Medical and Health Sciences

Permanent URI for this collection

https://nru.uncst.go.ug/handle/123456789/124

Browse

Now showing 1 - 20 of 4809

Associations of menstrual health with school absenteeism and examination performance among Ugandan secondary school students: A prospective study
(Public Library of Science (PLoS), 2026-01-23) Christopher Baleke;; Levicatus Mugenyi;; Kate A. Nelson ;; Katherine A. Thomas;; Denis Ndekezi;; Jonathan Reuben Enomut;; Connie Alezuyo;; John Jerrim;; Helen A. Weiss
Background Relatively few studies have quantified the amount of school missed due to poor menstrual health, or the impact of poor menstrual health on examination performance. Methods We conducted secondary observational analyses from data nested within a cluster-randomised trial of a menstrual health intervention in 60 Ugandan secondary schools (The trial is registered as ISRCTN45461276). We used baseline data from trial participants in both arms, and endline data from the control arm participants. School absenteeism was estimated as the self-reported number of days absent due to menstruation per month and examination performance was assessed by an independently set assessment by the Uganda National Examination Board. We estimated adjusted incidence rate ratios (aIRR) for associations with school absenteeism, using negative binomial regression adjusted for school-level clustering. We estimated adjusted standardised mean differences (aSMD) in examination scores using mixed-effects linear regression. Results Of the 3312 participants who reported menstruating in the past 6 months at baseline, 323 (9.8%) reported missing at least one day of school per month due to menstruation (mean days missed = 0.30 per month, 95%CI 0.27–0.34). Similarly, of the 1192 participants in the trial control arm seen at endline, 135 (11.3%) reported missing at least one day due to menstruation (mean days missed = 0.31 per month (95%CI 0.27–0.37)). There was evidence that menstrual-related absenteeism and poorer examination performance at endline were both associated with baseline use of inadequate menstrual materials, negative menstrual attitudes, unmet menstrual practice needs, and experience of menstrual-related teasing. In addition, absenteeism due to menstruation was associated with menstrual pain, and poorer examination performance was associated with poorer baseline menstrual knowledge. Conclusion Among Ugandan students, multiple dimensions of menstrual health are associated with school absenteeism and examination performance.
Interepidemic Rift Valley fever in East Africa: the recent risk landscape and projected impacts of global change
(The royal society publishing, 2026-01-28) Eskew, Evan A;; Clancey, Erin;; Singh, Deepti ;; Situma, Silvia;; Nyakarahuka, Luke;; Njenga, M Kariuki;; Nuismer, Scott L
Rift Valley fever (RVF) is a zoonotic disease that causes sporadic, multi-country epidemics. However, there is limited understanding of RVF virus circulation during interepidemic periods and the potential impacts of global change on interepidemic RVF. To address these knowledge gaps, we built a predictive model using recent interepidemic RVF outbreak data from Kenya, Tanzania and Uganda. We then projected interepidemic RVF risk for three future time periods (2021–2040, 2041–2060, 2061–2080) under three global change scenarios representing different trajectories for climate and human population distribution (SSP126, SSP245, SSP370). Our model identified interepidemic RVF risk hotspots in east Kenya, east Tanzania and southwest Uganda. Hydrology was a major driver of disease risk: hotspots emerged in association with lakes and rivers, and risk peaked during May–July following the long rains season (March–May). Projections under global change scenarios suggested that disease risk will generally decrease over time. Nevertheless, owing to expected human population growth, we estimate that > 90 million people in the study region will be exposed to interepidemic RVF by 2061–2080, which is nearly double the historical (1970–2000) estimate of approximately 49 million people. Mitigating the future health impacts of RVF will require increased disease surveillance, prevention and control effort in risk hotspots.
Effective communication and missed opportunities during family conferences of patients in ICU in Western Uganda
(Springer Nature, 2026-01-21) Atwiine Ashely Mukama;; Brian Turigye;; Atwine Fortunate B
Abstract Background Effective communication in the intensive care unit (ICU), such as conferences between clinicians and family members as surrogate decision–makers, is key since patients frequently lack decision-making capacity because of the severity of their illness. However, there is little evidence about family conferencing, processes and missed opportunities during family conferences from the perspective of family members. This study explored the process, structure and missed opportunities during family conferencing among the family members of patients in the intensive care unit (ICU) of one Regional Referral Hospital in western Uganda. Methods A qualitative study was conducted in the general ICU. Close family members who participated in patient care provided information about the family conferencing procedure. The data were collected via individual interviews, transcribed verbatim and analysed using content analysis as described by Krippendorff. Findings The participants were middle-aged and ranged from 25 to 60 years, with good level of education, and most of them were employed. The generated categories were dichotomized into two sections. The first section explored the factors related to the process linked to readiness and the structure of family conferences. The observations included accidental meetings, which were conducted in unfamiliar places, were attended by an unintegrated disciplinary team, and mostly discussed patients’ values, care and treatment management. Uncertain experiences revealed perceived satisfactory communication to some family members, whereas others reported sadness with missed opportunities in the process of family conferences. Conclusion Family conferences lack adequate preparedness, and family members’ emotions are missed in care. This study recommends that family conferencing protocols be followed to enhance effective communication skills that align with family members’ emotions.
