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Item AI-Driven Tuberculosis Hotspot Mapping to Optimize Active Case-Finding: Implementing the Epi-Control Platform in Uganda(MDPI AG, 2026-01) Amanya, Geofrey;; Hashmi, Sumbul;; Stow, Jessica Sarah ;; Tumwesigye, Philip;; Nkhata, Bernadette;; Mubiru, Kelvin Roland;; Budts, Anne-Laure;; Potgieter, Matthys Gerhardus;; Balcha, Seyoum Dejene;; Bamuloba, Muzamiru;; Zitho, Andiswa;; Henry, Luzze;; Nabukenya-Mudiope,; Mary G.;; Van Cauwelaert, CarolineTuberculosis remains a major public health concern in Uganda, one among the thirty high TB burden countries globally. Despite national progress, gaps persist due to asymptomatic disease, diagnostic limitations, and uneven access to healthcare within the country. This study implemented the Epi-control platform, an AI-driven predictive modelling tool, to predict community-level hotspots and support data-driven active case-finding (ACF). Using retrospective chest X-ray screening data, we integrated demographic, environmental, and human development indicators from open-source databases to model TB risk at sub-parish level. A proprietary Bayesian modelling framework was deployed and validated by comparing TB yields between predicted hotspots and non-hotspot locations. Across Uganda, the model identified significantly higher TB yields in hotspot areas (risk ratio = 1.69, 95% CI 1.41–2.02; p < 0.001). The Central and Western regions showed the highest concentrations of hotspots, consistent with their population density and urbanization patterns. The results show that the model prioritized areas with higher observed ACF yield in this retrospective dataset, supporting its potential operational use for screening prioritization under similar implementation conditions. The results demonstrate that AI-based predictive modelling can enhance the efficiency of ACF by targeting high-risk areas for screening. Integrating such predictive tools within national TB programmes may support screening planning and resource prioritization; prospective evaluation and external validation are needed to assess generalisability and incremental impact. Publicly Available Content DatabaseItem Multilevel analysis of factors associated with abortion among adolescents in Uganda insights from UDHS 2022 dataset(Public Library of Science, 2026-01-12) Stephen Mungau;; Joan Nanteza;; Genevieve DupuisUnsafe abortion is a major reproductive health challenge, causing 7.9% of global maternal deaths and 9.6% in East Africa. In Uganda, about 8% of maternal deaths result from unsafe abortions. Early sexual activity, poor access to sex education, restrictive laws and stigma push adolescents into unsafe practices. Limited safe services force many to use dangerous methods leading to severe complications and high maternal mortality. This study examined determinants and prevalence of abortion among Ugandan female adolescents using the 2022 Uganda Demographic and Health Survey dataset of 5,125 females aged 15-24 who had ever engaged in sexual activity. The dependent variable was binary (1 for ever terminated, 0 for never). Weighted data were analyzed using descriptive statistics, ordinary and mixed effect logistic regression models to explore individual- and cluster-level influences. Intra-class correlation and likelihood ratio tests assessed cluster variation. Findings showed 562 adolescents had ever aborted. Those whose first sex was before age 15 were 3.44 times more likely to abort compared to those aged 20-24 while those aged 15-17 were 2.24 times more likely. Married adolescents had twice the odds compared to never married, and cohabiting adolescents were 2.44 times more likely. Compared to those with education beyond secondary, adolescents with no education, primary and secondary schooling were 5.8, 2.99 and 3.01 times more likely to abort. Regional variations accounted for 16.8% of variance, with intra-class correlation of 4.9%. Overall, 11.0% of Ugandan female adolescents reported abortion. Key determinants included age at first sex, marital status, education, contraceptive use and internet use. Region-level factors contributed 4.9% of variation highlighting the need for cluster-level interventions alongside individual approaches.Item Longitudinal Trends in Physical Activity Among Older Adults With and Without HIV in Uganda(SAGE Publications, 2026-01) Ratnayake, Aneeka;; Tong, Yao;; Reynolds, Zahra ;; Chamut, Steffany;; Quach, Lien T.;; Mbabazi, Phoebe;; Sagar, Shruti;; Maling, Samuel;; North, Crystal M.;; Passell, Eliza;; Yoo-Jeong, Moka;; Tsai, Alexander C.;; Paul, Robert;; Ritchie, Christine S.;; Seeley, Janet;; Hoeppner, Susanne S.;; Atwiine, Flavia;; Tindimwebwa, Edna;; Okello, Samson;; Nakasujja, Noeline;; Saylor, Deanna;; Greene, Meredith L.;; Asiimwe, Stephen;; Tanner, Jeremy A.;; Siedner, Mark J.;; Olivieri-Mui, BrianneIntroductionPhysical Activity (PA) and its links to frailty, quality of life (QoL), and other comorbidities in older Ugandans living with HIV remain under-explored.MethodsWe analyzed data from three annual assessments of older people living with HIV (PLWH) and age- and sex-similar people not living with HIV (PnLWH). We fitted linear generalized estimating equations (GEE) regression models to estimate the correlates of PA, including demographics, frailty, QoL, HIV, and other comorbidities.ResultsWe enrolled 297 PLWH and 302 PnLWH. Older age (b = -157.34, 95% CI [-222.84, -91.83]), living with HIV (b = -979.88 [95% CI: -1878.48, -81.28]), frailty (b = -3011.14 [95% CI: -4665.84, -1356.45]), and comorbidities (b = -2501.75 [95% CI: -3357.44, -1646.07]) were associated with lower overall PA. Higher general QoL (b = 89.96 [95% CI: 40.99, 138.94]) was associated with higher PA.ConclusionPA interventions may support wellbeing of older people in the region, and tailored interventions should be explored. MEDLINEItem Perspectives of Primary Health Facility Leaders on the Contributions of Clinical Residents During Community Placement in Southwestern Uganda(Dove Medical Press, 2026-01) Kawungezi PC;; Ntaro M;; Turyakira E ;; Wesuta AC;; Tushabe A;; Matte M;; Ndizeye R;; Mwebembezi F;; Turigye