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Recent Submissions

The Role of Health Networks in Disseminating Knowledge about Infant HIV Testing in Rural Uganda: Population-Based Sociocentric Network Study
(AIDS and Behavior, 2025) Alison B. Comfor; James Moody; Julian Adong; Carol S. Camlin; Theodore D. Ruel; Scholastic Ashaba; Jessica M. Perkins; Charles Baguma; Emily N. Satinsky; Justus Kananura; E. Betty Namara; Mercy Juliet; Bernard Kakuhikire; Cynthia C. Harper; Alexander C. Tsai
Early testing of infants exposed to HIV can significantly decrease mortality for those linked to HIV treatment. Infants exposed to HIV should first be tested at 6 weeks of age, but only 60% are tested as recommended. Little research has focused on the role of social networks in disseminating information about infant HIV testing. We conducted a cross sectional, sociocentric network study of all adults living in a rural parish in Uganda (N=1,383) and gathered data on socio-demographic characteristics, self-reported HIV status, and knowledge about infant testing recommendations. We administered a culturally-adapted name generator to measure the parish health network. We fitted a multivariable general ized linear regression model with a logit distribution to estimate the association between having at least one social tie with correct knowledge about early infant testing and individual knowledge about infant testing. Having at least one social tie who knew about infant HIV testing at 6 weeks was positively associated with correct knowledge about early infant testing (adjusted odds ratio [aOR] 1.42, 95% confidence interval [CI] 1.07- 1.88, p-value=0.02). Correct knowledge about early infant testing was also associated with having daily contact with social ties (aOR 1.31, 95% CI 1.00-1.71, p-value=0.05) and being considered an authority for health advice within the network (aOR 1.81, 95% CI 1.18-2.77, p-value=0.01). These findings suggest that interventions to enhance peer-to-peer information exchange could increase knowledge about early infant testing, since individuals rely on close, frequently contacted social ties. Network-central individuals can also be engaged to disseminate information about early infant testing
Prevalence, associated factors, and machine learning-based prediction of depression, anxiety, and stress among university students: a cross-sectional study from Bangladesh
(Journal of Health, Population and Nutrition, 2025) Md Emran Hasa; Mohammad Arif; S. M. Rakibul Hasan; Moses Muwanguzi; Joan Abaatyo; Mark Mohan Kaggwa; Moneerah Mohammad ALmerab; Pawel A. Atroszko; Mohammad Muhit; Firoj Al-Mamun; Mohammed A. Mamun
Background: Mental health challenges are a growing global public health concern, with university students at elevated risk due to academic and social pressures. Although several studies have exmanined mental health among Bangladeshi students, few have integrated conventional statistical analyses with advanced machine learning (ML) approaches. This study aimed to assess the prevalence and factors associated with depression, anxiety, and stress among Bangladeshi university students, and to evaluate the predictive performance of multiple ML models for those outcomes. Methods: A cross-sectional survey was conducted in February 2024 among 1697 students residing in halls at two public universities in Bangladesh: Jahangirnagar University and Patuakhali Science and Technology University. Data on sociodemographic, health, and behavioral factors were collected via structured questionnaires. Mental health outcomes were measured using the validated Bangla version of the Depression, Anxiety, and Stress Scale-21 (DASS 21). Statistical analyses included chi-square tests and binary logistic regression, while seven ML models including, K-Nearest Neighbors (KNN), Random Forest (RF), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), Logistic Regression (LR), and Support Vector Machine (SVM) were employed to predict mental health outcomes. Results: The prevalence of depression, anxiety, and stress was 56.9%, 69.5%, and 32.2%, respectively. Significant associated factors for depression included unfriendly family relationships, enrollment in commerce, and cigarette smoking. Female gender, unfriendly family relationships, academic year, and cigarette smoking were significant factors for stress. No significant factors were identified for anxiety. Among ML models, SVM achieved the highest accuracy for depression prediction (accuracy = 0.5693; precision = 0.7560; log loss = 0.6847), LR for anxiety (accuracy = 0.6948; precision = 0.7881), and CatBoost for stress (accuracy = 0.6706; precision = 0.6454; F1-score = 0.5777; log loss = 0.6284). Feature importance analyses highlighted faculty of study and relation with family as the top predictors. ROC-AUC values indicated moderate discriminatory performance (all ≥ 0.5). Conclusions: Integrating machine learning with conventional analyses enhances the identification and prediction of factors associated with depression, anxiety, and stress among university students. These findings support the implementation of campus-based mental health screening, accessible counseling, and peer support programs, and highlight the value of data-driven approaches for developing targeted university mental health policies.
