Medical and Health Sciences

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Survival of children with endemic Burkitt lymphoma in a prospective clinical care project in Uganda
(Pediatric blood & cancer, 2019-06-03) McGoldrick, Suzanne M.; Mutyaba, Innocent; Namirembe, Constance; Nabakooza, Susan; Ndagire, Mariam
“Endemic” Burkitt lymphoma (BL) is a common childhood cancer in Africa. Social and treatment factors may contribute to poor survival. With the aim of improving BL outcomes in Uganda, we undertook a comprehensive project (BL Project) that provided diagnostic support, access to standard chemotherapy, nutritional evaluations, and case management. We evaluated survival of children with BL in the context of the project. Patients followed by the BL Project who consented to research were enrolled in this study. Children with a pathology diagnosis consistent with BL were eligible. Data were collected prospectively. First-line chemotherapy generally consisted of six cycles of cyclophosphamide, vincristine, low-dose methotrexate (COM). We used Kaplan–Meier and Cox regression analyses to evaluate factors associated with overall survival (OS). Between July 2012 and June 2017, 341 patients with suspected BL presented to the BL Project. One hundred eighty patients with a pathology-based diagnosis were included in this study. The median age was seven years (interquartile range, 5–9), 74% lived ≥100 km from the Uganda Cancer Institute, 61% had late-stage disease, 84% had ECOG performance status < 3, 63% reported B-symptoms, and 22% showed neurologic symptoms. Fewer than 10% abandoned therapy. The four-year OS rate was 44% (95% CI, 36%–53%). In a multivariate model, ECOG status was significantly associated with mortality. The BL Project reduced effects of lacking supportive care and oncology resources, and allowed patients from Uganda to receive curative intent therapy with minimal loss to follow-up. Nonetheless, OS remains unacceptably low. Improved therapeutic approaches to endemic BL are urgently needed in Africa.
Ebola haemorrhagic fever outbreak in Masindi District, Uganda: outbreak description and lessons learned
(BMC infectious diseases, 2011-12-28) Borchert,Matthias; Mutyaba,Imaam; Lutwama, Julius; Bisoborwa, Geoffrey
Ebola haemorrhagic fever (EHF) is infamous for its high case-fatality proportion (CFP) and the ease with which it spreads among contacts of the diseased. We describe the course of the EHF outbreak in Masindi, Uganda, in the year 2000, and report on response activities. We analysed surveillance records, hospital statistics, and our own observations during response activities. We used Fisher's exact tests for differences in proportions, t-tests for differences in means, and logistic regression for multivariable analysis. The response to the outbreak consisted of surveillance, case management, logistics and public mobilisation. Twenty-six EHF cases (24 laboratory confirmed, two probable) occurred between October 21st and December 22nd, 2000. CFP was 69% (18/26). Nosocomial transmission to the index case occurred in Lacor hospital in Gulu, outside the Ebola ward. After returning home to Masindi district the index case became the origin of a transmission chain within her own extended family (18 further cases), from index family members to health care workers (HCWs, 6 cases), and from HCWs to their household contacts (1 case). Five out of six occupational cases of EHF in HCWs occurred after the introduction of barrier nursing, probably due to breaches of barrier nursing principles. CFP was initially very high (76%) but decreased (20%) due to better case management after reinforcing the response team. The mobilisation of the community for the response efforts was challenging at the beginning, when fear, panic and mistrust had to be countered by the response team. Large scale transmission in the community beyond the index family was prevented by early case identification and isolation as well as quarantine imposed by the community. The high number of occupational EHF after implementing barrier nursing points at the need to strengthen training and supervision of local HCWs. The difference in CFP before and after reinforcing the response team together with observations on the ward suggest a critical role for intensive supportive treatment. Collecting high quality clinical data is a priority for future outbreaks in order to identify the best possible FHF treatment regime under field conditions.
Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago Hospital, Uganda
(BMC medical education, 2006-03-01) Mutyaba,Twaha; Mmiro,Francis A.; Elisabete, Weiderpass
Cervical cancer is the commonest cancer of women in Uganda. Over 80% of women diagnosed in Mulago national referral and teaching hospital, the biggest hospital in Uganda, have advanced disease. Pap smear screening, on opportunistic rather than systematic basis, is offered free in the gynaecological outpatients clinic and the postnatal/family planning clinics. Medical students in the third and final clerkships are expected to learn the techniques of screening. Objectives of this study were to describe knowledge on cervical cancer, attitudes and practices towards cervical cancer screening among the medical workers of Mulago hospital.