B;; Ngonzi J;; Mulogo EMPeter Chris Kawungezi,1 Moses Ntaro,1 Eleanor Turyakira,1 Andrew Christopher Wesuta,1 Angela Tushabe,1 Michael Matte,1 Ronnie Ndizeye,1 Fred Mwebembezi,1 Brian Turigye,1 Joseph Ngonzi,2 Edgar Mugema Mulogo1 1Department of Community Health, Mbarara University of Science and Technology, Mbarara City, Uganda; 2Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara City, UgandaCorrespondence: Peter Chris Kawungezi, Mbarara University of Science and Technology, P.O Box 1410, Mbarara City, Uganda, Tel +256704904714, Email pkawungezi@yahoo.comBackground: The Mbarara University of Science and Technology (MUST)’s First Mile Community Health Program (FMCH) has facilitated community placement of clinical residents at Primary Healthcare (PHC) facilities within the MUST catchment area in southwestern Uganda. While community-based training of medical residents is common in sub-Saharan Africa, little is known about how PHC facility leaders perceive its effect on service delivery in Uganda. This assessment aimed to describe the perspectives of PHC facility leaders on the impact of clinical residents’ community placements on PHC services in southwestern Uganda between 2018 and 2023.Methods: From July 2018 to December 2023, 152 clinical residents from ten specialties were placed at PHC facilities in southwestern Uganda. This was a cross-sectional study based on qualitative data-collection techniques. This study focused on MUST clinical residents and PHC facilities in the MUST catchment in southwestern Uganda. We conducted KIIs with 15 health facility leaders until no new ideas emerged. Data were deductively analyzed using WHO’s five strategic directions. Transcripts were transcribed verbatim, repeatedly reviewed, and coded into predefined categories. Interviewers bracketed their own experiences to ensure facility leaders’ perspectives were accurately captured.Results: Of the 15 facility leaders interviewed, most were male and from government HC IVs. Leaders reported that resident placements improved health service delivery through community engagement, enhancing care models through training, mentorship and low-cost innovations, and improving service coordination, including establishing specialized clinics and promoting better use of equipment. Residents also supported advocacy and resource mobilization. However, short placements, inconsistent outreach, staff shortages and lack of specialists limited continuity and sustainability.Conclusion: Facility leaders reported perceived improvement in strengthening PHC services by the clinical residents. Sustaining these gains will require institutionalized partnerships and evaluation of long-term impact. This could contribute to the advancement of primary healthcare services.Keywords: universal health coverage, health systems strengthening, community placement, service delivery gaps, health professional, medical practiceItem The burden of travelling for cervical cancer treatment in Uganda:A mixed-method study(Blackwell Publishing Ltd, 2024-02) Dau, Hallie;; Zhou, Chuanlin;; Nankya, Esther ;; Naguti, Priscilla;; Basemera, Miriam;; Payne, Beth A.;; Vidler, Marianne;; Singer, Joel;; McNair, Avery;; AboMoslim, Maryam;; Mithani, Nadia;; Smith, Laurie;; Orem, Jackson;; Nakisige, Carolyn;; Ogilvie, GinaBackground Uganda has one of the highest rates of cervical cancer in the world. Many women are diagnosed and treated with advanced stages of the disease. With only one facility offering comprehensive cervical cancer care in Uganda, many women are required to travel significant distances and spend time away from their homes to receive cervical cancer care. It is important to understand the burden of time away from home while attending treatment because it can inform the expansion of cervical cancer treatment programmes. The aim of this mixed‐methods paper is to describe how the distance to cervical cancer treatment locations impacts women in Uganda. Methods Women were recruited from 19 September, 2022, to 17 January, 2023, at the Uganda Cancer Institute (UCI) and the cancer clinic at Jinja Regional Referral Hospital (JRRF). Women were eligible for the study if they were (i) aged ≥18 years with a histopathologic diagnosis of cervical cancer; (ii) being treated at the UCI or JRRF for cervical cancer; and (iii) able to provide consent to participate in the study in English, Luganda, Lusoga, Luo, or Runyankole. All participants completed a quantitative survey and a selected group was sampled for semi‐structured interviews. Data were analysed using the convergent parallel mixed‐methods approach. Descriptive statistics were reported for the quantitative data and qualitative data using an inductive‐deductive thematic analysis approach. Results In all, 351 women participated in the quantitative section of the study and 24 in the qualitative. The quantitative and qualitative findings largely aligned and supported one another. Women reported travelling up to 14 h to receive treatment and 20% noted that they would spend three or more nights away from home during their current visit. Major themes of the qualitative include means of transportation, spending the night away from home, and financial factors. Conclusion Our findings show that travelling to obtain cervical cancer care can be a significant burden for women in Uganda. Approaches should be considered to reduce this burden such as additional satellite cervical cancer clinics or subsidised transportation options.Item Prevalence of diarrhea and water sanitation and hygiene (WASH) associated factors among children under five years in Lira City Northern Uganda: Community based study(Public Library of Science, 2024-06) Auma, Brenda;; Musinguzi, Marvin;; Ojuka, Edward ;; Kigongo, Eustes;; Tumwesigye, Raymond;; Acup, Walter;; Kabunga, Amir;; Opio, BoscoBackground Children under the age of five experience a significant disease burden from diarrheal illnesses. This poses a severe public health risk as the second leading cause of infant death worldwide, after pneumonia. Lira City in Uganda is one of the developing urban areas with limited information about the diarrheal