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Item Nodding syndrome: an enigmatic neglected tropical disease, a newly recognized neurodegenerative disorder with regional clusters in East Africa; could it be an early-onset Alzheimer´s disease?(PAMJ Clinical Medicine, 2021-12) Kitara, David Lagoro; Lemos, Bernardo; Bump, Jesse BoardmanNodding Syndrome (NS) is an enigmatic childhood neurological disorder clustered in East Africa. Histo-immunopathological analysis of brains of deceased NS children showed brain atrophy, neurofibrillary tangles, and tau protein deposition mainly in the entorhinal cortex. The aim of this paper is to describe the clinical and neurological presentations, to use Modified Rankin Scale (MRS) to assess disability and observe possible similarities to an early-onset Alzheimer´s disease. Methods: a case-control study involving 21 NS cases, 21 age and sex-matched community controls, 21 younger healthy siblings and 21 biological parents was conducted. Each NS child and controls underwent clinical and neurological examinations and MRS was used to assess the level of disability. Ethical approval was obtained, and STATA version 14.1 was used for data analysis. A p-value less than 0.05 was considered significant. Results: children with NS exhibited significant cognitive disability in many ways, including poor immediate recall (short-term memory) 15/21 (71.4%), disorientation 13/21 (61.9%), muteness 4/21 (19.0%), poor delayed recall 11/21 (52.4%), and poor concentration 9/21 (42.9%). Just over half of NS-affected children 11/21 (52.4%) exhibited abnormal coordination of limb movements, but majority had normal cranial nerves 18/21 (85.7%), slightly less than half had a normal gait 10/21 (47.6%), and no significant association was observed between poor MRS (score ≥2) with; current age (χ2=4.039, p=0.854), underweight (χ2=1.636, p=0.201), age at onset (χ2=10.611; p=0.389), and reported duration of the syndrome (χ2=4.604, p=0.466). Conclusion: clinical and neurological findings suggest cognitive decline is related primarily to disorders of entorhinal cortex similarly observed in early-onset Alzheimer´s disease. It may not be too early to to suggest that NS is an early-onset Alzheimer´s disease. suggest that NS is an early-onset Alzheimer´s disease.Item Nodding Syndrome (NS) in Northern Uganda(British Journal of Medicine & Medical Research, 2013) Kitara, David Lagoro; Mwaka, Amos Deogratius; Anywar, Denis Arony; Uwonda, Gilbert; Abwang, Bernard; Kigonya, EdwardAims: To conduct an epidemiological study to establish the association between malnutrition, metabolic disorder and Onchocerciasis to Nodding Syndrome (NS) in Northern Uganda. Study Design: Case-control study design. Place and Duration of Study: Odek and Atiak sub counties in Gulu and Amuru districts between 10th to 20th June 2012. Methodology: We recruited consecutively 101 children with probable NS in the 2 sub counties in Gulu and Amuru districts. Controls were from the same population but without symptoms of NS and were matched by age, sex and residents. History and physical examinations were conducted; anthropometry, blood samples and skin snips were obtained from cases and controls. Researchers were pediatricians, psychiatrists, nurses, laboratory scientists and epidemiologists. The research proposal was approved by the Ministry of Health and the IRB of Gulu University. Results: There was a statistically significant association between NS with malnutrition (t=0.142; p=0.044), Onchocerciasis (Χ2 = 152.74, p<0.001; OR 7.025 95% CI 3.891, 12.682) and High Anion Gap (Χ2=146.752, p<0.001; OR 6.313 95%CI 4.027, 9.895). Conclusion: Nodding syndrome is associated with metabolic disorder in young children who are malnourished and infected with Onchocerciasis.Item Training Needs Assessment for Clinicians at Antiretroviral Therapy Clinics: evidence from a national survey in Uganda(Human resources for health, 2009-08-23)To increase access to antiretroviral therapy in resource-limited settings, several experts recommend "task shifting" from doctors to clinical officers, nurses and midwives. This study sought to identify task shifting that has already occurred and assess the antiretroviral therapy training needs among clinicians to whom tasks have shifted. The Infectious Diseases Institute, in collaboration with the Ugandan Ministry of Health, surveyed health professionals and heads of antiretroviral therapy clinics at a stratified random sample of 44 health facilities accredited