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Development and Optimization of Controlled Drug Release Formulation of Diclofenac Sodium Based on Osmotic Technology
(Int J Pharm Res Allied Sci, 2012-07-03) Mutyaba, Michael Romeo; Wang, Bo; Xue, He ying
The aim of this study is to develop and optimize an osmotically controlled drug delivery system of Diclofenac sodium. Osmotically controlled oral drug delivery systems utilize osmotic pressure for controlled delivery of active drugs. Drug delivery from these systems, to a large extent, is independent of the physiological factors of the gastrointestinal tract .Differential scanning calorimeter (DSC) was used to evaluate the drug–excipient compatibility , based on the results of DSC, excipients defined in the formula were found to be compatible with Diclofenac sodium. Formulation variables like type of osmotic agent (Sodium chloride, Mannitol, Lactose) , level of pore former and plasticizer , percent weight gain were found to affect the drug release from the developed formulations. The release performance of Diclofenac sodium from the optimized formulations was studied over a period of 12 h. Drug release was inversely proportional to the membrane weight but directly related to the initial level of pore former in the membrane. On the basis of release results, a three-level three-factorial Box–Behnken experimental design was used to characterize and optimize three formulation parameters, i.e. level of osmotic agent , pore former and plasticizer .The chosen dependent variables (responses) were a cumulative percentage of dissolved diclofenac sodium over a period of 12 h..The release from the developed formulations was independent of pH and agitational intensity, but dependent on the osmotic pressure of the release media. From dissolution models it was observed that drug release from optimized formulation exhibited zero order release kinetics. The formulations were found to be stable after 3 months of accelerated stability studies (40 o C and 75%RH). Prediction of steady-state levels using the superposition method showed the plasma concentrations of Diclofenac sodium to be within the desired range
Urologic complications among women with advanced cervical cancer at a tertiary referral hospital in Uganda
(International Journal of Gynecology & Obstetrics, 2011-08-16) Atuhairwe, Susan; Busingye, Robert B.; Sekikubo, Musa; Nakimuli, Annettee; Mutyaba, Twaha
To determine the prevalence of and factors associated with urologic complications among women with advanced cervical cancer before treatment in Uganda. In total, 283 women with histologically confirmed stage IIB–IVB cervical cancer who were admitted to Mulago Hospital over a 6-month period were studied. Abdominopelvic scan was carried out to check for hydronephrosis and hydroureter and to measure the tumor volume. Serum creatinine and urea levels were measured, and the presence of anuria and vesicovaginal fistula (VVF) was ascertained from self-reporting and clinical records. Urologic complications were present in 138 (48.8%) women. Hydronephrosis, VVF, hydroureter, and anuria were present in 112 (39.6%), 21 (7.4%), 11 (3.9%), and 9 (3.2%) women, respectively; serum creatinine and urea levels were elevated in 48 (17.0%) women. Stage of disease was significantly associated with urologic complications: stage IIIB odds ratio (OR) 3.36 (95% confidence interval [CI], 1.57–7.20); stage IVA OR 17.10 (95% CI, 6.07–48.16); P < 0.001. There is a high prevalence of urologic complications among women with advanced cervical cancer; these complications are significantly associated with the stage of cervical cancer.
Aerobic cervical bacteriology and antibiotic sensitivity patterns in patients with advanced cervical cancer before and after radiotherapy at a national referral hospital in Uganda
(International Journal of Gynecology & Obstetrics, 2014-07-18) Mubangizi, Louis; Namusoke, Fatuma; Mutyaba, Twaha
To determine prevalent aerobic cervical bacteria and sensitivity to commonly used antibiotics in patients with advanced cervical cancer before and after 4 weeks of external beam radiotherapy (EBRT). Cervical swabs were collected prior to the initial radiation dose and after 4 weeks of radiotherapy at Mulago Hospital. Aerobic culture was performed on blood agar, chocolate agar, and MacConkey agar, and incubated at 35–37 ° for 24–48 hours. Isolates were identified using colonial morphology, Gram staining, and biochemical analysis. Sensitivity testing was performed via Kirby–Bauer disk diffusion and dilution. Differences in the proportions of bacteria isolated before and after radiotherapy were compared. Paired t test was used to obtain differences in sensitivity before and after radiotherapy. Normal flora increased significantly after EBRT (P = 0.02). There was no significant change in overall proportion of positive cultures. Sensitivity to commonly used antibiotics improved (P = 0.05) and resistance significantly decreased (P = 0.005). Significant differences were seen mainly with ciprofloxacin, ceftriaxone, and gentamicin. Four weeks of EBRT did not sterilize the cervix but resulted in an increase in normal flora. Radiotherapy appeared to reduce resistance to commonly used antibiotics. Sensitivity to chloramphenicol was higher than for the more commonly used antibiotics.
