Medical and Health Sciences
Permanent URI for this collection
Browse
Recent Submissions
Item Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study(Elsevier Ltd, 2025-12) Opolot, Godfrey;; Olupot-Olupot, Peter;; Okware, Samuel ;; Izudi, JonathanHighlights•Risk factors for MDR-TB among people with HIV (PWH) are understudied. •We found that retreatment TB is strongly associated with MDR-TB among PWH. •We recommend that PWH with prior TB treatment require MDR-TB surveillance. •Additionally, treatment adherence support may benefit PWH with retreatment TB.Item Logics of acquiring medicines from informal retailers in four African countries(Taylor & Francis group, 2025-12) Wagnild, Janelle M.;; Asiedu Owusu, Samuel;; Mariwah, Simon ;; Kolo, Victor I.;; Vandi, Ahmed;; Bambaiha Namanya, Didacus;; Kuwana, Rutendo;; Jayeola, Babatunde;; Hampshire, KateIn sub-Saharan Africa and other low-income contexts, informal medicine markets are widespread. Understanding the drivers of consumer demand is important, especially given the concerns and risks associated with medicines in the informal sector. This study aims to 1) describe the informal medicine sector in four anglophone African countries, and 2) understand why people patronize informal medicine sellers. Participant observation was conducted in eight markets (37 market stalls) across Ghana, Nigeria, Sierra Leone, and Uganda, supplemented by data collected during focus group discussions (with = 611 participants) and key informant interviews (with = 111), in which we discussed where participants got medicines in their communities and underlying reasons. We identified four distinct groups of actors in the informal medicine sector: sellers at weekly markets, itinerant peddlers, roadside sellers, and operators of general provision shops. There were multiple rationales for patronage of informal sellers that varied depending on the context, including flexibility in payment options, convenience and accessibility, and social/cultural drivers. Importantly, there were tradeoffs and tensions between these drivers that participants had to negotiate within the contexts of their current circumstances. These findings suggest that the informal medicine market is segmented and complex, and that patronage is driven by multiple logics that are rooted in gaps in formal healthcare provision. Regulatory measures therefore need to go hand-in-hand with efforts to address these gaps and expand effective access to quality-assured medicines through [inter alia] offering more flexible modes of payment, reducing public-sector medicine stock-outs, and improving patient-physician trust and communication. MEDLINEItem Strategies to Enhance COVID-19 Vaccine Uptake among Prioritized Groups, Uganda–Lessons Learned and Recommendations for Future Pandemics(U.S. National Center for Infectious Diseases, 2024-07) Kiiza, Daniel;; Semanda, Judith Nanyondo;; Kawere, Boneventure Brian ;; Ajore, Claire;; Wasswa, Christopher Kaliisa;; Kwiringira, Andrew;; Tumukugize, Emmanuel;; Sserubidde, Joel;; Namyalo, Nashiba;; Wadria, Ronald Baker;; Mukiibi, Peter;; Kasule, Julie;; Chemos, Ivan;; Ruth, Acham Winfred;; Atugonza, Ritah;; Banage, Flora;; Wibabara, Yvette;; Ampaire, Immaculate;; Driwale, Alfred;; Vosburgh, Waverly;; Nelson, Lisa;; Lamorde, Mohammed;; Boore, AmyCOVID-19 vaccination was launched in March 2021 in Uganda and initially prioritized persons >50 years of age, persons with underlying conditions, healthcare workers, teachers, and security forces. However, uptake remained low 5 months after the program launch. Makerere University's Infectious Diseases Institute supported Uganda's Ministry of Health in optimizing COVID-19 vaccination uptake models by using point-of-care, place of worship, and place of work engagement and the Social Assistance Grant for Empowerment model in 47 of 135 districts in Uganda, where we trained influencers to support mobilization for vaccination outreach under each model. During July-December, vaccination rates increased significantly in targeted regions, from 92% to 130% for healthcare workers, 40% to 90% for teachers, 25% to 33% for security personnel, 6% to 15% for persons >50 years of age, and 6% to 11% for persons with underlying conditions. Our approach could be adopted in other targeted vaccination campaigns for future pandemics.COVID-19 vaccination was launched in March 2021 in Uganda and initially prioritized persons >50 years of age, persons with underlying conditions, healthcare workers, teachers, and security forces. However, uptake remained low 5 months after the program launch. Makerere University's Infectious Diseases Institute supported Uganda's Ministry of Health in optimizing COVID-19 vaccination uptake models by using point-of-care, place of worship, and place of work engagement and the Social Assistance Grant for Empowerment model in 47 of 135 districts in Uganda, where we trained influencers to support mobilization for