disease among children under the age of 5 years. This study aimed to determine the prevalence and assess the water, sanitation and hygiene related factors associated with diarrheal diseases among children under five years in Lira City. Methods The study was conducted among 492 care takers of children under the age of 5 years in Lira City between August 2022 and September 2022. Data was collected using an interviewer administered questionnaire and a multi-stage sampling was used to select study participants. Data was analyzed by bivariate and multivariate logistic regression using STATA version 17. P-value of < 0.05 was considered statistically significant. Results Out of 541 participants, 492 responded. The majority of the respondents, 425(86.4%) were female, 146(29.7%) had children aged 1–12 months, 192 (39%) had primary level education, and 155(31.5%) were self-employed. The prevalence of diarrhea among children under five years was 130(26.4%) and the associated factors with diarrheal disease were children between 49–60 months old (AOR = 0.12, 95% CI : 0.03–0.39, P = 0.001), cleaning the latrine more times (AOR = 0.42, 95% CI : 0.22–0.81, P = 0.010) and not treating water (AOR = 1.84, 95% CI : 1.11–3.06, P = 0.018). Conclusion There is high prevalence of diarrhea among children under 5 years of age. The study’s findings highlight the need for ongoing efforts to lower the prevalence of diarrheal illnesses among children under the age of five in Uganda’s emerging urban areas.Item Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey(BioMed Central, 2024-01) Tumwizere, Godfrey;; K. Mbonye, Martin;; Ndugga, PatriciaBackground Timely and adequate Antenatal Care (ANC) effectively prevents adverse pregnancy outcomes and is crucial for decreasing maternal and neonatal mortality. High-parity women (5 + children) are at higher risk of maternal mortality. Limited information on the late timing of ANC among this risky group continues to hamper Uganda’s efforts to reduce maternal mortality ratios and improve infant and child survival. This study aimed to determine factors associated with attendance of the first ANC after 12 weeks of gestation among high-parity women in Uganda. Methods This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5,266 women (aged 15–49) with five or more children. A complementary log-log regression model was used to identify factors associated with late ANC attendance among high-parity women in Uganda. Results Our findings showed that 73% of high parity women delayed seeking their first ANC visit. Late ANC attendance among high-parity women was associated with distance to the health facility, living with a partner, partner’s education, delivery in a health facility, and Desire for more children. Women who did not find the distance to the health facility when going for medical help to be a big problem had increased odds of attending ANC late compared to women who found distance a big problem (AOR = 1.113, CI: 1.004–1.234), women not living with partners (AOR = 1.196, 95% CI = 1.045–1.370) having had last delivery in a health facility (AOR = 0.812, 95% CI = 0.709–0.931), and women who desired to have another child (AOR = 0.887, 95% CI = 0.793–0.993) had increased odds compared to their counterparts. Conclusions To increase mothers’ timely attendance and improve maternal survival among high-parity women in Uganda, programs could promote and strengthen health facility delivery and integrate family planning with other services such as ANC and postnatal care education to enable women to seek antenatal care within the recommended first trimester. This study calls for increased support for programs for education, sensitization, and advocacy for health facility-based deliveries. This could be done through strengthened support for VHT and community engagement activities.Item “If your mother does not teach you, the world will…”: a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda(BioMed Central, 2023-04-11) Ndugga, Patricia;; Kwagala, Betty;; Wandera, Stephen Ojiambo ;; Kisaakye, Peter;; Mbonye, Martin K.;; Ngabirano, FredAdolescents experience a host of sexual and reproductive health (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV/AIDS, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents' risky sexual behaviors. However, communication between parents and adolescents is limited. This study explored the facilitators and barriers to parent-adolescent communication about sexual and reproductive health. We conducted a qualitative study in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising of parents, adolescents (10-17 years), and 25 key informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software. Parents' ability to communicate with their children is hindered by cultural barriers, busy work schedules, and a lack of knowledge. Engaging all stakeholders including parents to deconstruct sociocultural norms around adolescent SRH, developing the capacity of parents to confidently initiate and convey accurate SRH information, initiation of SRH discussions at early ages, and integrating parent-adolescent communication into parenting interventions, are potential strategies to improve SRH communication between parents and adolescents in high-risk settings such as borders.Item Reduced CCR5 expression among Uganda HIV controllers(BioMed Central, 2023-05-25) Nyiro, Brian;; Amanya, Sharon Bright;; Bayiyana, Alice ;; Wasswa, Francis;; Nabulime, Eva;; Kayongo, Alex;; Nankya, Immaculate;; Mboowa, Gerald;; Kateete, David Patrick;; Sande, Obondo JamesAbstract Background Several mechanisms including reduced CCR5 expression, protective HLA, viral restriction factors, broadly neutralizing antibodies, and more efficient T-cell responses, have been reported to account for HIV control among HIV controllers. However, no one mechanism universally accounts for HIV control among all controllers. In this study we determined whether reduced CCR5 expression accounts for HIV control among Ugandan HIV controllers. We determined CCR5 expression among Ugandan HIV controllers compared with treated HIV non-controllers through ex-vivo characterization