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Population Effectiveness of Dolutegravir Implementation in Uganda: A Prospective Observational Cohort Study (DISCO), 48-Week Results
(The Journal of Infectious Diseases, 2024) Suzanne, M. McCluskey; Muyindike, Winnie R.; Nanfuka, Victoria; Omoding, Daniel; Nimusiima, Komukama; Barigye, Ian T.; Kansiime, Lydia; Tumusiime, Justus; Taing, N. Aung; Ashley, Stuckwisch; Bethany, Hedt-Gauthier; Vincent, C. Marconi; Mahomed-Yunus, S. Moosa; Deenan, Pillay; Jennifer, Giandhari; Richard, Lessells; Ravindra, K. Gupta; Mark, J. Siedner
Background Tenofovir/lamivudine/dolutegravir (TLD) is the preferred first-line antiretroviral therapy (ART) regimen for people with HIV (PWH), including those who were previously virologically suppressed on nonnucleoside reverse transcriptase inhibitors (NNRTIs). We sought to estimate the real-world effectiveness of the TLD transition in Ugandan public-sector clinics. Methods We conducted a prospective cohort study of PWH aged ≥18 years who were transitioned from NNRTI-based ART to TLD. Study visits were conducted on the day of TLD transition and 24 and 48 weeks later. The primary end point was viral suppression (<200 copies/mL) at 48 weeks. We collected blood for retrospective viral load (VL) assessment and conducted genotypic resistance tests for specimens with VL >500 copies/mL. Results We enrolled 500 participants (median age 47 years; 41% women). At 48 weeks after TLD transition, 94% of participants were in care with a VL <200 copies/mL (n = 469/500); 2% (n = 11/500) were lost from care or died; and only 2% (n = 9/500) had a VL >500 copies/mL. No incident resistance to DTG was identified. Few participants (2%, n = 9/500) discontinued TLD due to adverse events. Conclusions High rates of viral suppression, high tolerability, and lack of emergent drug resistance support use of TLD as the preferred first-line regimen in the region. Conclusions High rates of viral suppression, high tolerability, and lack of emergent drug resistance support use of TLD as the preferred first-line regimen in the region.
Partnering to Improve Mentorship Capacity for Ugandan Reproductive Health Researchers: Program Description and Evaluation
(The American Journal of Tropical Medicine and Hygiene, 2023) Julie M. Buser; Ella August; Faelan E. Jacobson-Davies; Felix Bongomin; Edward Kumakech; Rachel Gray; Pebalo Francis Pebolo; Anna Grace Auma,; Tamrat Endale
Mentorship is essential to health researchers in achieving their full potential and advancing public health. In most low-resource settings, there is a paucity of training on how to be a successful mentor. The Center for International Reproductive Health Training at the University of Michigan conducted and evaluated a workshop at two universities in Uganda for mentors of new reproductive health research grant awardees. The program aimed to strengthen mentors’ mentorship skills and to identify ways to foster institutional support for mentoring. Mentors rated their post-training skills using a 5-point Likert scale (not skilled to extremely skilled) immediately and 3 months after the training. Ten of 19 mentors who participated in the training completed the evaluation. The majority were 41 to 50 years old, male, midcareer faculty. Immediately after the training, mentors rated themselves (mean ± SD) highest in knowledge of research ethics (4.4 ± 0.5), fostering independence in mentees (4.3 ± 0.9), and understanding the benefits of mentoring (3.9 ± 1.1). Mentors felt least confident in fostering institutional change to support mentorship (3.3 ± 0.8), communication (3.5 ± 0.5), and overcoming adversity (3.5 ± 0.8). The two most important things the mentors learned were how to appreciate and manage diversity and how they can benefit from mentorship. Barriers to mentoring that persisted after the program ended included lack of time and institutional resources. Enhancing mentorship training opportunities will foster a generation of scientists who are more supported, skilled, and productive in research, leading to better reproductive and public health outcomes in their communities.