Modeling Learners’ Attitudinal Shifts in Transformation Geometry under Technology-enhanced and Conventional Van Hiele Phased Instruction
(African Journal of Research in Mathematics, Science and Technology Education, 2025-07-21) Issa Ndungo; Sudi Balimuttajjo; Edwin Akugizibwe; Charles Magoba Muwonge
This study compared shifts in learners’ attitudes under two instructional strategies: technology-enhanced Van Hiele phased instruction (TVHPI) and conventional Van Hiele phased instruction (CVHPI). A quasi- experimental design was used with 245 learners in the CVHPI group and 238 learners in the TVHPI group. Owing to non-normal data distribution, non-parametric tests were applied. The Wilcoxon signed- rank test revealed significant improvements in attitudes from pre-test to post-test in both groups (p < 0.001), with CVHPI showing a strong effect (rβ = 0.970) and TVHPI demonstrating an even larger shift (rβ = 0.998). Further analysis using the Mann–Whitney U-test and a difference-in-differences model confirmed that TVHPI led to a greater positive change in attitudes than CVHPI. These findings extend the Van Hiele theory beyond its traditional focus on geometric reasoning by demonstrating its potential to influence learners’ attitudes positively, an effect that is further amplified through integrating technology, such as GeoGebra, into phased instruction. Thereby supporting technology-enhanced, learner-centred approaches aligned with Uganda’s Competency-Based Curriculum.
Epidemiology of ocular trauma in limited-resource settings: a narrative review
(Frontiers in Medicine, 2025-08-25) Jessica Pelletie; Kakande Reaga; Sarah McLeo; Noah Kronk; Kamoga Dickson; Kyle Ohman; Matthew Santo
Ocular trauma disproportionately impacts low- and middle-income countries (LMICs) and contributes significantly to blindness and disability in these settings. While numerous publications address the epidemiology of ocular trauma in limited-resource settings, there are no systematic reviews, meta-analyses, or large-scale review articles investigating this topic further. In this article, the authors summarize, compare, and contrast the extant literature on ocular trauma in LMICs. With this synthesis of the available data, the article aims to identify commonalities and potential targets for systemic change in preventing ocular injury and its associated morbidity. The authors seek to highlight modifiable risk factors which may be addressed by providers, health care systems, government agencies, and employers alike.
Diverging pathways: exploring the interplay between hospital readmission and postdischarge mortality in paediatric sepsis in low-income settings
(BMJ Global Health, 2025) Cherri Zhang; Niranjan Kissoon; J Mark Ansermino; Vuong Nguyen; Elias Kumbakumba; Stephen Businge; Abner Tagoola; Nathan Kenya-Mugisha; Jerome Kabakyenga; Matthew O Wiens
Background: Mortality and readmission rates are high in low-income countries following hospital discharge; however, few studies have studied the relationship between these outcomes. Hospital readmission is a complex outcome as it reflects illness severity and health-seeking behaviour. This study aims to better understand the heterogeneous nature of hospital readmission, especially as it pertains to mortality. Methods: Secondary analysis of a prospective, multisite, observational cohort study included children aged 0–60 months old admitted to hospital with suspected sepsis. We used Fine-Gray models and Cox proportional hazards regression to identify and contrast risk factors for readmission and postdischarge mortality. We also compared the risk ratio of the two outcomes across several domains, including diagnosis, postdischarge time period and study site. Results: Of 6074 children discharged, 376 (6.2%) died, while 1106 (18.2%) were readmitted shortly after discharge. The median time to death and readmission was 28 (IQR: 9–74) and 79.5 (IQR: 30–130) days, respectively. A few patient characteristics, such as prior care seeking and hypoxaemia, were associated with both mortality and readmission. However, other characteristics, such as malnutrition (adjusted HR (aHR): 5.58 (95% CI: 4.20 to 7.43)), HIV (aHR: 1.89 (95% CI: 1.20 to 2.98)) and unplanned discharge (aHR: 3.31 (95% CI: 2.61 to 4.21)), were strongly predictive of postdischarge mortality but not readmission (aSHR: 0.67 (95% CI: 0.56 to 0.81), 0.64 (95% CI: 0.40 to 1.00) and 0.81 (95% CI: 0.67 to 0.98), respectively). The overall rate ratio of readmission to postdischarge mortality was 3.12 (95% CI: 2.77 to 3.50) and increased over time, mostly due to decreasing mortality. Conclusions: Readmission as an outcome measure reflects perceived illness severity, health system capacity and complex healthcare-seeking behaviour. Unlike mortality, readmission is not a reliable surrogate for recurrent illness and should not be used as a primary measure of impact for programmes aiming to improve postdischarge outcomes.
