Medical and Health Sciences
Permanent URI for this collection
Browse
Recent Submissions
Item Quality of Life among HIV Patients with NCDs Receiving Antiretroviral Therapy in Wakiso District, Uganda: Exploring Key Determinants(African Health Sciences, 2025-05-12) Christopher Ddamulira1,2,; James Wanzima2; Lawrence Sserwanga4 ,; Eria Muwanguzi2 ,; Frank Pio Kiyingi2,3,; Stephen S Kizza2Background: Uganda, like many other nations, faces a double burden of communicable and non-communicable diseases due to the severe impacts of HIV, antiretroviral therapy, and the increasing number of HIV-positive individuals. Objective: To determine the factors that influence the quality of life among HIV patients with NCDs receiving antiretroviral therapy in Wakiso District, Uganda. Methods: A cross-sectional survey was conducted in Wakiso, Uganda, among HIV patients with NCDs receiving antiretroviral therapy and drug refills from Community Drug Distribution Points (CDDP). 219 participants completed questionnaires between November 2019 and December 2020. The factors assessed as predictors included health promotion, community support system, patient monitoring, age, sex, education level, and marital status. The diagnosis of NCDs was based on documented evidence ofiabetes Mellitus (DM) and Hypertension (HT); fasting blood sugar >7.0 mmol/L (126 mg/dl) for DM, and blood pressure > 140/90mmhg for HT. Data analysis included descriptive statistics, path analysis, and Structural Equation Modeling (SEM), which were used to verify and test the model. Results: The research found that most HIV patients were female (61.6%), aged 40 or older (94.5%), with secondary school or less education (69.4%). 54.8% were single. Community-based NCD services, such as health promotion (β=0.58, P=0.006), community support system (β=0.24, p<0.001), and patient monitoring system (β=0.46, p<0.001), directly influenced the quality-of-life improvements, along with other factors like education level (β=0.76, p<0.001) and marital status (β=0.57, P=0.002). Conclusion: The quality of life for HIV-positive individuals with NCDs in Wakiso district requires strengthening community-integrated HIV-NCD interventions to improve the overall quality of life for these individuals.Item Youths' strategies for HIV status disclosure in rural Kenya and Uganda: “You can't just trust everyone”(Elsevier Ltd, 2025-10-17) Johnson-Peretz, Jason;; Onyango, Anjeline;; Akatukwasa, Cecilia ;; Atwine, Fredrick;; Owino, Lawrence;; Arunga, Titus M.O.;; Nyabuti, Marilyn;; Litunya, Janice;; Kabami, Jane;; Mwangwa, Florence;; Kamya, Moses R.;; Havlir, Diane;; Ruel, Theodore;; Ayieko, James;; Camlin, Carol S.HIV status disclosure is influenced by social values, roles, and rules people take on and adapt, aligned with developmental transitions and cultural expectations. Understanding motivations for disclosure among adolescents and young adults with HIV (AYAH) is important for promoting HIV care engagement. A cluster-randomized controlled trial in 28 rural communities in Kenya and Uganda tested an intervention to improve viral suppression and health outcomes among AYAH 15–24 years of age. A longitudinal qualitative study embedded within the trial aimed to identify the intervention's mechanisms of action via semi-structured interviews with n = 111 AYAH, providers (n = 45), and selected family members. Analysis for this paper focused on motivations and barriers to disclosure among AYAH, with attention to targets/confidants, contexts, and communication strategies. Social roles and expectations influenced HIV status disclosure motivations among AYAH, including filial piety towards parents, spontaneous reciprocity with friends, and conscientiousness towards school supervisors. Women tended to prefer disclosure before marriage. Younger men tended to prefer disclosure after marriage, but older male youth looking for seroconcordance in a partner were willing to disclose before marriage. Medication bottles or pills often provided a contextual opening for disclosure conversations. Disclosure of antiretroviral therapy (ART) use appeared to present more significant hurdles than disclosure of HIV status alone. Encouraging not only HIV status but treatment disclosure may facilitate support for ART adherence. Tailoring disclosure strategies to particular target-confidant types may help youth disclose more easily and validate their social values and chosen ties while supporting successful care engagement. •HIV disclosure patterns are important indicators of how youth manage the transition to adult HIV care.•Communication of HIV status often involves several distinguishable steps.•When viewed as a process, HIV disclosure is shaped by cultural contexts, social roles, and social rules for communication.•HIV disclosure is not always about disclosure of HIV status as such but is often linked with disclosure of treatment status.