to provide this therapy. A sample of 265 doctors, clinical officers, nurses and midwives reported on tasks they performed, previous human immunodeficiency virus training, and self-assessment of knowledge of human immunodeficiency virus and antiretroviral therapy. Heads of the antiretroviral therapy clinics reported on clinic characteristics. Thirty of 33 doctors (91%), 24 of 40 clinical officers (60%), 16 of 114 nurses (14%) and 13 of 54 midwives (24%) who worked in accredited antiretroviral therapy clinics reported that they prescribed this therapy (p < 0.001). Sixty-four percent of the people who prescribed antiretroviral therapy were not doctors. Among professionals who prescribed it, 76% of doctors, 62% of clinical officers, 62% of nurses and 51% of midwives were trained in initiating patients on antiretroviral therapy (p = 0.457); 73%, 46%, 50% and 23%, respectively, were trained in monitoring patients on the therapy (p = 0.017). Seven percent of doctors, 42% of clinical officers, 35% of nurses and 77% of midwives assessed that their overall knowledge of antiretroviral therapy was lower than good (p = 0.001) Training initiatives should be an integral part of the support for task shifting and ensure that antiretroviral therapy is used correctly and that toxicity or drug resistance do not reverse accomplishments to date.Item Enablers of and barriers to ART adherence among female sex workers in mid-western Uganda: a qualitative study(BioMed Central Ltd, 2025-01) Apuulison, David Friday; Nabawanuka, Brenda; Muhoozi, Michael; Aryampa, Julian; Irumba, Pauline; Katsomyo, Edson; Asiimwe, Moses; Epuitai, Joshua; Akugizibwe, Pardon; George, Wasswa; Rubaihayo, JohnFemale sex workers (FSWs) in Uganda experience numerous barriers to antiretroviral therapy (ART) adherence. We used the planned behavior theory to help explore the enablers and barriers to ART adherence among FSWs. Understanding the barriers to ART adherence may help contribute to the development of interventions to improve ART adherence among the FSWs. A descriptive qualitative study was conducted in Fort portal City. We conducted 30 in-depth interviews among FSWs who had been taking ART for at least six months. Furthermore, six key informant interviews were conducted with healthcare workers and leaders of the FSWs initiative. Data collection lasted for two months. Thematic deductive analysis was applied to analyse the data through the lens of the theory of planned behavior. The attitudes, subjective norms, and perceived behavioral control influenced adherence to ART. Positive attitudes including perceived benefits of ART, and experiencing positive outcomes from taking ART were seen to enable its adherence. Subjective norms such as social support, disclosure of HIV status, seeing others take ART, and aspirations of longer life enabled ART adherence. Taking ART in the morning, responsive and respectful healthcare workers, and availability of food/basic needs facilitated compliance with ART adherence. Negative attitudes such as misconceptions and fear of side effects hindered ART adherence. Social disapproval of sex work and or HIV, lack of social support, gender-based violence, non-disclosure, stigma, and abandonment hindered the use of ART among FSWs. Socio-economic constraints (e.g., food scarcity), and occupation-related factors (substance use, incarceration, busy and predictable schedules, and abrupt migrations) were the additional barriers to ART adherence. ART adherence among FSWs was influenced by attitudes, subjective norms, and perceived behavioral control. Addressing these barriers in ART adherence through targeted interventions could facilitate ART adherence and improve health outcomes among FSWs. MEDLINEItem Development of a non-specialist worker delivered psychological intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda and Ukraine(BioMed Central Ltd, 2025-01) Nadkarni, Abhijit;; Massazza, Alessandro;; Tol, Wietse A ;; Bogdanov, Sergiy;; Andersen, Lena S;; Moore, Quincy;; Roberts, Bayard;; Weiss, Helen A;; Singh, Soumya;; Neuman, Melissa;; May, Carl;; Fuhr, Daniela CDespite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs).BACKGROUNDDespite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs).CHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs.METHODSCHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs.In the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3).RESULTSIn