vaccination outreach under each model. During July-December, vaccination rates increased significantly in targeted regions, from 92% to 130% for healthcare workers, 40% to 90% for teachers, 25% to 33% for security personnel, 6% to 15% for persons >50 years of age, and 6% to 11% for persons with underlying conditions. Our approach could be adopted in other targeted vaccination campaigns for future pandemics. MEDLINE - AcademicItem An outbreak of scabies in a fishing community in Hoima District, Uganda, February − June, 2022(BioMed Central Ltd, 2025-07-01)Background 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. Methods 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. Results 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. Conclusion 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.Item The impact of shifts in PEPFAR funding policy on HIV services in Eastern Uganda (2015–21)(Oxford University Press, 2024-01-23) Zakumumpa, Henry;; Paina, Ligia;; Ssegujja, Eric ;; Shroff, Zubin Cyrus;; Namakula, Justin;; Ssengooba, FreddieAlthough donor transitions from HIV programmes are increasingly common in low-and middle-income countries, there are limited analyses of long-term impacts on HIV services. We examined the impact of changes in President’s Emergency Plan for AIDS Relief (PEPFAR) funding policy on HIV services in Eastern Uganda between 2015 and 2021.We conducted a qualitative case study of two districts in Eastern Uganda (Luuka and Bulambuli), which were affected by shifts in PEPFAR funding policy. In-depth interviews were conducted with PEPFAR officials at national and sub-national levels (n = 46) as well as with district health officers (n = 8). Data were collected between May and November 2017 (Round 1) and February and June 2022 (Round 2). We identified four significant donor policy transition milestones: (1) between 2015 and 2017, site-level support was withdrawn from 241 facilities following the categorization of case study districts as having a ‘low HIV burden’. Following the implementation of this policy, participants perceived a decline in the quality of HIV services and more frequent commodity stock-outs. (2) From 2018 to 2020, HIV clinic managers in transitioned districts reported drastic drops in investments in HIV programming, resulting in increased patient attrition, declining viral load suppression rates and increased reports of patient deaths. (3) District officials reported a resumption of site-level PEPFAR support in October 2020 with stringent targets to reverse declines in HIV indicators. However, PEPFAR declared less HIV-specific funding. (4) In December 2021, district health officers reported shifts by PEPFAR of routing aid away from international to local implementing partner organizations. We found that, unlike districts that retained PEPFAR support, the transitioned districts (Luuka and Bulambuli) fell behind the rest of the country in implementing changes to the national HIV treatment guidelines adopted between 2017 and 2020. Our study highlights the heavy dependence on PEPFAR and the need for increasing domestic financial responsibility for the national HIV response.Item Mixed-methods evaluation of a Global South-North research fellowship in Uganda: Global health experiential fellowship (GHEF)(Elsevier Ltd, 2025-12) Lee, Yang Jae;; Kazungu, Rauben;; Ssekalo, Ibrahim ;; Blackwell, Scott;; Nakaziba, Kayera Sumaya;; Monnig, Emery;; Mbabazi, Rita;; Muwereza, Peter;; Waiswa, Faizo;; Ingabire, Haba;; Vega, Alesha Cid;; Brown, Adam D.;; Rohrbaugh, Robert;; Rosenheck, Robert;; Waiswa, Peter;; Kohrt, Brandon A.Introduction: Integrated, simultaneous training of Global South and North trainees offers novel opportunities to enhance equitable collaboration and research capacity in global health. While existing programs often focus on exchange rotations or separate training tracks, simultaneous training of Global South and North trainees in the same intensive program remains understudied. We describe the Global Health Experiential Fellowship (GHEF), which combines research training with shared living arrangements and collaborative work in rural Uganda. Program description: GHEF is a five-week research training program for pre-doctoral students from Uganda and the United States. The program addresses power imbalances in North-South partnerships through shared leadership between Ugandan and American co-directors, with Ugandan team leaders supervising daily activities. Fellows work in mixed teams on qualitative mental health projects, while shared living arrangements foster cultural exchange. Since 2021, GHEF has trained 39 Ugandan students from three universities and 102 American students from 12 universities. Ugandan fellows participate without fees, subsidized by American fellows. Methods: We conducted a mixed-methods evaluation. Qualitative data were collected through interviews with 10 fellows (5 Ugandan, 5 American). Research