The Influence of Family Structures, Support Systems and Teenage Mothers’ Agency in Kanungu District, Uganda
(Journal of Research Innovation and Implications in Education, 2025) Miriam Tugiramasiko; Specioza Twinamasiko; Benjamin Musiita; Elizabeth Kemigisha; Daniel Atwine; Upton Nuwagira
The situation of teenage motherhood in Kanungu District, Uganda, is characterized by significant socio-economic and health problems. This study aimed at establishing the relationship between family structures and support systems and teenage mothers’ agency, especially in relation to health care, education and social support. Data were collected from 345 teenage mothers (13–19 years) using structured questionnaires and analyzed using R version 4.5.0. The results indicated that 66.4% of the respondents lived in nuclear families and open family communication was found to enhance agency (χ² = 12.45, p = 0.002) while limited communication was found to decrease decision making power. Although grandparent-headed households were noted (10.2% in Kihihi Town Council), structural differences were not statistically significant (p > 0.006). Weak family support was found to be associated with high economic needs (72%) and social exclusion (66.1%), and second teenage pregnancies were more frequent among those with poor family relations (χ² = 10.78, p = 0.001). In conclusion, although family structure alone was not a significant factor, communication quality and family support were found to be the most important factors that influenced teenage mothers’ agency. It is therefore recommended that emotional support, family counseling, education re-entry programs, and community-based support networks should be enhanced.
Resilience amid Stigma: Analyzing the Agency and Well-Being of Teenage Mothers in Rural Uganda
(Journal of Social and Development Sciences, 2025) Miriam Tugiramasiko; Benjamin Musiita; Specioza Twinamasiko
Teenage motherhood remains a significant public health and socio-economic challenge in Uganda, especially in rural areas where access to education and health care services and economic opportunities is limited and social stigma and rejection are prevalent. The study explores the agency applied by teenage mothers to improve their well-being in rural Uganda particularly in Kanungu District. The study employed a phenomenological research design, and data were collected through in-depth interviews that involved Community Development Officers (CDO’s) and parents, focus group discussions (FGDs) which involved the teenage mothers, and key informant interviews (KIIs) that involved the District officials, Non-Government Organizations (NGO’s), Religious and community leaders. Findings reveal that family structures, parenting styles, cultural norms and institutional gaps significantly shape teenage mothers’ ability to act independently, access services, and plan for their prospects positively. Supportive family relationships were found to be essential in strengthening resilience, self-confidence, and decision-making capability, whereas neglectful and harsh environments compounded vulnerability and isolation. Teenage mothers employed different forms of agency for them to survive such as engaging in vocational training, informal labor and seeking support from (NGO’s). Community actors, particularly CDO’s emphasized the urgent need for family sensitization, better adolescent-friendly services, increased family awareness and targeted empowerment programs. The study recommends community sensitization, strengthening family and institutional support systems, increasing access to youth-friendly health and education services, and integrating tailored vocational and financial programs for young mothers and pregnant teenagers to advance their agency and holistic well-being in rural Uganda.
