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Genetic subgroups inform on pathobiology in adult and pediatric Burkitt lymphoma
(Blood, 2023-02-23) Nicole, Thomas; Namirembe, Constance; Ogwang, Martin D.; Omoding, Abraham
Burkitt lymphoma (BL) accounts for most pediatric non-Hodgkin lymphomas, being less common but significantly more lethal when diagnosed in adults. Much of the knowledge of the genetics of BL thus far has originated from the study of pediatric BL (pBL), leaving its relationship to adult BL (aBL) and other adult lymphomas not fully explored. We sought to more thoroughly identify the somatic changes that underlie lymphomagenesis in aBL and any molecular features that associate with clinical disparities within and between pBL and aBL. Through comprehensive whole-genome sequencing of 230 BL and 295 diffuse large B-cell lymphoma (DLBCL) tumors, we identified additional significantly mutated genes, including more genetic features that associate with tumor Epstein-Barr virus status, and unraveled new distinct subgroupings within BL and DLBCL with 3 predominantly comprising BLs: DGG-BL (DDX3X, GNA13, and GNAI2), IC-BL (ID3 and CCND3), and Q53-BL (quiet TP53). Each BL subgroup is characterized by combinations of common driver and noncoding mutations caused by aberrant somatic hypermutation. The largest subgroups of BL cases, IC-BL and DGG-BL, are further characterized by distinct biological and gene expression differences. IC-BL and DGG-BL and their prototypical genetic features (ID3 and TP53) had significant associations with patient outcomes that were different among aBL and pBL cohorts. These findings highlight shared pathogenesis between aBL and pBL, and establish genetic subtypes within BL that serve to delineate tumors with distinct molecular features, providing a new framework for epidemiologic, diagnostic, and therapeutic strategies.
Implementing and Evaluating a Mobile Phone–Supported and Family-Centered Rehabilitation Program for People With Stroke in Uganda (F@ce 2.0):Protocol for a Randomized Controlled Trial
(JMIR Publications, 2024-09-25) Eriksson, Gunilla;; Kamwesiga, Julius Tunga;; Fors, Uno ;; Oyana, Tonny;; von Koch, Lena;; Ytterberg, Charlotte;; Guidetti, Susanne
Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke.BACKGROUNDStroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke.This study aims to implement F@ce 2.0, a mobile phone-supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0.OBJECTIVEThis study aims to implement F@ce 2.0, a mobile phone-supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0.A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process.METHODSA randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process.Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025.RESULTSRecruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025.This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries.CONCLUSIONSThis study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries.DERR1-10.2196/60955.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)DERR1-10.2196/60955. MEDLINE - Academic
Implementation of post-discharge malaria chemoprevention (PDMC) in Benin, Kenya, Malawi, and Uganda: stakeholder engagement meeting report
(BioMed Central, 2024-03-27) Hill, Jenny
A Stakeholder engagement meeting on the implementation of post-discharge malaria chemoprevention (PDMC) in Benin, Kenya, Malawi, and Uganda was held in Nairobi, Kenya, on 27 September 2023. Representatives from the respective National Malaria Control Programmes, the World Health Organization (WHO) Geneva, Africa Regional and Kenya offices, research partners, non-governmental organizations, and the Medicines for Malaria Venture participated. PDMC was recommended by the WHO in June 2022 and involves provision of a full anti-malarial treatment course at regular intervals during the post-discharge period in children hospitalized with severe anaemia in areas of moderate-to-high malaria transmission. The WHO recommendation followed evidence from a meta-analysis of three clinical trials and from acceptability, delivery, cost-effectiveness, and modelling studies. The trials were conducted in The Gambia using monthly sulfadoxine-pyrimethamine during the transmission season, in Malawi using monthly artemether-lumefantrine, and in Kenya and Uganda using monthly dihydroartemisinin-piperaquine, showing a significant reduction in all-cause mortality by 77% (95% CI 30–98) and a 55% (95% CI 44–64) reduction in all-cause hospital readmissions 6 months post-discharge. The recommendation has not yet been implemented in sub-Saharan Africa. There is no established platform for PDMC delivery. The objectives of the meeting were for the participating countries to share country contexts, plans and experiences regarding the adoption and implementation of PDMC and to explore potential delivery platforms in each setting. The meeting served as the beginning of stakeholder engagement within the PDMC Saves Lives project and will be followed by formative and implementation research to evaluate alternative delivery strategies in selected countries. Meeting highlights included country consensus on use of dihydroartemisinin-piperaquine for PDMC and expansion of the target group to "severe anaemia or severe malaria", in addition to identifying country-specific options for PDMC delivery for evaluation in implementation research. Further exploration is needed on whether the age group should be extended to school-age children. Publicly Available Content Database