Spectrophotometric analysis of artesunate injections availablein community pharmacies in Northern and Western Uganda
(Taylor & Francis group, 2025-06-12) Ayogu, Ebere Emilia;; Ngolryeko, Emmanuel Aryon;; Ezeonwumelu, Joseph Obiezu Chukwujekwu ;; Wawata, Ibrahim Garba;; Sadiq, Bashir Olaniyi
The surge in different brands of artesunate injection in Uganda, has raised the need for this study, which aimed at quantifying the actual amount of artesunate in different brands of artesunate injections available in Northern and Western Uganda.AIMThe surge in different brands of artesunate injection in Uganda, has raised the need for this study, which aimed at quantifying the actual amount of artesunate in different brands of artesunate injections available in Northern and Western Uganda.The wavelength at maximum absorbance of pure artesunate powder was determined using Ultraviolet-visible spectrophotometer and Beer Lambert's plot was generated. This was validated and used to assay 27 brands of artesunate.MATERIALS AND METHODSThe wavelength at maximum absorbance of pure artesunate powder was determined using Ultraviolet-visible spectrophotometer and Beer Lambert's plot was generated. This was validated and used to assay 27 brands of artesunate.In the spectrophotometric assay method used, Beer Lambert's law was obeyed within the range of 20 µg/ml-140 µg/ml with linear regression equation of y = 0.012 + 0.030 and correlation coefficient of (R2) 0.999 (n = 9). The limits of detection (sensitivity) and quantification were found to be 0.83 mg/ml and 2.09 mg/ml respectively. About 66.6% (18) and 33.3% (9) had actual artesunate content higher and lower than labeled claim respectively, while 40.7% (11) had deviations from labeled claim that were within acceptable limits.RESULTSIn the spectrophotometric assay method used, Beer Lambert's law was obeyed within the range of 20 µg/ml-140 µg/ml with linear regression equation of y = 0.012 + 0.030 and correlation coefficient of (R2) 0.999 (n = 9). The limits of detection (sensitivity) and quantification were found to be 0.83 mg/ml and 2.09 mg/ml respectively. About 66.6% (18) and 33.3% (9) had actual artesunate content higher and lower than labeled claim respectively, while 40.7% (11) had deviations from labeled claim that were within acceptable limits.Most brands of artesunate injection assayed deviated from labeled claim, regional/environmental factor impacted much on the stability of artesunate thus there is need for further screening of the quality of artesunate injection in circulation in view of the therapeutic consequences of substandard artesunate injection.CONCLUSIONMost brands of artesunate injection assayed deviated from labeled claim, regional/environmental factor impacted much on the stability of artesunate thus there is need for further screening of the quality of artesunate injection in circulation in view of the therapeutic consequences of substandard artesunate injection. MEDLINE - Academic
Prevention messages and AIDS risk behavior in Kampala, Uganda
(Informa UK Limited, 2011-06-16) Hearst, Norman; Kajubi, Phoebe; Hudes, Esther Sid; Maganda, Albert K.; Green, Edward C.
Uganda was one of the first countries to substantially reduce HIV rates through behavior change, but these gains have not continued in recent years. Little is known about what messages Ugandans are currently hearing about AIDS prevention, what they themselves believe to be important prevention strategies, and how these beliefs are associated with behavior. We interviewed men and women aged between 20 and 39 in two poor peri-urban areas of Kampala, using a random sample, cross-sectional household survey design. Respondents provided detailed reports of sexual behavior over the past six months, the main prevention message they are currently hearing about AIDS, and their own ranking of the importance of prevention strategies. Condom use was the main AIDS prevention message that respondents reported hearing, followed by getting tested. These were also what respondents themselves considered most important, followed closely by faithfulness. Abstinence was the lowest ranked strategy, but a higher ranking for this prevention strategy was the only one consistently associated with less risky behavior. A higher ranking for condoms was associated with higher levels of risk behavior, while the ranking of testing made no difference in any behavior. These results present challenges for AIDS prevention strategies that rely primarily on promoting condoms and testing. HIV prevention programs need to assess their impact on behavior.
