The National Research Repository of Uganda - NRU

Welcome to the National Research Repository of Uganda, abbreviated as "NRU". NRU was established in 2021. NRU is a collection of scholarly output by researchers from the UNCST Community, including scholarly articles and books, electronic theses and dissertations, conference proceedings, journals, technical reports and digitised library collections. It is the official Institutional Archive (IA) of UNCST.

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For information about the publishers' copyright policy on archiving your articles online or in an institutional archive, visit the Sherpa Site at http://www.sherpa.ac.uk/romeo.php The site gives a summary of the permissions normally given as part of each publisher's copyright transfer agreement. If you wish to publish your research findings in the NRU, please contact NRU administrator at admin@uncst.go.ug for details. NRU operates both open access and closed access models. Access to fulltext has been restricted in adherence to the UNCST Intellectual Property Rights (IPR) and Copyrights policies.

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Community health worker–facilitated telehealth for moderate–severe hypertension care in Kenya and Uganda: A randomized controlled trial
(Public Library of Science, 2025-06) 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, James
Background Hypertension 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. Methods and findings 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. Conclusion 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.
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Healthcare providers’ perceptions on post abortion intrauterine contraception: A qualitative study in central Uganda
(Public Library of Science, 2025-12-05) Kayiga, Herbert;; Looft-Trägårdh, Emelie;; Cleeve, Amanda ;; Kakaire, Othman;; Tumwesigye, Nazarius Mbona;; Byamugisha, Josaphat;; Gemzell-Danielsson, Kristina
Background Despite access to post abortion intrauterine contraception, the uptake of Intrauterine devices (IUDs) in Uganda remains low. Whether the perceptions of healthcare providers towards IUDs have a role in the provision of post abortion IUDs remains unclear. We explored perceptions on post abortion IUD provision among healthcare providers in Uganda, focusing on barriers and facilitators in regards to provision and uptake. Methods Between 1 st August 2022 and 30 th September 2022, forty-five in-depth interviews were conducted among healthcare providers of different cadres at sixteen public health facilities in central Uganda. We used the case study design to explore the healthcare providers’ perceptions. The interviews were primarily to help us understand the perceptions of healthcare providers towards IUDs. All interviews were audio-recorded and transcribed verbatim. Themes were identified using the conventional inductive content analysis. Results From the analysis, three themes emerged. Theme one covered health system related barriers in regards to IUD provision such as healthcare providers’ and health facility challenges. The second theme focused on the challenges in post abortion contraceptive counselling focusing on IUDs. The third theme covered the motivating factors and participants’ views on how to scale up IUD uptake and provision within post abortion care in Uganda. We found that lack of appropriate knowledge and skills on IUD provision, and heavy workloads, negatively impacted IUD provision. Inadequate facilities, IUD stock-outs, and minimal community sensitization also limited the utilization of IUDs. Furthermore, language barriers, community misconceptions around IUDs, long travel distances to the health facility, and partner refusal, contributed to the low uptake of post abortion IUDs. To address the identified barriers and scale up post abortion IUD provision, participants recommended addressing health system barriers, regular in-service refresher trainings, mentoring and supervision. They emphasized the importance of addressing contraceptive misconceptions and men’s opposition to IUDs through community sensitization. Conclusion In this study we identified several barriers to post abortion IUD provision, highlighting an urgent need to address health system barriers including healthcare providers’ skills and knowledge gaps, supply chain challenges, and to ensure that facilities are conducive to quality contraceptive counselling. Provision of on-job refresher trainings, mentoring and supervision, are key motivators that can be utilized in supporting healthcare providers towards post abortion IUD provision. To further increase uptake, efforts are needed to dispel contraceptive myths and misconceptions at the community level.