Medical students’ knowledge, attitudes, and motivation towards antimicrobial resistance efforts in Eastern Uganda
(Public Library of Science, 2025-02-06) Babuya, Jonathan;; Waruingi, Daniel;; Mungujakisa, Douglas ;; Ahimbisibwe, Osmas;; Kako, Victoria Ruth;; Aporu, Faith;; Mugume, Emmanuel;; Nyamupachitu, Julian;; Kiyimba, Kenedy
Learning beyond the classroom is important for holistic engagement in antimicrobial resistance(AMR) mitigation. Extracurricular interventions can catalyze multidisciplinary engagement and inspire innovative solutions. This study aimed to determine the knowledge, attitudes, and motivations influencing medical students' engagement in AMR Club initiatives at Busitema University, Uganda. This was a descriptive cross-sectional study conducted at Busitema University among undergraduate students pursuing Bachelors of Medicine and Surgery, Bachelor of Science in Nursing, and Bachelor of Science in Anesthesia and Critical care. Data collection was performed using a semi-structured, pre-tested questionnaire and administered to the participants The Bloom's cut-off method was used to analyse the knowledge of the participants, while bivariate analysis was conducted using the chi square test. Multivariable logistic regression analysis was used to identify factors independently associated with students' engagement in AMR club activities. Of the 193 study participants, 71.5%(n) demonstrated sufficient knowledge about antimicrobial resistance (AMR), as determined using Bloom's cutoff categories ([greater than or equal to]60% classified as sufficient, <60% as insufficient), with an average knowledge score of 68.18% (SD ±16.12). Additionally, 90% of participants acknowledged the significance of incorporating AMR topics into their curriculum, while 87.5% emphasized the need for AMR training using a One Health approach. The major motivations for students to engage in extracurricular activities addressing AMR were peer influence (n = 42), university support (n = 35), and inspiration drawn from peer mentors' work (n = 35). The students demonstrated a high level of knowledge and positive attitudes towards AMR but highlighted the need for further in-depth training. Participation in extra-curricular activities such as involvement in an AMR Club, was found to significantly influence students' engagement in AMR related interventions.
Delayed culture conversion predicts poor outcomes for isoniazid mono-resistant TB in Uganda: a retrospective cross-sectional study from 2017– 2022
(BioMed Central Ltd, 2025-07-01) Kabugo, Joel;; Sande, Obondo James;; Kabahita, Jupiter Marina ;; Namutebi, Joanita;; Mujuni, Dennis;; Oundo, Hellen Rosette;; Kisakye, Daniel;; Batte, Dorothy Nassozi;; Joloba, Moses;; Mboowa, Gerald
BackgroundIsoniazid-resistant, Rifampicin-susceptible Tuberculosis (TB) is estimated to occur in 13% of new cases and 17% of previously treated cases. Current WHO guidelines recommend treatment with Rifampicin (RFP), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (LFX, Q) for 6 months in patients with isoniazid mono-resistant TB (Hr-TB) but the effectiveness and use of other regimens in managing Hr-TB has not been established. There is a need to pay increased attention to the timely identification of Hr-TB patients to improve treatment success along with the reduction of the risk for further drug resistance development. This study was performed to determine the treatment outcomes and their associated factors among isoniazid mono-resistant TB patients in Uganda.MethodsThis was a cross-sectional study performed among newly diagnosed and retreatment TB patients whose sputum samples were referred to the National TB Reference Laboratory (NTRL)-Uganda from March 2017 to March 2022. Patient samples exhibiting Isoniazid mono-resistance as determined by phenotypic drug resistance testing (DST) were included in this study. Samples with data incompleteness and those whose treatment centers could not be traced were excluded from the study. Selected samples were tested for mutations associated with Isoniazid resistance using line probe. Patient demographic data was obtained from the National TB Reference Laboratory (NTRL) electronic data system and request forms with additional data, such as