 2024-07-15) Mutamba, Byamah B.; Twikirize, Gad; Ssemalulu, Jimmy; Semakula, Lynn; Cappo, David
Integration of diagnosis and treatment for mental, neurological, and substance use (MNS) disorders into primary health care is a recommended strategy to improve access to services in low-and middle-income countries. Despite numerous initiatives for integration of mental health care in Uganda, there has not been an evaluation of health management information system (HMIS) records to determine whether MNS disorders are routinely diagnosed. We sought to determine diagnostic pattern of MNS disorders at primary health facilities in Wakiso and Kampala districts, the most populous regions of Uganda. Lower-level primary health facilities were visited to obtain records from HMIS registers, to document diagnoses of MNS disorders. Secondary data analysis was conducted and descriptive statistics reported. A total of 40 primary health care facilities were visited representing 58.6% of the health facilities in the study districts. More than half (54.8%) and almost all (87.5%) of the lower-level health facilities in Wakiso district and Kampala district respectively were visited. The proportion of MNS disorders diagnosed at lower-level primary health facilities in Uganda is very low with Epilepsy the most common MNS diagnosis recorded. Reasons for such low numbers of diagnoses at primary health facilities are discussed as are possible solutions.
LLIN Evaluation in Uganda Project (LLINEUP2)—Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020–21 national mass distribution campaign: a cross-sectional survey of 12 districts
(BioMed Central, 2022-10-19) Okiring, Jaffer;; Gonahasa, Samuel;; Nassali, Martha ;; Namuganga, Jane F.;; Bagala, Irene;; Maiteki‑Sebuguzi, Catherine;; Opigo, Jimmy;; Nabende, Isaiah;; Nangendo, Joanita;; Kabami, Jane;; Ssewanyana, Isaac;; Kiwuwa, Steven M.;; Nankabirwa, Joaniter I.;; Dorsey, Grant;; Briggs, Jessica;; Kamya, Moses R.;; Staedke, Sarah G.
Abstract Background In 2020–2021, long-lasting insecticidal nets (LLINs) were distributed nationwide in Uganda during the COVID-19 pandemic. A cross-sectional survey was conducted in 12 districts to evaluate the impact of the campaign 1–5 months after LLIN distribution. Methods During April–May 2021, households were randomly selected from target areas (1–7 villages) surrounding 12 government-run health facilities established as Malaria Reference Centres; at least 50 households were enrolled per cluster. Outcomes included household ownership of LLINs distributed through the universal coverage campaign (UCC) (at least one UCC LLIN), adequate coverage of UCC LLINs (at least one UCC LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Multivariate logistic regression models were used to identify household- and individual-level factors associated with outcomes, controlling for clustering around health facilities. Results In total, 634 households, with 3342 residents and 1631 bed-nets, were included. Most households (93.4%) owned at least 1 UCC LLIN, but only 56.8% were adequately covered by UCC LLINs. In an adjusted analysis, the factor most strongly associated with adequate coverage by UCC LLINs was fewer household residents (1–4 vs 7–14; adjusted odds ratio [aOR] 12.96, 95% CI 4.76–35.26, p < 0.001; 5–6 vs 7–14 residents; aOR 2.99, 95% CI 1.21–7.42, p = 0.018). Of the 3166 residents of households that owned at least one UCC LLIN, only 1684 (53.2%) lived in adequately covered households; 89.9% of these used an LLIN the previous night, compared to 1034 (69.8%) of 1482 residents living in inadequately covered households. In an adjusted analysis, restricted to residents of inadequately covered households, LLIN use was higher in children under-five than those aged 5–15 years (aOR 3.04, 95% CI 2.08–4.46, p < 0.001), and higher in household heads than distantly-related residents (aOR 3.94, 95% CI 2.38–6.51, p < 0.001). Conclusions Uganda’s 2021–21 campaign was successful, despite the COVID-19 pandemic. In future campaigns, strategies should be adopted to ensure high LLIN coverage, particularly for larger households. A better understanding of the drivers of LLIN use within households is needed to guide future interventions, educational messages, and behaviour change communication strategies; school-aged children and distantly-related residents appear vulnerable and could be targeted.
Prevalence of depression in Uganda: A systematic review and meta-analysis
(Public Library of Science, 2022-10-20) Kaggwa, Mark Mohan;; Najjuka, Sarah Maria;; Bongomin, Felix ;; Mamun, Mohammed A.;; Griffiths, Mark D.
Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7-34.1, I.sup.2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).
Quality of Care and Post-discharge Morbidity among Children Diagnosed with Severe Malaria in Rural Uganda: A prospective cohort study
(PLOS Global Public Health, 2024-10-07) Kniss, Jennifer M.; Baguma, Emmanuel; Ntaro, Moses; Mulogo, Edgar; Karabyo, Samson; Boyce, Ross M.
Pediatric severe malaria is a significant contributor of morbidity and mortality in Uganda. Most information is derived from tertiary referral centers and urban centers. Little is known about routine care or post-discharge outcomes in rural areas. We conducted a longitudinal cohort study of pediatric severe malaria at St. Paul’s Level IV Health Center (SPHC) in Kasese, Uganda. We collected demographic, clinical, and laboratory results, and conducted follow-up 14 days post-discharge to assess patient outcomes in the immediate post-discharge period. The initial cohort included 187 children aged 0 to 17 years enrolled between July 9th, 2023 and January 9th, 2024. Almost all (94.7%) participants had a parasitological confirmed malaria diagnosis by rapid diagnostic tests or blood smear. While at SPHC, 95.7% of patients received 3+ doses of intravenous Artesunate, and 92.0% also received oral antimalarials. 62.0% had at least one symptom of severe malaria, with altered consciousness (40.6%) and convulsions (29.9%) the most frequently reported. 26.1% had evidence of severe malarial anemia (Hb <5 g/dl), of whom 93.5% received a blood transfusion. Most (82.2%) patients received care that we assessed as consistent with key elements of WHO management guidelines. We were able to contact 183 of the 187 patient caregivers post-discharge. Caregivers reported that 25.6% of patients were experiencing symptoms related to their hospitalization, with fever (18.5%) and nausea/ not feeding well (10.3%) reported most frequently. Children who experienced altered consciousness during their acute illness had 1.69 times the adjusted risk of reporting symptoms 14-days post-discharge compared to those who did not have altered consciousness (aRR: 1.69, 95% CI: 1.01–2.82). Six deaths were recorded, including three at SPHC and three post-transfer or discharge. Findings suggest that at private health facilities in rural areas, treatment appears to be consistent with guidelines. Future research should investigate high morbidity in the immediate post-discharge period.
Population-based Cohort Data used to Assess trends in Early Resumption of Sexual Activity after Voluntary Medical Male Circumcision in Rakai, Uganda
(Plos one, 2024-11-21) Daama, Alex; Nalugoda, Fred; Kankaka, Edward; Kasango, Asani; Nantume, Betty; Sewankambo, Nelson; Kigozi, Godfrey
Voluntary medical male circumcision (VMMC) reduces the risk of heterosexual acquisition of HIV by 50%–60%. The Uganda Ministry of Health recommends abstinence of sex for 42 days after VMMC to allow complete wound healing. However, some men resume sex early before the recommended period. We estimated trends in prevalence and risk factors of early sex resumption (ESR) among VMMC clients in Rakai, Uganda, from 2013–2020. Data from the Rakai Community Cohort Study (RCCS), a cross-sectional study, were analyzed. Data included consenting males aged 15–49 years in RCCS who self-reported having received VMMC between the period of 2013 to 2020. ESR prevalence and associated risk factors were assessed using modified Poisson regression to estimate adjusted prevalence ratios (aPR). Overall, 1,832 participants were included in this study. ESR decreased from 45.1% in 2013 to 14.9% in 2020 (p<0.001). Across the first three surveys, ESR prevalence was consistently higher among the married participants than the never married participants, aPR = 1.83, 95% CI: [1.30,2.57]; aPR = 2.46, 95% CI: [1.50,4.06]; aPR = 2.22, 95% CI: [1.22,4.03]. ESR prevalence was higher among participants who reported to have more than one sexual partner than participants with one partner, aPR = 1.59, 95% CI: [1.16,2.20]. In the fourth survey from 2018–2020, ESR prevalence was significantly higher among participants with primary education than participants with post-primary, aPR = 2.38, 95% CI: [1.31, 4.30]. However, ESR prevalence was lower among participants aged at least 45 years than participants aged 15–19 years, aPR = 0.0, 95% CI: [1.86e-07, 2.69e-06]. Overall, participants who reported primary school as their highest level of education reported ESR more often than those with post-primary education aPR = 2.38, 95% CI: [1.31, 4.30]. Occupation and known HIV status were not associated with ESR. Self-reported ESR after VMMC declined between 2013 and 2020. Targeted efforts for counseling focusing on married men, men who had multiple sex partners, and men with lower levels of education may decrease ESR.