•Treatment disclosure may be better at increasing support for ART adherence and engagement than HIV status disclosure alone.Item Trends in sales of sugar-sweetened beverages and associated type 2 diabetes burden in nine African countries: an ecological time-series analysis(Taylor & Francis group, 2025-10-09) Karugu, Caroline H.;; Asiki, Gershim;; Mthembu, Senzo ;; Iddi, Samuel;; Kaberia, Peter M.;; Mohamed, Shukri F.;; Sanya, Richard E.;; Kiwuwa-Muyingo, Sylvia;; Vandevijvere, Stefanie;; Agyemang, CharlesSugar-sweetened beverages (SSBs) are recognized contributors to the global rise in non-communicable diseases. While the link between SSB intake and adverse health outcomes is well established, long-term data from African countries are limited.BACKGROUNDSugar-sweetened beverages (SSBs) are recognized contributors to the global rise in non-communicable diseases. While the link between SSB intake and adverse health outcomes is well established, long-term data from African countries are limited.To assess trends in SSB sales and their associations with type 2 diabetes (T2D) burden across nine African countries from 2010 to 2024.OBJECTIVETo assess trends in SSB sales and their associations with type 2 diabetes (T2D) burden across nine African countries from 2010 to 2024.We conducted an ecological time-series analysis using national-level data from Cameroon, Côte d'Ivoire, Ethiopia, Ghana, Kenya, Morocco, Nigeria, South Africa, and Uganda. Annual changes in per capita and total SSB sales, national T2D prevalence, and the number of adults with T2D were analyzed. Country-specific multivariate Vector Autoregressive (MVAR) models estimated associations between SSB sales and T2D outcomes.METHODSWe conducted an ecological time-series analysis using national-level data from Cameroon, Côte d'Ivoire, Ethiopia, Ghana, Kenya, Morocco, Nigeria, South Africa, and Uganda. Annual changes in per capita and total SSB sales, national T2D prevalence, and the number of adults with T2D were analyzed. Country-specific multivariate Vector Autoregressive (MVAR) models estimated associations between SSB sales and T2D outcomes.SSB sales rose across all countries, with the sharpest per capita increases in Cameroon (+173.8%), Nigeria (+119.1%), and Côte d'Ivoire (+88.5%). T2D trends varied: Ethiopia, Morocco, and South Africa showed rising prevalence and case numbers, while Ghana and Nigeria showed declines. Per capita SSB sales were significantly associated with adult T2D burden in Ghana (β = 0.41, p = 0.005) and Ethiopia (β = 0.37, p = 0.039. Total SSB volume was associated with T2D burden in Kenya (β = 0.49, p = 0.046) and with T2D prevalence in Nigeria, Morocco, and Côte d'Ivoire.RESULTSSSB sales rose across all countries, with the sharpest per capita increases in Cameroon (+173.8%), Nigeria (+119.1%), and Côte d'Ivoire (+88.5%). T2D trends varied: Ethiopia, Morocco, and South Africa showed rising prevalence and case numbers, while Ghana and Nigeria showed declines. Per capita SSB sales were significantly associated with adult T2D burden in Ghana (β = 0.41, p = 0.005) and Ethiopia (β = 0.37, p = 0.039. Total SSB volume was associated with T2D burden in Kenya (β = 0.49, p = 0.046) and with T2D prevalence in Nigeria, Morocco, and Côte d'Ivoire.Rising SSB sales may be contributing to the T2D burden in African countries. This calls for context-specific regulatory measures, such as fiscal taxes and front-of-pack labels.CONCLUSIONSRising SSB sales may be contributing to the T2D burden in African countries. This calls for context-specific regulatory measures, such as fiscal taxes and front-of-pack labels. MEDLINE - AcademicItem Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study(Elsevier Ltd, 2025-12) Ssentongo, Saadick Mugerwa;; Appeli, Saidi;; Izudi, Jonathan•Low prevalence (1.9%) of advanced HIV disease at diagnosis in rural Uganda.•Although imprecise, male sex is associated with advanced HIV disease.•Findings suggest progress towards earlier HIV diagnosis. Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count <200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis. Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61). The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.Item Cognitive interviewing for understanding and adaptation of mental health screening instruments among people living with HIV in rakai, Uganda: the thinking a lot questionnaire, the patient health questionnaire 9 (PHQ-9), and the hopkins symptoms checklist (HSCL)(Elsevier Ltd, 2025-12) West, Nora S.;; Namuganga, Lydia P.;; Isabirye, Dauda ;; Nakubulwa, Rosette;; Ddaaki, William;; Nakyanjo, Neema;; Nalugoda, Fred;; Murray, Sarah M.;; Kennedy, Caitlin E.Mental health is conceptualized differently across cultures, making exploration of the understandability of screening tools for the purpose of adaptation critical. In Uganda, we used cognitive interviewing to understand comprehension of and make adaptations to three scales for measuring psychological distress: the Thinking Too Much (TTM) Questionnaire, the Patient Health Questionnaire 9 (PHQ-9), and the Hopkins Symptoms Checklist (HSCL). We recruited 12 people living with HIV from the Rakai Community Cohort Study (RCCS) and interviewed seven potential users of the scales (four RCCS survey interviewers and three local health workers). Data were analyzed systematically using a team-based matrix approach. The HSCL was generally well understood, with minor clarifications needed. The TTM Questionnaire was also well understood, though differences between “how much” and “how often” required specificity. Both included local idioms of distress from prior adaptations. The PHQ-9 performed less well, with many questions interpreted variably or showing unclear local applicability, especially among people living with HIV. For example, questions about trouble concentrating were misunderstood, focusing on examples like newspapers rather than the broader issue of concentration. Future research should explore the validity and utility of commonly used instruments as mental health research expands in Africa, and both researchers and public health programmers should consider the strengths and limitations of screening instruments in their setting. •Adapts mental health tools for cultural relevance in Uganda.