treatment regimen, adverse effects, and treatment start dates obtained from treatment registers. The independent variables available (age, sex, regimen used, M. tuberculosis mutation genes for isoniazid, specifically InhA and KatG, history of TB, HIV status, and reporting year) were assessed as possible factors in the relationship between Hr-TB and treatment success.ResultsA total of 85 isoniazid monoresistant isolates from different patients were analyzed in this study. In this study, most of the participants belonged to the category of newly diagnosed 35/85 (41.2%). Most of the participants 36/85, 42.3%) turned culture negative at month one upon initiation of treatment. The findings from this study show that the most dominant Mycobacterium tuberculosis mutation occurred in the KatG MUT1 region with a nucleotide change of S315T1. There was no significant treatment outcome difference among the different age groups in this study when compared (unsuccessful Vs successful treatment, median age 35.4 years and 35.86 years, p = 0.078). However, the study found that most deaths were among people aged above 36 years 71.4%, (5/7 participants).ConclusionThis study revealed Isoniazid mono-resistant TB as a significant factor associated with delayed culture conversion of beyond two (2) months. This emphasizes the need for prompt detection using routine point-of-care testing molecular diagnostic platforms to test for Isoniazid and Rifampicin resistance to improve TB treatment outcomes and reduce failures.Clinical trial numberNot applicable. Publicly Available Content Database
Strategies Utilized During Sudan Virus Disease Outbreak Response in Kampala City, Uganda, 2022 − 2023
(Springer Nature B.V, 2025-07-04) Mackline, Ninsiima;; Migisha, Richard;; Ndyabakira Alex ;; Katana, Elizabeth;; Aanyu Dorothy;; Kabami Zainah;; Zalwango, Jane Frances;; Naiga Hellen Nelly; Kiggundu, Thomas; Agaba Brian; Zavuga, Robert; Kizito, Saudah Namubiru; Goretti, Zalwango Marie; King, Patrick; Wanyana, Mercy Wendy; Simbwa, Brenda Nakafeero;; Naiga Hellen Nelly;; Kiggundu, Thomas;; Agaba Brian;; Zavuga, Robert;; Kizito, Saudah Namubiru;; Goretti, Zalwango Marie;; King, Patrick;; Wanyana, Mercy Wendy;; Simbwa, Brenda Nakafeero;; Et.al
Abstract Background On October 8, 2022, Kampala, the capital city of Uganda, recorded its first Sudan virus disease (SVD) case. We described strategies utilized by Kampala Capital City Authority (KCCA) during SVD outbreak response in Kampala City from October 2022 − January 2023. Methods We reviewed daily situation reports submitted by KCCA incident management team to document strategies implemented throughout the SVD response. During SVD After Action Review (AAR), we convened consensus meetings with the Directorate of Public Health and Environment, incident management team, rapid response teams, and representatives from implementing partners. The AAR served as a structured platform for reflection and consensus-building through semi-structured group discussions among stakeholders. Findings were thematically synthesized to identify effective strategies and operational challenges encountered during SVD response in Kampala City. Results KCCA established an incident management system to coordinate the SVD response. Daily coordination meetings were held with rapid response teams and implementing partners to address emerging challenges. A centralized call and dispatch center served as the coordination hub for rapid response teams, facilitating timely verification of alerts and response to suspected SVD cases. Case investigation teams established epidemiological linkages among confirmed SVD cases and identified contacts for daily follow up. Designated ambulances were utilized to transport high-risk patients to isolation units, while confirmed cases were referred to Entebbe Ebola Treatment Unit. Infection prevention and control teams provided essential decontamination services and distributed IEC materials to affected health facilities and communities. KCCA also leveraged innovative strategies such as drones to disseminate public health messages, distributed placards with SVD symptoms and preventive measures, and actively engaged business communities, media outlets, and local leaders to enhance public awareness and risk communication. Conclusion KCCA’s response to the 2022 Sudan virus disease outbreak demonstrated effectiveness of leveraging existing coordination structures, adapting surveillance tools, and engaging communities in a complex city setting. The integration of emergency preparedness efforts and contextualized approaches such as mobile phone tracking, closed-circuit television (CCTV) footage, school-based interventions, and drone utilization contributed to timely containment. These strategies demonstrate valuable best practices for strengthening emergency preparedness and response capacities in high-risk urban settings.