Long-term risk of tuberculosis among individuals with Xpert Ultra trace screening results in Uganda: a longitudinal follow-up study
(Elsevier Ltd, 2025-10-07) Sung, Joowhan;; Nantale, Mariam;; Nalutaaya, Annet ;; Biché, Patrick;; Mukiibi, James;; Akampurira, Joab;; Kiyonga, Rogers;; Kayondo, Francis;; Mukiibi, Michael;; Visek, Caitlin;; Kamoga, Caleb E;; Dowdy, David W;; Katamba, Achilles;; Kendall, Emily A
Systematic screening for tuberculosis using Xpert Ultra can generate trace results of uncertain significance. Additional microbiological testing in this context is often negative, but untreated individuals might still progress to culture-positive disease. We aimed to estimate the 2-year risk of tuberculosis among screened participants with trace-positive sputum (PWTS). In this longitudinal follow-up study, we conducted Ultra-based systematic screening for tuberculosis in Kampala, Uganda, from Feb 2, 2021, to April 27, 2024, enrolling PWTS as well as participants who were Ultra-positive or Ultra-negative controls. Recruitment occurred primarily through community-based screening events and door-to-door screening. Ultra sputum testing was offered to individuals aged 15 years or older who were not on active tuberculosis treatment, regardless of their symptoms. All PWTS, as well as age-matched and sex-matched participants with negative screening results and consecutive participants with positive screening results, were recruited. Participants underwent extensive initial evaluation, and untreated PWTS and negative-control participants were followed up with re-testing for up to 24 months. Our primary outcome was the cumulative hazard of tuberculosis among PWTS, using two definitions of tuberculosis: one incorporating clinician judgement and one strictly microbiological. We then compared hazards between PWTS and negative-control participants. We also assessed whether the presence of symptoms or chest x-ray abnormalities at baseline were associated with tuberculosis diagnosis during follow-up in PWTS. We screened 31 505 people for tuberculosis in Uganda using sputum Xpert Ultra as an initial test through event-based and door-to-door screening. We enrolled 128 PWTS and 139 age-matched and sex-matched control participants who were Ultra-negative (negative-control participants) into prospective cohorts and 110 control participants who were Ultra-positive (more than trace) for cross-sectional comparison. Of 128 PWTS, 79 (62%) were male, 49 (38%) were female, and 19 (15%) were HIV positive; 45 (35%) were recommended for treatment upon enrolment, eight (6%) were lost to follow-up within 3 months, and 75 (56%) were followed up for a median of 706 days (IQR 344–714), of whom 19 (25%) were recommended for treatment during follow-up. The cumulative hazard of tuberculosis among PWTS not treated at baseline was 0·24 (95% CI 0·15–0·40) at 1 year and 0·33 (0·21–0·54) at 2 years, versus 0·03 (0·01–0·10) at 2 years for negative-control participants. Hazards were similar for microbiologically defined tuberculosis (0·36 [95% CI 0·22–0·58] for PWTS vs 0·02 [0·01–0·10] for negative-control participants at 2 years). Tuberculosis diagnosis during follow-up was strongly associated with atypical baseline chest x-ray (ie, interpreted by radiologists as having any abnormality; hazard ratio 14·6 [95% CI 3·3–63·8]) but not with baseline symptoms (cough, fever, night sweats, or weight loss). Individuals with trace-positive sputum during screening have a substantial 2-year risk of tuberculosis, even when extensive initial evaluations do not confirm disease. Treatment should be considered for most screening participants with trace-positive sputum and atypical chest imaging. National Institutes of Health and the Gates Foundation.