History, evolution and future of environmental health in Uganda
(Informa UK Limited, 2018-12-03) Ndejjo, Rawlance; Atusingwize, Edwinah; Oporia, Frederick; Ssemugabo, Charles; Musoke, David; Ssemwanga, David K.; Halage, Abdullah Ali; Isunju, John Bosco; Kansiime, Winnifred; Mubeezi, Ruth; Mugambe, Richard Kibirango; Mbaha, Emery Patrice; Luyima, Paul; Ssempebwa, John C.
This article explores the history and evolution of Environmental Health in Uganda under four key themes: training and practice; research; governance, policy and regulatory framework; and challenges. The article also describes the future of the profession. Through a review of documents and key informant interviews, it is noted that Environmental Health in Uganda dates back to colonial times when the country was affected by diseases including plague, trypanosomiasis and small pox. Concerted efforts were advanced to train cadres that would improve the sanitation status and address the prevailing disease burden. Over several decades, the Environmental Health profession has evolved in many areas of training, practice, research and governance, policy and legal framework amidst several challenges. The future of Environmental Health in Uganda will require more advanced training and research, broadened practice, and streamlined governance.
HIV/AIDS Orphans' Education in Uganda
(Informa UK Limited, 2006-01-13) Kakooza, James; Kimuna, Sitawa R.
The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.
Human aflatoxin exposure in Uganda: Estimates from a subset of the 2011 Uganda AIDS indicator survey (UAIS)
(Informa UK Limited, 2020-11-20) Nicholas C. Zitomer; Abigael O. Awuor; Marc-Alain Widdowson; Daniel, Johnni H.; Sternberg, Maya R.; Rybak, Michael E.; Mbidde, Edward K.
Aflatoxins are carcinogenic mycotoxins that contaminate a variety of crops worldwide. Acute exposure can cause liver failure, and chronic exposure can lead to stunting in children and liver cancer in adults. We estimated aflatoxin exposure across Uganda by measuring a serum biomarker of aflatoxin exposure in a subsample from the 2011 Uganda AIDS Indicator Survey, a nationally representative survey of HIV prevalence, and examined its association with geographic, demographic, and socioeconomic variables. We analysed a subsample of 985 serum specimens selected among HIV-negative participants from 10 survey-defined geographic regions for serum aflatoxin B1-lysine (AFB1-lys) by use of isotope dilution LC-MS/MS and calculated results normalised to serum albumin. We used statistical techniques for censored data to estimate geometric means (GMs), standard deviations, and percentiles. We detected serum AFB1-lys in 71.7% of specimens (LOD = 0.5 pg/mg albumin). Unadjusted GM AFB1-lys (pg/mg albumin) was 1.33 (95% CI: 1.21–1.47). Serum AFB1-lys was higher in males (GM: 1.57; 95% CI: 1.38–1.80) vs. females (GM: 1.12; 95% CI: 0.97–1.30) (P = .0019), and higher in persons residing in urban settings (GM: 2.83; 95% CI: 2.37–3.37) vs. rural (GM: 1.10; 95% CI: 0.99–1.23) (P < .0001). When we used a multivariable censored regression model to assess confounding and interactions among variables we found that survey region, gender, age, occupation, distance to marketplace, and number of meals per day were statistically significant predictors of aflatoxin exposure. While not nationally representative, our findings provide an improved understanding of the widespread burden of aflatoxin exposure throughout Uganda and identify key geographic, demographic, and socioeconomic factors that may modulate aflatoxin exposure risk.