Maternal morbidity during labor in Mulago hospital
(International Journal of Gynecology & Obstetrics, 2001-05-16) Mutyaba, S.T.; Mmiro, F.A.
Mothers who delivered in the Mulago Hospital, Mulago, Uganda were enrolled in the study between March and August 1997. Of 9043 deliveries, there were 550 cases with morbidities, giving a morbidity prevalence rate of 6082 morbidities per 100 000 deliveries. Maternal mortality during the same period was 774 per 100 000 deliveries, giving a rate of 7.85 morbidities per death. Poor access to a health facility was associated with most morbidities. Pregnancy induced hypertension (preeclampsia and eclampsia) was the most frequent morbidity (26.41%), followed by sepsis (15.72%) and postpartum haemorrhage (10.53%). Maternal illnesses had negative effects on fetal outcome.
In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary Academic Hospital in Johannesburg, South Africa
(Journal of Cardiovascular Development and Disease, 2023-08-15) Ndaba , Lindokuhle; Mutyaba, Arthur; Mpanya, Dineo; Tsabedze,Nqoba
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5–8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04–0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach.
Pulmonary granuloma formation during latent Cryptococcus neoformans infection in C3HeB/FeJ mice involves progression through three immunological phases
(mBio, 2025-01-01) Betancourt, Jovany J.; Mutyaba, Issa; Meya, David B.; Nielsen, Kirsten
Cryptococcus neoformans is a fungal pathogen that can cause lethal disease in immunocompromised patients. Immunocompetent host immune responses, such as formation of pulmonary granulomas, control the infection and prevent disseminated disease. Little is known about the immunological conditions establishing the latent infection granuloma in the lungs. To investigate this, we performed an analysis of pulmonary immune cell populations, cytokine changes, and granuloma formation during infection with a latent disease-causing clinical isolate in C3HeB/FeJ mice over 360 days. We found that latently infected mice progress through three phases of granuloma formation where different immune profiles dominate: an early phase characterized by eosinophilia, high IL-4/IL-13, and C. neoformans proliferation in the lungs; an intermediate phase characterized by multinucleated giant cell formation, high IL-1α/IFNγ, granuloma expansion, and increased blood antigen levels; and a late phase characterized by a significant expansion of T cells, granuloma condensation, and decreases in lung fungal burden and blood antigen levels. These findings highlight a complex series of immune changes that occur during the establishment of granulomas that control C. neoformans in the lungs and lay the foundation for studies to identify critical beneficial immune responses to Cryptococcus infections.