of CD4 + T cells isolated from archived PBMCs collected from the two distinct groups. Results The percentage of CCR5 + CD4 + T cells was similar between HIV controllers and treated HIV non-controllers (ECs vs. NCs, P = 0.6010; VCs vs. NCs, P = 0.0702) but T cells from controllers had significantly reduced CCR5 expression on their cell surface (ECs vs. NCs, P = 0.0210; VCs vs. NCs, P = 0.0312). Furthermore, we identified rs1799987 SNP among a subset of HIV controllers, a mutation previously reported to reduce CCR5 expression. In stark contrast, we identified the rs41469351 SNP to be common among HIV non-controllers. This SNP has previously been shown to be associated with increased perinatal HIV transmission, vaginal shedding of HIV-infected cells and increased risk of death. Conclusion CCR5 has a non-redundant role in HIV control among Ugandan HIV controllers. HIV controllers maintain high CD4 + T cells despite being ART naïve partly because their CD4 + T cells have significantly reduced CCR5 densities.Item Timeliness and completeness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020–2021(BioMed Central, 2023-04-04) Nansikombi, Hildah Tendo;; Kwesiga, Benon;; Aceng, Freda L. ;; Ario, Alex R.;; Bulage, Lilian;; Arinaitwe, Emma S.Disease surveillance provides vital data for disease prevention and control programs. Incomplete and untimely data are common challenges in planning, monitoring, and evaluation of health sector performance, and health service delivery. Weekly surveillance data are sent from health facilities using mobile tracking (mTRAC) program, and synchronized into the District Health Information Software version 2 (DHIS2). The data are then merged into district, regional, and national level datasets. We described the completeness and timeliness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020-2021.INTRODUCTIONDisease surveillance provides vital data for disease prevention and control programs. Incomplete and untimely data are common challenges in planning, monitoring, and evaluation of health sector performance, and health service delivery. Weekly surveillance data are sent from health facilities using mobile tracking (mTRAC) program, and synchronized into the District Health Information Software version 2 (DHIS2). The data are then merged into district, regional, and national level datasets. We described the completeness and timeliness of weekly surveillance data reporting on epidemic prone diseases in Uganda, 2020-2021.We abstracted data on completeness and timeliness of weekly reporting of epidemic-prone diseases from 146 districts of Uganda from the DHIS2.Timeliness is the proportion of all expected weekly reports that were submitted to DHIS2 by 12:00pm Monday of the following week. Completeness is the proportion of all expected weekly reports that were completely filled and submitted to DHIS2 by 12:00pm Wednesday of the following week. We determined the proportions and trends of completeness and timeliness of reporting at national level by year, health region, district, health facility level, and facility ownership.METHODSWe abstracted data on completeness and timeliness of weekly reporting of epidemic-prone diseases from 146 districts of Uganda from the DHIS2.Timeliness is the proportion of all expected weekly reports that were submitted to DHIS2 by 12:00pm Monday of the following week. Completeness is the proportion of all expected weekly reports that were completely filled and submitted to DHIS2 by 12:00pm Wednesday of the following week. We determined the proportions and trends of completeness and timeliness of reporting at national level by year, health region, district, health facility level, and facility ownership.National average reporting timeliness and completeness was 44% and 70% in 2020, and 49% and 75% in 2021. Eight of the 15 health regions achieved the target for completeness of ≥ 80%; Lango attained the highest (93%) in 2020, and Karamoja attained 96% in 2021. None of the regions achieved the timeliness target of ≥ 80% in either 2020 or 2021. Kampala District had the lowest completeness (38% and 32% in 2020 and 2021, respectively) and the lowest timeliness (19% in both 2020 and 2021). Referral hospitals and private owned health facilities did not attain any of the targets, and had the poorest reporting rates throughout 2020 and 2021.RESULTSNational average reporting timeliness and completeness was 44% and 70% in 2020, and 49% and 75% in 2021. Eight of the 15 health regions achieved the target for completeness of ≥ 80%; Lango attained the highest (93%) in 2020, and Karamoja attained 96% in 2021. None of the regions achieved the timeliness target of ≥ 80% in either 2020 or 2021. Kampala District had the lowest completeness (38% and 32% in 2020 and 2021, respectively) and the lowest timeliness (19% in both 2020 and 2021). Referral hospitals and private owned health facilities did not attain any of the targets, and had the poorest reporting rates throughout 2020 and 2021.Weekly surveillance reporting on epidemic prone diseases improved modestly over time, but timeliness of reporting was poor. Further investigations to identify barriers to reporting timeliness for surveillance data are needed to address the variations in reporting.CONCLUSIONWeekly surveillance reporting on epidemic prone diseases improved modestly over time, but timeliness of reporting was poor. Further investigations to identify barriers to reporting timeliness for surveillance data are needed to address the variations in reporting. MEDLINE - AcademicItem Predictors of female condom utilisation among women of reproductive age (15–49 years) in Rakai district, Uganda: a cross-sectional study(BioMed Central, 2025-09-26) Shannon, Ahumuza;; Kevin, Nwanna Uchechukwu;; Gbadamosi, Mojeed AkoredeThe female condom serves as a dual protective device, preventing the spread of HIV/AIDS, unintended pregnancies and other sexually transmitted infections (STIS). When it comes to sexual protection and contraception, the female condom is an essential tool for women's empowerment. Females are more susceptible than males to acquiring STIs due to their