The PROCAN-B study Protocol: Early Diagnosis of PROstate CANcer for Black Men—a Community-Centred Participatory approach in Scotland and the North-East of England
(PLoS One, 2024-12-31) Jong, Christie-de; Kotzur, Marie; Nnyanzi, Lawrence; Kabuye, John; Kalemba,Martin; Robb, Kathryn A.
Prostate cancer is the most common cancer in the UK and Black African-Caribbean men are twice as likely to develop prostate cancer as white men. These cancer inequalities need urgent tackling. Barriers to early diagnosis are complex and require complex solutions. Culturally-tailored, community-centred and participatory approaches show promise in tackling cancer inequalities. We aim to co-design a culturally appropriate intervention to tackle barriers to early diagnosis of prostate cancer for Black men in Scotland and the North-East of England using a community-centred participatory approach. The PROCAN-B study is a mixed methods study set in Scotland and the North-East of England. A Public Involvement and Community Engagement (PICE) group (n = 12), is involved at every step of the research. Drawing on principles of the Integrated Screening Action model (I-SAM), the study has 8 objectives: 1) to explore barriers to early diagnosis of prostate cancer among Black men (45+) through focus groups (n = 12); 2) to co-design a culturally acceptable peer-led intervention to tackle barriers to early diagnosis of prostate cancer in Black men; 3) to train members of the community as ‘peer-facilitators’ (n = 8); 4) to deliver the intervention in each location, facilitated by peer-facilitators, with a purposive sample (n = 20) of Black men (45+); 5) to qualitatively evaluate the intervention through focus groups; 6) to refine the intervention based on qualitative feedback; 7) to pilot the refined intervention with another purposive sample (n = 40) through a cross-sectional survey pre- and post-intervention; 8) to qualitatively evaluate the refined intervention through focus groups to further refine the intervention.
Vascular Surgery in Sub-Saharan Africa: Challenges and Opportunities—The Experience of Uganda
(A Global Perspective, 2016-10-21) Mwambu, Tom P.; Kabuye, Ronald; Oketcho, Michael
Sub-Saharan Africa (SSA) is home to among the least developed nations in the world with the exception of the Republic of South Africa. The average annual economic growth rate for the region is estimated at 5 % [1] with about 42.7 % of the population living on less than USD 1.9 a day [2]. Communicable diseases such as malaria and respiratory tract diseases such as tuberculosis rank highest in the regions’ disease burden however, due to changing lifestyles non-communicable diseases (NCDs) including cardiovascular disease are on the increase. Vascular surgical services do come with a high cost including availability of specialist human resource, necessary sundries and appropriate equipment which are all not readily available in sub-Saharan Africa including Uganda. In such low socio-economic settings allocation of resources to the health sector is a challenge and availing resources for appropriate vascular surgical care remains an uphill task.
A qualitative study exploring attitudes and perceptions of the COVID‑19 booster vaccine in minority ethnic individuals in North East England
(Journal of Public Health, 2024-02-27) Eberhardt, Judith; Kabuye, John; Ling, Jonathan
COVID-19 booster vaccine uptake among minority ethnic individuals in the United Kingdom has been lower than in the general population. This is the case not only for the first and second dose of the vaccine, but particularly for the booster dose. However, little research has examined psychosocial factors contributing to vaccine hesitancy in minority ethnic individuals. This study conducted a qualitative exploration, informed by Protection Motivation Theory, of attitudes towards and perceptions of the COVID-19 booster vaccination among ethnic minority individuals in North East England. Semi-structured interviews were conducted with 16 ethnic minority individuals (11 females, five males) aged between 27 and 57, residing in North East England. Inductive thematic analysis showed that perceived susceptibility to COVID-19 influenced vaccination decisions. Perceived response costs acted as barriers to COVID-19 booster vaccination among interviewees, in the form of time constraints and a perceived lack of practical support in the event of experiencing side effects from the vaccine. There was a lack of confidence in the vaccine, with individuals seeing it as lacking sufficient research. Participants also spoke of medical mistrust due to historical events involving medical experimentation on minority ethnic individuals. Interviewees suggested involving community leaders in addressing people’s concerns, misassumptions, and lack of confidence in COVID-19 vaccination. Campaigns to increase COVID-19 booster vaccine uptake need to be designed to address physical barriers towards vaccination, misconceptions, and a lack of confidence in the vaccine. Further research needs to determine the effectiveness of enlisting community leaders in these efforts.