A randomized clinical trial comparing safety, clinical and parasitological response to artemether-lumefantrine and chlorproguanil-dapsone in treatment of uncomplicated malaria in pregnancy in Mulago hospital, Uganda
(The Journal of Infection in Developing Countries, 2008-04-01) Kaye, Daniel Kabonge; Nshemerirwe, Ruth; Mutyaba, Twaha Serunjogi; Ndeezi, Grace
Malaria infection during pregnancy is a major public health problem. Due to increasing resistance to Chloroquine and Sulphadoxine/Pyrimethamine, the Ugandan national policy on malaria treatment was changed in 2005 to Artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. The policy recommends assessment of safety and efficacy of alternative drugs for treatment of uncomplicated malaria. We compared the efficacy and safety of Artemether-Lumefantrine (Coartem®) and Chlorproguanil-Dapsone (Lapdap®) in the management of uncomplicated malaria in pregnancy. Methodology: We enrolled 110 pregnant women in the second and third trimester of pregnancy who presented to Mulago hospital, Uganda, with uncomplicated malaria. The study design was an open-label randomized clinical trial. Participants were randomized to receive either Artemether-Lumefantrine (Coartem® 20mg/120mg) orally or Chlorproguanil-Dapsone (Lapdap®) orally for 3 consecutive days. Primary endpoints were clinical and parasitological response assessed on days 0, 1, 2, 4, 7, 14 and 28. Adverse effects, clinical response (treatment failure) and parasitological response were compared. Analysis was by intention to treat. Results: Of the 100 women who completed the study, there was no statistically significant difference in clinical and parasitological response by Day 4. The mean fever clearance time 3.0 days with Lapdap® versus 2.5 days with Coartem® was comparable. Likewise, mean parasite clearance time of 2.4 and 2.2 days for Lapdap® and Coartem® respectively was comparable. The adverse effects were comparable between the two groups. Conclusion: Artemether-Lumefantrine and Chlorproguanil-Dapsone have high and comparable cure rates and similar safety profiles when used for treatment of uncomplicated malaria in pregnancy.
Acceptability of study procedures (self‑collected introital swabs, blood draws and stool sample collection) by students 10–16 years for an HPV vaccine effectiveness study: a pilot study
(BMC Research Notes, 2016-03-16) Nakalembe, Miriam; Mutyaba, Twaha; Mirembe, Florence
A cohort study was planned to evaluate vaccine immunogenicity and effect of malaria and helminth co-infections on the bivalent Human papilloma virus (HPV) vaccine. The study would involve self collected introital swabs, blood draws and stool sample collection. We therefore conducted a pilot study to assess the acceptability of these procedures among the students and their parents. A cross-sectional study among forty four students from two purposively selected primary schools of Western Uganda. Exit interviews and two focus group discussions (FGD) (for parents) were conducted. Acceptability was measured by willingness to undergo the procedures again, recommending the procedures to others as well as proportion of introital swabs positive for β globulin. FGD determined acceptability of the parents and explored opinions and perceptions that would influence their decisions. HPV-16/18 and β globulin deoxyribonucleic acid (DNA) were analysed using a polymerase chain reaction (PCR) kit. All the students (100 %) in the study were willing to provide a self- collected introital swab and a stool sample as well as recommending their friends while (86.3 %) were willing for blood draws. There were 40/44 (90.1 %) self collected introital swabs that had positive result for human β globulin though none of them was positive for HPV-16/18. In the FGD, it emerged that parents concerns were on the blood draws and introital swab collection which were addressed. The study procedures were highly acceptable among this study population of students and their parents. Follow-up to assess HPV vaccine effectiveness and factors that may influence the vaccine in this age group is feasible.
Highly Heterogeneous Kaposi Sarcoma–Associated Herpesvirus Oral Shedding Kinetics Among People With and Without Kaposi Sarcoma and Human Immunodeficiency Virus Coinfection
(US: Oxford University Press., 2024-09-23) Krantz,Elizabeth M.; Mutyaba, Innocent; Nankoma, Janet; Orem, Jackson
An improved understanding of oral Kaposi sarcoma–associated herpesvirus (KSHV) viral dynamics could provide insights into transmission risk and guide vaccine development. We evaluated KSHV oral shedding dynamics in Ugandan adults stratified by Kaposi sarcoma (KS) and human immunodeficiency virus (HIV) status. Participants were followed for ≥4 weeks, with daily home oral swab collection to quantify KSHV using polymerase chain reaction. Shedding rates were defined by number of days with KSHV DNA detected divided by total days with swabs and compared by group using hurdle models. Two hundred ninety-five participants were enrolled; median age was 35 years (range, 18–71 years), and 134 (45%) were male. KSHV was detected more frequently among participants with KS (HIV positive [HIV+]/KS+, 56/76 [74%]; HIV negative [HIV−]/KS+, 9/18 [50%]) than those without KS (HIV+/KS−, 36/125 [29%]; HIV−/KS−, 16/76 [21%]); odds of shedding did not differ significantly by HIV status. Among participants with KSHV detected, shedding rates did not differ significantly by group. Median per-participant viral loads among positive samples were lowest in HIV+/KS+ (3.1 log10 copies/mL) and HIV−/KS+ (3.3 log10 copies/mL) participants relative to HIV+/KS− (3.8 log10 copies/mL) and HIV−/KS− (4.0 log10 copies/mL) participants. All groups had participants with low viral load intermittent shedding and participants with high viral load persistent shedding. Within each group, individual KSHV shedding rate positively correlated with median KSHV log10 copies/mL, and episode duration positively correlated with peak viral load. Oral KSHV shedding is highly heterogeneous across Ugandan adults with and without KS and HIV. Persistent shedding is associated with higher median viral loads regardless of HIV and KS status.