A scoping review of community-based stroke rehabilitation in low-resource settings
(SAGE Publications, 2025-08-08) Hardianto, Yudi;; Lynch, Elizabeth;; Irwan, Andi Masyitha ;; Kandasamy, Thoshenthri;; Purvis, Tara;; Callisaya, Michele L;; Lindley, Richard I;; Gandhi, Dorcas;; Liu, Ning;; Abd Aziz, Noor Azah;; Pandian, Jeyaraj;; Cadilhac, Dominique A
Background: There is a need for accessible and affordable rehabilitation services in low-resource settings (low- and middle-income countries) to support the increasing number of survivors of stroke. Aims: To synthesize existing literature on the delivery of community-based stroke rehabilitation programs in low-resource settings. Summary of review: We followed the PRISMA Scoping Review guidelines. Seven databases (including MEDLINE, PsycINFO, and CINAHL) were searched to identify relevant articles published between January 2012 and December 2024. Studies were considered if they included physical rehabilitation strategies as part of a community-based rehabilitation program for individuals with stroke aged ⩾18 years in low-resource settings. Titles, abstracts, and full texts were screened by multiple authors for inclusion. A predefined template that covered physical rehabilitation strategies, setting, providers, frequency, session duration, and program duration was used for data extraction. Results were synthesized narratively. After screening 2892 abstracts, 25 studies were included from 11 countries throughout Asia, Africa, and South America. Most studies were carried out in middle-income countries, with only one study taking place in a low-income country (Uganda). Over half of the studies (n = 16) were randomized controlled trials (RCTs). The physical rehabilitation programs were primarily delivered at home, in person, by a single healthcare professional, typically a physiotherapist or nurse. Session duration was not specified for more than half of the studies. Where reported, sessions were 1 h or less, usually occurring at least once weekly over a 2-to-3-month period. Over 36 different outcome measures were identified, with the Barthel Index being the most common (48%). Overall, 10 RCTs showed a statistically significant difference between intervention and control groups, while five RCTs had no significant difference at the post-intervention outcome evaluation. None of the included publications reported costs or cost-effectiveness data. Conclusion: Community-based rehabilitation programs in low-resource settings differ in their physical rehabilitation strategies and characteristics. While the evidence base in this field is growing, the lack of cost-effectiveness evaluations means there is limited guidance to inform investment in, or optimization of, these multi-component, community-based programs. Graphical abstract
Emergence of measles virus genotype D8 amidst endemic B3 circulation in Uganda, 2023-2025
(Elsevier, 2024-11-24) Prossy Namuwulya;; Irene Turyahabwe;; Rena Nakyeyune ;; Molly Birungi;; Phionah Tushabe;; James Peter Eliku;; Francis Aine;; Jonathan Comfort Haumba;; Mathias Ssenono;; Lucy Nakabazzi;; Maria Nabbuto;; Jacob Mpiima;; Micheal Baganizi;; Immaculate Ampeire;; Annet Kisakye;; Qouilazoni Aquino Ukuli;; Henry Bukenya;; Josephine Bwogi;; Barnabas Bakamutumaho
Objectives: Measles remains a significant global health threat, with recurrent outbreaks, even in regions such as America, where the disease had been eliminated. Despite the availability of an effective and freely accessible vaccine, measles remains a global burden especially in children. The World Health Organization (WHO) estimated 107,500 measles-related deaths in 2023, with over 95% occurring in low- and middle-income countries reflecting fragile health systems. Uganda has similarly experienced persistent outbreaks since 2023. This study aimed at investigating the emergence of measles genotype D8 in Uganda for the first time, alongside the endemic measles genotype B3. Methods: To track measles circulating strains, molecular genotyping targeting the measles virus N450 region was performed on 137 specimens. Phylogenetic analysis of the sequences was carried out along with WHO reference sequences and GenBank selected sequences. Results: Alongside the endemic B3 genotype, genotype D8 was detected for the first time in Uganda, revealing co-circulation of both lineages. Conclusions: The detection of measles D8 alongside the endemic B3 indicated possible gaps in the existing surveillance system and vaccination coverage. These findings highlight the critical importance of molecular surveillance and the urgent need to enhance measles vaccination coverage.
Temporal variability and flooding influence the ecological niche of Biomphalaria intermediate hosts for Schistosoma mansoni in rural Uganda
(The royal society publishing, 2026-01-26) Iacovidou, Melissa A.;; Byaruhanga, Anatol M.;; Besigye, Fred ;; Nabatte, Betty;; Kabatereine, Narcis B.;; Chami, Goylette F.
Understanding the niches of intermediate hosts and vectors for environmentally transmitted pathogens is crucial for identifying endemic areas, assessing habitat suitability and targeting interventions. This study focuses on intermediate hosts of intestinal schistosomes, with over 700 million people at risk of lifelong infection. We compared habitat suitability and species interactions across 674 sites in 52 villages in rural Uganda between 2022 and 2024, capturing a severe flooding event. Spatiotemporal models incorporating a polygon-based method to account for space with time as a fixed effect were developed to analyse snail abundance for Biomphalaria sudanica and B. stanleyi. B. sudanica was associated with marshy sites near lake shorelines and presence of hyacinths, while B. stanleyi was more likely to be found in deeper waters with Vallisneria plants. However, cohabitation was common for both species. Habitat suitability for each species fluctuated temporally, and more starkly with extreme flooding, resulting in switching of species dominance. Our study suggests that events consistent with climate change may influence habitat suitability without necessitating an expansion of environmental areas. Our models enable tracking of dynamic ecological niches that, if replicated elsewhere and for other intermediate hosts or vectors, can be used to better target environmental and community interventions as environmental conditions change. MEDLINE
Co-designing family planning interventions: Insights from religious leaders in urban eastern Uganda
(Elsevier, 2026-01-20) Jacquellyn Nambi Ssanyu;; Catherine Birabwa;; Kharim Mwebaza Muluya ;; Felix Kizito;; Sarah Namutamba;; Moses Kyangwa;; Othman Kakaire;; Peter Waiswa;; Rornald Muhumuza Kananura
Background: In Uganda, religion strongly influences family planning (FP) practices, yet religious leaders are often excluded from FP program design and delivery. Engaging them meaningfully could help address misconceptions and improve voluntary FP uptake. Methods: We applied Community-Based Participatory Action Research and Human-Centered Design to engage 16 religious leaders from Muslim, Catholic, Anglican, and Pentecostal faiths in Jinja City and Iganga Municipality, eastern Uganda. Faith-specific discussions were conducted using a structured agenda and co-moderated by participants. Data from audio recordings and notes were transcribed, translated, and analyzed thematically. Results: All religious leaders expressed openness to FP but differed in their definitions and preferred methods. Christian leaders associated FP with responsible parenthood and manageable family sizes, while Muslim leaders emphasized parental responsibility without limiting fertility, stressing faith in divine provision. Natural methods were widely accepted, while hormonal methods were met with caution due to health concerns. There was unanimous opposition to providing FP to unmarried adolescents, with abstinence endorsed as the only acceptable option. Leaders welcomed the opportunity to share FP messages through their platforms, provided materials were accurate, respectful of religious values, and comprehensive in scope. Conclusions: Religious leaders can play a pivotal role in advancing FP awareness and acceptance when engaged as partners in design and messaging. Programs should prioritize culturally sensitive communication, clarify misconceptions, and co-create strategies that align with faith-based perspectives. These approaches can enhance trust, shift social norms, and improve access to FP services, especially in communities where religious influence is strong.