New Trauma Score versus Kampala Trauma Score II in predicting mortality following road traffic crash: a prospective multi-center cohort study
(BMC emergency medicine, 2024-07-29) Damulira, John; Muhumuza, Joshua; Kabuye, Umaru; Ssebaggala, Godfrey; Lule, Herman
Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population.
Thyroidectomy underLocal versus General Anesthesia in Health Camp Settings in Uganda: a Randomized Prospective Equivalence Singleblind Controlled trial
(BMC surgery, 2025-02-19) Kabuye, Umaru; Fualal, Jane Odubu; Lule, Herman
Endemic goiter is highly prevalent in Uganda, placing a considerable surgical burden on the healthcare system. Across Africa, prevalence varies widely, reaching 60.2%, with visible goiter affecting 30% of Uganda’s rural population despite salt iodization programs. Despite evidence supporting thyroidectomy under local anesthesia (LA) for selected cases, its importance is underestimated moreover with limited access to general anesthesia (GA) and critical care providers in resource-constrained settings. The trial compared outcomes of thyroidectomy under LA versus GA in grade 1–2 uncomplicated euthyroid goiter patients in Uganda, with an aim to assess feasibility of LA as an alternative technique. In this prospective equivalence randomized, single-blind controlled trial, participants with grade 1–2 uncomplicated euthyroid goiters were enrolled and randomly assigned to two arms (LA and GA) during surgical camps in Uganda. The study compared early postoperative outcomes, including nausea, vomiting, hematoma formation, transient voice changes, and pain at 6, 12, and 24 h. It also assessed overall incurred material and medication costs, patient satisfaction using a 5-point Likert scale, and willingness to undergo a similar procedure with the same anesthetic technique at 30 days. Fifty-eight participants undergoing thyroidectomy received random assignment, twenty-nine for each arm. No significant differences were found between the 2 groups in demographics, symptom duration, and early post-operative complications or patients’ level of satisfaction (P > 0.05). However, the overall material and medication costs were significantly lower in the LA Group (P < 0.001). Thyroidectomy under LA can be performed in a well-selected patient population with low complication rates and comparable patient satisfaction to GA. These findings may support LA for thyroidectomy as a valuable cost-efficient alternative, especially in low-resource settings with fewer GA providers.
Ganga hospital open injury severity score as a predictor of early failure of limb salvage among gustilo type III A and B tibia fractures in Uganda: a prospective cohort study
(BMC surgery, 2025-02-21) Okuku, Maxwel Dancan; Kabuye, Umaru; Khadolwa, Stephen Angira; Okedi, Francis Xaviour; Ibe, Michael Usman
Despite advances in antibiotic therapy and microsurgery, the management of Gustilo and Anderson type IIIA and B open tibia fractures continues to pose a considerable challenge in developing countries. This has evolved from historical immediate amputation to modern approaches that prioritize both aesthetics and functional outcomes. Nonetheless, a consensus on limb salvage versus amputation remains elusive, prompting the development of prognostic limb scoring systems. Our study assessed the predictive accuracy of the Ganga Hospital Open Injury Severity Score (GHOISS) for early failure of limb salvage in Gustilo type IIIA and B tibia injuries. This was a prospective study that examined open tibia fractures at two tertiary hospitals in the emergency and orthopaedic units between June and October 2023. Fifty-three (26 IIIB and 27 IIIA) satisfied the study inclusion and exclusion criteria. Four injuries (type IIIA) in paediatric patients that had met the inclusion criteria were excluded from analysis to ensure homogeneity and generalizability of the results due to their small numbers. The severity of injury for each Gustilo type III A and B tibia fracture was determined using the GHOISS, and limb salvage decisions were made irrespective of the GHOISS. Follow-up was extended for up to fourteen days to assess the necessity of secondary amputation in salvaged limbs. Among 49 Gustilo type IIIA and B tibia fractures, 43 were successfully salvaged, while 6 necessitated amputation (4 primary, 2 secondary). A GHOISS of 13 demonstrated maximum specificity (90.7%) and sensitivity (83.3%) in predicting amputation, with an AUC of 0.923 (95% CI 0.804–0.977), indicating strong discriminatory accuracy. The GHOISS reliably predicted outcomes in patients with Gustilo type IIIA and B tibia fractures, with a score of 13 demonstrating optimal sensitivity and specificity above which early failure of limb salvage is anticipated.