Participatory approaches, local stakeholders and cultural relevance facilitate an impactful community-based project in Uganda
(Health Promotion International, 2020) James, O’Donovan; Andrew, Thompson; Christina, Stiles; Japheth, A. Opintan; Kabali, Ken; Ian, Willis; Mwebe, Edward Mutimba; Nalweyiso, Elizabeth; Mugabi, Henry; Kateete, David P.; Ameniko, Matthew; Govina, George; Rachel, Weberman; Edward, O’Neil Jr; Niall, Winters; Ankur, Mutreja
Sanitation is a major global challenge that is often addressed at national and international levels, while community opinions and beliefs are neglected. To promote water, sanitation and hygiene (WASH) we organized a cross-cultural knowledge exchange workshop to assess participatory methods for engaging local stakeholders. The workshop included 22 participants from all sectors of society. Practical solutions to sanitation challenges were identified and later shared with a local community. Qualitative and quantitative analyses were used to assess impact and showed participatory methods were highly valued to encourage information sharing among widely varied stakeholders, and that video was a particularly successful approach when engaging with local communities. An 8-month follow-up survey of village members revealed excellent information recall, positive behaviour changes and a desire for future visits. Our evidence suggests that community-based participation helped identify solutions to WASH issues affecting rural communities in resource-poor settings. Engaging in a multicultural knowledge-share was particularly valuable as it enabled participants to recognize they have common challenges and allowed them to share low-cost solutions from their different communities. Our use of video was widely viewed as an ideal means of circulating findings, as it communicated information to people with a wide variety of community roles and to all age groups. Its relevance was increased by adopting a culturally appropriate context by involving local communities in workshop activities. We recommend that research in low- and middle-income countries should be mindful of the environmental context in which WASH is implemented, and encourage acceptance by engaging with communities through the use of varied participatory methods.
Sentiment Analysis of Social Media Data on Ebola Outbreak Using Deep Learning Classifiers
(Life, 2024) Mirugwe, Alex; Ashaba, Clare; Namale, Alice; Akello, Evelyn; Bichetero, Edward; Kansiime, Edgar; Nyirenda, Juwa
The Ebola virus disease (EVD) is an extremely contagious and fatal illness caused by the Ebola virus. Recently, Uganda witnessed an outbreak of EVD, which generated much attention on various social media platforms. To ensure effective communication and implementation of targeted health interventions, it is crucial for stakeholders to comprehend the sentiments expressed in the posts and discussions on these online platforms. In this study, we used deep learning techniques to analyse the sentiments expressed in Ebola-related tweets during the outbreak. We explored the application of three deep learning techniques to classify the sentiments in 8395 tweets as positive, neutral, or negative. The techniques examined included a 6-layer convolutional neural network (CNN), a 6-layer long short-term memory model (LSTM), and an 8-layer Bidirectional Encoder Representations from Transformers (BERT) model. The study found that the BERT model outperformed both the CNN and LSTM-based models across all the evaluation metrics, achieving a remarkable classification accuracy of 95%. These findings confirm the reported effectiveness of Transformer-based architectures in tasks related to natural language processing, such as sentiment analysis.
The COVID-19 pandemic and its impacts on diet quality and food prices in sub-Saharan Africa
(PLoS ONE, 2023) Abbas, Ismail; Madzorera, Isabel; Apraku, Edward A.; Amani, Tinkasimile; Dielbeogo, Dasmane; Zabre, Pascal; Millogo, Ourohire; Nega, Assefa; Chukwu, Angela; Firehiwot, Workneh; Mapendo, Frank; Bruno, Lankoande; Elena, Hemler; Dongqing, Wang; Sulemana, W. Abubakari; Kwaku, P. Asante; Till, Baernighausen; Japhet, Killewo; Ayoade, Oduola; Ali, Sie; Abdramane, Soura; Said, Vuai; Emily, Smith; Yemane, Berhane; Wafaie, W. Fawz