Delayed patient isolation and associated factors during the mpox outbreak in Uganda, July-December 2024
(Elsevier, 2025-12-21)
Objective: Rapid detection and isolation of mpox mpox patients reduces transmission. We assessed delays in patient isolation and associated factors during the mpox outbreak in Uganda from July to December 2024 to inform response efforts. Methods: We selected all laboratory-confirmed cases isolated at two mpox isolation centers in Uganda from July 24 to December 29, 2024. Time-to-Isolation (TTI) was number of days from symptom onset to isolation, categorized as ‘short’ (0-3 days) or ‘delayed’ (>3 days) based on operational benchmarks for rapid containment of a highly infectious disease and the biological urgency of early isolation of mpox cases. We summarized data from case narratives into descriptive statistics and used multivariable logistic regression to measure the level of association of individual factors with delayed TTI which was the outcome variable. Reasons for short or delayed TTI were obtained from qualitative interviews. Results: Among 832 mpox patients, 709 (91%) had delayed TTI, 473 (57%) were males, 713 (86%) were ≥18 years old, 698 (83%) had not visited a health facility before isolation, and 742 (89%) had self-medicated before isolation. Age ≥18 years (aOR = 2.6, 95% CI = 1.6-4.2) and self-medication (aOR = 5.4, 95% CI = 1.7-17.1) were associated with delayed TTI. Interviewed mpox patients with delayed TTI (n = 9) attributed this to lack of diagnostic skills among healthcare workers and attributed their delayed care-seeking to personal economic concerns. Mpox patients with short TTIs (n = 6) attributed this to prior knowledge about mpox from social media and response teams. Conclusion: Most mpox patients experienced delayed TTI, associated with being older than 18 years and self-medication, and driven by misdiagnosis and individual economic concerns. Targeting risk communication and strengthening frontline diagnostic capacity could improve early case detection and management.
Pilot mental health sensitisation programme for community leaders in Uganda: impact evaluation
(Cambridge University Press, 2025-07-30) Shuttleworth, Linda;; Pontin, Francesca
Despite worldwide uptake, there has been little published evaluation of actually delivering the World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) in typical low- and middle-income countries (LMICs). This paper aims to evaluate the impact of a pilot study in which mhGAP guidelines for mental health sensitisation of community leaders were implemented in 1-day training events across 25 urban and rural health facilities ( n = 1004 community leaders) in Uganda. A multiple choice mental health questionnaire was used to assess the community leaders’ mental health knowledge before and after completing the training. Training was evaluated across multiple sites and qualitative feedback comments were used to identify key themes on the impact of the training. The sensitisation training was found to be affordable, accessible and effective, and could be replicated in other LMICs and settings with local adaptations. CrossRef
Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda
(Taylor & Francis group, 2025-12-02) Deane, Kevin;; Atusingwize, Edwinah;; Musoke, David
Malaria continues to be one of the leading causes of morbidity and mortality in Africa. Recent progress towards eliminating malarias has stagnated and, in some cases began to reverse. One key dimension which remains poorly understood in malaria research is the social determinants of the disease, which direct attention to the conditions in which people live and work. We present findings from a qualitative study that explored perceptions and understanding of the social determinants of malaria in Uganda, one of the main endemic countries. We conducted 14 key informant interviews, 10 focus group discussions with community members, and 11 in-depth interviews with households recently impacted by malaria. Our participants identified livelihoods and related practices as important social determinants. These included engaging in crop production with a focus on maize cultivation, livestock husbandry, construction, a range of activities conducted at dusk/night, and the gendered nature of specific livelihoods. The precise mechanisms noted through which these livelihood activities were related to malaria include increasing exposure to mosquitoes at dusk/night, the creation of new mosquito breeding sites, attracting mosquitoes to housing, providing feeding sites for mosquitoes, working near mosquito breeding sites, and the role that gendered care responsibilities play in exposing children to mosquitoes. Our findings emphasize the importance of engaging in these livelihood activities, given that they are widespread in Uganda and other African countries. We recommend that malaria prevention be incorporated into socio-economic development strategies, and urge researchers, policy makers, practitioners and other stakeholders to engage with the social determinants of malaria. International Bibliography of the Social Sciences (IBSS)