An Unusual Occurrence of Penetrating Aortic Arch Injury by a Ball‑point Pen: a case report and review of the literature
(Journal of Cardiothoracic Surgery, 2022-12-12) Ariaka, Herbert; Magala, John Paul; Kebba, Naomi; Kabuye, Ronald; Namirembe, Stella Magara; Nalule, Miriam
Aortic arch injuries account for about 8% of thoracic aortic injuries. Penetrating zone I neck injuries account for 18% of vascular injuries in the neck and have great potential to traverse to involve thoracic vascular structures as well. The hard and soft signs of vascular injury facilitate triage of patients on an individual basis. We present a case of a ball-point pen traversing through zone I of the neck and causing penetrating aortic arch injury with minimal mediastinal haemorrhage. We present a polytrauma patient who was admitted with traumatic brain injury and a ball-point pen lodged above the sternal notch in zone I of the neck following a road traffic accident. He underwent mediastinal exploration via a median sternotomy. The ball-point pen was found penetrating the anterior wall of the aortic arch and resting in its lumen. The ball-point pen was successfully explanted and primary repair of the penetrating aortic arch injury was done. He had an uneventful recovery without any added secondary neurological complications. Penetrating aortic arch injuries are rare compared to injuries of the ascending aorta and descending aorta. They require a high index of suspicion, rapid investigation and urgent intervention in view of their high associated fatality. The ball-point pen in this case assumed the shape of a plug which acted as a seal at the site of injury preventing catastrophic exsanguination.
Euthyroidectomy under local versus general anesthesia in health camp settings in Uganda: a protocol for randomized prospective equivalence single-blind controlled trial
(Trials, 2023-05-31) Kabuye, Umaru; Fualal, Jane Odubu; Lule, Herman
Endemic goiter is highly prevalent in Uganda at 60.2%, contributing to the high surgical burden. While compelling evidence suggest that in selected cases, thyroidectomy under local anesthesia (LA) is associated with fewer post-operative complications, low costs, and short hospital stays, local anesthesia is not considered a priority technique for thyroidectomy in resource-constrained settings such as Uganda, despite having fewer general anesthesia (GA) and critical care providers. The objective of this trial is to compare euthyroidectomy under local versus general anesthesia among patients with grade 1–2 uncomplicated euthyroid goiter in Uganda. This prospective equivalence randomized, single-blind controlled trial protocol will be conducted among eligible participants with grade 1–2 uncomplicated euthyroid goiters. The recruitment processes will start in October 2022 and end in April 2023. Consenting participants with an indication for thyroidectomy will be randomized into two arms of 29 participants in each arm during the Bulamu Health Care Organization surgical camps in Uganda. The primary outcome of this trial protocol is to compare the early post-operative complications of euthyroidectomy done under LA versus GA. The outcome variables include post-operative pain based on visual analogue scale, nausea, vomiting, hematoma formation, and transient voice changes determined at an interval of 6, 12, and 24 h and at 30 days. In addition, we shall compare the surgical site infection rates, procedure costs, hospital stay, and patients’ level of satisfaction based on a 5-point Likert scale and their willingness to undergo a similar surgery using the same anesthetic technique between the two groups. We hypothesize that euthyroidectomy under LA could potentially offer similar benefits as GA, reduce costs related to procedure, complications, and hospital stay while at the same time mitigating the unmet need for surgery attributable to shortage of general anesthesia providers and critical care facilities in low-income settings.
Synchronous sigmoid‑cecal volvulus: a rare case of large‑bowel obstruction—a case report
(Journal of Medical Case Reports, 2024-10-09)
Large bowel obstruction caused by volvulus poses a life-threatening risk without immediate intervention. Sigmoid colon volvulus is predominant (43–75%), followed by cecal volvulus 10–52%). Synchronous double colonic volvulus is extremely rare, with limited documented cases in academic literature. We report a case of synchronous volvulus involving the sigmoid colon and cecum in a 45-year-old male of the Toro tribe from Fort Portal city in western Uganda who presented with acute abdominal pain, distension, and complete constipation for 2 days, accompanied by five episodes of non-bloody feculent vomiting and anorexia. Upon admission, the patient presented with stable vital signs and a mildly tender, tympanic, distended abdomen with absent bowel sounds. Plain radiographs revealed the characteristic “coffee bean” sign, indicative of sigmoid volvulus. Following optimization, laparotomy confirmed synchronous volvulus involving both the sigmoid and cecum. Subsequently, a total colectomy with end ileostomy was performed, after which the patient experienced an uneventful recovery. Synchronous double colonic volvulus, a rare condition, is frequently overlooked clinically. Timely recognition and intervention are crucial to address diagnostic challenges and prevent potentially fatal outcomes.