Experiences of Research Coproduction in Uganda; Comment on “Research Coproduction: An Underused Pathway to Impact”
(Kerman University of Medical Sciences, 2024-11-20) Musoke, David;; Nakalawa, Suzan;; Brown, Michael Obeng ;; Lubega, Grace Biyinzika;; Gibson, Linda
This commentary reflects on the principles of research coproduction discussed by Rycroft-Malone et al through our experiences in Uganda, particularly within the partnership between Nottingham Trent University (UK) and Makerere University (Uganda). The commentary highlights the coproduction process we have employed in community health projects in Wakiso district, Uganda, by examining both the opportunities and challenges inherent in this collaborative approach. We further highlight the importance of continuous stakeholder engagement, contextspecific communication, and power-sharing, demonstrating how research coproduction can decolonize research methodologies and enhance the relevance and impact of health interventions. By recognising the inequities between North-South partnerships, this commentary contributes to the discourse on how research coproduction can practically be implemented to drive meaningful, community-centred change while addressing the complexities involved. The lessons drawn from our experiences offer a pathway for other global partnerships aiming to integrate the principles of research coproduction into their work. CrossRef
Implementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda)
(BioMed Central Ltd, 2025-08-11) Longenecker, Chris T.;; Kiggundu, John Baptist;; Ayebare, Florence ;; Muddu, Martin;; Kayima, James;; Mutungi, Gerald;; Ssinabulya, Isaac;; Schwartz, Jeremy I.;; Spiegelman, Donna;; Tong, Guangyu;; Nugent, Rachel;; Aifah, Angela;; Kagoya, Faith;; Cameron, Drew B.;; Hutchinson, Brian;; Kamya, Moses R.;; Katahoire, Anne R.;; Semitala, Fred C
Hypertension (HTN) is the leading cause of cardiovascular morbidity and mortality among people living with HIV (PLWH) in Africa, yet integration of hypertension treatment in HIV clinics is sub-optimal. Cost-effective strategies to implement evidence-based hypertension care for this population are urgently needed to preserve the life-expectancy gains of antiretroviral therapy. Building on insights gained from a comprehensive mixed-methods formative assessment, we used a human-centered design approach to develop a multi-component HIV-HTN integration (HTN-PLUS) strategy. In a stepped-wedge cluster randomized trial, we are assessing the effectiveness, costs, and implementation of HTN-PLUS as well as a less resource intensive strategy of providing HTN medication and blood pressure cuffs (HTN-BASIC) free of charge to clinics. The trial is being conducted in 16 public and private not-for-profit HIV clinics in Kampala and Wakiso districts in Uganda. The co-primary effectiveness outcomes are population BP control (screened and documented BP < 140/90 mmHg) and HTN patient BP control [BP < 140/90 mmHg among PLWH with HTN]. The trial is designed to have > 80% power to detect a 12%-point increase in both outcomes compared to the pre-implementation control period across a range of scenarios of baseline hypertension prevalence and temporal improvements in the control period. At two pre-specified time points, we are conducting a Learn-As-You-Go optimization analysis and will adapt the HTN-PLUS strategy accordingly. To assess implementation outcomes, we have enrolled a prospective longitudinal mixed-methods cohort study of clinic health workers and PLWH with HTN. An extensive economic evaluation will include time and motion studies, facility-based costing, and out-of-pocket cost surveys to determine costs and cost-effectiveness from a societal perspective. Innovative implementation strategies to integrate evidence-based hypertension care for PLWH in Africa must be informed by the health workers and PLWH who are cared for across diverse HIV clinics. These clinics currently provide high quality HIV care as evidenced by high rates of HIV viral suppression but often lack the knowledge, skills and resources to provide HTN care. Funders and policymakers critically need to know both the effectiveness and costs to scale these strategies and potentially expand them to include other non-AIDS comorbidities.
Predictors of survival among children and adolescents with rhabdomyosarcoma treated in a single resource-limited centre —Uganda
(BioMed Central Ltd, 2025-08-11) Nyeko, Richard;; Geriga, Fadhil;; Angom, Racheal ;; Kambugu, Joyce Balagadde;; van Heerden, Jaques
The treatment outcomes for children and adolescents with rhabdomyosarcoma (RMS) in low-income countries are poor. However, there is a paucity of literature on RMS and its management outcomes in low-resource settings. We evaluated the treatment of RMS with the aim of identifying prognostic factors during management to improve outcomes. We sourced data on children under 18 years treated for rhabdomyosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Kaplan-Meier survival analysis and Cox's proportional hazards model were used for five-year survival analysis. One hundred twenty-eight RMS cases were identified, with a median age of 6.0 years (IQR 3.6-10.0). The most common primary tumour site was the head and neck region, comprising non-parameingeal sites, 37 (28.9%); parameingeal sites, 32 (25.0%); and orbital tumours, 17 (13.3%). Overall, 68 (53.1%) of the primary tumour sites were unfavourable sites. Seventeen (13.3%) patients had metastatic disease at diagnosis, primarily to the lungs, 11 (64.8%). Embryonal and alveolar RMS accounted for 50.0% and 20.3% of the cases, respectively. Only 31 (24.2%) of the patients underwent surgery, and 36 (28.1%) were irradiated. The treatment completion rate was 33.6%, while 46.1% abandoned treatment. Only 25 (19.5%) patients were alive at the time of the study, 65 (50.8%) had died, and 38 (29.7%) had an unknown status. The five-year overall and event-free survival rates were 35% and 30%, respectively. Orbital primary tumour site (HR = 2.86; 95% CI 1.12-7.31; p = 0.028), metastatic disease (HR = 4.09; 95% CI 2.01-8.31; p < 0.001), elevated serum lactate dehydrogenase at diagnosis above 400 U/L (HR = 2.80; 95% CI 1.46-5.33; p = 0.002), and lack of local control (HR = 3.33; 95% CI 1.34-8.29; p = 0.010) were significant factors for poor survival. Rhabdomyosarcoma outcomes in Ugandan children are largely poor, with high treatment abandonment and mortality. Concerted, multidisciplinary efforts are needed to improve outcomes in this setting.