Antimicrobial stewardship in private pharmacies in Wakiso district, Uganda: a qualitative study
(Informa UK Limited, 2023-12-31) Musoke, David; Lubega, Grace Biyinzika; Gbadesire, Mimi Salome; Boateng, Stephanie; Twesigye, Belinda; Gheer, Jagdeep; Nakachwa, Betty; Brown, Michael Obeng; Brandish, Claire; Winter, Jody; Ng, Bee Yean; Russell-Hobbs, Kate; Gibson, Linda
Background Antimicrobial resistance (AMR) is a major global health concern with increasing reports of microorganisms resistant to most of the available antibiotics. There are limited data on antibiotic practices, perceptions and self-medication among Ugandans, necessitating this study. Methods A cross-sectional study was conducted among patients at Kiruddu National Referral Hospital, Kampala, Uganda. A pre-tested interviewer administered a questionnaire that was used to collect data after an informed consent. Chi-square tests and logistic regression were used to assess associations between outcome and exposure variables. A P<0.05 was statistically significant. Results A total of 279 patients (response rate=71%) with a median age of 32 years participated in the study. The majority were females (55.6%, n=155) and from the outpatient department (74.9%, n=209). Overall, 212 (76%) participants had taken an antibiotic in the past 6 months, and some 22.2% (n=47) of the participants had practiced self-medication. Male participants (adjusted odds ratio (aOR)=2.13, 95% confidence intervals (CI): 1.01 to 4.50, P=0.046) and Muslims (aOR=4.37, 96% CI:1.54 to 12.44, P=0.006) were more likely to self-medicate. Employees (aOR=0.06, 95% CI:0.01 to 0.51, P=0.010) and patients with tertiary education (aOR=0.14, 95% CI: 0.02 to 0.81, P=0.028) were less likely to practice self-medication. About 33% (n=70) of the participants had not completed treatment dosage during their last course of antibiotic treatment because of feeling better (60%, n=42), lack of money to purchase the medication (15.7%, n=11) and side effects (10%, n=7). Whereas 169 participants (79.7%) believed that not completing treatment would have an impact on their personal health, only 96 participants (45.3%) believed that this behaviour could affect the health of others. Conclusion Antibiotic misuse is significant among patients in Uganda. Continuous health education programs aimed at informing the public on antimicrobial resistance, and its dangers are recommended to curtail this challenge.
Aortic Knob Diameter in Chest Radiographs of Healthy Adults in Uganda
(Informa UK Limited, 2022-03) Magera, Steven; Sereke, Senai Goitom; Okello, Emmy; Ameda, Faith; Erem, Geoffrey
Background The burden of cardiovascular diseases, such as aortic and degenerative diseases, grows in the aging population. Chest radiograph still plays an important role in the diagnosis of cardiovascular diseases. Aortic knob diameter in chest radiographs can be used to evaluate early changes of the aortic structure and together with clinical and laboratory findings. This study was aimed at determining the mean values of aortic knob diameter among healthy adults in Uganda. Methods We conducted a descriptive cross-sectional study in three selected hospitals in Kampala Uganda. All participants had normal chest radiographs without radiological evidence of cardiovascular disease. Chest radiograph findings extracted included aortic knob diameter, aortic arch diameter, transverse heart diameter, and transverse thoracic diameter. All films were independently examined by two experienced radiologists. Results We analyzed chest radiograph findings of 294 participants, of which 204 (69.4%) were male. Aortic knob diameter increased with age (p – 0.000). The mean aortic knob diameter of males was higher than for females (3.14±0.34cm versus 2.77±0.37cm, p – 0.000). The mean aortic knob diameter on the digital screen was higher than plain films (3.03±0.393cm versus 2.96±0.392cm, p – 0.000). Aortic knob diameter positively correlated with age (p – 0.000) and aortic arch diameter (p – 0.000). Aortic knob diameter also correlated positively with a transverse thoracic diameter (p – 0.05), transverse heart diameter (p – 0.05), and cardiothoracic ratios (p – 0.05). Conclusion The aortic knob diameter was higher in males and there was a positive correlation with age, aortic arch diameter, transverse heart diameter, and transverse thoracic diameter. Aortic knob diameter measurements should be done on digital rather than printed x-ray films.
The effect of BCG revaccination on the response to unrelated vaccines in urban Ugandan adolescents (POPVAC C): an open-label, randomised controlled trial
(The Lancet Global Health, 2024-11-24) Nassuuna, Jacent; Zirimenya, Ludoviko; Nkurunungi, Gyaviira; Ninsiima, Caroline; Amongi, Susan
Immune responses induced by several important vaccines differ between populations, with reduced responses in low-income and rural settings compared with high-income and urban settings. BCG immunisation boosts immune responses to some unrelated vaccines in high-income populations. We aimed to test the hypothesis that BCG revaccination can enhance responses to unrelated vaccines in Ugandan schoolchildren.