•Enables accurate distress screening for people living with HIV.•Enhances treatment adherence and health outcomes locally.•Serves as a model for mental health tool adaptation in Africa.•Promotes global equity in culturally sensitive mental health care.Item Relationship between baseline right ventricular systolic function and left ventricular recovery at six-months of follow up among women with peripartum cardiomyopathy in Uganda(Elsevier B.V, 2025-09-07) Nabbaale, Juliet;; Okello, Emmy;; Nakimuli, Annettee ;; Chakafana, Graham;; Sliwa, KarenAbstractBackgroundLV recovery in Peripartum Cardiomyopathy (PPCM) depends on several baseline factors including left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVEDD), duration of symptoms. The role baseline RV function in LV recovery remains poorly described. This study sought to determine the relationship between baseline RV systolic function and LV recovery at six-months follow up among women with PPCM in Uganda. MethodsProspective cohort study of 80 PPCM cases and 80 healthy matched controls observed over a 6-month period while on goal-directed medical therapy (GDMT). All enrolled participants had a 12-lead electrocardiography, echocardiography at baseline and at 6-months follow-up for assessment of LV systolic function using LV global longitudinal strain (LV GLS) and LV EF whereas RV systolic function was assessed using; fractional area change (FAC), tricuspid annular plane excursion (TAPSE), RV lateral wall S’ (RV S’), fractional wall strain (FWS) and RV global longitudinal strain (RV GLS). ResultsThe mean data of cases included age of 33.6 ± 6.6 years, LVEF 35.7 ± 11.0 %, LV GLS −11.9 ± 4.7 % and RV GLS −14.7 ± 10.9 %, RV FAC 32.9 ± 13.5 %, Lat S’ 10.6 ± 3.0 cm/s and RV FWS −17.1 ± 7.2 %. LV recovery occurred among 46.3 % cases. Factors which predicted LV recovery included heart rate and LVEDD. ConclusionUnder half of PPCM cases had LV recovery at six-months on GDMT and Bromocriptine. Baseline heart rate and LVEDD predicted LV recovery.Item Leveraging digital technologies to reduce cancer disparities in low-income and middle-income countries(Elsevier Ltd, 2025-11-14) Gichoya, Judy W;; Mwavu, Rogers;; Minja, Frank ;; Kaonga, Nadi;; Purkayastha, Saptarshi;; Newsome, JaniceIn a rural clinic in southwestern Uganda, Dr Sarah examines cervical images on her smartphone, receiving real-time artificial intelligence-powered guidance from a gynaecologic oncologist located hundreds of miles away. Once imaginary, this scenario now represents a highly probable future of digital health innovation transforming cancer care globally. With over 35 million new cases of cancer estimated by 2050, and up to 70% of deaths anticipated to disproportionately occur in low-income and middle-income countries (LMICs), digital solutions can be leveraged to accelerate the closure of these cancer care gaps. The global oncology community has responded to this imminent crisis by proposing several interventions, including promoting workforce education, mentorship, and task shifting; supporting early diagnosis and referrals through integrated diagnostics; prioritising and implementing prevention strategies such as tobacco cessation, cervical cancer screening, and vaccination; standardising and personalising treatment through increased participation in clinical trials and provision of essential cancer medications; and strengthening health-care systems. Across all these strategic pillars, digital health tools are crucial for advancing cancer care and narrowing existing global and geographical disparities in LMICs. In this Series paper, we evaluate the current status of these digital innovations in the context of cancer care.In a rural clinic in southwestern Uganda, Dr Sarah examines cervical images on her smartphone, receiving real-time artificial intelligence-powered guidance from a gynaecologic oncologist located hundreds of miles away. Once imaginary, this scenario now represents a highly probable future of digital health innovation transforming cancer care globally. With over 35 million new cases of cancer estimated by 2050, and up to 70% of deaths anticipated to disproportionately occur in low-income and middle-income countries (LMICs), digital solutions can be leveraged to accelerate the closure of these cancer care gaps. The global oncology community has responded to this imminent crisis by proposing several interventions, including promoting workforce education, mentorship, and task shifting; supporting early diagnosis and referrals through integrated diagnostics; prioritising and implementing prevention strategies such as tobacco cessation, cervical cancer screening, and vaccination; standardising and personalising treatment through increased participation in clinical trials and provision of essential cancer