skills were assessed using the Assessment of Key Interviewing Factors for Research Assistants (AKIRA) pre- and post-fellowship among 14 fellows (7 Ugandan, 7 American). Results: Ugandan fellows gained formal research training, while American fellows gained perspectives on field-based methodologies. Cultural exchange facilitated intercultural learning. AKIRA scores showed improvement in Ugandan fellows’ skills (pre-fellowship mean = 1.125; post-fellowship mean = 1.536; p = 0.0117). Discussion: GHEF's simultaneous training model offers a promising approach to equitable collaboration and building research capacity in global mental health.Item Post-traumatic stress disorder and associated factors among soldiers retiring from active service in Uganda: Across sectional study(Elsevier Ltd, 2025-12) Bigirwa, Dan Mwangye;; Rukundo, Godfrey Zari;; Kirabira, Joseph ;; Maling, Samuel;; Favina, Alain;; Muwanguzi, Moses;; Ainamani, Herbert Elvis;; Ashaba, ScholasticPost-traumatic stress disorder (PTSD) is one of the commonest mental health challenges among veterans and service members. However, studies on PTSD and its associated factors among military personnel in Uganda are limited. This study estimated the prevalence of PTSD and associated factors among soldiers retiring from active service in Uganda. In this cross-sectional study we recruited 247 retiring soldiers and assessed for PTSD using the PTSD check list for DSM-5. We also collected information on socio-demographic characteristics including gender, age, number of years in military service, level of education, and marital status, alcohol use, drug use, exposure to life, childhood trauma, and depression. participants. Of the 247 participants, 97 % (n = 239) were male, 47 % (n = 115), the average age was 46 (SD = 8.03) years, and the average duration of military service was 22 (SD = 8.36) years. The prevalence of PTSD among study participants was 13 % (n = 32). The factors associated with PTSD were moderate to hazardous alcohol consumption (aOR = 3.44; 95 % CI = 1.27–9.28; p = 0.02) and depression (aOR = 6.19; 95 % CI = 2.15–17.84; p = 0.0010). This study found a 13 % prevalence of PTSD among retiring military personnel in Uganda, with depression and hazardous alcohol use significantly increasing its odds. These findings underscore the need for targeted mental health screening and intervention during the transition to civilian life, particularly addressing depression and alcohol use. •Post traumatic disorder is prevalent among soldiers retiring from service in Uganda.•Post-traumatic stress disorder and alcohol commonly co-occur among Ugandan soldiers.•Routine mental health assessment among is needed for their mental wellbeing.Item Is equity meaningfully incorporated into pandemic preparednessand response? A scoping review and critical analysis of Ebola andCOVID-19 outbreak responses in Uganda 2019-2023(Taylor & Francis group, 2025-12) Gema Redondo;; Linda Murray;; Collette Bromhead ;; Issa MakumbiSocietal inequities produce vulnerabilities that infectious disease can exploit. Current approaches to pandemic prevention, detection and response are led by the International Health Regulations IHR and the Global Health Security Agenda. However, to contain the spread of infectious diseases, localised action to address systemic inequities must be considered. The purpose of this scoping review and equity analysis is to 1) Synthesise the available information on Uganda’s Ebola Virus Disease (EVD) and COVID-19 preparedness and outbreak responses between 2019 and 2023, and 2) Critique if and how Uganda’s Ministry of Health incorporated concepts of health equity in its EVD and COVID-19 interventions, while building national capacity to identify and prevent public health emergencies. This scoping review and critical analysis was conducted following the five-stage process defined by Levac et al. After identification and screening, the scoping review was based on six preparedness and response plans, three after-action reviews, and 20 grey literature and peer-reviewed articles. The findings revealed that the EVD and COVID-19 preparedness and response plans in Uganda show the country’s commitment and readiness for early detection and response to infectious disease outbreaks. However, further examination of the plans reveals missed opportunities to address systemic inequities. The ongoing mpox outbreak, declared a PHEIC by WHO on July 23, 2022, with significant impacts in African countries including Uganda, further underscores the need for a paradigm shift in managing infectious disease outbreaks. Such a shift may be similar to that experienced by the field of disaster risk reduction, which underwent a significant transformation at the Sendai Conference in 2015 towards a more holistic and proactive approach that addresses underlying systemic issues and focuses on building resilience. The exclusive focus on biomedical strategies to manage