Coinfection of COVID-19 and Tuberculosis in Uganda
(Institute of Tropical Medicine, 2023-06) Nuwagira, Edwin;; Mpagama, Stellah G.;; Katusiime, Asumpta ;; Natamba, Bobson;; Baluku, Joseph Baruch;; Lai, Peggy S.
The clinical features and outcomes of tuberculosis (TB) and COVID-19 coinfection are not well established. This short report describes 11 people with TB/COVID-19 coinfection in Uganda. The mean age was 46.9 ± 14.5 years; eight (72.7%) were male and two (18.2%) were coinfected with HIV. All patients presented with cough whose median duration was 71.1 (interquartile range, 33.1, 109) days. Eight (72.7%) had mild COVID-19 whereas two (18.2%) died, including one with advanced HIV disease. All patients were treated with first-line anti-TB drugs and adjunct therapy for COVID-19 using national treatment guidelines. This report presents the possibility of the coexistence of the two diseases and calls for more vigilance, screening, and collective prevention measures for both COVID-19 and TB. CrossRef
Decreased susceptibility of Plasmodium falciparum to both dihydroartemisinin and lumefantrine in northern Uganda
(Nature Publishing Group UK, 2022-10-26) Tumwebaze, Patrick K.;; Conrad, Melissa D.;; Okitwi, Martin ;; Orena, Stephen;; Byaruhanga, Oswald;; Katairo, Thomas;; Legac, Jennifer;; Garg, Shreeya;; Giesbrecht, David;; Smith, Sawyer R.;; Ceja, Frida G.;; Nsobya, Samuel L.;; Bailey, Jeffrey A.;; Cooper, Roland A.;; Rosenthal, Philip J.
“Someone who hates themself doesn’t come for their drugs”: Experiences of mental health along the HIV care continuum in South-Central, Uganda
(Public Library of Science, 2024-10-10) West, Nora S.;; Ddaaki, William;; Murray, Sarah M. ;; Nakyanjo, Neema;; Isabirye, Dauda;; Nakubulwa, Rosette;; Nalugoda, Fred;; Surkan, Pamela J.;; Hutton, Heidi E.;; Kennedy, Caitlin E.
IntroductionPoor mental health occurs more frequently among people living with HIV. Understanding what mental health problems occur and at what point during the continuum of HIV care is critical to ensure these problems are identified and appropriately addressed. We explored how mental health is experienced along the HIV care continuum in Rakai, Uganda.MethodsWe conducted qualitative semi-structured in-depth interviews with 20 adults living with HIV and 10 health workers from March to December 2020. Interviews followed a timeline approach. Responses were analyzed using content analysis.ResultsAt the time of HIV diagnosis, nearly all participants described a range of strong emotions, including shock, fear and intense worry. Most participants described continued fear and intense worry leading up to, and at the time of, ART initiation. However, they said these emotions often subside after ART is initiated and viral suppression is achieved. Across interviews and at multiple points of the continuum, participants discussed how fear and worry led individuals to be “thinking too much” or be in “deep thoughts” and experience self-hatred. Individuals who stopped taking ART were thought to have more severe mental health problems (“madness”, psychosis, suicidality). Participants were divided about the mental health of persons who returned to care after disengagement.ConclusionIn this setting, mental health problems experienced by people living with HIV are dynamic across the care continuum. With expanded HIV testing campaigns and Universal Test and Treat policies, targeted interventions for psychosocial support at the time of testing and ART initiation remain critical. Agricultural Science Database
Enhanced yield of active case finding for leprosy in Uganda, using an integrated ‘Community door to door Awareness raising, Screening, Testing, Treatment and Prevention’ (CAST) campaign in Uganda
(British Leprosy Relief Association, 2025-04-04) Turyahabwe, Stavia;; Kengonzi, Rose;; Kawuma, Joseph ;; Gerwing, Lisa;; Muzamiru, Bamuloba;; Geofrey, Amanya
Summary Background Uganda undertook a six-month national-level campaign to improve access to TB and leprosy services following the negative impacts of COVID-19 on health care services. This paper aims to present the results of a detailed case analysis of all patients with leprosy from 2022 to 2023 and to illustrate the benefit of integrating leprosy active case finding in the tuberculosis awareness, screening, testing, treatment, and prevention (CAST) campaign. Methods The activities implemented during the campaign included community awareness raising and screening and management of suspected TB and Leprosy patients. Data collected at the community level was aggregated at the facility level and entered in an online system. Data analysis from a custom database created for the CAST campaign was conducted. Results Three episodes of the CAST campaign were carried out in March 2022, September 2022, and March 2023. Of the 6,715,810 individuals screened for TB and leprosy, 55% were female. 14,560 were diagnosed with TB. In addition, 4302 individuals had skin lesions suspicious of leprosy, and 5% (196) were diagnosed with leprosy and started on treatment. The overall proportion of leprosy patients contributed by the campaign was 49% (196/399), 60% being from the West Nile region. Conclusions The CAST campaign is an innovative strategy to improve TB and Leprosy control in Uganda. It is crucial to continuously monitor and evaluate the campaign progress, making adjustments as needed to ensure its success. The results also justify the integration of TB and Leprosy programmes particularly in remote settings with high disease burdens. Keywords: Leprosy, CAST campaign, COVID 19, integration
Prevalence, aetiology, and service mapping of dementia in rural Uganda. Part of DEPEND Uganda (Dementia Epidemiology, unmet Need and co-Developing Solutions in Uganda).