biological makeup. Females are particularly vulnerable to sexual abuse following substance use. The uptake of female condoms has been a significant challenge in Uganda, and their uptake remains low. Limited research exists on the subject of female condom use in Uganda; hence, this study was undertaken and used the Health Belief Model to investigate the prevalence and factors associated with the use of female condoms among women of reproductive age in Rakai district, Uganda. This cross-sectional study used a multistage random sampling method with a sample size of 125 women. Data were gathered using an interviewer-administered questionnaire and assessed with the Health Belief Model against the outcome variable, which was Female Condom utilisation. Log-binomial regression model analysis was done using SPSS version 25. The prevalence of utilising female condoms was 34%. The socio-demographic variables of the respondents that influenced FC utilisation were age (26-35 years) (aPR: 0.84, CI: 0.76-0.93, p < 0.001) and Monthly income (200,000-500,000 Ugx) (aPR: 0.14, CI: 0.03-0.74, p = 0.021). Also, perceived severity (aPR: 2.9, CI: 1.14-7.35, p = 0.026) and perceived benefits (aPR: 6.6, CI: 1.19-36.70, p = 0.031) were significantly associated with the outcome variable. Our significance level was 0.05 with a 95% confidence interval. The prevalence of utilisation of female condoms was low; age, religion, marital status, monthly income, perceived severity and benefits were the predictors of female condom use among women of reproductive age. Therefore, health education and awareness should be carried out at the community level to increase the sensitisation of female condoms by emphasising the importance of their use in preventing HIV/AIDS, STIs, and unintended pregnancies. Gale OneFile: Nursing and Allied HealthItem Health professionals’ stigmatizing attitudes towards people with mental illness: A cross-sectional study in a referral hospital in Uganda(Public Library of Science, 2024-12-02) Abaatyo, Joan;; Nyemara, Novatus;; Ashaba, ScholasticHealth professionals in primary care settings show stigmatizing attitudes towards people with mental illness (PMI), leading to undermined quality of care delivered. However, information is sparse on stigmatizing attitudes of health professionals towards PMI in Uganda. This study aimed to discover the levels of stigmatizing attitudes towards PMI and associated factors among health professionals in Uganda. We enrolled 254 health professionals at Mbarara Regional Referral Hospital in a cross-sectional study. Community attitude towards mental illness-2 (CAMI-2) scale was used to assess stigmatizing for attitudes. Linear regression was used to determine factors associated with level of stigmatizing attitudes. The average overall CAMI score for all participants was 91.1±16.6. Nurses/midwives compared to doctors had significantly higher total CAMI score (p<0.001), and higher malevolent (p = 0.01) and non-acceptance attitudes (p = 0.02) than doctors. Doctors had significantly lower authoritarian attitudes than clinical officers, (p = 0.004). Being male (aCoef: -4.86; p = 0.02), increase in compassion satisfaction (aCoef: -0.44; p = 0.02), and increased mental health knowledge (aCoef: -2.90; p = <0.001), increased likelihood of having lower levels of stigmatizing attitudes, while being a non-psychiatric health professional was associated with higher levels of stigmatizing attitudes (aCoef: 12.08; p = 0.01). Health professionals exhibit moderate levels of stigmatizing attitudes towards PMI and stigmatizing attitudes are more among nurses/midwives. Various steps including providing education and training on mental illness, promoting community integration and social inclusion, and advocating for policies, should be taken to reduce stigmatizing attitudes of health professionals towards PMI. Gale OneFile: ScienceItem Malaria epidemics and its drivers in Uganda in 2022(BioMed Central Ltd, 2025-07-17) Aregawi, Maru W.;; Maiteki, Catherine;; Rek, John C. ;; Agaba, Bosco;; Katureebe, Charles;; Ranjbar, Mansour;; Zhang, Chunzhe;; Kiware, Samson;; Opigo, JimmyIn Uganda, malaria is a year-round health threat, with transmission intensity varying across regions. Despite ongoing intensified interventions, an unprecedented malaria resurgence in early 2022 affected several districts, prompting a swift response from the National Malaria Control Division (NMCD). This study aims to assess the scale and underlying causes of the epidemics, quantify the excess cases and deaths, and propose targeted prevention and response strategies. District Health Information System (DHIS2) data from 2017 to 2022 were analysed. A 75th percentile threshold from 2017 to 2021 was used to define true malaria epidemics and compare them to the suspected 2022 epidemic. Excess cases, admissions, and deaths were quantified using area under the curve (AUC) calculations. The level of epidemics was compared across districts with Indoor Residual Spraying (IRS) and Integrated Community Case Management (iCCM) interventions. Precipitation data from multiple sources were used to evaluate rainfall patterns and their impact on malaria epidemics. Malaria cases were lowest in 2018 but rose by 31% in 2022 compared to the 2017-2021 3rd quartile. Sixty-four of 146 districts experienced epidemics, with 4 facing persistent epidemics year-round. The 2022 epidemic accounted for 3,379,309 (95% CI 1,553,714, 5,339,709) total excess outpatient malaria cases (confirmed and presumed), 3,018,920 (95% CI 1,321,951, 4,661,201) excess confirmed cases, 149,789 (95% CI 66,029, 235,743) excess inpatient cases. Paradoxically, more epidemics occurred in IRS and iCCM districts. Precipitation patterns were consistent across years and were insignificantly correlated with the 2022 epidemic. Provinces with bimodal rainfall patterns were more prone to epidemics, while unimodal regions had fewer epidemics but higher incidence rates. Rainfall lagged by two months (Lag 2) significantly increased malaria incidence (p < 0.01), with each millimetre of rainfall two months prior associated with 13.4 additional malaria cases. The 