Associations between the microbiome and immune responses to an adenovirus-based HIV-1 candidate vaccine are distinct between African and US cohorts
(American Society for Microbiology, 2026-01-15) Li, Yuhao;; Stieh, Daniel J;; Droit, Lindsay ;; Kim, Andrew HyoungJin;; Rodgers, Rachel;; Mihindukulasuriya, Kathie A;; Wang, Leran;; Pau, Maria G;; Yuan, Olive;; Virgin, Herbert W;; Barouch, Dan H;; Baldridge, Megan T;; Handley, Scott A
Optimization of prophylactic vaccine regimens to elicit strong, long-lasting immunity is an urgent need highlighted by the COVID-19 pandemic. Stronger vaccine immunogenicity is frequently reported in individuals living in high-income countries compared to individuals living in low- and middle-income countries. While numerous host genetic and immune factors may influence vaccine responses, geographic restrictions to vaccine effectiveness may also be influenced by the intestinal microbiota, which modulates host immune systems. However, the potential role of the gut microbiota on responses to HIV-1 vaccines has not yet been explored. We analyzed the bacteriome by targeted 16S sequencing and the virome by virus-like particle sequencing of 154 fecal samples collected from healthy individuals in Uganda, Rwanda, and the United States early (week 2) and late (week 26) after vaccination with multivalent adenovirus serotype 26 (Ad26)-vectored mosaic HIV-1 vaccines. Vaccination did not affect the enteric bacteriome or virome regardless of geographic location. However, geography was the major driver of microbiota differences within this cohort. Differences in overall bacterial and viral diversity and in specific microbial taxa, including and , between participants from the United States and East African countries correlated with differential immune responses, including specific antibody titers, antibody functionality, and cellular immune responses to vaccination regimens. These findings support the microbiota as a putative modifier of vaccine immunogenicity.IMPORTANCEOur research examined how gut bacteria might influence vaccine effectiveness in different parts of the world. We studied adults from the United States, Rwanda, and Uganda who received an experimental HIV vaccine. We found that participants from East Africa had more diverse gut bacteria than those from the United States, but their immune responses to the vaccine were weaker. This is the first study to directly show this relationship between higher gut bacterial diversity and reduced vaccine effectiveness in the same group of people. We also identified specific types of bacteria that were linked to either stronger or weaker immune responses. These findings are particularly relevant now as we use vaccines globally to fight diseases like COVID-19, as they suggest that regional differences in gut bacteria and might help explain why vaccines work better in some places than others. This could inform how we design and test future vaccines. PubMed
Low-dose yellow fever vaccination in infants: a randomised, double-blind, non-inferiority trial
(Elsevier Ltd, 2026-01-13) Kimathi, Derick;; Juan-Giner, Aitana;; Bob, Ndeye S ;; Orindi, Benedict;; Namulwana, Maria L;; Diatta, Antoine;; Cheruiyot, Stanley;; Fall, Gamou;; Dia, Moussa;; Hamaluba, Mainga M;; Nyehangane, Dan;; Karanja, Henry K;; Gitonga, John N;; Mugo, Daisy;; Omuoyo, Donwilliams O;; Hussein, Mwatasa;; Oloo, Elizaphan;; Kamau, Naomi;; Wafula, Jackline;; Bendera, Josephine;; Silvester, Namanya;; Mwavita, James;; Joshua, Musiimenta;; Thuranira, Jane M;; Agababyona, Collins;; Ngetsa, Caroline;; Aisha, Nalusaji;; Moki, Felix;; Buluku, Titus;; Munene, Marianne;; Mwanga-Amumpaire, Juliet;; Lutwama, Julius;; Kayiwa, John;; Kamaara, Eunice;; Barrett, Alan D;; Kaleebu, Pontiano;; Bejon, Philip;; Sall, Amadou A;; Grais, Rebecca F;; Warimwe, George M
WHO recommends fractional dose vaccination to address yellow fever vaccine shortages during outbreaks. In adults, a 500 IU dose has recently been shown to be non-inferior to the full standard dose, but the minimum effective dose for children is unknown.BACKGROUNDWHO recommends fractional dose vaccination to address yellow fever vaccine shortages during outbreaks. In adults, a 500 IU dose has recently been shown to be non-inferior to the full standard dose, but the minimum effective dose for children is unknown.We conducted a randomised, double-blind, non-inferiority trial at two centres in Kenya and Uganda, including infants aged 9-12 months with no previous yellow fever vaccination or infection. Participants were randomly assigned 1:1 in blocks of variable sizes of four, six, or eight to receive either the standard dose (>13 000 IU) or 500 IU of the Institut Pasteur de Dakar (Dakar, Senegal) 17D-204 yellow fever