the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3).CHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine.CONCLUSIONSCHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine. MEDLINE - AcademicItem Community health system capacities and capabilities within an evolving community health policy framework: mixed methods study of stakeholders in central Uganda(British Medical Journal Publishing Group, 2025-01) Kabanda, Richard;; Ocaatre, Ronald Miria;; Atwine, Diana ;; Kim, Bounggui;; Waiswa, Simon Erisa;; Kavuma, Prichard Denzel;; Lee, Yeni;; Mutoni, Loretah;; Kim, Solyi;; Park, Yein;; Okuga, Monica;; Tweheyo, RaymondEmpowering communities through identifying and unlocking community capacities and capabilities is vital for improving community health systems. This study assessed the community health system's status quo and readiness for implementing a government-led, partner-supported community health worker project.OBJECTIVESEmpowering communities through identifying and unlocking community capacities and capabilities is vital for improving community health systems. This study assessed the community health system's status quo and readiness for implementing a government-led, partner-supported community health worker project.A mixed methods cross-sectional study.DESIGNA mixed methods cross-sectional study.Two districts and one city in central Uganda.SETTINGTwo districts and one city in central Uganda.21 key informants (KIIs) with district leaders, 4 focus group discussions (FGDs) with community health workers (CHWs) termed as village health teams in the Ugandan setting and a survey of 487 CHWs and 419 pregnant women who had childbirth 12 months before.PARTICIPANTS21 key informants (KIIs) with district leaders, 4 focus group discussions (FGDs) with community health workers (CHWs) termed as village health teams in the Ugandan setting and a survey of 487 CHWs and 419 pregnant women who had childbirth 12 months before.KIIs and FGDs explored community health system resources using the WHO health systems building blocks and the UNICEF health system strengthening maturation model. However, the surveys explored the work-related attributes and services delivered by the CHWs and to the community, respectively.STUDY MEASURESKIIs and FGDs explored community health system resources using the WHO health systems building blocks and the UNICEF health system strengthening maturation model. However, the surveys explored the work-related attributes and services delivered by the CHWs and to the community, respectively.A framework analysis was used for qualitative data in NVivo 14. While descriptive and stratified analyses were conducted for quantitative data in Stata I/C 15.0: proportions for the varied geographical entities were compared using the t-test with p values <0.05 considered significant, one-way ANOVA was used to compare means.ANALYSISA framework analysis was used for qualitative data in NVivo 14. While descriptive and stratified analyses were conducted for quantitative data in Stata I/C 15.0: proportions for the varied geographical entities were compared using the t-test with p values <0.05 considered significant, one-way ANOVA was used to compare means.Overall, all sites had relatively strong governance of community health only challenged by multiple implementing partners that were weakly coordinated. There was an exclusive paper-based information management system that linked to the national DHIS-2 software. Community reporting rates varied between 20% and 80%. Community health financing was weak, similarly to commodities availability. The mean age of the community health workforce was high at 50.9 (SD 11.9); the majority reported adequate skills in service delivery except for community first aid, Kangaroo mother care and noncommunicable diseases. Households' most received CHW services included home visits, treatment for sick under-five children and child immunisation.RESULTSOverall, all sites had relatively strong governance of community health only challenged by multiple implementing partners that were weakly coordinated. There was an exclusive paper-based information management system that linked to the national DHIS-2 software. Community reporting rates varied between 20% and 80%. Community health financing was weak, similarly to commodities availability. The mean age of the community health workforce was high at 50.9 (SD 11.9); the majority reported adequate skills in service delivery except for community first aid, Kangaroo mother care and noncommunicable diseases. Households' most received CHW services