infectious diseases fails to address the social aspects of transmission, the local perceptions of illness, and community vulnerabilities often associated with social and historical perspectives. The social determinants of health disparities should be incorporated into pandemic planning and response. This will contribute to fostering equitable health outcomes and resilience in the face of the multifaceted challenges posed by future pandemics and environmental changes.Item Placental malaria induces a unique methylation profile associated with fetal growth restriction(Taylor & Francis, 2025-12) Ozarslan, Nida;; Mong, Corina;; Ategeka, John ;; Li, Lin;; Buarpung, Sirirak;; Robinson, Joshua F.;; Kizza, Jimmy;; Kakuru, Abel;; Kamya, Moses R.;; Dorsey, Grant;; Rosenthal, Philip J.;; Gaw, Stephanie L.Fetal growth restriction (FGR) is associated with perinatal death and adverse birth outcomes, as well as long-term complications, including increased childhood morbidity, abnormal neurodevelopment, and cardio-metabolic diseases in adulthood. Placental epigenetic reprogramming associated with FGR may mediate these long-term outcomes. Placental malaria (PM), characterized by sequestration of Plasmodium falciparum-infected erythrocytes in placental intervillous space, is the leading global cause of FGR, but its impact on placental epigenetics is unknown. We hypothesized that placental methylomic profiling would reveal common and distinct mechanistic pathways of non-malarial and PM-associated FGR. We analyzed placentas from a US cohort with no malaria exposure (n = 12) and a cohort from eastern Uganda, a region with a high prevalence of malaria (n = 12). From each site, 8 cases of FGR and 4 healthy controls were analyzed. PM was diagnosed by placental histopathology. We compared the methylation levels of over 850K CpGs of the placentas using Infinium MethylationEPIC v1 microarray. Non-malarial FGR was associated with 65 differentially methylated CpGs (DMCs), whereas PM-FGR was associated with 133 DMCs, compared to their corresponding controls without FGR. One DMC (cg16389901, located in the promoter region of BMP4) was commonly hypomethylated in both groups. We identified 522 DMCs between non-malarial FGR vs. PM-FGR placentas, independent of differing geographic location or cellular composition. Placentas with PM-associated FGR have distinct methylation profiles compared to placentas with non-malarial FGR, suggesting novel epigenetic reprogramming in response to malaria. Larger cohort studies are needed to determine the distinct long-term health outcomes in PM-associated FGR pregnancies.Item Application of the Method of Triads to Evaluate the Performance of Food Frequency Questionnaires and Biomarkers as Indicators of Long-term Dietary Intake(American journal of epidemiology, 2001-12-15) Kabagambe, Edmond K.; Baylin, Ana; Spiegelman, Donna; Campos, HanniaLittle is documented about the performance of the food frequency questionnaire (FFQ) in US minority groups and in populations in developing countries. The authors applied a novel technique, the method of triads, to assess the validity and reproducibility of the FFQ among Hispanics. The subjects were men (n = 78) and women (n = 42) living in Costa Rica. Seven 24-hour dietary recalls and two FFQ interviews (12 months apart) were conducted between 1995 and 1998 to estimate dietary intake during the past year. Plasma and adipose tissue samples were collected from all subjects. Validity coefficients, which measure the correlation between observed and “true” dietary intake, were also estimated. The median validity coefficients for tocopherols and carotenoids estimated by dietary recall, the average of the two FFQs, and plasma were 0.71, 0.60, and 0.52, respectively. Compared with adipose tissue, plasma was a superior biomarker for carotenoids and tocopherols. Adipose tissue was a poor biomarker for saturated and monounsaturated fatty acids but performed well for polyunsaturated fatty acids (validity coefficients, 0.45–1.01) and lycopene (validity coefficient, 0.51). This study also showed that biomarkers did not perform better than the FFQ and that they should be used to complement the FFQ rather than substitute for it.Item Prevalence of Overweight and Obesity in Young Adults in Uganda(African health sciences, 2010-09-29) Baalwa, J.; Byarugaba, B.B.; Kabagambe, K.E.; Otim, A.M.Obesity in young adults is rising and predicts diabetes and cardiovascular diseases later in life. Data on prevalence and determinants of obesity in developing countries are needed for primary prevention. Objectives: To determine the prevalence of overweight and obesity in young adults in urban (Kampala city) and rural areas (Kamuli District) of Uganda. Methods: Cross-sectional survey of 683 randomly selected young adults aged 18-30 years. Obesity was defined as body mass index (BMI) > 30 kg/m2 and overweight as BMI > 25 kg/m2. Distribution of BMI by socio-demographic