2022 malaria epidemic affected 64 districts, with over 3.3 million excess cases and nearly 150,000 excess admissions. Gaps in IRS, iCCM, and intervention coverage, along with minimal rainfall correlation and high vulnerability in bimodal regions, highlight the need for better surveillance, sustainable funding, and tailored responses. While climate was not the main driver, programmatic deficiencies, vector composition shift, reduced efficacy of insecticides, coverage and effectiveness of the interventions likely fueled the epidemic. Strengthening epidemic preparedness, response, and investment will be crucial to preventing future outbreaks and achieving long-term malaria control in Uganda. Gale OneFile: Nursing and Allied HealthItem Comparing full immunisation status of children (0–23 months) between slums of Kampala City and the rural setting of Iganga District in Uganda: a cross-sectional study(BioMed Central, 2023-08) Jammeh, Awa;; Muhoozi, Michael;; Kulane, Asli ;; Kajungu, DanImmunisation remains the most cost-effective public health intervention in preventing morbidity and mortality due to Vaccine-Preventable Diseases (VPDs). The study aims to compare the differences in immunisation coverage amongst children aged 0 to 23 months living in slums of Kampala city and Iganga as rural districts in Uganda.BACKGROUNDImmunisation remains the most cost-effective public health intervention in preventing morbidity and mortality due to Vaccine-Preventable Diseases (VPDs). The study aims to compare the differences in immunisation coverage amongst children aged 0 to 23 months living in slums of Kampala city and Iganga as rural districts in Uganda.This study utilises data from a cross-sectional survey done in 2019 in the slums of Kampala City and the rural district of Iganga within the Health and Demographic Surveillance Site (HDSS). It included 1016 children aged 0-23 months and their parents. A logistic regression model was used to analyse the relationship between multiple independent variables and the binary dependent variables (fully immunised) using Stata statistical software. The measures of association were odds ratios reported with a corresponding 95% confidence interval.METHODSThis study utilises data from a cross-sectional survey done in 2019 in the slums of Kampala City and the rural district of Iganga within the Health and Demographic Surveillance Site (HDSS). It included 1016 children aged 0-23 months and their parents. A logistic regression model was used to analyse the relationship between multiple independent variables and the binary dependent variables (fully immunised) using Stata statistical software. The measures of association were odds ratios reported with a corresponding 95% confidence interval.Out of the 1016 participants, 544 participants live in the rural area and 472 participants in the slums. Slums had 48.9% (n = 231) of fully immunised children whilst rural areas had 43.20% (n = 235). The multivariate analysis showed that children living in slums are more likely to be fully immunised as compared to their counterparts in rural areas (Odds ratio:1.456; p = 0.033; CI:1.030-2.058). Immunisation coverage for BCG (98.9%), Polio 0 (88.2%), Penta1 (92.7%), and Pneumo1 (89.8%) were high in both settlements. However, the dropout rate for subsequent vaccines was high 17%, 20% and 41% for Penta, pneumococcal and rota vaccines respectively. There was poor uptake of the new vaccines with slums having 73.4% and 47.9% coverage for pneumococcal and rota vaccines respectively and rural areas had 72.1% and 7.5% for pneumococcal and rota vaccines respectively.RESULTSOut of the 1016 participants, 544 participants live in the rural area and 472 participants in the slums. Slums had 48.9% (n = 231) of fully immunised children whilst rural areas had 43.20% (n = 235). The multivariate analysis showed that children living in slums are more likely to be fully immunised as compared to their counterparts in rural areas (Odds ratio:1.456; p = 0.033; CI:1.030-2.058). Immunisation coverage for BCG (98.9%), Polio 0 (88.2%), Penta1 (92.7%), and Pneumo1 (89.8%) were high in both settlements. However, the dropout rate for subsequent vaccines was high 17%, 20% and 41% for Penta, pneumococcal and rota vaccines respectively. There was poor uptake of the new vaccines with slums having 73.4% and 47.9% coverage for pneumococcal and rota vaccines respectively and rural areas had 72.1% and 7.5% for pneumococcal and rota vaccines respectively.The low full immunisation status in this study was attributed to the child's residence and the occupation of the parents. Lack of education and poor access to messages on immunisation (inadequate access to mass media) are other contributing factors. Educational messages on the importance of immunisation targeting these underserved populations will improve full immunisation coverage.CONCLUSIONThe low full immunisation status in this study was attributed to the child's residence and the occupation of the parents. Lack of education and poor access to messages on immunisation (inadequate access to mass media) are other contributing factors. Educational messages on the importance of immunisation targeting these underserved populations will improve full immunisation coverage. MEDLINE - AcademicItem Community health worker–facilitated telehealth for moderate–severe hypertension care in Kenya and Uganda: A randomized controlled trial(Public Library of Science, 2025-06) 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, JamesBackground 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. Methods and findings 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. Conclusion 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.Item Healthcare providers’ perceptions on post abortion intrauterine contraception: A qualitative study in central Uganda(Public Library of Science, 2025-12-05) Kayiga, Herbert;; Looft-Trägårdh, Emelie;; Cleeve, Amanda ;; Kakaire, Othman;; Tumwesigye, Nazarius Mbona;; Byamugisha, Josaphat;; Gemzell-Danielsson, KristinaBackground Despite access to post abortion intrauterine contraception, the uptake of Intrauterine