Article 1: Supervision, Performance Assessment, and Recognition Strategy (SPARS) - a multipronged intervention strategy for strengthening medicines management in Uganda: method presentation and facility performance at baseline
(Informa UK Limited, 2016-05-31) Trap, Birna; Ladwar, Denis Okidi; Oteba, Martin Olowo; Embrey, Martha; Khalid, Mohammed; Wagner, Anita Katharina
Background Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline). Methods To build MM capacity at health facilities, health workers were trained as MM supervisors to visit health facilities, assess MM performance, and use the findings to provide support and standardize MM practices. Performance is assessed based on 25 MM indicators covering five domains: dispensing quality (7 indicators), prescribing quality (5), stock management (4), storage management (5) and ordering and reporting (4). From the end of 2010 to 2013, MM supervisors assessed baseline MM performance of 1384 government (85 %) and private not-for-profit facilities at all levels of care in about half of Uganda’s districts. Results The overall MM baseline median score was 10.3 out of a maximum of 25 with inter-quartile range (IQR) of 8.7–11.7. Facility domain scores (out of a maximum of 5) were as follows: storage management, median score of 2.9 (IQR 2.3–3.4); stock management 2.3 (IQR 2.0–2.8), ordering and reporting 2.2 (IQR 1.3–2.5), and dispensing quality 2.1 (IQR 1.7–2.7). Performance in prescribing quality was 0.9 (IQR 0.4–1.4). Significant regional differences were found: overall scores were highest in the Northern region (10.7; IQR 9.2–12.4) and lowest in the Eastern region (9.6; (IQR 7.8–11.2) (p < 0.001). Overall scores did not differ by facility ownership; however, government facilities scored lower in dispensing and storage and higher in ordering and reporting. Hospitals scored higher overall and in domains other than prescribing and stock management. Districts classified a priori as having high capacity for implementing SPARS had higher scores at baseline compared to lower-capacity districts. Conclusion Assessing and building national capacity in MM is needed in both private not-for-profit and government facilities at all levels of care. The indicator-based, multipronged SPARS assessment has been described here, while the strategy’s impact has yet to be documented.
Schistosome and malaria exposure and urban–rural differences in vaccine responses in Uganda: a causal mediation analysis using data from three linked randomised controlled trials
(The Lancet Global Health, 2024-11-21) Natukunda, Agnes; Nkurunungi, Gyaviira; Ninsiima, Caroline; Nyanzi, Ruth; Kiwudhu, Fred; Nassanga, Beatrice
Vaccine immunogenicity and effectiveness vary geographically. Chronic immunomodulating parasitic infections including schistosomes and malaria have been hypothesised to be mediators of geographical variations. We compared vaccine-specific immune responses between three Ugandan settings (schistosome-endemic rural, malaria-endemic rural, and urban) and did causal mediation analysis to assess the role of Schistosoma mansoni and malaria exposure in observed differences. We used data from the control groups of three linked randomised trials investigating the effects of intensive parasite treatment among schoolchildren. All participants received the BCG vaccine (week 0); yellow fever (YF-17D), oral typhoid (Ty21a), human papillomavirus (HPV; week 4); and HPV booster and tetanus–diphtheria (week 28). Primary outcomes were vaccine responses at week 8 and, for tetanus–diphtheria, week 52. We estimated the total effect (TE) of setting on vaccine responses and natural indirect effect (NIE) mediated through current or previous infection with S mansoni or malaria, and baseline vaccine-specific responses.
Design and Evaluation of a Novel Mobile Phone Application to Improve Palliative Home-Care in Resource-Limited Settings
(Journal of Pain and Symptom Management, 2021-07-21) Harding, Richard; Namisango, Eve; Luyirika, Emmanuel; Chifamba, Dickson
Mobile health (mHealth) provides an opportunity to use internet coverage in low- and middle-income countries to improve palliative care access and quality. This study aimed to design a mobile phone application (app) to enable or improve communication between family caregivers, community caregivers, and palliative care teams; to evaluate its acceptability, processes, and mechanisms of action; and to propose refinements. A codesign process entailed collaboration between a Project Advisory Group and collaborators in India, Uganda, and Zimbabwe. We then trained community and family caregivers to use an app to communicate patient-reported outcomes to their palliative care providers each week on a data dashboard. App activity was monitored, and qualitative in-depth interviews explored experience with the app and its mechanisms and impact. N = 149 caregivers participated and uploaded n = 837 assessments of patient-reported outcomes. These data were displayed to the palliative care team on an outcomes dashboard on n = 355 occasions. Qualitative data identified: 1) high acceptability and data usage; 2) improved understanding by team members of patient symptoms and concerns; 3) a need for better feedback to caregivers, for better prioritisation of patients according to need, for enhanced training and support to use the app, and for user-led recommendations for ongoing improvement. An outcomes-focused app and data dashboard are acceptable to caregivers and health-care professionals. They are beneficial in identifying, monitoring, and communicating patient outcomes and in allocating staff resource to those most in need.