“We might have been prescribing antibiotics to clients who do not need them”: a mixed methods study of knowledge, attitudes, and practices related to antibiotic use for pediatric acute respiratory illness among community health workers in Uganda
(BMC Public Health, 2025) Emily J. Ciccon; Ana T. Bravo Gutierrez; Grace Nyangoma; Victoria Shelus; Georget Kibaba; Fred Mwebembezi; Emmanuel Baguma; Raquel Reyes; Jonathan J. Juliano; Ross M. Boyce; Moses Ntaro; Edgar M. Mulogo
Background: In many resource-constrained settings, community health workers (CHW) often provide the initial care for children under five years of age. As part of integrated community case management (iCCM) programs, CHW frequently diagnose and treat acute respiratory illness (ARI), a leading cause of pediatric mortality and indication for antibiotic use globally. Yet knowledge and perceptions of antibiotic prescribing for ARI among CHW are not well studied. The goal of this study was to assess knowledge, attitudes, and practices related to antibiotics among CHW implementing a stepped-wedge trial of an enhanced iCCM algorithm for children with ARI in rural Uganda to inform future antimicrobial stewardship strategies. Methods: We conducted a nested mixed methods study with a convergent parallel design, administering surveys before and after the stepped wedge trial and individual semi-structured interviews at study end. We employed descriptive statistics, Wilcoxan rank sum tests, and thematic content analysis methods. Results: A total of 63 of 67 (94.0%) CHW completed both baseline and follow-up surveys, and 15 CHW were interviewed. The median age of the full cohort was 40 (IQR: 35–47) years with 9.5 years of CHW experience (IQR: 4.0 14.0 years). Almost all CHW (95.2%) identified amoxicillin as an antibiotic at baseline, and most associated antibiotics with treating bacterial diseases (baseline: 82.5%, follow-up: 93.7%, p = 0.05). Most perceived antibiotics as harmful to patients when prescribed unnecessarily. At follow-up, more CHW disagreed that antibiotics should be prescribed when in doubt. They welcomed additional education about antimicrobial resistance and diagnostic tools to advance antimicrobial stewardship (AMS). Conclusion: CHW were overall familiar with antibiotics and their potential harms. They were eager to gain knowledge regarding AMS and AMR and share it with their communities. CHW represent an underutilized resource for AMS interventions and should be included in their design and implementation.
Quality of maternal and newborn care services in Uganda: a scoping review
(Journal of Medicine, Surgery, and Public Health, 2025) Brian Turigye; Edgar Mugema Mulogo; Jonathan Kajjimu; Joseph Ngonzi
Despite significant advancements over the past two decades, mothers and newborns continue to experience preventable deaths, even when they give birth at healthcare facilities both globally and in Uganda. Evidence indicates that the quality of facility-based care may be a major factor contributing to this issue. This review aimed to identify, map, and synthesize all published studies on the quality of maternal and newborn care in Uganda. Following the Arksey and O’Malley five-stage framework for scoping reviews, a search strategy was employed to retrieve articles published over 20 years, from 2004 to 2024, in PubMed, EMBASE, and Web of Science. Two independent reviewers screened the extracted articles, first by title and abstract, and subsequently by full text, utilizing Covidence. Data were mapped according to the World Health Organization (WHO) Quality of Maternal and Newborn Care (QMNC) framework. Of the 2482 studies identified, 36 were included in this review. The majority of the studies focused on human resources and infrastructure, with few addressing the experience of care. Overall, the standards of care were inadequate across the studies, with particularly poor conditions noted in lower-tier government health facilities. Despite the critical importance of quality care in reducing maternal and newborn mortality, levels have remained persistently low in Uganda over the past 20 years, especially in public facilities. There is an urgent need to rethink the health system approach and deliberately enhance the quality of care if Uganda is to meet the 2030 global targets.
Snail intermediate host occurrence recorded by citizen scientists in rural Uganda and the Democratic Republic of the Congo
(GigaByte, 2025-08-11) Noelia Valderrama-Bhraunxs; Larissa Bonifacio; Julius Tumusiime; Germain Kapou; Daisy Namirembe; Casim Umba-Tolo; Grace Kagoro-Rugunda; Patrick Mitashi-Mulopo; Joule Mandinga; Liesbet Jacobs; Tine Huyse
Snail-borne parasitic diseases, such as schistosomiasis and fascioliasis, pose significant public health and economic challenges worldwide. Schistosomiasis affects over 250 million people globally, with most cases in sub-Saharan Africa, while fascioliasis contributes substantially to livestock morbidity and economic losses. Freshwater snails (Biomphalaria, Bulinus, and Radix spp.) act as intermediate hosts, making their surveillance critical for disease control. Mass drug administration alone is insufficient, as high reinfection rates highlight the need for complementary strategies, including targeted snail control. To address limited malacological capacity and logistical constraints, the ATRAP project trained 50 citizen scientists in Uganda and the Democratic Republic of the Congo to monitor intermediate host snails at the genus level. Between 2020 and 2023, citizens recorded 31,490 snail occurrences. Data quality was ensured through automatic validation and manual verification of submitted snail pictures. This rigorously curated dataset, combining citizen science with expert validation, provides valuable insights for mapping snail distributions, identifying high-risk transmission areas, and developing sustainable, cost-effective snail control strategies.