(Wellcome, 2025-01-24) Prynn, Josephine;; Alinaitwe, Racheal;; Kimono, Beatrice ;; Peto, Tunde;; Ashton, Nicholas J;; Steves, Claire J;; Mugisha, Joseph;; Prince, Martin
Background Dementia prevalence in low- and middle-income countries is increasing, yet epidemiological data from African populations remain scarce. Crucial risk factors differ in Africa from more intensively studied global areas, including a higher burden of cerebrovascular disease and HIV, but lower rates of other risk factors like physical inactivity. Understanding dementia aetiology in African settings has been limited by the expensive and invasive nature of biomarker testing. This study leverages developments in blood-based and retinal imaging biomarker technology to examine the drivers of dementia in older Ugandans. People with dementia have complex needs benefiting from multi-dimensional support. Understanding current services will allow identification of barriers and opportunities to strengthen support available to people with dementia and their families. Methods The study is nested within the General Population Cohort run by the Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Research Unit. All adults aged 60+ (around 1400) are undergoing brief cognitive screening. In Part 1, cohort participants are selected based on screening scores to undergo detailed cognitive assessment, using methods developed by the 10/66 Dementia Research Group. Part 2 is a case control study of people with and without dementia using antecedent data, questionnaires, physical assessment, retinal imaging, and Alzheimer’s blood-based biomarkers. We will also compare disability, frailty, quality of life, and social engagement in people with and without dementia. Part 3 assesses current formal support structures for people with dementia through review of publicly available literature and expert interviews. Conclusions This is the first study in Africa using blood-based and retinal imaging biomarkers to examine pathological processes underlying dementia, and systematically map services available for people with dementia. This paves the way for effective policy strategies and further focused research regarding both dementia prevention and support for affected people and their families. CrossRef
ST-segment elevation myocardial infarction heart of Charlotte one-year (STEMI HOC-1) study: a prospective study protocol
(BMC Cardiovascular Disorders, 2023-08-11) Badianyama, Marheb; Mutyaba, Arthur; Nel, Samantha; Tsabedze, Nqoba
ST-segment elevation myocardial infarction (STEMI) is a clinically distinguishable yet lethal sequela of ischaemic heart disease (IHD). In sub-Saharan Africa (SSA), death due to acute STEMI is increasing. In South Africa, there is a paucity of data available on the clinical outcomes of acute STEMI within one year for individuals treated in the public healthcare sector. This study primarily seeks to determine the one-year all-cause mortality rate of acute STEMI. The study also assesses the value of serum cardiac biomarkers of myocardial damage and serum uric acid in predicting all-cause mortality in STEMI. This is a single-centre observational prospective cohort of all consecutive individuals presenting with an acute STEMI to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Research data will be sourced on admission through electronic medical records, blood laboratory results and coronary angiography reports, and at follow-up through periodic telephonic interviews and standardised echocardiograms. At least 355 eligible participants will be continuously followed over one year, and clinical outcomes will be measured 30 days, three months, six months and one year after the index hospitalisation. This study provides insights into the demographic, risk factors and clinical profiles of individuals with STEMI in South Africa. Its findings may improve the risk stratification, prognostication, and therapeutic management of STEMI patients in our setting. By comparing the clinical outcomes between the different coronary reperfusion strategies, our results may guide clinicians in providing better patient treatment, particularly in sub-Saharan Africa, where access to percutaneous coronary intervention may be limited. Furthermore, the study offers insights into the routine use of baseline serum uric acid as a potential low-cost prognostic biomarker of all-cause mortality in STEMI. Finally, this study’s findings may be of public health significance to local policymakers to aid in reinforcing primary prevention strategies and developing structured referral networks for timely coronary reperfusion of acute STEMI.