included home visits, treatment for sick under-five children and child immunisation.The existing CHW system has governance and reporting strengths but could be enhanced through revitalization, enhanced coordination of stakeholders, providing appropriate training, work tools, supervision and engaging the community for accountability of results.CONCLUSIONSThe existing CHW system has governance and reporting strengths but could be enhanced through revitalization, enhanced coordination of stakeholders, providing appropriate training, work tools, supervision and engaging the community for accountability of results.Item Professional Image of Nursing and Midwifery in East Africa: an Exploratory Analysis(BMC nursing, 2021-03-06) Ndirangu, Eunice Wambui; Sarki, Ahmed Mohammed; Mbekenga, Columba; Edwards, GraceEvidence suggests that there is a negative image of nursing and midwifery that does not promote these professions as attractive career options. Furthermore, there is a paucity of studies documenting how nursing and midwifery is perceived in East Africa and where such studies exist they are country-specific. The aim of this study was to explore views regarding the image of nursing and midwifery among nurses and midwives in three East African countries, Kenya, Tanzania and Uganda. An exploratory descriptive cross-sectional study administered online using Survey Monkey Questionnaires assessed the views and perceptions of nurses and midwives regarding the image of nursing and midwifery professions. Descriptive statistics and Pearson’s Chi square tests were used to analyse the data. The semi-structured questions were analysed using content analysis. A total of 551 participants took part in the study. The majority were females (61.8%), registered nurses/ midwives (45.8%), and aged 30–39 years (34.2%). Most of the respondents were from Kenya (39.7%) and Uganda (32.9%). About two-thirds of the nurses and midwives in this study perceived nursing/midwifery as both trusted and respected professions and expressed having a level of control over how their image was portrayed. Conversely, the nurses and midwives were conscious that the public had mixed responses about the nursing/midwifery professions specifically, some members of the public described nurses/midwives as professionals, knowledgeable and caring, others perceived nurses/midwives to be rude, cruel, unkind, lazy, unkempt, and maids. This study offers an interesting insight about the image of nursing/midwifery in East Africa. Findings from this study will inform policy makers and educators about key concepts that affect the image of nursing and midwifery in East Africa. The findings will be used to design marketing materials to help improve the image of nursing and midwifery in the region and other African countries.Item Open and Distance Learning Programs for Nursing and Midwifery Education in East Africa: Protocol for a Scoping Review(JMIR research protocols, 2021-01-11) Isangula, Kahabi; Tumbwene, Mwansisya; Columba, Mbekenga; Pallangyo, Eunice; Ndirangu-Mugo, EuniceIn the face of growing modernity and the coronavirus disease 2019 (COVID-19) pandemic, open and distance learning (ODL) is considered to play an important role in increasing access to education worldwide. There is a robust evidence base demonstrating its cost effectiveness in comparison with conventional class-based teaching; however, the transition to this new paradigm of learning for nursing and midwifery courses has been difficult in low-income countries. While there are notable efforts to increase internet and education access to health care professionals, not much is known about ODL for nurses and midwives in East African countries. The objective of this scoping review is to understand whether ODL programs for nursing and midwifery education exist, the drivers of their adoption, their implementation, the topics/courses covered, their acceptability, and their impacts in East African countries. The scoping review methodology employs the framework developed by Arksey and O’Malley. Using an exploratory approach, a two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing ODL initiative for nurses and midwives in Uganda, Tanzania, and Kenya. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardized form.Item Prevalence of Hypertension in Low- and Middle-Income Countries A Systematic Review and Meta-Analysis(Medicine, 2015-12-19) Sarki, Ahmed; Nduka, Chidozie U.; Kandala, Ngianga-Bakwin; Uthman, Olalekan A.Item Prevalence of sickle cell trait and needs assessment for uptake of sickle cell screening among secondary school students in Kampala City, Uganda(Plos one, 2024-01-19) Namukasa, Shamim; Maina, Rose; Among, Grace; Atukwatse, Joseph; SarkiI, Ahmed M.Sickle cell disease (SCD) is one of the most frequent and traumatizing genetic disease in Uganda, with the prevalence of the sickle cell trait (SCT) estimated at 13.3% leading to serious psycho-social and economic impact on the patients and their families.Item Factors Influencing the Use of Multiple HIV Prevention Services among Transport Workers in a City in South Western Uganda(PLOS Global Public Health, 2023-03-02) Betunga, Benjamin; Atuhaire, Phionah; Mugisha, Richard; Asiimwe , John BaptistThe use of multiple HIV prevention services has been found to decrease the risk of acquiring HIV when tailored to individuals at risk of HIV exposure, including transport workers. Therefore, we assessed the uptake of multiple HIV prevention services (≥2) and associated factors among transport workers in a city in Southwestern Uganda. This cross-sectional study comprised motorcycle taxi riders, motor vehicle and truck drivers, aged 18 to 55 years who were selected and responded to an interviewer-administered questionnaire, between November 2021 and February 2022. Data was analyzed using descriptive statistical and modified Poisson regression analyses. Out of 420 participants, 97.6% were male, with a median age of 28 years and the majority were aged <34 years (84.6%). Overall, less than half (45.3%) of the participants had used multiple (≥2) HIV prevention services within a one-year period. Many participants had used condoms (32.2%) followed by voluntary HIV counseling and testing (27.1%), and safe male circumcision (17.3%). Most participants who tested for HIV had ever used condoms (16.2%), followed by those who received safe male circumcision and had ever used condoms (15%), and those who tested for HIV and had started on antiretroviral therapy (ART) (9.1%). In the adjusted model, factors that were significantly associated with the use of multiple HIV prevention services included religion (aPR = 1.25, 95% CI = 1.05–1.49), the number of concurrent sex partners (aPR = 1.33, 95% CI = 1.10–1.61), prior HIV testing and awareness of HIV serostatus (aPR = 0.55, 95% CI = 0.43–0.70), awareness of HIV prevention services (aPR = 2.49, 95% CI = 1.16–5.38), and financial payment to access HIV services (aPR = 2.27, 95% CI = 1.47–3.49). In conclusion, the uptake of multiple HIV prevention services among transport workers remains suboptimal. Additionally, individual behavioral factors influence the use of multiple HIV services compared with other factors. Therefore, differentiated strategies are needed to increase the utilization of HIV prevention services among transport workers.Item Predictors of HIV Knowledge, Perceived Stigma and Risk among Transport Workers in Mbarara City, Southwestern Uganda(The East African Health Research Journal, 2024-06-26) Betunga, Benjamin; Nuwabine, Lilian; Katushabe, Eve; Among ,Grace; Asiimwe, John BaptistThe human immunodeficiency virus (HIV) prevalence among transport workers in sub-Saharan Africa remains high, estimated at as high as 9.9% in western Uganda compared with the national prevalence of 5.4%. The prevalence of HIV among transport workers has been partly attributed to the level of knowledge regarding HIV prevention, perceived HIV risk, and stigma. Accordingly, these have been linked to high-risk HIV transmission behaviours that increase the chances of acquiring HIV among adults. Therefore, this study investigated the predictors of HIV knowledge, perceived HIV risk, and stigma among transport workers in Mbarara city in southwestern Uganda.Item Capacity Building among Nursing and Midwifery Professional Associations in East Africa(Global Health Action, 2022-10-24) Ruhmel, Stephen; Ndirangu-Mugo, Eunice; Mwizerwa, Joseph; Pallangyo,EuniceDespite improvements in educational opportunities, policy changes, and pay raises in the nursing and midwifery professions in East Africa, poor working conditions, few professional development opportunities, and a general lack of respect for these professions predominate. These issues contribute to a low quality of care among a population with a high burden of communicable diseases. Health professional associations may help to address these challenges by providing a voice for nurses and midwives.Item The Traditional Medicine Practitioner’s Concept of Cancer, Herbal Medicine