Health system preparedness among African countries for disease outbreaks using the World Health Organisation Health systems framework: an awakening from the recent mpox outbreak
(Frontiers in Tropical Diseases, 2025-09-30) Innocent Ayesiga; Primrose Magala; Aghu Ovye; Jonathan Mawutor Gmanyam; Pius Atwau; Esther Ismaila; Henry Muwonge; Tom Didimus Ediamu; Lorna Atimango; Joy Malle Dogo; Lenz Nwachinemere Okoro; Edgar M. Mulogo; Sheba G. Nakacubo
Over time, numerous health issues have challenged Africa’s health systems, including reemerging and emerging pandemics and epidemics. International health bodies, such as the World Health Organisation (WHO), have developed various frameworks to help health systems maintain service delivery to their respective communities and individuals. The WHO’s health system framework is a six-pronged strategy to enhance healthcare service delivery. However, emerging epidemics, such as mpox, have hindered the integration of these components. This review explored the health preparedness of African countries to mitigate emerging and re-emerging epidemics using the WHO health system framework with a focus on mpox. The review found most African countries lack adequate health products, such as vaccines against mpox, and have limited human resources available to care for affected individuals. For instance, Africa’s health worker staffing is estimated at 1.55 per 1000 people compared to the 4.45 per 1000 WHO threshold. Many African countries, like Somalia, Uganda, Eritriea lack efficient health preparedness plans to enhance their readiness to address the epidemic. Nevertheless, these plans provide detailed information regarding mpox risks and how to mitigate them based on risk factors, such as reducing zoonotic spillover. Healthcare financing in is still challenged in many African countries like Uganda, Tanzania, and Ghana due to limited budgetary allocations, which affects the purchase and distribution of necessary resources for mpox prevention, control, and management. Cuts in funding from major donors, including United States Agency for International Development (USAID) and UK Aid (formerly known as Department of International Development, DFID), worsen the situation. However, African countries can leverage on innovation and risk factor mitigation, to fully equip their healthcare systems based on available frameworks for other re-emerging epidemics. Additionally, they must strategize avenues of self-sustenance, such as political commitment and depending on other resources to fund their health programs.
Enablers and challenges of integrating digital health into medical education curricula: a scoping review
(Discover Education, 2025) Wilson Tumuhimbise; Stefanie Theuring; Esther C. Atukunda; Mugyenyi R. Godfrey; Doreen Babirye; Fred Kaggwa; Mwavu Rogers; Kizza Gerald; Rebecca Nuwematsiko; Irene Wanyana; Daniel Atwine; Nelson Twinamasiko; John Paul Bagala; Richard Mugahi; Geoffrey Namara; Joseph Ngonzi; Rhoda Wanyenze; Juliet N. Sekandi; Angella Musiimenta
Background: The global strategy for digital health advocates digital health literacy in formal education and training curricula for all health professionals. However, little is known about the enablers and challenges of integrating digital health into medical training curricula. Methods: Guided by Arksey and O’Malley’s scoping review methodology, we searched the PubMed, Google Scholar, and ScienceDirect scholarly databases for peer-reviewed articles published between 2014 and 2024. Data extraction was guided by the consolidated framework for implementation research. Results: Thirty studies met the inclusion criteria and were analyzed. The enablers identified include the need for healthcare digitalization, reshaping the future daily work of healthcare professionals, decreasing students’ doubts about digital health and increasing the quality of patients’ care. On the other hand, a lack of infrastructure and educational materials, the dense nature of the existing curriculum, and bureaucratic tendencies were identified as challenges. The provision of consolidated funds and the establishment of dedicated digital health infrastructure, starting with elective and audited modular approaches, raising awareness, and educating stakeholders, emerged as implementation strategies for mitigating these challenges. Conclusion: Global progress toward integrating digital health literacy in formal medical training curricula remains slow. There is a need for concerted efforts and political commitment to offer guidance and moral and financial support for this integration.