Moving from Data Collection to Application: A Systematic Literature Review of Surgical Capacity Assessments and their Applications
(World journal of surgery, 2015-01-08) Carlson, Lucas C.; Mulwafu, Wakisa; Mutyaba, Frederick A.; Labib , Mohamed
Over the past decade, assessments of surgical capacity in low- and middle-income countries (LMICs) have contributed to our understanding of barriers to the delivery of surgical services in a number of countries. It is yet unclear, however, how the findings of these assessments have been applied and built upon within the published literature. A systematic literature review of surgical capacity assessments in LMICs was performed to evaluate current levels of understanding of global surgical capacity and to identify areas for future study. A reverse snowballing method was then used to follow-up citations of the identified studies to assess how this research has been applied and built upon in the literature. Twenty-one papers reporting the findings of surgical capacity assessments conducted in 17 different LMICs in South Asia, East Asia and Pacific, Latin America and the Caribbean, and sub-Saharan Africa were identified. These studies documented substantial deficits in human resources, infrastructure, equipment, and supplies. Only seven additional papers were identified which applied or built upon the studies. Among these, capacity assessment findings were most commonly used to develop novel tools and intervention strategies, but they were also used as baseline measurements against which updated capacity assessments were compared. While the global surgery community has made tremendous progress in establishing baseline values of surgical capacity in LMICs around the world, further work is necessary to build upon and apply the foundational knowledge established through these efforts. Capacity assessment data should be coordinated and used in ongoing research efforts to monitor and evaluate progress in global surgery and to develop targeted intervention strategies. Intervention strategy development may also be further incorporated into the evaluation process itself.
Predictors of insecticide-treated nets utilization among children under five years in refugee settlements in Uganda: analysis of the 2018–2019 Uganda Malaria Indicator Survey Henry Musoke Semakula & Frank Mugagga
(BioMed Central Ltd, 2025-01-21) Semakula, Henry Musoke;; Mugagga, Frank
Despite significant distribution of insecticide-treated net (ITNs) by the Government of Uganda to refugees, malaria is major cause of mortality and morbidity among children under five years in refugee settlements. This highlights the persistent challenges and complexities surrounding malaria control and prevention efforts in these settings. Studies that focus on the determinants of ITN utilization among children under five years in refugee settlements in Uganda are not available. Using the 2018-2019 Uganda's Malaria Indicator Survey (UMIS) data, analysis of the individual and household factors associated with utilization of ITN among children under five in refugee settlements of Uganda was conducted. This study focused on 589 children under five staying in refugee settlements located in Uganda. The extracted variables from the UMIS included social-economic factors associated with ITN utilization. Descriptive analysis was performed to generate summarized statistics, while inferential statistics by way of bivariate analysis were performed to assess the association between the outcome and the independent variables using the chi-square test, and multivariable logistic regression modelling to assess the magnitude of the associations after controlling for other covariates. All analyses considered the survey sampling design and sampling weights, and are conducted in Stata version 18. The odds of children sleeping under ITN were higher if their mothers had secondary and higher education (8.1 times) as well as primary education (1.5 times). The odds of children sleeping under ITN reduced by 50% if their mothers were pregnant. Interestingly, the odds of children sleeping under ITN were 70% lower if their mothers knew that 'not sleeping in nets' caused malaria. Mothers who were exposed to malaria messages had lower odds of their children sleeping under ITNs. The results highlight areas of intervention that can increase ITN use in refugee settlements of Uganda. Improving access to education for mothers, providing targeted health education on the importance of ITN, dispelling misconceptions about malaria transmission, facilitating the proper installation of ITNs among others, can all contribute to increased ITN utilization among children under five. MEDLINE
LLIN Evaluation in Uganda Project (LLINEUP)–effects of a vector control trial on Plasmodium infection prevalence and genotypic markers of insecticide resistance in Anopheles vectors from 48 districts of Uganda
(Nature Publishing Group UK, 2024-06-24) Lynd, Amy;; Gonahasa, Samuel;; Staedke, Sarah G. ;; Oruni, Ambrose;; Maiteki-Sebuguzi, Catherine;; Hancock, Penelope A.;; Knight, Erin;; Dorsey, Grant;; Opigo, Jimmy;; Yeka, Adoke;; Katureebe, Agaba;; Kyohere, Mary;; Hemingway, Janet;; Kamya, Moses R.;; McDermott, Daniel;; Lucas, Eric R.;; Donnelly, Martin J.