The innovative Pratt pouch could optimize dispensing nevirapine prophylaxis to HIV-exposed infants in pre-measured single dose pouches to increase completion of the full 6 week infant nevirapine regimen. Materials and methods Nineteen health facilities with highest HIV positivity rates among pregnant women across 9 districts in southwest and central Uganda were assigned to control and intervention groups. HIV-positive women enrolled at intervention facilities received pouches filled with premeasured single doses of nevirapine using Uganda national guidelines, which were integrated into the existing drug distribution system. During antenatal care (ANC) women received 14 pouches to cover time until the 6 day postpartum visit, with an additional 8 pouches if women were delayed in returning to the facility, and 28 pouches after delivery. Women enrolled at control facilities received standard nevirapine syrup following delivery for postnatal infant prophylaxis. In a select number of intervention facilities, during ANC, women received all 42 pouches needed to complete the 6 weeks regimen. Medical record data from enrolled women were extracted; interviews with HIV-positive women during postnatal care visits were conducted. Data were collected January to August 2018 (control sites) and October 2019 to February 2020 (intervention sites). Unadjusted and adjusted logistic regression models were used to identify factors associated with facility delivery, postnatal care follow-up visit, and completion of the full 6 weeks infant nevirapine regimen. Results Significantly more women in the intervention (n = 320) versus control (n = 340) group had facility delivery (292/316, 92.4% versus 169/340, 49.7%, p<0.0001), postnatal visits within 2 weeks postpartum (295/297, 99.3% versus 133/340, 39.1%, p<0.0001) and reported their infants completing the full 6 weeks infant prophylaxis regimen (299/313, 95.5% versus 210/242, 86.8%, p = 0.0002). Dispensing 42 versus 14 pouches during ANC did not have negative effects on these outcomes. Among out-of-facility deliveries, a higher proportion of infants received nevirapine within 72 hours of birth in the intervention versus control group, 95.8% versus 77.9%. In multivariate models, the intervention group was the only significant factor associated with facility delivery or completion of the full 6 weeks infant prophylaxis. Conclusions Use of the Pratt pouch resulted in an increase in HIV-exposed infants completing the full 6weeks prophylaxis regimen and associated benefits including increasing facility delivery and women’s adherence to postnatal care services.
Effects of the Pratt pouch model of dispensing nevirapine prophylaxis on HIV exposed infant completion of 6 weeks of prophylaxis in Uganda
(PLoS ONE, 2021) Bitarakwate, Edward; Kim, Ashburn; Kazooba, Patrick; Khamasi, Ronald; Natumanya, Eliab; Herrera, Nicole; Owomugisha, Boaz; Robert, A. Malkin; Kisaakye, Linda
The innovative Pratt pouch could optimize dispensing nevirapine prophylaxis to HIV-exposed infants in pre-measured single dose pouches to increase completion of the full 6 week infant nevirapine regimen. Materials and methods Nineteen health facilities with highest HIV positivity rates among pregnant women across 9 districts in southwest and central Uganda were assigned to control and intervention groups. HIV-positive women enrolled at intervention facilities received pouches filled with premeasured single doses of nevirapine using Uganda national guidelines, which were integrated into the existing drug distribution system. During antenatal care (ANC) women received 14 pouches to cover time until the 6 day postpartum visit, with an additional 8 pouches if women were delayed in returning to the facility, and 28 pouches after delivery. Women enrolled at control facilities received standard nevirapine syrup following delivery for postnatal infant prophylaxis. In a select number of intervention facilities, during ANC, women received all 42 pouches needed to complete the 6 weeks regimen. Medical record data from enrolled women were extracted; interviews with HIV-positive women during postnatal care visits were conducted. Data were collected January to August 2018 (control sites) and October 2019 to February 2020 (intervention sites). Unadjusted and adjusted logistic regression models were used to identify factors associated with facility delivery, postnatal care follow-up visit, and completion of the full 6 weeks infant nevirapine regimen. Results Significantly more women in the intervention (n = 320) versus control (n = 340) group had facility delivery (292/316, 92.4% versus 169/340, 49.7%, p<0.0001), postnatal visits within 2 weeks postpartum (295/297, 99.3% versus 133/340, 39.1%, p<0.0001) and reported their infants completing the full 6 weeks infant prophylaxis regimen (299/313, 95.5% versus 210/242, 86.8%, p = 0.0002). Dispensing 42 versus 14 pouches during ANC did not have negative effects on these outcomes. Among out-of-facility deliveries, a higher proportion of infants received nevirapine within 72 hours of birth in the intervention versus control group, 95.8% versus 77.9%. In multivariate models, the intervention group was the only significant factor associated with facility delivery or completion of the full 6 weeks infant prophylaxis.