Symptom Prevalence and Burden in Cancer Patients with and without HIV/AIDS Reffered for Palliative Care
(Journal of Health Science, 2015-02-24) Zirimenya, Ludoviko; Musoke, Charles; Hutt, Evelyn
: The prevalence of cancer and that of HIV/AIDS is increasing in Uganda and throughout sub Saharan Africa. Unfortunately, little is known about the prevalence and burden of symptoms in patients with AIDS-Cancer and Cancer alone at first referral to a palliative care service. This study sets out to compare the prevalence and symptom burden between patients with AIDS-Cancer and those with Cancer only referred to a palliative care setting. Retrospective point prevalence survey of 150 randomly selected charts of patients referred to Hospice Africa Uganda (HAU) as per 2013. Of the 471 eligible patients’ charts, 168 were randomly selected and only 150 were included in the study. A chart review instrument was used to extract information from the charts. Data were entered into Epidata version 3.1, cleaned and analysed using Epidata Analysis and Excel. Of the 150 patients’ records: 78 (52%) had Cancer only diagnosis and 72 (48%) AIDS-Cancer diagnosis. Pain was most prevalent at 91.7% in the AIDS-Cancer group and 100% in the cancer only group. Three quarters reported pain as moderate to severe in both groups of patients. The five most prevalent symptoms in the AIDS-Cancer group were pain (91.7%), social distresses (38.9%), body swelling (27.8%), Anorexia (22.2%) and skin eruption (16.7%) while in the Cancer alone group were pain (100%), body swelling (25.6%), Anorexia (23.1%), social distresses (20.9%) and fatigue (17.9%). The average number of symptoms was 4.8 (2.3) in the Cancer group and 4.7 (2.3) in the AIDS-Cancer group Pain is highly prevalent in both Cancer only and AIDS-Cancer patients. The four most prevalent symptoms namely pain, social distresses, body swelling and anorexia are similar in both groups of patients. Social distresses occur highly in AIDS-Cancer patients.
Population differences in vaccine responses (POPVAC): scientific rationale and cross-cutting analyses for three linked, randomised controlled trials assessing the role, reversibility and mediators of immunomodulation by chronic infections in the tropics
(BMJ open, 2020-06-24) Nkurunungi, Gyaviira; Zirimenya, Ludoviko; Natukunda, Agnes; Ninsiima, Caroline; Akello, Mirriam
Vaccine-specific immune responses vary between populations and are often impaired in low income, rural settings. Drivers of these differences are not fully elucidated, hampering identification of strategies for optimising vaccine effectiveness. We hypothesise that urban–rural (and regional and international) differences in vaccine responses are mediated to an important extent by differential exposure to chronic infections, particularly parasitic infections. Three related trials sharing core elements of study design and procedures (allowing comparison of outcomes across the trials) will test the effects of (1) individually randomised intervention against schistosomiasis (trial A) and malaria (trial B), and (2) Bacillus Calmette-Guérin (BCG) revaccination (trial C), on a common set of vaccine responses. We will enrol adolescents from Ugandan schools in rural high-schistosomiasis (trial A) and rural high-malaria (trial B) settings and from an established urban birth cohort (trial C). All participants will receive BCG on day ‘0’; yellow fever, oral typhoid and human papilloma virus (HPV) vaccines at week 4; and HPV and tetanus/diphtheria booster vaccine at week 28. Primary outcomes are BCG-specific IFN-γ responses (8 weeks after BCG) and for other vaccines, antibody responses to key vaccine antigens at 4 weeks after immunisation. Secondary analyses will determine effects of interventions on correlates of protective immunity, vaccine response waning, priming versus boosting immunisations, and parasite infection status and intensity. Overarching analyses will compare outcomes between the three trial settings. Sample archives will offer opportunities for exploratory evaluation of the role of immunological and ‘trans-kingdom’ mediators in parasite modulation of vaccine-specific responses.