Soluble Markers of B-Cell Stimulation During Asymptomatic and Symptomatic Malaria Parasitemia in Children in Uganda
(JCO Global Oncology, 2016-11-10) Mutyaba, Innocent; Byakika-Kibwika, Pauline; Phipps, Warren; Kamya, Moses
In vitro, Burkitt lymphoma (BL) cell lines express high levels of several cytokines, including CCL3/MIP-1 alpha, CXCL10/IP-10, and IL-10, among others. These cytokines may promote lymphoma development through B- cell hyperstimulation. To understand the influence of malaria infection on cytokine expression in vivo and the potential role in BL development, we sought to characterize the expression of specific cytokines during malaria among children from a region where malaria and BL are endemic. We studied children participating in a prospective malaria cohort in Uganda. Plasma cytokines were assessed in each child at 3 time points representing 3 disease states: no malaria, asymptomatic malaria, and symptomatic malaria. We assessed both equality of cytokine distribution at the 3 time points using Kruskal-Wallis test and the factors associated with cytokine expression using generalized estimating equations. Among the 41 children, median age was 5.0 (0.8-10.3) years when normal, 5.9 (0.8-10.6) years during asymptomatic malaria, and 5.7 (0.5-10.8) years during symptomatic malaria; 39% (16/41) participants were female. There was a significant increase for IL-10 (p<0.001), IL-6 (p=0.04) and IP-10 (p=0.002) during malaria parasitemia compared to no malaria. In the adjusted models, for every one log increase in the parasite density, the odds of high IL10 expression increased by 80% (OR=1.8, 95% CI: 1.3-2.6, P=<0.001), the odds of high IL6 by 30% (OR=1.3, 95% CI: 1.0-1.7, p=0.04), and the odds of high TNFα by 40% (OR=1.4, 95% CI: 1.1-1.8, p=0.01). Younger children (0-4.9 years) had 400% (OR=5, 95% CI=1.7-25, p=0.001) increase in the odds of high IL10 expression compared to older counterparts (5-11 years). Infection with malaria parasites is associated with an immunological response characterized by elevated B-cell stimulatory cytokines including: IL10, IL6, TNFalpha and IP10. These cytokines may mediate B-cell stimulation and related oncogenic DNA changes that lead to BL. Results of EBV viremia are forthcoming.