medications; and strengthening health-care systems. Across all these strategic pillars, digital health tools are crucial for advancing cancer care and narrowing existing global and geographical disparities in LMICs. In this Series paper, we evaluate the current status of these digital innovations in the context of cancer care. MEDLINE - AcademicItem Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study(Elsevier Ltd, 2025-12) Opolot, Godfrey;; Olupot-Olupot, Peter;; Okware, Samuel ;; Izudi, JonathanHighlights•Risk factors for MDR-TB among people with HIV (PWH) are understudied. •We found that retreatment TB is strongly associated with MDR-TB among PWH. •We recommend that PWH with prior TB treatment require MDR-TB surveillance. •Additionally, treatment adherence support may benefit PWH with retreatment TB.Item Logics of acquiring medicines from informal retailers in four African countries(Taylor & Francis group, 2025-12) Wagnild, Janelle M.;; Asiedu Owusu, Samuel;; Mariwah, Simon ;; Kolo, Victor I.;; Vandi, Ahmed;; Bambaiha Namanya, Didacus;; Kuwana, Rutendo;; Jayeola, Babatunde;; Hampshire, KateIn sub-Saharan Africa and other low-income contexts, informal medicine markets are widespread. Understanding the drivers of consumer demand is important, especially given the concerns and risks associated with medicines in the informal sector. This study aims to 1) describe the informal medicine sector in four anglophone African countries, and 2) understand why people patronize informal medicine sellers. Participant observation was conducted in eight markets (37 market stalls) across Ghana, Nigeria, Sierra Leone, and Uganda, supplemented by data collected during focus group discussions (with = 611 participants) and key informant interviews (with = 111), in which we discussed where participants got medicines in their communities and underlying reasons. We identified four distinct groups of actors in the informal medicine sector: sellers at weekly markets, itinerant peddlers, roadside sellers, and operators of general provision shops. There were multiple rationales for patronage of informal sellers that varied depending on the context, including flexibility in payment options, convenience and accessibility, and social/cultural drivers. Importantly, there were tradeoffs and tensions between these drivers that participants had to negotiate within the contexts of their current circumstances. These findings suggest that the informal medicine market is segmented and complex, and that patronage is driven by multiple logics that are rooted in gaps in formal healthcare provision. Regulatory measures therefore need to go hand-in-hand with efforts to address these gaps and expand effective access to quality-assured medicines through [inter alia] offering more flexible modes of payment, reducing public-sector medicine stock-outs, and improving patient-physician trust and communication. MEDLINEItem Strategies to Enhance COVID-19 Vaccine Uptake among Prioritized Groups, Uganda–Lessons Learned and Recommendations for Future Pandemics(U.S. National Center for Infectious Diseases, 2024-07) Kiiza, Daniel;; Semanda, Judith Nanyondo;; Kawere, Boneventure Brian ;; Ajore, Claire;; Wasswa, Christopher Kaliisa;; Kwiringira, Andrew;; Tumukugize, Emmanuel;; Sserubidde, Joel;; Namyalo, Nashiba;; Wadria, Ronald Baker;; Mukiibi, Peter;; Kasule, Julie;; Chemos, Ivan;; Ruth, Acham Winfred;; Atugonza, Ritah;; Banage, Flora;; Wibabara, Yvette;; Ampaire, Immaculate;; Driwale, Alfred;; Vosburgh, Waverly;; Nelson, Lisa;; Lamorde, Mohammed;; Boore, AmyCOVID-19 vaccination was launched in March 2021 in Uganda and initially prioritized persons >50 years of age, persons with underlying conditions, healthcare workers, teachers, and security forces. However, uptake remained low 5 months after the program launch. Makerere University's Infectious Diseases Institute supported Uganda's Ministry of Health in optimizing COVID-19 vaccination uptake models by using point-of-care, place of worship, and place of work engagement and the Social Assistance Grant for Empowerment model in 47 of 135 districts in Uganda, where we trained influencers to support mobilization for vaccination outreach under each model. During July-December, vaccination rates increased significantly in targeted regions, from 92% to 130% for healthcare workers, 40% to 90% for teachers, 25% to 33% for security personnel, 6% to 15% for persons >50 years of age, and 6% to 11% for persons with underlying conditions. Our approach could be adopted in other targeted vaccination campaigns for future pandemics.COVID-19 vaccination was launched in March 2021 in Uganda and initially prioritized persons >50 years of age, persons with underlying conditions, healthcare workers, teachers, and security forces. However, uptake remained low 5 months after the program launch. Makerere University's Infectious Diseases Institute supported Uganda's Ministry of Health in optimizing COVID-19 vaccination uptake models by using point-of-care, place of worship, and place of work engagement and the Social Assistance Grant for Empowerment model in 47 of 135 districts in Uganda, where we trained influencers to support mobilization for vaccination outreach under each model. During July-December, vaccination rates increased significantly in targeted regions, from 92% to 