use and the Patients Perceived Benefits (Clinical outcomes) in Selected Districts of Central Uganda: An Exploratory Study Protocol(Research Square, 2021-10-01) Asiimwe, John Baptist; Nagendrappa, Prakash B.; Atukunda, Esther C.; Nambozi, Grace; Ogwang, Patrick E.; Sarki, Ahmed M.; Kamatenesi, Maud M.In sub-Saharan Africa, herbal medicine for cancer is dispensed by traditional medicine practitioners (TMPs) to a large extent, who may not have adequate knowledge about the disease and this has been found to contribute to the late presentation of cancer patients to clinics and hospitals leading to poor patient outcomes.Item Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya(International Journal of Africa Nursing Sciences, 2019-10-17) Kabo, Jane W.; Holroyd, Eleanor; Edwards, Grace; Sarki, Ahmed M.To clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. A descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. The majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). Attention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya.Item Delayed completion of pneumococcal conjugate vaccination among children 4–48 months in rural Uganda: a socio-demographic inquiry(BioMed Central Ltd, 2025-01) Malemo, Herbert;; Tamale, Andrew;; Kakwangire, Paul ;; Igwe, Matthew C.;; Mwine, Dickens R.;; Asiimwe, Isa;; Mbina, Solomon A.;; Abalinda, Mary G.In spite of the commendable global Pneumococcal Conjugate Vaccine (PCV) coverage in the last two decades, completion and timeliness of receipt of all the required doses are still below target. In Uganda, the 3 + 0 PCV regimen has been reported to have a steady decline in the completion rate and the reasons for the delayed completion are unidentified. This study aimed at assessing the influence of socio-demographic factors on delayed PCV completion among young children. A cross-sectional study design among 362 child/caretakers pairs in Bugongi Town Council was employed. Using stratified sampling – Allocation Proportional to Size, data was collected using pretested questionnaires; entered and analysed using STATA v14 and significant statistical association was considered at P ≤ 0.05. Of the 362 children, majority (53.87%) were boys. Child mean age was 25.1 ± 14.3 months. 87.6% caretakers were females and majorities of them were aged 20–29yrs (47.8%), peasant farmers (79.8%), married (90.6%), attained primary education (63.5%) and earned average monthly income of UGX 10,000 – UGX 50,000 (41.4%). Of the 362 children, 92 (25.4%) had delayed to receive their PCV-3 doses. Only boy child [cOR = 1.65, (95%CI: 1.03–2.66); P = 0.039) and caretaker’s age 30–39 [cOR = 2.12 (95%CI: 1.06–4.24); P = 0.033) showed statistical significance at bivariate analysis. The multivariate model found parent’s age 20–29 years [aOR = 2.39 (1.14–5.01); P = 0.021] and 30–39 years [aOR = 2.51 (1.16–5.45); P = 0.020] as positively associated factors whereas being married [aOR = 0.20 (0.04–0.96); P = 0.044] was the only negatively associated factors to delayed completion of PCV vaccination among young children. Among children who complete the last dose of PCV vaccination, a considerable proportion are actually receiving it late which may result into eventual failure to curb the targeted pneumococcal infections. Thus, concerted efforts in terms of sensitization are un-doubtfully desired especially among caretakers aged 20–39 years as well as those who are not married.Item Determinants of continuation on HIV pre-exposure propylaxis among female sex workers at a referral hospital in Uganda: a mixed methods study using COM-B model(BioMed Central Ltd, 2025-01) Kawuma, Samuel; Katwesigye, Rodgers; Walusaga, Happy; Akatukunda, Praise; Nangendo, Joan; Kabugo, Charles; Kamya, Moses R; Semitala, Fred CFemale sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre-exposure prophylaxis (PrEP) has been recommended as a key component of the HIV combination prevention strategy. Although patient initiation of PrEP has improved, continuation rates remain low. This study evaluated PrEP continuation among FSWs and explored potential determinants of PrEP adherence within a public referral hospital in urban Uganda. We conducted an explanatory sequential mixed method study at Kiruddu National referral hospital in Uganda. Secondary data on socio demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021 and data analyzed on July 15,2023. We used Kaplan-Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers. Of the 292 FSWs initiated on PrEP, median