Association Between HIV Infection and Cancer Stage at Presentation at the Uganda Cancer Institute
(J Glob Oncol, 2018-10-16) Menon, Manoj P.; Mutyaba, Innocent O.; Okuku, Fred M.; Orem, Jackson; Casper, Corey
The HIV epidemic has contributed to the increasing incidence of cancer in sub-Saharan Africa, where most patients with cancer present at an advanced stage. However, improved access to HIV care and treatment centers in sub-Saharan Africa may facilitate earlier diagnosis of cancer among patients who are HIV positive. To test this hypothesis, we characterized the stage of cancer and evaluated the factors associated with advanced stage at presentation among patients in Uganda. We conducted a retrospective analysis of adult patients with any of four specific cancers who presented for care in Kampala, Uganda, between 2003 and 2010. Demographic, clinical, and laboratory data were abstracted from the medical record, together with the outcome measure of advanced stage of disease (clinical stage III or IV). We identified measures for inclusion in a multivariate logistic regression model We analyzed 731 patients with both AIDS-defining cancers (cervical [43.1%], and non-Hodgkin lymphoma [18.3%]), and non–AIDS-defining cancers (breast [30.0%] and Hodgkin lymphoma [8.6%]). Nearly 80% of all patients presented at an advanced stage and 37% had HIV infection. More than 90% of patients were symptomatic and the median duration of symptoms before presentation was 5 months. In the multivariate model, HIV-positive patients were less likely to present at an advanced stage as were patients with higher hemoglobin and fewer symptoms. Patients with limited access to primary care may present with advanced cancer because of a delay in diagnosis. However, patients with HIV now have better access to clinical care. Use of this growing infrastructure to increase cancer screening and referral is promising and deserves continued support, because the prognosis of HIV-positive patients with advanced cancer is characterized by poor survival globally.
Intrinsic Brainstem Epidermoid: Case Report and Literature Review
(Wits Journal of Clinical Medicine, 2020-11-09) Labuschagne, Jason; Mutyaba, Denis; Koranteng, Promise
Epidermoid cysts are rare lesions of the central nervous system, representing 1-2% of all intracranial tumours. These mass lesions are typically found in the parasellar region or cerebellopontine angle. As far as we are aware only 15 cases of an intrinsic brainstem epidermoid have been reported in the pediatric population to date. We report a case in which an 8-yearold male patient with an intrinsic brainstem epidermoid was misdiagnosed and treated as a diffuse intrinsic pontine glioma (DIPG). The child was subsequently referred to our unit failing response to treatment at the index hospital. Magnetic resonance imaging (MRI) revealed a well-defined lesion, with clearly distinct borders, that was hypointense on T1WI, hyperintense on T2WI, had minimal contrast enhancement and had restricted diffusion on the DWI/ADC map. With the aid of intra-operative neurophysiological monitoring he underwent surgical resection of the lesion. Histopathology revealed abundant nucleated and anucleated squamous cells, in keeping with an epidermoid tumor. Clinical follow up at 3 months post-surgery showed significant improvement in the child’s pre-surgical neurological function. Follow up MRI at 3 months and a year post surgery revealed that the lesion is stable following near total resection. The objective of this case report is to highlight this unusual condition which may otherwise be misdiagnosed and to encourage a more universal acceptance of the need for either brainstem biopsies in atypical brainstem lesions or formal resection of lesions amenable to safe surgical resection.
Intra‑operative monitoring as an adjuvant to standard vagus nerve stimulation implantation
(Child's Nervous System, 2021-07-23) Labuschagne, Jason; Mutyaba,Denis; Casieri, Claudia
The treatment of refractory epilepsy by vagus nerve stimulation (VNS) is a well-established therapy. Complications following VNS insertion may be procedure-related or stimulation-related. Herein, we describe our technique of intra-operative neuro-monitoring (IONM) in an attempt to diminish these adverse events. This retrospective study describes 66 consecutive patients between the ages of 3 and 12 years who had undergone primary VNS implantation. The study population consisted of two cohorts, one in which the VNS device was implanted according to the standard described technique and a second group in which IONM was used as an adjuvant during the VNS device placement. Prior to VNS insertion, a Pediatric Voice Handicap Index (PVHI) was performed to assess voice-related quality of life, and this was repeated at 3 months following VNS insertion. Sixty-six patients underwent the VNS implantation. Forty-three patients had a “standard” VNS insertion technique performed, whereas 23 had IONM performed during the VNS implantation. There were significant changes in the PVHI scores across both cohorts at 3-month follow-up. There were no statistically significant differences in PVHI scores between the monitored group and non-monitored group at 3-month follow up. IONM can be used during VNS insertions to ensure correct placement of the leads on CNX. IONM may minimise vocal cord stimulation by placing the lead coils on the area of nerve eliciting the least amount of vocal cord EMG response. IONM however does not appear to improve voice outcomes at early follow up.