130% for healthcare workers, 40% to 90% for teachers, 25% to 33% for security personnel, 6% to 15% for persons >50 years of age, and 6% to 11% for persons with underlying conditions. Our approach could be adopted in other targeted vaccination campaigns for future pandemics. MEDLINE - AcademicItem An outbreak of scabies in a fishing community in Hoima District, Uganda, February − June, 2022(BioMed Central Ltd, 2025-07-01)Background Scabies, an infectious parasitic disease, is endemic in most resource-poor tropical areas, including Uganda. On May 21, 2022, the Ugandan Ministry of Health was notified of > 1,000 cases of scabies in Hoima District. We investigated to assess the scope of the outbreak, identify associated factors, and recommend interventions. Methods We defined a suspected scabies case as the onset of an itchy pimple-like skin rash or crusting from January 2021 to July 2022 in a resident of Hoima District. We reviewed medical records, performed active community case-finding, and computed attack rates by age, sex, and village per 1,000 population. Using logistic regression, we compared exposures among 101 case persons and 99 unmatched controls living in Rwentale Landing Site in Hoima during June 2022. Results We line listed 2,236 suspected cases in Hoima District. Children aged 5–14 years were more affected (AR = 64/1,000) than persons aged ≥ 15 years (AR = 8/1,000) ( p < 0.001). Males (AR = 27/1,000) were more affected than females (AR = 15/1,000) ( p < 0.001). Of the 54 affected villages, Rwentale Village had the highest attack rate (AR = 233/1,000 population). Rwentale Village includes a fishing area known as Rwentale Landing Site where 1,119 (50%) cases in Hoima District were identified. At this landing site, cases began in April 2022 shortly after the end of the peak fishing and trading season. Being aged 5–14 years (AOR = 4.9, 95%CI: 2.0–12), being male (AOR = 2.4, 95%CI 1.1–5.1), living with another case (AOR = 3.1, 95%CI: 1.5–6.2), and sharing three or more personal care items (towel, beddings, clothes, or sponges) (AOR = 2.2, 95%CI: 1.1–4.6) were associated with scabies. Conclusion This scabies outbreak was likely initiated by person-to-person interactions during peak fishing and trading months at a landing site and propagated by close household interactions. Community sensitization on scabies, especially before fishing and trading seasons is recommended for prevention and early control of scabies in the region. Additionally, establishing a surveillance system for scabies, in high-risk areas such as fishing communities may facilitate timely detection and control of future outbreaks.Item The impact of shifts in PEPFAR funding policy on HIV services in Eastern Uganda (2015–21)(Oxford University Press, 2024-01-23) Zakumumpa, Henry;; Paina, Ligia;; Ssegujja, Eric ;; Shroff, Zubin Cyrus;; Namakula, Justin;; Ssengooba, FreddieAlthough donor transitions from HIV programmes are increasingly common in low-and middle-income countries, there are limited analyses of long-term impacts on HIV services. We examined the impact of changes in President’s Emergency Plan for AIDS Relief (PEPFAR) funding policy on HIV services in Eastern Uganda between 2015 and 2021.We conducted a qualitative case study of two districts in Eastern Uganda (Luuka and Bulambuli), which were affected by shifts in PEPFAR funding policy. In-depth interviews were conducted with PEPFAR officials at national and sub-national levels (n = 46) as well as with district health officers (n = 8). Data were collected between May and November 2017 (Round 1) and February and June 2022 (Round 2). We identified four significant donor policy transition milestones: (1) between 2015 and 2017, site-level support was withdrawn from 241 facilities following the categorization of case study districts as having a ‘low HIV burden’. Following the implementation of this policy, participants perceived a decline in the quality of HIV services and more frequent commodity stock-outs. (2) From 2018 to 2020, HIV clinic managers in transitioned districts reported drastic drops in investments in HIV programming, resulting in increased patient attrition, declining viral load suppression rates and increased reports of patient deaths. (3) District officials reported a resumption of site-level PEPFAR support in October 2020 with stringent targets to reverse declines in HIV indicators. However, PEPFAR declared less HIV-specific funding. (4) In December 2021, district health officers reported shifts by PEPFAR of routing aid away from international to local implementing partner organizations. We found that, unlike districts that retained PEPFAR support, the transitioned districts (Luuka and Bulambuli) fell behind the rest of the country in implementing changes to the national HIV treatment guidelines adopted between 2017 and 2020. Our study highlights the heavy dependence on PEPFAR and the need for increasing domestic financial responsibility for the national HIV response.Item Mixed-methods evaluation of a Global South-North research fellowship in Uganda: Global health experiential fellowship (GHEF)(Elsevier Ltd, 2025-12) Lee, Yang Jae;; Kazungu, Rauben;; Ssekalo, Ibrahim ;; Blackwell, Scott;; Nakaziba, Kayera Sumaya;; Monnig, Emery;; Mbabazi, Rita;; Muwereza, Peter;; Waiswa, Faizo;; Ingabire, Haba;; Vega, Alesha