Prevalence trends of transfusion-transmitted infections at a tertiary private hospital blood bank in Uganda: a retrospective 6-year review (2017–2022)
(BioMed Central, 2025-05-07) Kanyike, Andrew Marvin;; Kakuba, Frank;; Mayambala, Posiano ;; Nalunkuma, Racheal;; Nakandi, Rachael Mukisa;; Mulumba, Yusuf;; Namulema, Edith;; Nsingo, Simon Peter;; Ssebuufu, Robinson
Background Blood transfusion is a life-saving medical intervention that can transmit transfusion-transmitted infections (TTIs). In Uganda, prevalent infections in the general population may increase the risk of TTIs. This study determined the trends in seroprevalence of TTIs, including the Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and syphilis among blood donations over a 6-year period at a tertiary hospital blood bank in Uganda. Methods This was a retrospective cross-sectional study utilizing data from Mengo Hospital Rotary Blood Bank in central Uganda. Data was accessed through the central electronic system of Uganda Blood Transfusion Services for January 2017 to December 2022. Data was analyzed using STATA version 16.0. Descriptive statistics and time trend analysis were performed. A p -value < 0.05 was considered statistically significant. Results We analyzed 24,547 blood donations, the majority of which were male donors (18,525, 75.5%) within the age group of 25–40 years (9737, 39.7%) and of Blood group O (12,509, 51.0%). The overall prevalence of TTIs was 8.7% (2,142) and significantly higher among males (8.9%, p < 0.001) and those over 40 years (10.7%, p < 0.01). Syphilis had the highest prevalence at 3.0%, followed by HBV (2.8%), HCV (1.7%), and HIV (1.3%). Co-infections were observed in 0.6% (136) of the donors, with the most common being HBV and syphilis (33, 0.1%). The prevalence trends of TTIs analysed among new donations decreased from 13.7% in 2017 to 8.9% in 2022 ( p = 0.124). Only HCV showed a statistically significant variation, decreasing from 5.2% in 2017 to 1.7% in 2022 ( p = 0.009). Conclusion There is a decreasing trend of TTIs among blood donors in Central Uganda, although the prevalence of HBV and Syphilis remains high. Additional public health interventions to decrease TTI rates in the general population may increase the safety of blood transfusions.
Retention outcomes during same-day antiretroviral therapy initiation in health facilities and outreach settings of Rakai, Uganda, 2016–2021
(Wiley Subscription Services, Inc, 2025-05-21) Basiima, Jesca;; Ssempijja, Victor;; Ndyanabo, Anthony ;; Bua, Grace Mong;; Bbaale, Denis;; Chang, Larry W.;; Serwadda, David;; Kagaayi, Joseph;; Fitzmaurice, Arthur G.;; Grabowski, Kate;; Nalugoda, Fred;; Kigozi, Godfrey;; Gray, Ronald;; Wawer, Maria;; Nakigozi, Gertrude;; Reynolds, Steven J.