Characterising people who inject drugs, and association with HIV infection: A situation analysis in Kampala City, Uganda
(PLOS Global Public Health, 2025-02-26) Mudiope, Peter; Nangendo, Joanita; Mutyaba, Samuel; Mutamba, Byamah B.; Nanyenya, Nicholus; Makumbi, Fredrick; Laker-Oketta, Miriam; Wanyenze, Rhoda
Uganda implements interventions for injection drug use, but significant barriers hinder efforts to effectively reach and support persons who inject drugs (PWID). We describe characteristics of PWID, and associated risk behaviour, to inform the designing of programmes that are tailored to clients’ needs and preferences. A cross-sectional survey (August 23rd to December 5th, 2023) in Kampala interviewed 354 PWID (≥18-years) at selected venues(bars,lodges, street corners and ghetto). Peer eductors and counsellors administered a structured questionnaire covering socio-demographics, drug use, sexual risk, and medical history. HIV serostatus was determined by self-report or testing for consenting participants without history of recent testing Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviour of PWID. Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues included fever (32.9%), cough (32.5%), malaria (22%), and sexually transmitted infections (15%). Over 82.6% were introduced to drugs by close acquaintances. HIV prevalence among participants was 3.7%, higher in females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status. Our study provides valuable insight into the socio-demographic, mental, physical health, and HIV risk behaviour of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence in this population compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviour suggests an urgent need for targeted interventions to address these intertwined challenges.
Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute
(Plos on, 2018-02-01) Menon, Manoj; Mutyaba, Innocent; Okuku, Fred; Orem, Jackson
Cancer treatment options in sub-Saharan Africa are scarce despite an increasing burden of disease. Identification of those cancer patients who would benefit most from the limited resources available would allow broader and more effective therapy. We conducted a retrospective analysis of patients over the age of 18 at the time of a pathologic diagnosis of NHL between 2003 and 2010 who were residents of Kyandondo County (Uganda) and presented to the Uganda Cancer Institute for care. A total of 128 patients were included in this analysis. Chemotherapy was recommended to 117 (91.4%) of the patients; the odds of recommending chemotherapy decreased for each additional month of reported symptoms prior to diagnosis. Of the 117 patients to whom chemotherapy was recommended, 111 (86.7%) patients received at least 1 cycle of chemotherapy; HIV infected patients, as well as those with a lower hemoglobin and advanced disease at the time of diagnosis were significantly less likely to complete therapy. Among the patients who initiated chemotherapy, twenty patients died prior to treatment completion (including nine who died within 30 days). Hemoglobin level at the time of presentation was the only variable associated with early mortality in the adjusted model. In resource-poor areas, it is essential to align health care expenditures with interventions likely to provide benefit to affected populations. Targeting cancer therapy to those with a favorable chance of responding will not only save limited resources, but will also prevent harm in those patients unlikely to realize an effect of cancer-directed therapy
‘If her body responds then you know she wants it’: a qualitative study on how young people in Ecuador and Uganda understand and practice consent
(Taylor & Francis group, 2025-06-26) De Meyer, Sara;; Lau, Katie;; Kemigisha, Elizabeth ;; Cevalllos, Ana;; Rost, Lucia;; Michielsen, Kristien;; Kågesten, Anna;; van Reeuwijk, Miranda
Background Although progress has been made, adolescent sexual and reproductive health and rights (ASRHR) remain a global public health concern and continued investments are necessary. The way young people perceive, and experience sexual consent is at the centre of free and informed decision-making, a critical element of ASRHR. Nevertheless, the evidence on young people’s views of sexual consent remains limited, especially in low- and middle-income countries. Objectives To explore how young people (aged 18 to 26) understand and practice sexual consent in low- and middle-income countries. Methods Qualitative in-depth interviews and focus group discussions were conducted among 173 young people in Ecuador (Guayaquil) and Uganda (Kampala city), involving young people in data collection and analysis. The Hickman and Muehlenhard’s (1999) framework was used to categorize the ways young people express sexual consent: direct and indirect verbal and nonverbal signals. Results We found that reflecting on sexual consent was relatively new for many participants and challenging to define. Few young people seemed to know how to apply consent in their daily lives, explaining that asking consent was often not possible in their relationships and sexual encounters. Influencing factors such as gender norms, the type of relationship and age were mentioned. Non-direct, non-verbal consent were the most commonly used strategies, meaning that sexual consent was mostly interpreted from body language or indirect questions – opening a window for sexual risks. Conclusion Our findings call for SRHR programming that promotes communication and equality and supports skills in recognizing, giving and receiving sexual consent.