Cid;; Brown, Adam D.;; Rohrbaugh, Robert;; Rosenheck, Robert;; Waiswa, Peter;; Kohrt, Brandon A.Introduction: Integrated, simultaneous training of Global South and North trainees offers novel opportunities to enhance equitable collaboration and research capacity in global health. While existing programs often focus on exchange rotations or separate training tracks, simultaneous training of Global South and North trainees in the same intensive program remains understudied. We describe the Global Health Experiential Fellowship (GHEF), which combines research training with shared living arrangements and collaborative work in rural Uganda. Program description: GHEF is a five-week research training program for pre-doctoral students from Uganda and the United States. The program addresses power imbalances in North-South partnerships through shared leadership between Ugandan and American co-directors, with Ugandan team leaders supervising daily activities. Fellows work in mixed teams on qualitative mental health projects, while shared living arrangements foster cultural exchange. Since 2021, GHEF has trained 39 Ugandan students from three universities and 102 American students from 12 universities. Ugandan fellows participate without fees, subsidized by American fellows. Methods: We conducted a mixed-methods evaluation. Qualitative data were collected through interviews with 10 fellows (5 Ugandan, 5 American). Research skills were assessed using the Assessment of Key Interviewing Factors for Research Assistants (AKIRA) pre- and post-fellowship among 14 fellows (7 Ugandan, 7 American). Results: Ugandan fellows gained formal research training, while American fellows gained perspectives on field-based methodologies. Cultural exchange facilitated intercultural learning. AKIRA scores showed improvement in Ugandan fellows’ skills (pre-fellowship mean = 1.125; post-fellowship mean = 1.536; p = 0.0117). Discussion: GHEF's simultaneous training model offers a promising approach to equitable collaboration and building research capacity in global mental health.Item Post-traumatic stress disorder and associated factors among soldiers retiring from active service in Uganda: Across sectional study(Elsevier Ltd, 2025-12) Bigirwa, Dan Mwangye;; Rukundo, Godfrey Zari;; Kirabira, Joseph ;; Maling, Samuel;; Favina, Alain;; Muwanguzi, Moses;; Ainamani, Herbert Elvis;; Ashaba, ScholasticPost-traumatic stress disorder (PTSD) is one of the commonest mental health challenges among veterans and service members. However, studies on PTSD and its associated factors among military personnel in Uganda are limited. This study estimated the prevalence of PTSD and associated factors among soldiers retiring from active service in Uganda. In this cross-sectional study we recruited 247 retiring soldiers and assessed for PTSD using the PTSD check list for DSM-5. We also collected information on socio-demographic characteristics including gender, age, number of years in military service, level of education, and marital status, alcohol use, drug use, exposure to life, childhood trauma, and depression. participants. Of the 247 participants, 97 % (n = 239) were male, 47 % (n = 115), the average age was 46 (SD = 8.03) years, and the average duration of military service was 22 (SD = 8.36) years. The prevalence of PTSD among study participants was 13 % (n = 32). The factors associated with PTSD were moderate to hazardous alcohol consumption (aOR = 3.44; 95 % CI = 1.27–9.28; p = 0.02) and depression (aOR = 6.19; 95 % CI = 2.15–17.84; p = 0.0010). This study found a 13 % prevalence of PTSD among retiring military personnel in Uganda, with depression and hazardous alcohol use significantly increasing its odds. These findings underscore the need for targeted mental health screening and intervention during the transition to civilian life, particularly addressing depression and alcohol use. •Post traumatic disorder is prevalent among soldiers retiring from service in Uganda.•Post-traumatic stress disorder and alcohol commonly co-occur among Ugandan soldiers.•Routine mental health assessment among is needed for their mental wellbeing.Item Is equity meaningfully incorporated into pandemic preparednessand response? A scoping review and critical analysis of Ebola andCOVID-19 outbreak responses in Uganda 2019-2023(Taylor & Francis group, 2025-12) Gema Redondo;; Linda Murray;; Collette Bromhead ;; Issa MakumbiSocietal inequities produce vulnerabilities that infectious disease can exploit. Current approaches to pandemic prevention, detection and response are led by the International Health Regulations IHR and the Global Health Security Agenda. However, to contain the spread of infectious diseases, localised action to address systemic inequities must be considered. The purpose of this scoping review and equity analysis is to 1) Synthesise the available information on Uganda’s Ebola Virus Disease (EVD) and COVID-19 preparedness and outbreak responses between 2019 and 2023, and 2) Critique if and how Uganda’s Ministry of Health incorporated concepts of health equity in its EVD and COVID-19 interventions, while building national capacity to identify and prevent public health emergencies. This scoping review and critical analysis was conducted following the five-stage process defined by Levac et al. After identification