age was 26 years (interquartile range, 21-29), 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3-21). The continuation rates on PrEP at six (6) and 12 months were 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. However, the quantitative findings from the multivariable Cox Proportional Hazards Model did not align with the reported findings for the qualitative evaluation. Continuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness of PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.Item Prevalence, Circumstances, and Management of Acute Pesticide Poisoning in Hospitals in Kampala City, Uganda(Environmental health insights, 2017-09-04) Ssemugabo,Charles; Halage, Abdullah Ali; Neebye, Ruth Mubeezi; Nabankema, Victoria; Kasule, Massy Moses; Ssekimpi, Deogratius; Jørs, ErikThis study was aimed at assessing prevalence, circumstance, and management of acute pesticide poisoning in hospitals in Kampala. It was a retrospective cross-sectional study that involved reviewing of 739 poisoning patient records from 5 hospitals in Kampala. Of the 739 patients, 212 were due to pesticide poisoning resulting in a prevalence of 28.8%. About 91.4% (191/210) of the cases were due to organophosphate poisoning, 63.3% (133/210) were intentional, and 98.1% (206/210) were exposed through ingestion. Diagnosis was majorly based on poisoning history 91.2% (187/205), and clinical features such as airways, breathing, and circulation examination 48.0% (95/198); nausea and vomiting 42.9% (91/212); muscle weakness 29.7% (63/212); excessive salivation 23.1% (49/212); and confusion 20.3% (43/212). More than half of the patients admitted were treated using atropine 52.3% (113/212). The prevalence of acute pesticide poisoning was high with most managed based on physical and clinical examination.Item Effects of Teaching Health Care Workers on Diagnosis and Treatment of Pesticide Poisonings in Uganda(Environmental health insights, 2017-07-17)Acute pesticide poisoning in developing countries is a considerable problem, requiring diagnosis and treatment. This study describes how training of health care workers in Uganda affects their ability to diagnose and manage acute pesticide poisoning. A postintervention cross-sectional study was conducted using a standardized questionnaire. A total of 326 health care workers in Uganda were interviewed on knowledge and handling of acute pesticide poisoning. Of those, 173 health care workers had received training, whereas 153 untrained health care workers from neighboring regions served as controls. Trained health care workers scored higher on knowledge of pesticide toxicity and handling of acute pesticide poisoning. Stratification by sex, profession, experience, and health center level did not have any influence on the outcome. Training health care workers can improve their knowledge and treatment of pesticide poisonings. Knowledge of the subject is still insufficient among health care workers and further training is needed.Item Predictors of Length of Hospital Stay among Burns Patients in Mulago National Referral Hospital, Kampala- Uganda(Burns, 2016-06-17) Odoch, Richard; Atuhairwe,Christine; Amogin,Dina; Agaba,Elly; Nabankema, EvelynAccording to WHO (2014), burn injuries are a major problem to health care worldwide. Ninety five per cent of all burn cases occur in LMICs leading to prolonged and expensive hospital stays (WHO, 2009). In Uganda, burn injuries account for 11% of all childhood injuries (Nakitto & Lett, 2010). Burns Unit at Mulago National Referral Hospital is the only specialized burns care unit in the country. However, it was observed that patients in this unit spends unusually longer time in admission than the WHO (2015) recommended time. Thus the objective of this study was to determine the predictors of length of hospital stay among burn patients in Mulago National Referral Hospital Kampala, Burns Care Unit from July, 2014 to June, 2015.Methods: A retrospective study design was used by reviewing medical records of patients discharged from the Burns Care Unit from July, 2014 to June, 2015. Results: More than half (57.1%) of the patients in the study were male with children 5 years and below constituting 55.2%. The majority of patients (86.2%) got burnt at home. The average length of stay for patients was 24.3 days (±22.1 days). The degree/ depth of burns (OR=44.22, 95% CI =10.86- 180.08, P=0.000) was the single most significant predictor of length of stay of patients with burns at multivariate analysis level.