Pyrethroid bednets treated with the synergist piperonyl butoxide (PBO) offer the possibility of improved vector control in mosquito populations with metabolic resistance. In 2017-2019, we conducted a large-scale, cluster-randomised trial (LLINEUP) to evaluate long-lasting insecticidal nets (LLINs) treated with a pyrethroid insecticide plus PBO (PBO LLINs), as compared to conventional, pyrethroid-only LLINs across 104 health sub-districts (HSDs) in Uganda. In LLINEUP, and similar trials in Tanzania, PBO LLINs were found to provide greater protection against malaria than conventional LLINs, reducing parasitaemia and vector density. In the LLINEUP trial, we conducted cross-sectional household entomological surveys at baseline and then every 6 months for two years, which we use here to investigate longitudinal changes in mosquito infection rate and genetic markers of resistance. Overall, 5395 female Anopheles mosquitoes were collected from 5046 households. The proportion of mosquitoes infected (PCR-positive) with Plasmodium falciparum did not change significantly over time, while infection with non-falciparum malaria decreased in An. gambiae s.s., but not An. funestus. The frequency of genetic markers associated with pyrethroid resistance increased significantly over time, but the rate of change was not different between the two LLIN types. The knock-down resistance (kdr) mutation Vgsc-995S declined over time as Vgsc-995F, the alternative resistance mutation at this codon, increased. Vgsc-995F appears to be spreading into Uganda. Distribution of LLINs in Uganda was previously found to be associated with reductions in parasite prevalence and vector density, but here we show that the proportion of infective mosquitoes remained stable across both PBO and non-PBO LLINs, suggesting that the potential for transmission persisted. The increased frequency of markers of pyrethroid resistance indicates that LLIN distribution favoured the evolution of resistance within local vectors and highlights the potential benefits of resistance management strategies.Trial registration: This study is registered with ISRCTN, ISRCTN17516395. Registered 14 February 2017, http://www.isrctn.com/ISRCTN17516395 . MEDLINE
Early maternal separation leads to down-regulation of cytokine gene expression
(Metabolic brain disease, 2012-04-13) Dimatelis, J. J.; Mutyaba, A. K.; Daniels, W. M. U.; Stein, D. J.
Exposure to stressors may lead to subsequent alterations in the immune response. The precise mechanisms underlying such vulnerability are poorly understood, but may be hypothesized to include changes in cytokine systems. Maternal separation was used as a model of exposure to early life stressors. Subsequent cytokine gene expression was studied using a cytokine gene expression array. Maternal separation resulted in significant down-regulation of the expression of 6 cytokine genes; chemokine ligand 7, chemokine receptor 4, interleukin 10, interleukin-1beta, interleukin 5 receptor alpha and integrin alpha M. Specific cytokines may be involved in mediating the effects of early adversity on subsequent immunosuppression. Further work is needed to delineate fully the relationship between early adversity, immune alterations, and behavioural changes.
An outbreak of scabies in a fishing community in Hoima District, Uganda, February − June, 2022
(BioMed Central Ltd, 2025-07-01)
Scabies, an infectious parasitic disease, is endemic in most resource-poor tropical areas, including Uganda. On May 21, 2022, the Ugandan Ministry of Health was notified of > 1,000 cases of scabies in Hoima District. We investigated to assess the scope of the outbreak, identify associated factors, and recommend interventions. We defined a suspected scabies case as the onset of an itchy pimple-like skin rash or crusting from January 2021 to July 2022 in a resident of Hoima District. We reviewed medical records, performed active community case-finding, and computed attack rates by age, sex, and village per 1,000 population. Using logistic regression, we compared exposures among 101 case persons and 99 unmatched controls living in Rwentale Landing Site in Hoima during June 2022. We line listed 2,236 suspected cases in Hoima District. Children aged 5-14 years were more affected (AR = 64/1,000) than persons aged ≥ 15 years (AR = 8/1,000) (p < 0.001). Males (AR = 27/1,000) were more affected than females (AR = 15/1,000) (p < 0.001). Of the 54 affected villages, Rwentale Village had the highest attack rate (AR = 233/1,000 population). Rwentale Village includes a fishing area known as Rwentale Landing Site where 1,119 (50%) cases in Hoima District were identified. At this landing site, cases began in April 2022 shortly after the end of the peak fishing and trading season. Being aged 5-14 years (AOR = 4.9, 95%CI: 2.0-12), being male (AOR = 2.4, 95%CI 1.1-5.1), living with another case (AOR = 3.1, 95%CI: 1.5-6.2), and sharing three or more personal care items (towel, beddings, clothes, or sponges) (AOR = 2.2, 95%CI: 1.1-4.6) were associated with scabies. This scabies outbreak was likely initiated by person-to-person interactions during peak fishing and trading months at a landing site and propagated by close household interactions. Community sensitization on scabies, especially before fishing and trading seasons is recommended for prevention and early control of scabies in the region. Additionally, establishing a surveillance system for scabies, in high-risk areas such as fishing communities may facilitate timely detection and control of future outbreaks. MEDLINE

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