vaccine, co-administered with the measles-rubella vaccine. The primary outcome was seroconversion 28 days post-vaccination, defined as a four-fold or greater increase in antibody titre at day 28 from baseline (day 0), as measured by the 50% plaque reduction neutralisation test. Non-inferiority was shown if the lower bound of the 95% CI for the difference in seroconversion rates between doses exceeded -10 percentage points. Safety was assessed in the safety population, which included all participants who received a study vaccine dose. This study is registered with ClinicalTrials.gov (NCT04059471) and is complete.METHODSWe conducted a randomised, double-blind, non-inferiority trial at two centres in Kenya and Uganda, including infants aged 9-12 months with no previous yellow fever vaccination or infection. Participants were randomly assigned 1:1 in blocks of variable sizes of four, six, or eight to receive either the standard dose (>13 000 IU) or 500 IU of the Institut Pasteur de Dakar (Dakar, Senegal) 17D-204 yellow fever vaccine, co-administered with the measles-rubella vaccine. The primary outcome was seroconversion 28 days post-vaccination, defined as a four-fold or greater increase in antibody titre at day 28 from baseline (day 0), as measured by the 50% plaque reduction neutralisation test. Non-inferiority was shown if the lower bound of the 95% CI for the difference in seroconversion rates between doses exceeded -10 percentage points. Safety was assessed in the safety population, which included all participants who received a study vaccine dose. This study is registered with ClinicalTrials.gov (NCT04059471) and is complete.Between Oct 7, 2021, and June 14, 2023, 420 infants were enrolled and randomly assigned (210 participants in each group). The seroconversion rate at day 28 was 99% (95% CI 96-100; 177 of 179 infants) for the standard dose and 93% (88-96; 166 of 179 infants) for the 500 IU dose in the per-protocol population. The difference in seroconversion rate was -6·15 percentage points (95% CI -10·27 to -2·02); therefore, non-inferiority was not met for the 500 IU dose. 12 serious adverse events were reported in the study (eight in the 500 IU dose group and four in the standard dose group), but all were considered unrelated to vaccination.FINDINGSBetween Oct 7, 2021, and June 14, 2023, 420 infants were enrolled and randomly assigned (210 participants in each group). The seroconversion rate at day 28 was 99% (95% CI 96-100; 177 of 179 infants) for the standard dose and 93% (88-96; 166 of 179 infants) for the 500 IU dose in the per-protocol population. The difference in seroconversion rate was -6·15 percentage points (95% CI -10·27 to -2·02); therefore, non-inferiority was not met for the 500 IU dose. 12 serious adverse events were reported in the study (eight in the 500 IU dose group and four in the standard dose group), but all were considered unrelated to vaccination.Compared with the standard yellow fever vaccine dose, a dose of 500 IU did not meet the non-inferiority criterion, suggesting that minimum dose requirements in adults are not generalisable to infants. Therefore, standard yellow fever doses should be used for infants in the routine WHO Expanded Programme on Immunization.INTERPRETATIONCompared with the standard yellow fever vaccine dose, a dose of 500 IU did not meet the non-inferiority criterion, suggesting that minimum dose requirements in adults are not generalisable to infants. Therefore, standard yellow fever doses should be used for infants in the routine WHO Expanded Programme on Immunization.European and Developing Countries Clinical Trials Partnership and the Wellcome Trust.FUNDINGEuropean and Developing Countries Clinical Trials Partnership and the Wellcome Trust. MEDLINE - Academic
Expulsion rates and risk factors for intrauterine device expulsion following medical management of first-trimester incomplete abortions: A prospective cohort study in central Uganda
(British Medical Journal Publishing Group, 2025-11-25) Kayiga, Herbert;; Looft-Trägårdh, Emelie;; Cleeve, Amanda ;; Kakaire, Othman;; Tumwesigye, Nazarius Mbona;; Byamugisha, Josaphat;; Gemzell-Danielsson, Kristina
ObjectiveIntrauterine device (IUD) user rates remain below 5% in low-income countries yet fertility after first-trimester abortions returns within 2 weeks. IUDs provide effective contraception. This study set out to explore the risk factors for IUD expulsion after medical management of first-trimester incomplete abortions.DesignProspective cohort studySettingMulticentre study at five public health facilities in central Uganda.Participants1050 women with first-trimester incomplete abortion managed with misoprostol, recruited on giving informed consent.InterventionAfter selecting either copper or levonorgestrel (LNG) IUDs, participants were randomised to early (within 1 week) or standard (at 2–4 weeks) insertion and assessed on IUD expulsion 6 months later.Main outcome