The antiretroviral therapy (ART) initiation policy in Uganda recommends that ART is initiated on the same day of HIV diagnosis to those who do not have contraindications. We assessed determinants of retention in ART care at the first follow-up (FFU) after same-day ART initiation and retention in long-term care beyond the FFU visit.INTRODUCTIONThe antiretroviral therapy (ART) initiation policy in Uganda recommends that ART is initiated on the same day of HIV diagnosis to those who do not have contraindications. We assessed determinants of retention in ART care at the first follow-up (FFU) after same-day ART initiation and retention in long-term care beyond the FFU visit.We conducted a retrospective longitudinal analysis among persons living with HIV aged ≥18 years who initiated ART during April 2016-February 2021 after the inception of Uganda's Test-and-Treat ART policy, which states that 'all individuals diagnosed with HIV should initiate ART regardless of clinical stage CD4 count'. Missing the FFU after ART initiation (missing FFU) was defined as not returning for FFU within 1 month of ART initiation; loss to follow-up long-term (LTFU-LT) was defined as delaying more than 3 months to return for a scheduled ART drug refill after the FFU appointment. LTFU-LT time was defined as the time from the FFU visit date to the last follow-up visit date during the study period. We used log-binomial distributions to estimate unadjusted and adjusted relative risks (adjRRs) of missing FFU, and we used Cox proportional hazard models to estimate unadjusted and adjusted hazard ratios (adjHRs) for LTFU-LT.METHODSWe conducted a retrospective longitudinal analysis among persons living with HIV aged ≥18 years who initiated ART during April 2016-February 2021 after the inception of Uganda's Test-and-Treat ART policy, which states that 'all individuals diagnosed with HIV should initiate ART regardless of clinical stage CD4 count'. Missing the FFU after ART initiation (missing FFU) was defined as not returning for FFU within 1 month of ART initiation; loss to follow-up long-term (LTFU-LT) was defined as delaying more than 3 months to return for a scheduled ART drug refill after the FFU appointment. LTFU-LT time was defined as the time from the FFU visit date to the last follow-up visit date during the study period. We used log-binomial distributions to estimate unadjusted and adjusted relative risks (adjRRs) of missing FFU, and we used Cox proportional hazard models to estimate unadjusted and adjusted hazard ratios (adjHRs) for LTFU-LT.Overall, 8332 clients initiated ART on the same day of HIV diagnosis. Most were female (55%), aged 25-34 years (44%), resided in the semi-urban or rural district (41% and 41%, respectively) and had a median age of 25 years (IQR = 24-35). Overall, missing FFU was 15.1%. Increased likelihood/risk of missing FFU was seen in clients who initiated ART at outreach health service centres versus health facilities (adjRRs = 1.79, 95% CI = 1.6-2.0), in younger clients aged 18-24 years and 25-34 years versus ≥45 years [(adjRRs = 1.65, 95% CI = 1.3-2.0) and (adjRRs = 1.31, 95% CI = 1.1-1.6), respectively], and clients residing in agrarian districts versus fishing districts (adjRRs = 1.24, 95% CI = 1.1-1.4). Overall, the LTFU-LT rate was 25 clients/100 pys (95% CI = 23.9-25.9) and was associated with younger age (18-34 years versus ≥45 years, adjHRs = 1.77, 95% CI = 1.5-2.1), residence in semi-urban (adjHRs = 1.33, 95% CI = 1.2-1.5) or agrarian district (adjHRs = 1.30, 95% CI = 1.2-1.5) versus fishing-community district.RESULTSOverall, 8332 clients initiated ART on the same day of HIV diagnosis. Most were female (55%), aged 25-34 years (44%), resided in the semi-urban or rural district (41% and 41%, respectively) and had a median age of 25 years (IQR = 24-35). Overall, missing FFU was 15.1%. Increased likelihood/risk of missing FFU was seen in clients who initiated ART at outreach health service centres versus health facilities (adjRRs = 1.79, 95% CI = 1.6-2.0), in younger clients aged 18-24 years and 25-34 years versus ≥45 years [(adjRRs = 1.65, 95% CI = 1.3-2.0) and (adjRRs = 1.31, 95% CI = 1.1-1.6), respectively], and clients residing in agrarian districts versus fishing districts (adjRRs = 1.24, 95% CI = 1.1-1.4). Overall, the LTFU-LT rate was 25 clients/100 pys (95% CI = 23.9-25.9) and was associated with younger age (18-34 years versus ≥45 years, adjHRs = 1.77, 95% CI = 1.5-2.1), residence in semi-urban (adjHRs = 1.33, 95% CI = 1.2-1.5) or agrarian district (adjHRs = 1.30, 95% CI = 1.2-1.5) versus fishing-community district.Retention-strengthening strategies in tandem with same-day ART initiation efforts for younger clients and clients initiated on ART from mobile and outreach health service settings might improve HIV treatment retention. Best practices for retaining fishing-community clients might improve health outcomes if applied to agrarian and semi-urban communities.CONCLUSIONRetention-strengthening strategies in tandem with same-day ART initiation efforts for younger clients and clients initiated on ART from mobile and outreach health service settings might improve HIV treatment retention. Best practices for retaining fishing-community clients might improve health outcomes if applied to agrarian and semi-urban communities. MEDLINE - Academic

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