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Complete testing coverage for the early infant diagnosis algorithm and associated factors among infants exposed to HIV, Uganda, 2017–2019
(Public Library of Science, 2025-06-10) Akunzirwe, Rebecca;; Harris, Julie R.;; Kawungezi, Peter Chris ;; Wanyana, Mercy W.;; Lutalo, Tom;; Namukanja, Phoebe Monalisa;; Delaney, Augustina;; Migisha, Richard;; Nyamugisa, Esther;; Ondo, Doreen;; Kasibante, Philip;; Kadobera, Daniel;; Bulage, Lilian;; Zalwango, Jane Frances;; Ario, Alex Riolexus;; Nabitaka, Linda Kisaakye
Background Early infant diagnosis (EID) facilitates early initiation into HIV care for identified HIV-positive infants. According to the Uganda Ministry of Health, EID testing algorithm, testing for infants exposed to HIV (IEH) should occur at <6 weeks, 9 and 18 months of age, and 6 weeks after stopping breastfeeding. Uganda has faced challenges with loss to follow-up (LTFU) of IEH for EID. We assessed complete testing coverage (CTC) to the EID algorithm for IEH and associated factors. Methods We analyzed data from the 'Impact of the National Program for the Prevention of Vertical Transmission (PVT) of HIV in Uganda (2017-2019)' study. Mothers living with HIV whose infants tested HIV-negative at 4-12 weeks were enrolled in a prospective cohort (2017 - 2018) and followed until the IEH tested positive, died, was LTFU, or reached 18 months of age. We computed the proportion of IEH tested according to the EID algorithm among surviving infants. CTC was defined as undergoing HIV tests at three designated time points (excluding the 6 weeks after breastfeeding cessation) if HIV negative. IEH who were diagnosed with HIV but were tested at all recommended tests until that point were also considered to have CTC. We evaluated factors associated with CTC using modified Poisson regression. Results Among 1,804 IEH, 912 (51%) were male. Of the 1,804 IEH at baseline, 27 (1%) died. Among the 1,777 IEH included in the primary outcome analysis, 1,282 (72%) completed the study and 941 (53%) infants had CTC according to the EID testing algorithm including 40 (2%) who tested HIV-positive. Perceived discrimination due to HIV status [RR = 0.77, 95%CI (0.65-0.92)], having fewer pregnancies [RR = 0.97, 95%CI (0.68-0.99)], and reporting sexual violence [RR = 0.82, 95%CI (0.73-0.93)] by the mother of IEH were associated with non-CTC. Conclusion About half of IEH were tested at the recommended time points. Interventions to address stigma and sexual violence for mothers may improve CTC for the EID algorithm. Investigations are needed to explore associations between sexual violence, parity, and CTC for the EID algorithm.
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Trends and spatial distribution of neonatal sepsis, Uganda, 2016–2020
(BioMed Central, 2023-11-04) Migamba, Stella M.;; Kisaakye, Esther;; Komakech, Allan ;; Nakanwagi, Miriam;; Nakamya, Petranilla;; Mutumba, Robert;; Migadde, Deogratius;; Kwesiga, Benon;; Bulage, Lilian;; Kadobera, Daniel;; Ario, Alex R.
In Uganda, sepsis is the third-leading cause of neonatal deaths. Neonatal sepsis can be early-onset sepsis (EOS), which occurs ≤ 7 days postpartum and is usually vertically transmitted from the mother to newborn during the intrapartum period, or late-onset sepsis (LOS), occurring 8-28 days postpartum and largely acquired from the hospital environment or community. We described trends and spatial distribution of neonatal sepsis in Uganda, 2016-2020.BACKGROUNDIn Uganda, sepsis is the third-leading cause of neonatal deaths. Neonatal sepsis can be early-onset sepsis (EOS), which occurs ≤ 7 days postpartum and is usually vertically transmitted from the mother to newborn during the intrapartum period, or late-onset sepsis (LOS), occurring 8-28 days postpartum and largely acquired from the hospital environment or community. We described trends and spatial distribution of neonatal sepsis in Uganda, 2016-2020.We conducted a descriptive incidence study using routinely-reported surveillance data on in-patient neonatal sepsis from the District Health Information System version 2 (DHIS2) during 2016-2020. We calculated incidence of EOS, LOS, and total sepsis as cases per 1,000 live births (LB) at district (n = 136), regional (n = 4), and national levels, as well as total sepsis incidence by health facility level. We used logistic regression to evaluate national and regional trends and illustrated spatial distribution using choropleth maps.METHODSWe conducted a descriptive incidence study using routinely-reported surveillance data on in-patient neonatal sepsis from the District Health Information System version 2 (DHIS2) during 2016-2020. We calculated incidence of EOS, LOS, and total sepsis as cases per 1,000 live births (LB) at district (n = 136), regional (n = 4), and