Cross border population movements across three East African states: Implications for disease surveillance and response
(PLOS Glob Public Health, 2024) Patrick, King; Wanyana, Mercy Wendy; Mayinja, Harriet; Simbwa, Brenda Nakafeero; Zalwango, Marie Gorreti; Kobusinge, Joyce Owens; Migisha, Richard; Kadobera, Daniel; Kwesiga, Benon; Bulage, Lilian; Doreen, Gonahasa; Ahabwe, Babigumira Peter; Nchoko, Serah; Edna, Salat; Waithaka, Freshia; Gunya, Oscar; Odhiambo, Fredrick; Mutabazi, Vincent; Habimana, Metuschelah; Twagirimana, Gabriel; Ndabarinze, Ezechiel; Manishimwe, Alexis; Itiakorit, Harriet; Samuel, Kadivani; Katy, Seib; Ellen, Whitney; Alex, Riolexus Ario
The frequent population movement across the five East African Countries poses risk of disease spread in the region. A clear understanding of population movement patterns is critical for informing cross-border disease control interventions. We assessed population mobility patterns across the borders of the East African states of Kenya, Uganda, and Rwanda. In November 2022, we conducted Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), and participatory mapping. Participants were selected using purposive sampling and a topic guide used during interviews. Key informants included border districts (Uganda and Rwanda) and county health officials (Kenya). FGD participants were identified from border communities and travellers and these included truck drivers, commercial motorcyclists, and businesspersons. During KIIs and FGDs, we conducted participatory mapping using Population Connectivity Across Borders toolkits. Data were analysed using thematic analysis approach using Atlas ti 7 software. Different age groups travelled across borders for various reasons. Younger age groups travelled across the border for education, trade, social reasons, employment opportunities, agriculture and mining. While older age groups mainly travelled for healthcare and social reasons. Other common reasons for crossing the borders included religious and cultural matters. Respondents reported seasonal variations in the volume of travellers. Respondents reported using both official (4 Kenya-Uganda, 5 Rwanda-Uganda borders) and unofficial Points of Entry (PoEs) (14 Kenya-Uganda, 20 Uganda-Rwanda) for exit and entry movements on borders. Unofficial PoEs were preferred because they had fewer restrictions like the absence of health screening, and immigration and customs checks. Key destination points (points of interest) included: markets, health facilities, places of worship, education institutions, recreational facilities and business towns. Twenty-eight health facilities (10- Lwakhakha, Uganda, 10- Lwakhakha, Kenya, and 8- Cyanika, Uganda) along the borders were the most commonly visited by the travellers and border communities. Complex population movement and connectivity patterns were identified along the borders. These were used to guide cross-border disease surveillance and other border health strategies in the three countries. Findings were used to revise district response and preparedness plans by strengthening community-based surveillance in border communities.
Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda
(BMJ Global Health, 2023) Eleanor, Hutchinson; Kristian, Schultz Hansen; Sanyu, Jacquellyn; Amonya, Lydia Peace; Mundua, Sunday; Balabanova, Dina; Sian, E. Clarke; Kitutu Freddy Eric
The medicines retail sector is an essential element of many health systems in Africa and Asia, but it is also well known for poor practice. In the literature, it is recognised that improvements in the sector can only be made if more effective forms of governance and regulation can be identified. Recent debate suggests that interventions responsive to structural constraints that shape and underpin poor practice is a useful way forward. This paper presents data from a mixed-methods study conducted to explore regulation and the professional, economic and social constraints that shape rule breaking among drug shops in one district in Uganda. Our findings show that regulatory systems are undermined by frequent informal payments, and that although drug shops are often run by qualified staff, many are unlicensed and sell medicines beyond their legal permits. Most shops have either a small profit or a loss and rely on family and friends for additional resources as they compete in a highly saturated market. We argue that in the current context, drug shop vendors are survivalist entrepreneurs operating in a market in which it is extremely difficult to abide by policy, remain profitable and provide a service to the community. Structural changes in the medicines market, including removing unqualified sellers and making adjustments to policy are likely prerequisite if drug shops are to become places where individuals can earn a living, abide by the rules and facilitate access to medicines for people living in some of the world’s poorest countries.
Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study
(The Lancet Global Health, 2021) Okello, Emmy; Ndagire, Emma; Babu, Muhamed; Rachel, Sarnacki; Meghna, Murali; Jafesi, Pulle; Jenifer, Atala; Asha, C. Bowen; Marc, P. DiFazio; Nakitto, M. G.; Nada, S. Harik; Kansiime, Rosemary; Chris, T. Longenecker; Lwabi, Peter; Agaba, Collins; Scott, A. Norton; Omara, Isaac Otim; Oyella, Linda Mary; Tom, Parks; Rwebembera, Joselyn; Christopher, F. Spurney; Elizabeth, Stein; Laura, Tochen; David, Watkins; Meghan, Zimmerman; Jonathan, R. Carapetis; Craig, A. Sable; Andrea, Beaton
Background Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda. Methods For our prospective epidemiological study, we established acute rheumatic fever clinics at two regional hospitals in the north (Lira district) and west (Mbarara district) of Uganda and instituted a comprehensive acute rheumatic fever health messaging campaign. Communities and health-care workers were encouraged to refer children aged 3–17 years, with suspected acute rheumatic fever, for a definitive diagnosis using the Jones Criteria. Children were referred if they presented with any of the following: (1) history of fever within the past 48 h in combination with any joint complaint, (2) suspicion of acute rheumatic carditis, or (3) suspicion of chorea. We excluded children with a confirmed alternative diagnosis. We estimated incidence rates among children aged 5–14 years and characterised clinical features of definite and possible acute rheumatic fever cases. Findings Data were collected between Jan 17, 2018, and Dec 30, 2018, in Lira district and between June 5, 2019, and Feb 28, 2020, in Mbarara district. Of 1075 children referred for evaluation, 410 (38%) met the inclusion criteria; of these, 90 (22%) had definite acute rheumatic fever, 82 (20·0%) had possible acute rheumatic fever, and 24 (6%) had rheumatic heart disease without evidence of acute rheumatic fever. Additionally, 108 (26%) children had confirmed alternative diagnoses and 106 (26%) had an unknown alternative diagnosis. We estimated the incidence of definite acute rheumatic fever among children aged 5–14 years as 25 cases (95% CI 13·7–30·3) per 100 000 person-years in Lira district (north) and 13 cases (7·1–21·0) per 100 000 person-years in Mbarara district (west). Interpretation To the best of our knowledge, this is the first population-based study to estimate the incidence of acute rheumatic fever in sub-Saharan Africa. Given the known rheumatic heart disease burden, it is likely that only a proportion of children with acute rheumatic fever were diagnosed. These data dispel the long-held hypothesis that the condition does not exist in sub-Saharan Africa and compel investment in improving prevention, recognition, and diagnosis of acute rheumatic fever.
Infection prevention and control and water, sanitation, and hygiene status of healthcare facilities in the Greater Kampala Metropolitan region during the COVID-19 pandemic in Uganda
(PLOS Water, 2025-01-16) Mugambe, Richard K.;; Wanyenze, Rhoda K.;; Ssekamatte, Tonny ;; Isunju, John Bosco;; Nalugya, Aisha;; Wafula, Solomon T.;; Musoke, David;; Mukasa, Hajra Comfort;; Balen, Julie;; Yakubu, Habib;; Moe, Christine L.
Infection Prevention and Control (IPC) and Water Sanitation and Hygiene (WASH) are critical in preventing the spread of healthcare Associated Infections, including COVID-19. However, there was limited evidence on the status of IPC/WASH in healthcare facilities (HCFs) in Uganda amidst the COVID-19 pandemic which complicated IPC/WASH planning for the COVID-19 response. This study assessed IPC/WASH status for HCFs in the Greater Kampala Metropolitan Area (GKMA), during the COVID-19 pandemic, so as to inform programming and policy. A mixed methods cross-sectional study was conducted in 75 HCFs following the first wave of COVID-19 in Uganda. The mWater tool was used to collect quantitative data which were then analyzed into STATA version 16. A key informants’ guide was used to collect qualitative data, which was analyzed thematically and themes and quotes used to support the quantitative findings. Overall, 86.7% (65/75) of HCFs had an IPC committee and 72.3% (47/65) of these were functional. Besides, 90.7% (68/75) of the HCFs had an IPC focal person, and 49.3% (37/75) had a clear annual IPC activity plan. Unfortunately, only 32.3% (21/65) of the functional IPC committees received budgetary support for their activities. In terms of WASH infrastructure, 96.0% (72/75), 10.7% (8/75), 60.0% (45/75), and 22.7% (17/75) had access to a basic water service, a basic sanitation service, a basic hand hygiene service and a basic environmental cleaning respectively. Our study reveals that while most HCFs have IPC committees and focal persons, functional support remains limited, with half having a clear annual plan and less than a third receiving budgetary support. Nearly all HCFs have basic water services, but there are significant gaps in sanitation and environmental cleanliness domains. These findings highlight the urgent need for improved support and investment in IPC/WASH supplies and infrastructure to enhance infection control and public health outcomes in Uganda. CrossRef
HIV Treatment and Care of Adolescents: Perspectives of Adolescents on Community-Based Models in Northern Uganda
(Research and Palliative Care, 2023) Miyingo, Charles; Mpayenda, Teddy; Nyole, Ruth; Ayinembabazi, Joan; Ssepuuya, Mujib; Ssebuwufu, Eddie Marvin; Sean, Steven Puleh; Udho, Samson; Kabunga, Amir