Surgical outcomes of brain tumors in Africa: challenges, progress, and future perspectives
(Springer Berlin Heidelberg, 2025-06-05) Aderinto, Nicholas;; Olatunji, Gbolahan;; Kokori, Emmanuel ;; Ogieuhi, Ikponmwosa Jude;; Babalola, Adetola Emmanuel;; Lawal, Zainab Doyinsola;; Woldehana, Nathnael Abera;; Isarinade, David Timilehin;; Aboje, John Ehi;; Isarinade, David Timilehin;; Nazar, Muhammad Wajeeh;; Adewumi, Adeola Elizabeth;; Agbo, Chinonyelum Emmanuel
Abstract Background Brain tumors pose a significant health challenge globally, with limited comprehensive data on their surgical outcomes in Africa. This review explores the surgical landscape, challenges, and future directions for brain tumor management on the continent. Main body The prevalence of brain tumors in Sub-Saharan Africa, notably in Nigeria, Egypt, and Uganda, underscores the need for improved strategies. Despite challenges such as limited resources, studies demonstrate the feasibility and safety of neurosurgical interventions, emphasizing the adaptability of practices in resource-constrained environments. The review addresses risk factors, genetic considerations, and highlights the urgent need for expanded genomic studies in Africa. Challenges, including limited healthcare access, lack of specialized services, and socioeconomic factors, hinder optimal outcomes. Policymakers are urged to prioritize neurosurgical infrastructure, implement training programs, and foster international collaborations. Telemedicine, public awareness campaigns, and research initiatives are crucial components for enhancing surgical outcomes. Conclusion The proposed comprehensive policy approach aims to overcome barriers, improve access, and ultimately contribute to global efforts in combating brain tumors in Africa.
Term stillbirths in Eastern Uganda: a community-based prospective cohort study
(Taylor & Francis, 2025-02-03) Chebet, Martin;; Olupot-Olupot, Peter;; Weeks, Andrew D ;; Engebretsen, Ingunn Marie S;; Okalany, Noela Regina Akwi;; Okello, Francis;; Tylleskär, Thorkild;; Burgoine, Kathy;; Mukunya, David
Main findings: Prolonged labour and malaria were the most common attributable causes of term stillbirths in Eastern Uganda, while intimate partner violence and advanced maternal age were the identified risk factors. Added knowledge: Since there are limited recent data on stillbirths that include children born at home in Uganda, these results, which are based on over 6000 births, contribute to a better understanding of the current incidence, the common attributable causes and the risk factors of stillbirths in Uganda. Global health impact for policy and action: These results underscore the need for public health interventions to improve labour care, prevent malaria in pregnancy and reduce intimate partner violence in order to reduce stillbirths in Uganda.