measuresPrimary outcome was IUD expulsion rates at 6 months. Secondary outcomes were risk factors for IUD expulsions.ResultsBetween 8 July 2023 and 31 May 2024, 532 (50.7%) participants chose LNG IUDs, 488 (46.5%) chose copper IUDs, while 30 (2.9%) participants chose not to use IUDs. The IUD expulsion rate was 4.6% (95% CI 3.48 to 6.07). IUD expulsion was significantly associated with low overall satisfaction with IUD insertion procedure and use (adjusted odds ratio (aOR)=7.99, 95% CI 4.83 to 13.22, p<0.001), anxiety during the IUD insertion (aOR=4.28, 95% CI 1.09 to 16.85, p=0.038), use of ultrasound at follow-up (aOR=8.41, 95% CI 4.56 to 15.5, p<0.001) and breastfeeding at the time of IUD insertion (aOR=1.48, 95% CI 0.26 to 4.98, p=0.042).ConclusionOffering IUD insertion immediately after medical management of first-trimester incomplete abortion is associated with low expulsion rates and should be offered as a safe choice. ProQuest Health & Medical Complete (Alumni)
Phytochemical profile, antibacterial activity and acute toxicity of Rhoicissus tridentata used to manage dog bites
(Elsevier Ltd, 2025-11-25) Paul Mukasa;; Patrick Engeu Ogwang;; Christopher Adaku ;; Moses Andima;; Samuel Baker Obakiro;; Julius Bunny Lejju;; Ibrahim Ntulume;; Denis Byamugisha;; Emmanuel Ntambi;; Yuhao Ren;; Richard Oriko Owor
Dog bites often result into polymicrobial wound contamination, which pose several health risks including bacterial infections. In Uganda, Rhoicissus tridentata is traditionally used to manage dog bites, yet its secondary metabolite profile, antibacterial efficacy, and in-vivo toxicity had remained unexplored. Thus, the metabolites and the scientific evidence to validate the antibacterial activity and safety of the plant was limited. Identification of potent antibacterial agents could be crucial to manage dog-bite-related bacterial infections. The root extracts were analyzed using UHPLC–HRMS/MS—qTOF, followed by MZmine processing, and the metabolites characterized with GNPS Feature-Based Molecular Networking. For the first time, the high-resolution metabolomic approach resulted into annotation of 15 bioactive polyphenols like flavonoids, tannins. The antibacterial activity of the extracts was evaluated against standard strains of the zoonotic oral bacteria commonly associated with dog bites, namely: Enterococcus faecalis (ATCC 29,212), Streptococcus aureus (ATCC 25,932), Streptococcus mutans (ATCC 25,175), Proteus mirabilis (ATCC 25,933), Klebsiella pneumoniae (ATCC 700,603), and Escherichia coli (ATCC 25,922). The extracts exhibited moderate antibacterial activity against all the strains. The MIC and MBC ranged from (0.78 to 6.25) and (1.56 to 12.5) mg/mL respectively. The MBC/MIC ratios were between 1.9 and 2, signifying bactericidal extracts. In vivo acute toxicity testing, the extract showed no adverse signs of toxicity at doses up to 5000 mg/kg (LD50 > 5000 mg/kg), suggesting a favorable safety margin. These findings support the ethnopharmacological use of R. tridentata in managing dogbite-related bacterial infections and merit further investigations on its bioactive constituents identified for future antibacterial discovery.
Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda
(Elsevier Ltd, 2025-11-27) Jonathan Izudi;; Saidi Appeli;; Francis Bajunirwe
Rationale: Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective: We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods: We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results: Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion: FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.
Nutritional knowledge and attitudes of adolescents in public secondary schools in Uganda: a case study of Nansana Municipality, Uganda
(Taylor & Francis group, 2025-12-26) Joshua Ssemakula;; Edward Kansiime;; Kenneth Ssekatawa
This study investigated sources of nutrition information, attitudes, and nutrition knowledge towards the consumption of healthy foods among adolescents. A mixed cross-sectional study involving 1174 adolescents randomly chosen from all five public schools in Nansana Municipality was carried out. Information was gathered using a questionnaire and focus group discussions. From the findings, ‘television’ and ‘lessons taught in class’ were the most preferred sources of nutrition information, with percentage scores of 27.6% and 23.2%, respectively. Statistical analysis showed that adolescents with greater nutrition knowledge in themes: ‘nutrition and health outcomes’ and ‘nutrition function and sources’ significantly outperformed their peers on several items, for example, understanding the function of proteins (t = 4.67, p < .001, d = 0.26, 95% CI [0.14, 0.38]) and recognizing the cause of scurvy (t = 15.50, p < .001, d = 0.86, [0.74, 0.98]). A larger portion of participants exhibited negative attitudes towards healthy eating. These findings underscore the need for targeted interventions.