Background Differentiated service delivery models for people living with HIV continue to be scaled up to expand access to HIV services and treatment continuity. However, there is a gap in information on adolescents’ perspectives on community-based models. We aimed to explore the perspectives of adolescents living with HIV on community-based models in northern Uganda. Materials and Methods Between February and March 2022, we conducted a descriptive qualitative study at two health centres IV in Northern Uganda. Data was collected using an interview guide. The study had 25 purposively selected adolescents enrolled in community-based models for HIV care and treatment. The interviews were audio-recorded, transcribed verbatim, and translated. We analyzed data using a thematic approach. Results A total of 25 in-depth interviews with HIV-positive adolescents were conducted. More than half (52.0%) of the participants were females, 84.0% were not married, and 44.0% had no formal education. The mean age of the respondents was 15.6 (±1.9) years. The major themes were: community-based models currently accessed by adolescents, benefits, and challenges of the models. Although there are other community-based models (community pharmacies, home ART deliveries) our exploration only discovered two models used by these adolescents to access care, namely, Community Drug Distribution Point (CDDP) and Community Client-Led ART Delivery Groups (CCLADs). The benefits included reduced transportation costs, convenient service access, ART adherence, peer support, a comfortable environment and less stress. However, our results indicate that these models had some challenges, including lack of confidentiality and privacy, perceived stigma, and a lack of face-to-face interaction. Conclusion Our findings show that CDDP and CCLADs are the two CBMs used by adolescents in Lira District to access treatment and care. Adolescents benefited from these models through reduced transport costs, the convenience of accessing HIV care and treatment, and social support. The challenges associated with these models are lack of confidentiality and privacy, perceived stigma, and a lack of face-to-face interaction. The Ministry of Health should work with other implementing partners to strengthen the implementation of these models to improve HIV/AIDS service delivery for adolescents.
Lessons Learned from Sudan Ebola Virus Disease (SUDV) Preparedness in Rwanda: A Comprehensive Review and Way Forward
(Journal of Epidemiology and Global Health, 2023-06-28) Rwagasore, Edson; Mucunguzi, Valois H.; Benimana, Jean Luc; Rwagitinywa, Bruce; Muvunyi, Claude Mambo
Ebola Virus Disease (EVD) is a severe and often fatal illness that affects humans and has significant public health implications, including high mortality rates, strain on healthcare systems, and social and economic disruption. On 20 September 2022, Uganda declared an Ebola disease outbreak caused by the Sudan ebolavirus species. The neighboring countries of Uganda were classified by World Health Organization (WHO) as being at high risk of Sudan Ebola Virus Disease (SUDV) importation. The country of Rwanda implemented different sustainable strategies and activities to prepare and ensure a timely and effective response to SUDV outbreaks once it has arrived in the country. We aimed to highlight the sustainable strategies and activities implemented for SUDV preparedness and the subsequent lessons learnt in Rwanda.
Childhood Lead Exposure After the Phaseout of Leaded Gasoline: An Ecological Study of School-Age Children in Kampala, Uganda
(Environmental health perspectives, 2010) Lauren, K. Graber; Daniel, Asher; Natasha, Anandaraja; Richard, F. Bopp; Karen, Merrill; Mark, R. Cullen; Luboga, Samuel; Leonardo, Trasande
Background Tetraethyl lead was phased out of gasoline in Uganda in 2005. Recent mitigation of an important source of lead exposure suggests examination and re-evaluation of the prevalence of childhood lead poisoning in this country. Ongoing concerns persist about exposure from the Kiteezi landfill in Kampala, the country’s capital. Objectives We determined blood lead distributions among Kampala schoolchildren and identified risk factors for elevated blood lead levels (EBLLs; ≥ 10 μg/dL). Analytical approach Using a stratified, cross-sectional design, we obtained blood samples, questionnaire data, and soil and dust samples from the homes and schools of 163 4- to 8-year-old children representing communities with different risks of exposure. Results The mean blood lead level (BLL) was 7.15 μg/dL; 20.5% of the children were found to have EBLL. Multivariable analysis found participants whose families owned fewer household items, ate canned food, or used the community water supply as their primary water source to have higher BLLs and likelihood of EBLLs. Distance < 0.5 mi from the landfill was the factor most strongly associated with increments in BLL (5.51 μg/dL, p < 0.0001) and likelihood of EBLL (OR = 4.71, p = 0.0093). Dust/soil lead was not significantly predictive of BLL/EBLL. Conclusions Lead poisoning remains highly prevalent among school-age children in Kampala. Confirmatory studies are needed, but further efforts are indicated to limit lead exposure from the landfill, whether through water contamination or through another mechanism. Although African nations are to be lauded for the removal of lead from gasoline, this study serves as a reminder that other sources of exposure to this potent neurotoxicant merit ongoing attention.
Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda
(Antimicrobial Resistance & Infection Control, 2024-07-16)
Effective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda
A cluster randomised trial to evaluate the effectiveness of household alcohol‑based hand rub for the prevention of sepsis, diarrhoea, and pneumonia in Ugandan infants (the BabyGel trial): a study protocol
(Trials, 2023-04-17) Chebet, Martin; Mukunya, David; Faragher, Eric Brian; Wandabwa, Julius; Weeks, Andrew
Infections are one of the leading causes of death in the neonatal period. This trial aims to evaluate if the provision of alcohol-based hand rub (ABHR) to pregnant women for postnatal household use prevents severe infections (including sepsis, diarrhoea, pneumonia, or death) among infants during the first three postnatal months.
Readiness to manage Ebola Virus Disease among emergency healthcare workers in Uganda: a nationwide multicenter survey
(BMC Health Services Research, 2024-10-23) Olum, Ronald; Atuhairwe, Irene; Kizito, Prisca Mary; Kalanzi, Joseph; Kerry, Vanessa
Emerging infectious diseases like the Ebola Virus Disease (EVD) pose significant global public health threats. Uganda has experienced multiple EVD outbreaks, the latest occurring in 2022. Frontline healthcare workers (HCWs) are at increased risk, yet there is insufficient evidence of existing knowledge of EVD of these HCWs. We aimed to assess the readiness of Uganda’s emergency HCWs to manage EVD and identify their training needs to inform targeted capacity-building interventions for future outbreaks.
“We have to clean ourselves to ensure that our children are healthy and beautiful”: findings from a qualitative assessment of a hand hygiene poster in rural Uganda
(BMC Public Health, 2019-01-03) Harrison, B. L.; Ogara, C.; Medina-Lara, A.; Weeks, A. D.
Neonatal sepsis is a major cause of mortality worldwide, with most deaths occurring in low-income countries. The World Health Organisation (WHO) ‘5 Moments for Hand Hygiene’ poster has been used to reduce hospital-acquired infections, but there is no similar tool to prevent community-acquired newborn infections in low-resource settings. This assessment, part of the BabyGel Pilot study, evaluated the acceptability of the ‘Newborn Moments for Hand Hygiene in the Home’ poster. This was an educational tool which aimed to remind mothers in rural Uganda to clean their hands to prevent neonatal infection.
Preventing neonatal sepsis in rural Uganda: a cross-over study comparing the tolerance and acceptability of three alcohol-based hand rub formulations
(BMC Public Health, 2018-11-20)
Neonatal sepsis causes 0.5 million deaths annually, mostly in low resource settings. Babies born in African rural homes without running water or toilet facilities are especially vulnerable. Alcohol-based hand rub (ABHR) may be used by mothers and carers as an alternative to hand washing with soap to prevent neonatal infection. However, no definite study has established the preferred formulation of hand rub for the mothers. This study aimed to assess the effects of addition of bitterants and perfume towards the acceptability of the alcohol-based hand rubs by the mothers in their homes after childbirth.