A systematic review and meta-analysis to assess the association between urogenital schistosomiasis and HIV/AIDS infection
(PLoS Neglected Tropical Diseases, 2020-06-15) Zirimenya, Ludoviko; Mahmud-Ajeigbe, Fatima; McQuillan, Ruth; Li, You
Urogenital schistosomiasis and HIV/AIDS infections are widespread in sub-Saharan Africa (SSA) leading to substantial morbidity and mortality. The co-occurrence of both diseases has led to the possible hypothesis that urogenital schistosomiasis leads to increased risk of acquiring HIV infection. However, the available evidence concerning this association is inconsistent. The aim of this study was to systematically review and quantitatively synthesize studies that investigated the association between urogenital schistosomiasis and HIV/AIDS infection.
NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard): Concept and Launch event report
(NIHR Open Research, 2023-06-27) Zirimenya, Ludoviko; Zalwango, Flavia; Karanja , Henry K.; Natukunda, Agnes; Kiwanuka, Achilles; Chibita, Monica
Vaccination is an important public health intervention, but not everyone benefits equally. Biological, social and structural factors render some communities vulnerable and unable to secure optimal health benefits from vaccination programmes. This drives health inequity and undermines wider vaccine impact by allowing the persistence of non-immune communities as foci for recurrent disease outbreaks. The NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard) aims to understand how biological, social, and structural factors interact to impair vaccine impact in vulnerable African communities.
Assessing community vulnerability to reduced vaccine impact in Uganda and Kenya: A spatial data analysis
(NIHR Open Research, 2025-03-17) Nalwanga, Robinah; Natukunda, Agnes; Zirimenya, Ludoviko; Kaleebu, Pontiano; Webb, Emily L.
Despite global efforts to improve on vaccine impact, many African countries have failed to achieve equitable vaccine benefits. Reduced vaccine impact may arise from interplay between structural, social, and biological factors, that hinder communities from achieving full benefits from vaccination programs. However, the combined influence of these factors to reduced vaccine impact and the spatial distribution of vulnerable communities remains poorly understood. In this work, we developed a Community Vaccine Impact Vulnerability Index (CVIVI) that integrates data on multiple risk factors associated with impaired vaccine impact. The index identifies communities are at risk of reduced vaccine impact, and key factors contributing to their vulnerability.
The effect of helminth infection on vaccine responses in humans and animal models: A systematic review and meta-analysis
(Parasite Immunology, 2022-06-17) Natukunda, Agnes; Zirimenya, Ludoviko; Nassuuna, Jacent; Nkurunungi, Gyaviira; Elliott, Alison M.; Webb, Emily L.
Vaccination has potential to eliminate infectious diseases. However, parasitic infections such as helminths may hinder vaccines from providing optimal protection. We reviewed existing literature on the effects of helminth infections and their treatment on vaccine responses in humans and animals. We searched literature until 31 January 2022 in Medline, EMBASE, Global health, Scopus, and Web of science; search terms included WHO licensed vaccines and human helminth types. Standardized mean differences (SMD) in vaccine responses between helminth infected and uninfected or anthelminthic treated and untreated individuals were obtained from each study with suitable data for meta-analysis, and combined using a random effects model. Analysis was stratified by whether helminth exposure was direct or prenatal and by vaccine type. This study is registered with PROSPERO (CRD42019123074). Of the 4402 articles identified, 37 were included in the review of human studies and 24 for animal experiments. For human studies, regardless of vaccine type, overall SMD for helminth uninfected/treated, compared to infected/untreated, was 0.56 (95% CI 0.04–1.07 and I2 = 93.5%) for direct helminth exposure and 0.01 (95% CI −0.04 to 0.07 and I2 = 85.9%) for prenatal helminth exposure. Effects of anthelminthic treatment were inconsistent, with no overall benefit shown. Results differed by vaccine type, with responses to live vaccines most affected by helminth exposure. For animal studies, the most affected vaccine was BCG. This result indicates that helminth-associated impairment of vaccine responses is more severe for direct, than for prenatal, helminth exposure. Further research is needed to ascertain whether deworming of individuals before vaccination may help improve responses.

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