and screening, the scoping review was based on six preparedness and response plans, three after-action reviews, and 20 grey literature and peer-reviewed articles. The findings revealed that the EVD and COVID-19 preparedness and response plans in Uganda show the country’s commitment and readiness for early detection and response to infectious disease outbreaks. However, further examination of the plans reveals missed opportunities to address systemic inequities. The ongoing mpox outbreak, declared a PHEIC by WHO on July 23, 2022, with significant impacts in African countries including Uganda, further underscores the need for a paradigm shift in managing infectious disease outbreaks. Such a shift may be similar to that experienced by the field of disaster risk reduction, which underwent a significant transformation at the Sendai Conference in 2015 towards a more holistic and proactive approach that addresses underlying systemic issues and focuses on building resilience. The exclusive focus on biomedical strategies to manage infectious diseases fails to address the social aspects of transmission, the local perceptions of illness, and community vulnerabilities often associated with social and historical perspectives. The social determinants of health disparities should be incorporated into pandemic planning and response. This will contribute to fostering equitable health outcomes and resilience in the face of the multifaceted challenges posed by future pandemics and environmental changes.Item Placental malaria induces a unique methylation profile associated with fetal growth restriction(Taylor & Francis, 2025-12) Ozarslan, Nida;; Mong, Corina;; Ategeka, John ;; Li, Lin;; Buarpung, Sirirak;; Robinson, Joshua F.;; Kizza, Jimmy;; Kakuru, Abel;; Kamya, Moses R.;; Dorsey, Grant;; Rosenthal, Philip J.;; Gaw, Stephanie L.Fetal growth restriction (FGR) is associated with perinatal death and adverse birth outcomes, as well as long-term complications, including increased childhood morbidity, abnormal neurodevelopment, and cardio-metabolic diseases in adulthood. Placental epigenetic reprogramming associated with FGR may mediate these long-term outcomes. Placental malaria (PM), characterized by sequestration of Plasmodium falciparum-infected erythrocytes in placental intervillous space, is the leading global cause of FGR, but its impact on placental epigenetics is unknown. We hypothesized that placental methylomic profiling would reveal common and distinct mechanistic pathways of non-malarial and PM-associated FGR. We analyzed placentas from a US cohort with no malaria exposure (n = 12) and a cohort from eastern Uganda, a region with a high prevalence of malaria (n = 12). From each site, 8 cases of FGR and 4 healthy controls were analyzed. PM was diagnosed by placental histopathology. We compared the methylation levels of over 850K CpGs of the placentas using Infinium MethylationEPIC v1 microarray. Non-malarial FGR was associated with 65 differentially methylated CpGs (DMCs), whereas PM-FGR was associated with 133 DMCs, compared to their corresponding controls without FGR. One DMC (cg16389901, located in the promoter region of BMP4) was commonly hypomethylated in both groups. We identified 522 DMCs between non-malarial FGR vs. PM-FGR placentas, independent of differing geographic location or cellular composition. Placentas with PM-associated FGR have distinct methylation profiles compared to placentas with non-malarial FGR, suggesting novel epigenetic reprogramming in response to malaria. Larger cohort studies are needed to determine the distinct long-term health outcomes in PM-associated FGR pregnancies.Item Application of the Method of Triads to Evaluate the Performance of Food Frequency Questionnaires and Biomarkers as Indicators of Long-term Dietary Intake(American journal of epidemiology, 2001-12-15) Kabagambe, Edmond K.; Baylin, Ana; Spiegelman, Donna; Campos, HanniaLittle is documented about the performance of the food frequency questionnaire (FFQ) in US minority groups and in populations in developing countries. The authors applied a novel technique, the method of triads, to assess the validity and reproducibility of the FFQ among Hispanics. The subjects were men (n = 78) and women (n = 42) living in Costa Rica. Seven 24-hour dietary recalls and two FFQ interviews (12 months apart) were conducted between 1995 and 1998 to estimate dietary intake during the past year. Plasma and adipose tissue samples were collected from all subjects. Validity coefficients, which measure the correlation between observed and “true” dietary intake, were also estimated. The median validity coefficients for tocopherols and carotenoids estimated by dietary recall, the average of the two FFQs, and plasma were 0.71, 0.60, and 0.52, respectively. Compared with adipose tissue, plasma was a superior biomarker for carotenoids and tocopherols. Adipose tissue was a poor biomarker for saturated and monounsaturated fatty acids but performed well for polyunsaturated fatty acids (validity coefficients, 0.45–1.01) and lycopene (validity coefficient, 0.51). This study also showed that biomarkers did not perform better than the FFQ and that they should be used to complement the FFQ rather than substitute for it.Item Prevalence of Overweight and Obesity in Young Adults in Uganda(African