national levels, as well as total sepsis incidence by health facility level. We used logistic regression to evaluate national and regional trends and illustrated spatial distribution using choropleth maps.During 2016-2020, 95,983 neonatal sepsis cases were reported, of which 71,262 (74%) were EOS. Overall neonatal sepsis incidence was 17.4/1,000 LB. EOS increased from 11.7 to 13.4 cases/1,000 LB with an average yearly increase of 3% (p < 0.001); LOS declined from 5.7 to 4.3 cases/1,000 LB with an average yearly decrease of 7% (p < 0.001). Incidence was highest at referral hospitals (68/1,000 LB) and lowest at Health Center IIs (1.3/1,000 LB). Regionally, total sepsis increased in Central (15.5 to 23.0/1,000 LB, p < 0.001) and Northern regions (15.3 to 22.2/1,000 LB, p < 0.001) but decreased in Western (23.7 to 17.0/ 1,000 LB, p < 0.001) and Eastern (15.0 to 8.9/1,000, p < 0.001) regions.RESULTSDuring 2016-2020, 95,983 neonatal sepsis cases were reported, of which 71,262 (74%) were EOS. Overall neonatal sepsis incidence was 17.4/1,000 LB. EOS increased from 11.7 to 13.4 cases/1,000 LB with an average yearly increase of 3% (p < 0.001); LOS declined from 5.7 to 4.3 cases/1,000 LB with an average yearly decrease of 7% (p < 0.001). Incidence was highest at referral hospitals (68/1,000 LB) and lowest at Health Center IIs (1.3/1,000 LB). Regionally, total sepsis increased in Central (15.5 to 23.0/1,000 LB, p < 0.001) and Northern regions (15.3 to 22.2/1,000 LB, p < 0.001) but decreased in Western (23.7 to 17.0/ 1,000 LB, p < 0.001) and Eastern (15.0 to 8.9/1,000, p < 0.001) regions.The high and increasing incidence of EOS in Uganda suggests a major gap in sepsis prevention and quality of care for pregnant women. The heterogenous distribution of neonatal sepsis incidence requires root cause analysis by health authorities in regions with consistently high incidence. Strengthening prevention and treatment interventions in Central and Northern regions, and in the most affected districts, could reduce neonatal sepsis. Employment of strategies which increase uptake of safe newborn care practices and prevent neonatal sepsis, such as community health worker (CHW) home visits for mothers and newborns, could reduce incidence.CONCLUSIONThe high and increasing incidence of EOS in Uganda suggests a major gap in sepsis prevention and quality of care for pregnant women. The heterogenous distribution of neonatal sepsis incidence requires root cause analysis by health authorities in regions with consistently high incidence. Strengthening prevention and treatment interventions in Central and Northern regions, and in the most affected districts, could reduce neonatal sepsis. Employment of strategies which increase uptake of safe newborn care practices and prevent neonatal sepsis, such as community health worker (CHW) home visits for mothers and newborns, could reduce incidence. MEDLINE - Academic
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Factors associated with wasting among pediatric cancer patients aged 2–17 years at Uganda cancer institute: A cross-sectional study
(Public Library of Science, 2025-09-26) Wannyana, Daisy;; Bagonza, Arthur;; Mwima, Sandrah Joyce ;; Nalwadda, Christine;; Ndejjo, Rawlance
Wasting is a major concern among pediatric cancer patients and significantly affects treatment outcomes and quality of life. However, limited data exist on the prevalence of wasting and its associated factors in low-income contexts. This study determined the prevalence of wasting and its associated factors among pediatric cancer patients aged 2--17 years at the Uganda Cancer Institute. An institutionally based, cross-sectional study was conducted among 270 systematically randomly selected caregiver‒child pairs. Univariate, bivariate, and multivariable analyses were conducted using STATA version 14. Variables with p-value < 0.05 were considered statistically significant. Among 270 pediatric cancer patients aged 2-17 years, 27.4% (n = 74) were wasted. Children aged 5 years and older had a 20% higher prevalence of wasting (aPR = 1.2; p = 0.002). Cancers near the gastrointestinal tract were associated with a 10% greater prevalence of wasting (aPR = 1.1; p = 0.028). Wasting was lower by 20% among children whose caregivers had tertiary education (aPR = 0.8; p = 0.002), whereas treatment effects increased wasting prevalence by 10% (aPR = 1.1; p = 0.013). Wasting is a prevalent form of malnutrition among pediatric cancer patients requiring the integration of nutritional services to address the nutritional needs of children, especially those aged greater than 5 years, those with cancers along the gastro-intestinal tract and those experiencing treatment effects. Additionally, health and nutrition education programs tailored to the caregiver's level of education are needed.