Elevated serum cortisol levels and associated factors among postpartum mothers in Mbarara district, rural south western Uganda
(Discover Medicine, 2025) Catherine Atuhaire; Taseera Kabanda; Daniel Atwine; Godfrey Zari Rukundo; Judith Byaruhanga; Samuel Maling; Francis Bajunirwe
Background: Serum cortisol is often elevated in postpartum mothers, but data on its prevalence and associated factors remain limited in many settings. The current study aimed at examining the factors associated with elevated serum cortisol levels among postpartum mothers in Mbarara district, rural southwestern Uganda. Methods: We conducted a facility based cross sectional study among mothers between 6 weeks and 6 months after childbirth. Using consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities, Mbarara Regional Referral Hospital and Bwizibwera Health Center IV, a county level health facility in rural southwestern Uganda. The blood cortisol levels were measured using a chemiluminescence with the use of a standard, commercially available competitive immunoassay (Diagnostic Products Corp. Nichols Institute Diagnostics, San Juan Capistrano, CA). Postpartum depression (PPD) was diagnosed using the Mini International Neuropsychiatric Interview (MINI) version 7.0.2, based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Results: We enrolled 309 postpartum mothers, and the prevalence of elevated serum cortisol levels was 26.2% (95% CI 22.0–31.4). Elevated serum cortisol levels were significantly associated with PPD (AOR = 2.9, 95% CI 1.6–5.3, p < 0.001), health facility level attended by the mother (AOR = 3.8, 95% CI 1.9–7.6, p = 0.001), pre-diabetes (AOR = 2.5, 95% CI 1.3–5.0, p = 0.008) and diabetes mellitus status (AOR = 4.0, 95% CI 1.8–8.9, p = 0.001), and decreased involvement in physical activity (AOR = 0.3, 95% CI 0.1–0.7, p = 0.002). Conclusion: In this study of elevated serum cortisol levels was significantly associated with postpartum depression, attending a rural healthcare facility, having pre-diabetes or diabetes mellitus status, and reduced physical activity. These findings underscore the need for targeted holistic interventions addressing both physical and mental health challenges in postpartum women
Early Nephropathy Screening as a Health Seeking Behavior Among Type 2 Diabetes Mellitus Patients: A Phenomenological Study in Southwestern Uganda
(Journal of Multidisciplinary Healthcare, 2025) Ritah Kiconco; Robert Kalyesubula; Naomi Sanyu; Bosco Bekiita Agaba; Erick Nyakundi Ondari; Deusdedit Tusubira; Gertrude N Kiwanuka
Background: Nephropathy screening is vital in type 2 diabetes mellitus (T2DM) management to prevent complications, yet uptake remains low in resource-limited settings like Southwestern Uganda. This study explored the barriers and facilitators influencing screening among T2DM patients and providers at the diabetic clinic of Mbarara Regional Referral Hospital. Methods: A qualitative cross-sectional study guided by a phenomenological approach to explore lived experiences around nephro pathy screening was conducted. Fifteen adult T2DM patients in care for ≥12 months and five healthcare providers (doctors, nurses, and a laboratory technician) were purposively sampled. Semi-structured, in-depth interviews were conducted. Data were analyzed using an inductive approach. Socio-demographics; including age, sex, education, and employment were collected. All interviews were audio- recorded, transcribed verbatim, and thematically analyzed using Dedoose (version 10.0.25). Study reporting adhered to the COREQ 32-item checklist. Results: Patients described diabetes as a burdensome and life-altering condition. Key barriers to nephropathy screening included financial constraints, lack of transport, limited awareness, and dissatisfaction with care. Despite these challenges, facilitators such as proactive provider encouragement, community outreach, and availability of free testing motivated screening uptake. Providers emphasized their critical role in educating patients and detecting nephropathy but reported systemic constraints, including staff shortages, equipment failures, limited knowledge on new disease trends and screening protocols. Both groups highlighted the need for routine integration of nephropathy screening into diabetes care and greater support from the health system. Conclusion: Nephropathy screening behaviors among T2DM patients are influenced by perceived disease severity, provider communication, and systemic barriers such as cost and infrastructure. While both patients and providers recognize the value of early detection, sustained screening is hindered by resource limitations and inconsistent implementation. Strengthening institutional capacity, integrating screening into routine care, and enhancing patient-provider engagement are essential to reducing the burden of diabetic nephropathy in the study setting.