health sciences, 2010-09-29) Baalwa, J.; Byarugaba, B.B.; Kabagambe, K.E.; Otim, A.M.Obesity in young adults is rising and predicts diabetes and cardiovascular diseases later in life. Data on prevalence and determinants of obesity in developing countries are needed for primary prevention. Objectives: To determine the prevalence of overweight and obesity in young adults in urban (Kampala city) and rural areas (Kamuli District) of Uganda. Methods: Cross-sectional survey of 683 randomly selected young adults aged 18-30 years. Obesity was defined as body mass index (BMI) > 30 kg/m2 and overweight as BMI > 25 kg/m2. Distribution of BMI by socio-demographic characteristics was determined. Results: Of the 683 participants, 50.5% were female and 53.2% were from Kampala. The overall prevalence of obesity and overweight was 2.3% and 10.4%, respectively. The prevalence of obesity was 4.4% in Kampala and 0% in Kamuli while the prevalence of overweight was 10.2% and 10.6% in Kampala and Kamuli, respectively. Compared to males, females were more likely to be obese (2.9% vs. 1.8%) or overweight (17.4% vs. 3.3%). Residing in the city, alcohol consumption, smoking, non-engagement in sports activities, commuting to school by taxi or private vehicle and being from a rich family were the main factors significantly associated (P<0.05) with obesity. Being female (p = 0.0001) and not engaging in any sports activities (P = 0.002) were two factors significantly associated with being overweight. Conclusion: We observed significant gender differences in the prevalence of obesity among young adults in Uganda. Contrary to expectation, we did not observe significant rural-urban differences in the prevalence of overweight.Item Black soldier fly larvae composting as a bioremediation approach for heavy metals and pathogens in fecal sludge cake(Springer International Publishing, 2025-12) Nalunga, Agnes;; Komakech, Allan John;; Karungi, Jeninah ;; Kabenge, Isa;; Schwarzböck, ThereseAbstract Black Soldier Fly Larvae (BSFL) composting is increasingly explored as a sustainable strategy to treat organic waste. This study assessed the potential of BSFL to reduce heavy metals and pathogens in fecal sludge cake (FSC) co-composted with fruit and vegetable waste (FVW) or cattle manure (CM). Seven treatments; T1 (100% FSC), T2 (75% FSC:25% CM), T3 (65% FSC:35% CM), T4 (55% FSC:45% CM), T5 (75% FSC:25% FVW), T6 (65% FSC:35% FVW), and T7 (55% FSC:45% FVW),were evaluated for reductions and bioaccumulation of heavy metals (Pb, Cu, Fe, Cr, Zn) as well as Escherichia coli (E.coli) and Staphylococcus aureus (S. aureus). Pb reduction ranged from 33.0% (T5) to 60.9% (T4), with the lowest bioaccumulation (4.4 mg/kg) in T4. Cu decreased by up to 43.1% (T7), while Zn showed the highest decrease (48.2%) in T6. Cr reduction peaked in T7 (32.4%), and Fe in T2 (28.7%). T5 achieved the highest E. coli reduction (99.8%), while T4 exhibited the highest S. aureus decrease (94.9%). Treatments with co-substrates (FVW or CM) consistently outperformed FSC alone, underlining their role in enhancing BSFL composting efficacy. These findings demonstrate the potential of BSFL composting to mitigate environmental and health risks associated with FSC use, offering a scalable solution for organic waste management in low-resource settings.Item Estimating global prevalence of gallbladder stones in general population from 2000 to 2024: systematic review and meta-analysis(Taylor & Francis group, 2025-12) Ning, Qingyang;; Ning, Qingyang;; Liu, Fen;; Fang, Yiqiao ;; Zhu, Xixi;; Liu, Jiaye;; Li, ZhihuiGallbladder stones (GS), is one of the most common and costly of all the gastrointestinal diseases. However, global prevalence estimates of GS remain heterogeneous due to methodological variations across studies, and consensus on risk factor hierarchies is still evolving. Therefore, we performed current study in order to estimate the global prevalence of GS. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Data were analysed the DerSimonian-Laird random-effects model with Logit transformations, and sensitivity analysis was performed using a 'Leave-one-out' approach. Of 18,277 identified records, 139 studies were included in the final analysis. The overall global prevalence of GS in the general population was 5.86% (95% CI 5.28-6.47). Marked geographical disparities were observed, with the highest prevalence in Uganda (21.92%, 95% CI 18.43-25.61) and the lowest in Australia (0.18%, 95% CI 0.17-0.18) - a 122-fold difference. Multivariable meta-regression showed that study size was the strongest predictor (importance: 97.79%). Regarding risk factors, female gender, age > 50 years, increased body mass index, and family history of GS were significantly associated with higher GS prevalence. In contrast, factors such as education level, smoking, alcohol consumption, lifestyle, vegetarian diet, and serum lipid levels had no significant impact. Comorbidities including hypertension, diabetes mellitus, and metabolic-associated fatty liver disease (MAFLD) were strongly correlated with elevated GS prevalence. This meta-analysis showed that the GS was a common disease and affected the health of one in twenty people worldwide. Accurate estimates of the global and population-based prevalence of GS are helpful for healthcare improvements. MEDLINE