Implementation of an infection prevention and control response strategy to combat the Sudan Virus Disease outbreak in an urban setting, the Kampala Metropolitan area, Uganda, 2022
(BMC Infectious Diseases, 2025-03-06) Nanyondo, S. Judith; Nakato, Shillah; Kwiringira, Andrew; Suubi, Rebecca; Lamorde, Mohammed
In October 2022, the Uganda Ministry of Health (MoH) confirmed the first case of a Sudan Virus Disease (SVD) outbreak in the Kampala Metropolitan area (KMA). A multicomponent infection prevention and control (IPC) strategy was implemented to control the spread of Orthoebolavirus sudanense (SUDV) in KMA. We describe the deployment of this strategy, its effect on IPC capacities, and the successful control of the SVD outbreak in KMA during the 2022 outbreak. The multicomponent IPC strategy included (1) IPC pillar coordination: an IPC task force convened by government and health partner representatives and designated focal persons at the district level (2) Ring IPC: intense and targeted IPC support was developed to provide support to healthcare facilities (HCFs) and communities around each confirmed case, (3) IPC in HCFs: HCFs were assessed using a modified WHO SVD IPC scorecard rapid assessment tool that measured 15 IPC capacity domains, mentorship and IPC supplies were provided to HCFs with low scores on the rapid assessment. A KMA task force was established, and 13 IPC Rings were activated; 790 HCFs were assessed for IPC readiness, and 2,235 healthcare workers (HCWs) were trained. The mean (± standard-deviation) IPC score was 59.2% (± 18.6%) at baseline and increased to 65.5% (± 14.7%) at follow-up after 2 weeks (p < 0.001) of support. The mean IPC scores at baseline were lowest for primary HCFs (57%) and private-for-profit HCFs (47.1%). Similar gaps were revealed across all HCFs, with eight out of 15 (53.3%) IPC capacity areas assessed, resulting in scores < 50% at baseline. At follow-up, only four out of 15 (26.7%) capacity areas (26.7%) were below this threshold. The IPC strategy enhanced the IPC capacities at HCFs and could be adopted for future outbreaks. Leadership commitment and resource allocation to IPC during non-outbreak periods are critical for preparedness, rapid response, and access to safe care.
Individual and household risk factors for Ebola disease among household contacts in Mubende and Kassanda districts, Uganda, 2022
(BMC Infectious Diseases, 2024-05-30) Migamba, Stella M.; Migisha, Richard; Nansikombi, Hildah T.; Zalwango, Jane Frances; Simbwa, Brenda; Julie, R. Harris
In 2022, an Ebola disease outbreak caused by Sudan virus (SUDV) occurred in Uganda, primarily affecting Mubende and Kassanda districts. We determined risk factors for SUDV infection among household members (HHM) of cases. We conducted a case-control and retrospective cohort study in January 2023. Cases were RT-PCR-confirmed SUDV infection in residents of Mubende or Kassanda districts during the outbreak. Case-households housed a symptomatic, primary case-patient for ≥ 24 h and had ≥ 1 secondary case-patient with onset < 2 weeks after their last exposure to the primary case-patient. Control households housed a case-patient and other HHM but no secondary cases. A risk factor questionnaire was administered to the primary case-patient or another adult who lived at home while the primary case-patient was ill. We conducted a retrospective cohort study among case-household members and categorized their interactions with primary case-patients during their illnesses as none, minimal, indirect, and direct contact. We conducted logistic regression to explore associations between exposures and case-household status, and Poisson regression to identify risk factors for SUDV infection among HHM. Case- and control-households had similar median sizes. Among 19 case-households and 51 control households, primary case-patient death (adjusted odds ratio [ORadj] = 7.6, 95% CI 1.4–41) and ≥ 2 household bedrooms (ORadj=0.19, 95% CI 0.056–0.71) were associated with case-household status. In the cohort of 76 case-HHM, 44 (58%) were tested for SUDV < 2 weeks from their last contact with the primary case-patient; 29 (38%) were positive. Being aged ≥ 18 years (adjusted risk ratio [aRRadj] = 1.9, 95%CI: 1.01–3.7) and having direct or indirect contact with the primary case-patient (aRRadj=3.2, 95%CI: 1.1–9.7) compared to minimal or no contact increased risk of Sudan virus disease (SVD). Access to a handwashing facility decreased risk (aRRadj=0.52, 95%CI: 0.31–0.88). Direct contact, particularly providing nursing care for and sharing sleeping space with SVD patients, increased infection risk among HHM. Risk assessments during contact tracing may provide evidence to justify closer monitoring of some HHM. Health messaging should highlight the risk of sharing sleeping spaces and providing nursing care for persons with Ebola disease symptoms and emphasize hand hygiene to aid early case identification and reduce transmission.

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