characteristics was determined. Results: Of the 683 participants, 50.5% were female and 53.2% were from Kampala. The overall prevalence of obesity and overweight was 2.3% and 10.4%, respectively. The prevalence of obesity was 4.4% in Kampala and 0% in Kamuli while the prevalence of overweight was 10.2% and 10.6% in Kampala and Kamuli, respectively. Compared to males, females were more likely to be obese (2.9% vs. 1.8%) or overweight (17.4% vs. 3.3%). Residing in the city, alcohol consumption, smoking, non-engagement in sports activities, commuting to school by taxi or private vehicle and being from a rich family were the main factors significantly associated (P<0.05) with obesity. Being female (p = 0.0001) and not engaging in any sports activities (P = 0.002) were two factors significantly associated with being overweight. Conclusion: We observed significant gender differences in the prevalence of obesity among young adults in Uganda. Contrary to expectation, we did not observe significant rural-urban differences in the prevalence of overweight.Item Black soldier fly larvae composting as a bioremediation approach for heavy metals and pathogens in fecal sludge cake(Springer International Publishing, 2025-12) Nalunga, Agnes;; Komakech, Allan John;; Karungi, Jeninah ;; Kabenge, Isa;; Schwarzböck, ThereseAbstract Black Soldier Fly Larvae (BSFL) composting is increasingly explored as a sustainable strategy to treat organic waste. This study assessed the potential of BSFL to reduce heavy metals and pathogens in fecal sludge cake (FSC) co-composted with fruit and vegetable waste (FVW) or cattle manure (CM). Seven treatments; T1 (100% FSC), T2 (75% FSC:25% CM), T3 (65% FSC:35% CM), T4 (55% FSC:45% CM), T5 (75% FSC:25% FVW), T6 (65% FSC:35% FVW), and T7 (55% FSC:45% FVW),were evaluated for reductions and bioaccumulation of heavy metals (Pb, Cu, Fe, Cr, Zn) as well as Escherichia coli (E.coli) and Staphylococcus aureus (S. aureus). Pb reduction ranged from 33.0% (T5) to 60.9% (T4), with the lowest bioaccumulation (4.4 mg/kg) in T4. Cu decreased by up to 43.1% (T7), while Zn showed the highest decrease (48.2%) in T6. Cr reduction peaked in T7 (32.4%), and Fe in T2 (28.7%). T5 achieved the highest E. coli reduction (99.8%), while T4 exhibited the highest S. aureus decrease (94.9%). Treatments with co-substrates (FVW or CM) consistently outperformed FSC alone, underlining their role in enhancing BSFL composting efficacy. These findings demonstrate the potential of BSFL composting to mitigate environmental and health risks associated with FSC use, offering a scalable solution for organic waste management in low-resource settings.Item Estimating global prevalence of gallbladder stones in general population from 2000 to 2024: systematic review and meta-analysis(Taylor & Francis group, 2025-12) Ning, Qingyang;; Ning, Qingyang;; Liu, Fen;; Fang, Yiqiao ;; Zhu, Xixi;; Liu, Jiaye;; Li, ZhihuiGallbladder stones (GS), is one of the most common and costly of all the gastrointestinal diseases. However, global prevalence estimates of GS remain heterogeneous due to methodological variations across studies, and consensus on risk factor hierarchies is still evolving. Therefore, we performed current study in order to estimate the global prevalence of GS. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Data were analysed the DerSimonian-Laird random-effects model with Logit transformations, and sensitivity analysis was performed using a 'Leave-one-out' approach. Of 18,277 identified records, 139 studies were included in the final analysis. The overall global prevalence of GS in the general population was 5.86% (95% CI 5.28-6.47). Marked geographical disparities were observed, with the highest prevalence in Uganda (21.92%, 95% CI 18.43-25.61) and the lowest in Australia (0.18%, 95% CI 0.17-0.18) - a 122-fold difference. Multivariable meta-regression showed that study size was the strongest predictor (importance: 97.79%). Regarding risk factors, female gender, age > 50 years, increased body mass index, and family history of GS were significantly associated with higher GS prevalence. In contrast, factors such as education level, smoking, alcohol consumption, lifestyle, vegetarian diet, and serum lipid levels had no significant impact. Comorbidities including hypertension, diabetes mellitus, and metabolic-associated fatty liver disease (MAFLD) were strongly correlated with elevated GS prevalence. This meta-analysis showed that the GS was a common disease and affected the health of one in twenty people worldwide. Accurate estimates of the global and population-based prevalence of GS are helpful for healthcare improvements. MEDLINEItem Quantifying mpox transmission and control: A regional analysis of vaccination strategies in East Africa(Elsevier B.V, 2025-03) Rabiu, Musa;; Fagbemigun, Bosede;; Fadugba, Sunday ;; Shatalov, Michael;; Malesela, Kekana;; Adeniji, AdejimiAfrica 