devices (IUDs) in Uganda remains low. Whether the perceptions of healthcare providers towards IUDs have a role in the provision of post abortion IUDs remains unclear. We explored perceptions on post abortion IUD provision among healthcare providers in Uganda, focusing on barriers and facilitators in regards to provision and uptake. Methods Between 1 st August 2022 and 30 th September 2022, forty-five in-depth interviews were conducted among healthcare providers of different cadres at sixteen public health facilities in central Uganda. We used the case study design to explore the healthcare providers’ perceptions. The interviews were primarily to help us understand the perceptions of healthcare providers towards IUDs. All interviews were audio-recorded and transcribed verbatim. Themes were identified using the conventional inductive content analysis. Results From the analysis, three themes emerged. Theme one covered health system related barriers in regards to IUD provision such as healthcare providers’ and health facility challenges. The second theme focused on the challenges in post abortion contraceptive counselling focusing on IUDs. The third theme covered the motivating factors and participants’ views on how to scale up IUD uptake and provision within post abortion care in Uganda. We found that lack of appropriate knowledge and skills on IUD provision, and heavy workloads, negatively impacted IUD provision. Inadequate facilities, IUD stock-outs, and minimal community sensitization also limited the utilization of IUDs. Furthermore, language barriers, community misconceptions around IUDs, long travel distances to the health facility, and partner refusal, contributed to the low uptake of post abortion IUDs. To address the identified barriers and scale up post abortion IUD provision, participants recommended addressing health system barriers, regular in-service refresher trainings, mentoring and supervision. They emphasized the importance of addressing contraceptive misconceptions and men’s opposition to IUDs through community sensitization. Conclusion In this study we identified several barriers to post abortion IUD provision, highlighting an urgent need to address health system barriers including healthcare providers’ skills and knowledge gaps, supply chain challenges, and to ensure that facilities are conducive to quality contraceptive counselling. Provision of on-job refresher trainings, mentoring and supervision, are key motivators that can be utilized in supporting healthcare providers towards post abortion IUD provision. To further increase uptake, efforts are needed to dispel contraceptive myths and misconceptions at the community level.Item Factors associated with wasting among pediatric cancer patients aged 2–17 years at Uganda cancer institute: A cross-sectional study(Public Library of Science, 2025-09-26) Wannyana, Daisy;; Bagonza, Arthur;; Mwima, Sandrah Joyce ;; Nalwadda, Christine;; Ndejjo, RawlanceWasting is a major concern among pediatric cancer patients and significantly affects treatment outcomes and quality of life. However, limited data exist on the prevalence of wasting and its associated factors in low-income contexts. This study determined the prevalence of wasting and its associated factors among pediatric cancer patients aged 2--17 years at the Uganda Cancer Institute. An institutionally based, cross-sectional study was conducted among 270 systematically randomly selected caregiver‒child pairs. Univariate, bivariate, and multivariable analyses were conducted using STATA version 14. Variables with p-value < 0.05 were considered statistically significant. Among 270 pediatric cancer patients aged 2-17 years, 27.4% (n = 74) were wasted. Children aged 5 years and older had a 20% higher prevalence of wasting (aPR = 1.2; p = 0.002). Cancers near the gastrointestinal tract were associated with a 10% greater prevalence of wasting (aPR = 1.1; p = 0.028). Wasting was lower by 20% among children whose caregivers had tertiary education (aPR = 0.8; p = 0.002), whereas treatment effects increased wasting prevalence by 10% (aPR = 1.1; p = 0.013). Wasting is a prevalent form of malnutrition among pediatric cancer patients requiring the integration of nutritional services to address the nutritional needs of children, especially those aged greater than 5 years, those with cancers along the gastro-intestinal tract and those experiencing treatment effects. Additionally, health and nutrition education programs tailored to the caregiver's level of education are needed.Item Spatial distribution of pathogenic fungal isolates from clinical samples in Uganda: Diagnostic gaps and trends, January 2020 - May 2024(Public Library of Science, 2025-07-17) Atim, Priscilla;; Gidudu, Samuel;; Bagaya, Bernard Ssentalo ;; Kambugu, Andrew;; Najjuka, Grace;; Winfred, Atuhaire D.;; Kanamwanji, Benedict;; Nabende, Esther;; Atukunda, Adella;; Kabazzi, Jonathan;; Joyoo, Sylvia;; Nansikombi, Hildah Tendo;; Ario, Alex RiolexusBackgroundPathogenic fungi cause approximately 13 million infections and 1.5 million deaths worldwide each year, yet surveillance and diagnosis remain inadequate in resource-limited settings. In Uganda, fungal infections affect approximately 4,099,357 per 45 million people annually, resulting in severe invasive diseases if untreated. This study describes laboratory-confirmed pathogenic fungal isolates from clinical samples in Uganda from January 2020 to May 2024, and highlights gaps in diagnostic capacity.MethodsWe abstracted data from the National Microbiology Reference Laboratory database, disaggregated pathogenic fungal isolates by the sex and age group of the patients, sample type, and isolated species, district, and year of isolation. Pathogenic fungal isolates were confirmed by culture and biochemical tests. Using Epi Info 7 software, we analyzed frequencies.ResultsAmong 8,136 clinical samples tested, fungal pathogens were isolated from 744 (9%) samples. Of these, the majority were obtained from female (92%), persons aged 16-35 years (68%). Most fungal pathogens (93.7%) were isolated from superficial clinical samples, while 6.3% from deep