Effect of prolonged cooking on pro-vitamin A levels of biofortified East African highland bananas
(Taylor & Francis, 2025-07-09) Buah, Stephen;; Kiwummulo, Janefer;; Paul, Jean-Yves ;; Walugembe, Joel;; Wegesa, Jackline;; Tumuhimbise, Robooni;; Tushemereirwe, Wilberforce
Genetically modified East African highland bananas (EAHBs) with elevated levels of pro-vitamin A (pVA) have been developed to address vitamin A deficiency (VAD) in Uganda. The green, mature fruits of EAHBs are traditionally prepared into “matooke,” a soft, savory dish made by peeling, steaming, and mashing the fruit. Biofortifying such a culturally embedded food offers an effective approach to improving nutrition, particularly among vulnerable populations. Field trials of pVA-biofortified EAHBs have been conducted at four locations across Uganda, with data collection nearing completion. However, the effect of prolonged cooking, a common traditional preparation method, on pVA carotenoid retention had not been evaluated. This study investigated the retention of β-carotene equivalents (β-CE) during extended cooking in two elite events, each of hybrid M9 and Nakitembe. After 1 h of cooking, β-CE concentrations declined significantly in both wild-type and biofortified lines. Further cooking, up to 8 h, did not result in additional significant losses. By the eighth hour, β-CE levels remained above the target threshold of 20 µg/g dry weight (DW) in one M9 event (21.7 µg/g DW) and both Nakitembe events (28.7 and 27.6 µg/g DW), compared to 12.8 and 17.6 µg/g DW in their respective wild-type controls. This confirms that the biofortified bananas can deliver meaningful nutritional benefits under customary preparation methods. These results are not only pivotal for selecting final lead and backup events but also provide compelling evidence of trait stability, further supporting the case for deployment of biofortified EAHBs to improve public health outcomes in East Africa.
Association between hyperuricemia and adverse perinatal outcomes among women with preeclampsia at a tertiary hospital in Southwestern Uganda: a prospective cohort study
(Nature Publishing Group, 2025-04-27) Omar Wehlie, Hani;; Fajardo Tornes, Yarine;; Businge, Julius ;; Byamukama, Onesmus;; Kayondo, Musa;; Kato Kalyebara, Paul;; Ngonzi, Joseph;; Lugobe, Henry Mark;; Ainomugisha, Brenda;; Tibaijuka, Leevan
Pre-eclampsia is a major cause of adverse perinatal outcomes, such as preterm birth and perinatal deaths, at Mbarara Regional Referral Hospital (MRRH). While serum uric acid is a crucial marker for predicting adverse outcomes, it is not routinely assessed. This study aimed to compare the incidence of adverse perinatal outcomes between women with and without hyperuricemia and determine the association between hyperuricemia and adverse perinatal outcomes among women with preeclampsia at MRRH. We conducted a prospective cohort study from March 2024 to June 2024 at the maternity ward of MRRH. We consecutively enrolled women diagnosed with preeclampsia who were at least 26 weeks gestational age and assessed their serum uric acid levels upon admission. The primary exposure was hyperuricemia (>6mg/dl) while the primary outcome was adverse perinatal outcomes. We compared the incidence of adverse perinatal outcomes among those with and without hyperuricemia using Chi-square and used multivariable modified Poisson regression analysis to determine the association between hyperuricemia and adverse perinatal outcomes among women with preeclampsia. Among the 111 women enrolled (mean age 28.3 ± 6.5 years), 43 (38.7%) had hyperuricemia. Adverse perinatal outcomes occurred in 55.9% (62/111). Women with hyperuricemia had higher rates of adverse outcomes (88%, = 38/43) than those without (35%, = 24/68). Specific outcomes were significantly more frequent among hyperuricemic women: fresh stillbirth (21% vs. 0%), low birth weight (49% vs. 26%), Apgar score <7 at 5 min (26% vs. 1%), NICU admission (76% vs. 26%), and early neonatal death (32% vs. 0%), < 0.05. Hyperuricemia was linked to a two-fold increased risk of one or more adverse outcomes (aRR 2.42, 95% CI: 1.54-3.80), fresh stillbirth (aRR 3.14, 95% CI: 1.79-5.48), low Apgar score (aRR 31.5, 95% CI: 3.8-260.9), NICU admission (aRR 2.44, 95% CI: 1.86-4.49), and early neonatal death (aRR 12.1, 95% CI: 4.22-33.98). Hyperuricemia is common in preeclamptic women at MRRH and is associated with significantly higher rates of complications. Routine serum uric acid testing is recommended for early detection and timely intervention to improve maternal and neonatal health outcomes. MEDLINE

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