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 = 2.51, suggesting the possibility of a rapid spread. Despite having the highest initial infection count and the lowest (1.23), Congo may have had delayed detection. The moderate 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.Item Community health worker–facilitated telehealth for moderate–severe hypertension care in Kenya and Uganda: A randomized controlled trial(Public Library of Science, 2025-06-05) Hickey, Matthew D.;; Owaraganise, Asiphas;; Ogachi, Sabina ;; Sang, Norton;; Wafula, Erick M.;; Kabami, Jane;; Sutter, Nicole;; Temple, Jennifer;; Muiru, Anthony;; Chamie, Gabriel;; Kakande, Elijah;; Petersen, Maya L.;; Balzer, Laura B.;; Havlir, Diane V.;; Kamya, Moses R.;; Ayieko, JamesHypertension is underdiagnosed and undertreated in sub-Saharan Africa. Improving hypertension treatment within primary health centers can improve cardiovascular disease outcomes; however, individuals with moderate-severe hypertension face additional barriers to care, including the need for frequent clinic visits to titrate medications. We conducted a pilot study to test whether a clinician-driven, community health worker (CHW)-facilitated telehealth intervention would improve hypertension control among adults with severe hypertension in rural Uganda and Kenya.BACKGROUNDHypertension is underdiagnosed and undertreated in sub-Saharan Africa. Improving hypertension treatment within primary health centers can improve cardiovascular disease outcomes; however, individuals with moderate-severe hypertension face additional barriers to care, including the need for frequent clinic visits to titrate medications. We conducted a pilot study to test whether a clinician-driven, community health worker (CHW)-facilitated telehealth intervention would improve hypertension control among adults with severe hypertension in rural Uganda and Kenya.We conducted a pilot randomized controlled trial (RCT) of hypertension treatment delivered via telehealth by a clinician (adherence assessment, counseling, decision-making) and facilitated by a CHW in the participant's home, compared to clinic-based hypertension care (NCT04810650). We recruited adults ≥40 years with BP ≥ 160/100 mmHg at household screening by CHWs, with no restrictions by HIV status. After initial evaluation at the clinic, participants were randomized to telehealth or clinic-based hypertension follow-up. Randomization assignment was not blinded, except for the study statistician. All participants were treated using standard country guideline-based antihypertensive drugs. The primary outcome was hypertension control at 24 weeks (BP < 140/90 mmHg). We also assessed hypertension control at 48 weeks. In intention-to-treat analyses, we compared outcomes between randomized arms with targeted minimum loss-based estimation using sample-splitting to select optimal adjustment covariates (candidates: age, sex, baseline hypertension severity, and country). We screened 2,965 adults ≥40 years, identifying 266 (9%) with severe hypertension and enrolling 200 (98 telehealth arms, 102 clinic arms). Participants were 67% women, median age of 62 years (Q1-Q3 51-72); 14% with HIV. Week 24 blood pressure was measured in 96/99 intervention and 99/102 control participants; week 24 hypertension control was 77% in telehealth and 51% in clinic arms (risk difference (RD) 26%, 95% confidence interval (CI) [14%, 38%], p < 0.001). Week 48 hypertension control was 86% in telehealth and 44% in clinic arms (RD 42%, 95% CI [30%, 53%], p < 0.001). Three participants died (telehealth: 2, clinic: 1); all deaths were unrelated to the study interventions. Our study was limited by its small sample size, although findings are strengthened by being conducted in three primary health centers across two countries.METHODS AND FINDINGSWe conducted a pilot randomized controlled trial (RCT) of hypertension treatment delivered via telehealth by a clinician (adherence assessment, counseling, decision-making) and facilitated by a CHW in the participant's home, compared to clinic-based hypertension care (NCT04810650). We recruited adults ≥40 years with BP ≥ 160/100 mmHg at household screening by CHWs, with no restrictions by HIV status. After initial evaluation at the clinic, participants were randomized to telehealth or clinic-based hypertension follow-up. Randomization assignment was not blinded, except for the study statistician. All participants were treated using standard country guideline-based antihypertensive drugs. The primary outcome was hypertension control at 24 weeks (BP < 140/90 mmHg). We also assessed hypertension control at 48 weeks. In intention-to-treat analyses, we compared outcomes between randomized arms with targeted minimum loss-based estimation using sample-splitting to select optimal adjustment covariates (candidates: age, sex, baseline hypertension severity, and country). We screened 2,965 adults ≥40 years, identifying 266 (9%) with