samples. High-vaginal swabs accounted for 71% of the clinical samples, with most cases from Kampala (32%) and Mbarara (26%) districts. The pathogenic fungal species identified included C. albicans (65.4%), non-albicans Candida spp. (30.6%) and C. neoformans (3.9%). We observed a sharp decline of identified pathogenic fungi from 299 (40%) in 2020-39 (5%) in 2024, reflecting diagnostic disruptions during the COVID-19 pandemic.ConclusionCandida spp. were the most commonly isolated pathogenic fungi, mainly among females and individuals aged 16-35 years from Kampala and Mbarara districts. There is need for targeted interventions against candidiasis in these groups and locations. This study also highlights the gaps in fungal diagnostic capacity in Uganda, as the national database was limited to Candida and Cryptococcus, emphasizing the need for improved diagnostic infrastructure, capacity-building and surveillance to enhance detection of pathogenic fungi.Item Structural equation modelling (SEM) for malaria prevalence and risk factors in Uganda(BioMed Central, 2025-11-07) Kakaire, Grace;; Chumoh, Edna Chepkemoi;; Salyungu, Mabula ;; Kerich, Gregory;; Too, Robert Kipchumba;; Kosgei, MathewBackground Malaria remains a leading cause of morbidity and mortality among children under five years in sub-Saharan Africa, despite extensive public health efforts. Its transmission is influenced by a complex interaction of socioeconomic, environmental, maternal, and child health factors. Traditional analytic approaches often fail to capture these multifaceted relationships. This study employs Structural Equation Modelling (SEM) to explore the latent and observed predictors of child malaria prevalence, offering a comprehensive understanding of the underlying pathways. Methods Utilizing secondary data from the 2018-2019 Uganda Malaria Indicator Survey (MIS), a SEM framework was constructed comprising four latent constructs: Socioeconomic Status (SES), Environment, Maternal Health, and Child Health. Each construct was defined by multiple observed variables, and the outcome of interest was the malaria status of the child. Factor loadings and regression coefficients were estimated using standardized model parameters. Model fit was assessed using indices including the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR). Results The SEM analysis demonstrated significant pathways from latent variables to child malaria prevalence. Child Health had the strongest positive association with malaria status (β = 0.22, p < 0.001), followed by a marginal negative association with the Environment construct (β = - 0.36, p = 0.056). Socioeconomic Status and Maternal Health were not statistically significant predictors. Model fit indices suggested a moderately acceptable fit (CFI = 0.786, TLI = 0.630, RMSEA = 0.064, SRMR = 0.053), indicating that the conceptual framework captured meaningful relationships. Conclusion This study highlights the value of SEM in disentangling the intricate network of factors influencing child malaria. The findings underscore the importance of child-level health conditions and environmental factors, while pointing to the limited direct effect of socioeconomic and maternal health variables. These insights can inform integrated intervention strategies that simultaneously address child health and environmental exposures to reduce the burden of malaria. Keywords: Child malaria, Structural equation modeling, Child health, Sub-Saharan AfricaItem Living with sickle cell in Uganda: A comprehensive perspective on challenges, coping strategies, and health interventions(Lippincott Williams & Wilkins, 2024-12-20) Obeagu, Emmanuel Ifeanyi;; Obeagu, Getrude UzomaSickle cell anemia (SCA) is a hereditary blood disorder with profound implications for affected individuals, particularly in resource-limited settings such as Uganda. This review explores the multifaceted aspects of SCA in Uganda, focusing on epidemiology, challenges faced by individuals, coping strategies, healthcare disparities, and community support. The study incorporates a thorough examination of the genetic landscape, prevalence, and the impact of SCA on the quality of life in Uganda. Coping strategies and resilience play a pivotal role in mitigating the impact of SCA on affected individuals. This review critically evaluates the various coping mechanisms employed by individuals in Uganda and the resilience demonstrated in the face of chronic illness. It explores the psychological, social, and cultural dimensions of coping and resilience, shedding light on adaptive strategies that contribute to improved quality of life. This article aims to contribute valuable insights into the specific challenges faced by individuals with SCA in Uganda, offering a foundation for targeted interventions, improved healthcare policies, and increased awareness within both the medical community and the broader society.Sickle cell anemia (SCA) is a hereditary blood disorder with profound implications for affected individuals, particularly in resource-limited settings such as Uganda. This review explores the multifaceted aspects of SCA in Uganda, focusing on epidemiology, challenges faced by individuals, coping strategies, healthcare disparities, and community support. The study incorporates a thorough examination of the genetic landscape, prevalence, and the impact of SCA on the quality of life in Uganda. Coping strategies and resilience play a pivotal role in mitigating the impact of SCA on affected individuals. This review critically evaluates the various coping mechanisms employed by individuals in Uganda and the resilience demonstrated in the face of chronic illness. It explores the psychological, social, and cultural dimensions of coping and resilience, shedding light on adaptive strategies that contribute to improved quality of life. This article aims to contribute valuable insights into the specific challenges faced by individuals with SCA in Uganda, offering a foundation for targeted interventions, improved healthcare policies, and increased awareness within both the medical community and the broader society. MEDLINE - Academic