Drivers of risky sexual behaviours among adolescents in Nebbi Municipality, Uganda: analytical cross-sectional study
(Taylor & Francis group, 2025-12-10) Kizito Omona;; George Wycliffe Bwire;; Godfrey Mugisa ;; Jane Tolit Akullu
Risky sexual behaviour among adolescents remains a major public health challenge in Uganda. In Nebbi Municipality, high rates of teenage pregnancy, early sexual debut, and HIV infections have compounded the problem. This study sought to determine individual, environmental, and family-level drivers associated with adolescents’ risky sexual behaviours. Analytical cross-sectional study was conducted from January 2022 to March 2022 using a mixed-methods approach. Multi-stage sampling was used to select 300 adolescents aged 10–19 years, who were interviewed using an interviewer-administered questionnaire. Quantitative data were analyzed using SPSS, while qualitative data were thematically coded and analyzed. We found that risky sexual behaviours were associated with multiple drivers, including school dropout (aPR = 2.27, 95% CI: 0.54–6.65), awareness of partner’s HIV status (aPR = 8.22, 95% CI: 3.11–33.19), and traditional beliefs (aPR = 5.48, 95% CI: 1.73–17.39). Qualitative findings revealed that many adolescents lacked the power to negotiate safe sex, were influenced by peers, social media, and financial hardship. Adolescents in Nebbi Municipality remain vulnerable to risky sexual behaviours due to a combination of factors. Our study highlighted the need for targeted preventive interventions that strengthen parental support, promote safe sexual negotiation skills, and engage schools and community structures.
Quantifying mpox transmission and control: A regional analysis of vaccination strategies in East Africa
(Elsevier B.V, 2025-09-05) Rabiu, Musa;; Fagbemigun, Bosede;; Fadugba, Sunday ;; Shatalov, Michael;; Malesela, Kekana;; Adeniji, Adejimi
Africa is home to the endemic mpox disease, especially in the tropical rain-forest regions of Central and West Africa. Although it is mostly found in the Democratic Republic of the Congo, reports of it have also come from other neighboring African nations. To understand the dynamics of mpox, we studied its spread in Burundi, Uganda, Rwanda, Congo, and Kenya before and after the implementation of interventions. Using a Bayesian framework, a simple mathematical model of Susceptible-Infected-Recovered type was calibrated and fitted to the 2022 mpox data covering the period before the introduction of intervention strategies. The model was then re-stratified to incorporate key epidemiological features, including vaccination with imperfect efficacy, partial immunity, exposure, and demographics. The transmission of mpox varied throughout East Africa, with Uganda exhibiting the highest basic reproduction number R0 = 2.51, suggesting the possibility of a rapid spread. Despite having the highest initial infection count and the lowest R0 (1.23), Congo may have had delayed detection. The moderate R0 values (1.35 and 1.88) in Rwanda and Burundi have implications for prompt intervention to control epidemics. Transmission and vaccination rates have a non-linear relationship with the thresholds required to contain mpox outbreaks. Our model shows that in high-transmission settings, substantially higher vaccination coverage (exceeding 80 % at an effectiveness of 70 %) is required to reduce the control reproduction number below unity, whereas in moderate-transmission contexts, coverage above 40 % may suffice. These quantitative thresholds provide actionable guidance for tailoring vaccination strategies to different epidemiological conditions. In particular, sustained vaccination strategies that achieve coverage above the threshold predicted by our model (approximately 80 %) can guarantee mpox eradication, even in situations with strong transmission rates. While real-world complexities such as heterogeneous risk groups and behavioral factors may affect outcomes, these findings shed light on potential quantitative thresholds and provide a foundation for more detailed, population-specific modeling of mpox interventions.
Prevalence of sleep disturbances and factors associated among school going children in Uganda, a cross-sectional study
(Elsevier B.V, 2024-12-09) Innocent, Baluku Reagan;; Lorraine, Oriokot;; Katabira, Elly ;; Sajatovic, Martha;; Catherine, Abbo;; Mark, Kaddumukasa
AbstractBackgroundSleep disturbances greatly impact children's academic performance and social well-being. This study set out to determine the prevalence of sleep disturbances and factors associated among school going children in Kawempe division, Kampala, Uganda. MethodsIn a community cross-sectional study, 548 study participants using random cluster sampling were enrolled. The children start lessons at 8am and end the days classes at 5pm. Random cluster sampling method was used to select participants from the 19 parishes in Kawempe district. Data was collected using a semi-structured questionnaire and Sleep Disturbance Scale for Children (SDSC). Descriptive statistics and multivariate binary logistic regression were performed with a p < 0.05 level of significance, and a 95 % confidence interval as a measure of association between the sleep disturbance. ResultsAbnormal total sleep score (T- score >70) was at 3.5 %, and overall, 21.7 % of the children had an abnormal score on at least one SDSC factor. Among the children with sleep disturbances, we noted the following factors; use of an electronic device before bed, sleeping <7 h at night, having unemployed parents and lack of regular parental interaction. ConclusionBetter understanding of sleep disturbances in needed to address challenges associated with sleep among children in Uganda.

Browse

Recent Submissions