severe hypertension and enrolling 200 (98 telehealth arms, 102 clinic arms). Participants were 67% women, median age of 62 years (Q1-Q3 51-72); 14% with HIV. Week 24 blood pressure was measured in 96/99 intervention and 99/102 control participants; week 24 hypertension control was 77% in telehealth and 51% in clinic arms (risk difference (RD) 26%, 95% confidence interval (CI) [14%, 38%], p < 0.001). Week 48 hypertension control was 86% in telehealth and 44% in clinic arms (RD 42%, 95% CI [30%, 53%], p < 0.001). Three participants died (telehealth: 2, clinic: 1); all deaths were unrelated to the study interventions. Our study was limited by its small sample size, although findings are strengthened by being conducted in three primary health centers across two countries.In this pilot, RCT, clinician-driven, CHW-facilitated telehealth for hypertension management improved hypertension control and reduced severe hypertension compared to clinic-based care. Telehealth focused on individuals with moderate-severe hypertension is a promising approach to improve outcomes among those with the highest risk for CVD.CONCLUSIONIn this pilot, RCT, clinician-driven, CHW-facilitated telehealth for hypertension management improved hypertension control and reduced severe hypertension compared to clinic-based care. Telehealth focused on individuals with moderate-severe hypertension is a promising approach to improve outcomes among those with the highest risk for CVD. MEDLINE - AcademicItem A case of blinding abdominal pain(South African Medical Journal, 2011-07-02) Mutyaba, A. K.; Gardiner,E. C.; Murphy, SA 12-year-old girl was admitted to hospital with a week's history of severe abdominal pain, distension and generalised weakness, and was managed for incomplete intestinal obstruction. Plain abdominal films were compatible with ileus, and ultrasound showed no ascites, no lymphadenopathy, and normal abdominal and pelvic organs. We saw her following the onset of new generalised tonic-clonic seizures. She was slightly obtunded with raised blood pressure (166/115 mmHg) and sinus tachycardia (130 bpm), apyrexial, and had mild psychomotor retardation and blindness with no light perception in either eye. Fundoscopy was normal. There was no meningism or sensorimotor deficit. Apart from a marginally low serum sodium level (131 mmol/l), the results of all biochemical and haematological investigations were normal. Inflammatory markers (c-reactive protein, erythrocyte sedimentation rate and procalcitonin) and cerebrospinal fluid assessment were normal.Item Experiences of Child Sexual Abuse Survivors with formal Child Protection Systems: An indigenist perspective(Journal of Comparative Social Work, 2025-07-08) Turyomurugyendo, Florence; Walakira, Eddy J.; Cecilie, Revheim; Twikirize, Janestic M.Preventing abuse in childhood and providing services to the victims requires a comprehensive child protection framework. Even when the government of Uganda has made deliberate efforts to facilitate protection of children, research shows that their efforts have largely been inadequate. Adopting an indigenous perspective that centers the structural inequalities that inform social relationships in families, communities and the society rather than the individual is paramount. Thus, this study examined how indigenous child protection systems can be integrated to complement formal approaches in responding to child sexual abuse. This article presents experiences of five adult women from Luuka district, Uganda who experienced rape during their childhood. Narrative inquiry was used to explore survivors’ experiences. This information was complemented by information from social workers who were purposively selected and interviewed using a semi-structured interview guide. Thematic analysis was used to analyse the findings and four major themes relating to survivors’ experiences emerged from this study. Survivors reported challenges with investigations, access to justice, lack of protective shelter and challenges in accessing medical services. In addition to formal child protection systems, survivors utilised services from indigenous child protection systems which included; Local Council 1, community volunteers, social groups and savings groups. Indigenous practices based on mutual aid and community organising addressed broader welfare needs of survivors, including enabling them to access education, linkage to services and access to shelter. The social support provided through indigenous models involved multiple social welfare functions, and addressed different child protection needs. However, poverty at the household and community level limits the scalability of such approaches. Accessing formal child protection services was found to be costly for the survivors. The Informal Child Protection System is more accessible, offers comprehensive services and demonstrates to buffer the formal systems.Item Diagnostic pattern of mental, neurological and substance use disorders at primary health care facilities in Uganda(International Journal of Mental Health Systems, 2024-07-15) Mutamba, Byamah B.; Twikirize, Gad; Ssemalulu, Jimmy; Semakula, Lynn; Cappo, DavidIntegration of diagnosis and treatment for mental, neurological, and substance use (MNS) disorders into primary health care is a recommended strategy to improve access to services in low-and middle-income countries. Despite numerous initiatives for integration of mental health care in Uganda, there has not been an evaluation of health management information system (HMIS) records to determine whether MNS disorders are routinely diagnosed. We sought to determine diagnostic pattern of MNS disorders at primary health facilities in Wakiso and Kampala districts, the most populous regions of Uganda. Lower-level primary health facilities were visited to obtain records from HMIS registers, to document diagnoses of MNS disorders. Secondary data analysis was conducted and descriptive statistics reported. A total of 40 primary health care facilities were visited representing 58.6% of the health facilities in the study districts. More than half (54.8%) and almost all (87.5%) of the lower-level health facilities in Wakiso district and Kampala district respectively were visited. The proportion of MNS disorders diagnosed at lower-level primary health facilities in Uganda is very low with Epilepsy the most common MNS diagnosis recorded. Reasons for such low numbers of diagnoses at primary health facilities are discussed as are possible solutions.Item LLIN Evaluation in Uganda Project (LLINEUP2)—Factors associated with coverage and use of long‑lasting insecticidal nets following the 2020–21 national mass distribution campaign: a cross-sectional survey of 12 districts(BioMed Central, 2022-10-19) Okiring, Jaffer;; Gonahasa, Samuel;; Nassali, Martha ;; Namuganga, Jane F.;; Bagala, Irene;; Maiteki‑Sebuguzi, Catherine;; Opigo, Jimmy;; Nabende, Isaiah;; Nangendo, Joanita;; Kabami, Jane;; Ssewanyana, Isaac;; Kiwuwa, Steven M.;; Nankabirwa, Joaniter I.;; Dorsey, Grant;; Briggs, Jessica;; Kamya, Moses R.;; Staedke, Sarah G.Abstract Background In 2020–2021, long-lasting insecticidal nets (LLINs) were distributed nationwide in Uganda during the COVID-19 pandemic. A cross-sectional survey was conducted in 12 districts to evaluate the impact of the campaign 1–5 months after LLIN distribution. Methods During April–May 2021, households were randomly selected from target areas (1–7 villages) surrounding 12 government-run health facilities established as Malaria Reference Centres; at least 50 households were enrolled per cluster. Outcomes included household ownership of LLINs distributed through the universal coverage campaign (UCC) (at least one UCC LLIN), adequate coverage of UCC LLINs (at least one UCC LLIN per 2 residents), and use of LLINs (resident slept under a LLIN the previous night). Multivariate logistic regression models were used to identify household- and individual-level factors associated with outcomes, controlling for clustering around health facilities. Results In total, 634 households, with 3342 residents and 1631 bed-nets, were included. Most households (93.4%) owned at least 1 UCC LLIN, but only 56.8% were adequately covered by UCC LLINs. In an adjusted analysis, the factor most strongly associated with adequate coverage by UCC LLINs was fewer household residents (1–4 vs 7–14; adjusted odds ratio [aOR] 12.96, 95% CI 4.76–35.26, p < 0.001; 5–6 vs 7–14 residents; aOR 2.99, 95% CI 1.21–7.42, p = 0.018). Of the 3166 residents of households that owned at least one UCC LLIN, only 1684 (53.2%) lived in adequately covered households; 89.9% of these used an LLIN the previous night, compared to 1034 (69.8%) of 1482 residents living in inadequately covered households. In an adjusted analysis, restricted to residents of inadequately covered households, LLIN use was higher in children under-five than those aged 5–15 years (aOR 3.04, 95% CI 2.08–4.46, p < 0.001), and higher in household heads than distantly-related residents (aOR 3.94, 95% CI 2.38–6.51, p < 0.001). Conclusions Uganda’s 2021–21 campaign was successful, despite the COVID-19 pandemic. In future campaigns, strategies should be adopted to ensure high LLIN coverage, particularly for larger households. A better understanding of the drivers of LLIN use within households is needed to guide future interventions, educational messages, and behaviour change communication strategies; school-aged children and distantly-related residents appear vulnerable and could be targeted.Item Prevalence of depression in Uganda: A systematic review and meta-analysis(Public Library of Science, 2022-10-20) Kaggwa, Mark Mohan;; Najjuka, Sarah Maria;; Bongomin, Felix ;; Mamun, Mohammed A.;; Griffiths, Mark D.Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7-34.1, I.sup.2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).