Digitizing HIV care in Uganda: Patient and provider perspectives on the AmFine patient portal
(Digital health, 2025) Ritah Kiconco; RaymondAtwine; FrancisKamuganga; MichaelKanyesigye; Dickens Owamaani; Naomi Sanyu; Wilson Tumuhimbise; Winnie Muyindike; Angella Musiimenta; James J. Cimino
Background: In resource-limited settings like Uganda, managing HIV care through conventional paper-based systems poses challenges such as inefficiencies in clinical workflows and limited patient engagement. The AmFine patient portal and mobile application was developed to digitize the paper-based “blue card” system and enhance patient-provider communication. Objective: To explore the lived experiences of patients and healthcare providers in using the AmFine patient portal and mobile application at the immune suppressive syndrome (ISS) Clinic of Mbarara Regional Referral Hospital, focusing on usability, motivation for use, challenges and suggestions for improvement. Methods: We conducted face-to-face in-depth interviews with 25 participants (21 patients and 4 healthcare providers) at the ISS Clinic of Mbarara Regional Referral Hospital between April 2023 and May 2023. Interviews were audio recorded, transcribed verbatim, and analyzed using codebook thematic analysis guided by Braun and Clarke’s approach. Coding was conducted in NVivo 12, and themes were developed inductively to explore participant experiences, perceived usability, and challenges of the AmFine patient portal and mobile application. Results: The AmFine patient portal and mobile application was positively perceived as enhancing communication and con venience. Patients appreciated the ability to send messages to providers without traveling to the clinic, fostering privacy and reducing stigma. Providers valued streamlined patient management and communication. Challenges included limited techno logical literacy among some patients, intermittent internet connectivity, and data costs. Suggestions for improvement included enhancing offline functionality, diversifying language options, and providing more detailed training sessions. Conclusions: The AmFine patient portal and mobile application demonstrated potential to improve HIV care delivery and patient engagement in a resource-limited setting. Addressing identified challenges can optimize system usability and adoption.
Analyzing trends and suggested instructional strategies for Geometry education: Insights from Uganda Certificate of Education-Mathematics Examinations, 2016-2022
(African Journal of Teacher Education, 2024) Issa Ndungo; Edwin Akugizibwe; Sudi Balimuttajjo
Geometry education plays a pivotal role in fostering analytical, spatial, and problem-solving skills among students. Nonetheless, there is still a problem with how well geometry training in Ugandan schools accomplishes these objectives and this is evident in the Uganda Certificate of Education (UCE) examinations. To close this gap, a comprehensive examination of data taken from Uganda National Examinations Board (UNEB) reports covering the years 2016 to 2022 was carried out; with an emphasis on candidates’ performance, the study looks at common geometric ideas, pinpoints areas of weakness for candidates, and assesses response quality. This study's content analysis reveals notable variations in the quality of responses to various mathematics areas, with geometry consistently having the largest percentage of poor responses. Interestingly, in most areas, attempt levels positively correlate with response quality; but, in the case of geometry, this correlation reverses, suggesting that learners in this domain confront different problems. These problems include using geometric principles for problem-solving, combining algebraic and geometric concepts, and spatial visualization. The study advocates for using technology, active and problem-based learning; as these approaches provide opportunities for experiential learning, and conceptual knowledge reinforcement to learners. All this will support ongoing attempts to enhance mathematics education, particularly in the field of geometry, within the Ugandan context.
Prevalence and Clinical Implications of Pyrazinamide Resistance in Newly Diagnosed TB Patients in Uganda
(Infection and Drug Resistance, 2025) Christopher Ndawula; Nalumaga Pauline Petra; Fredrickson B Wasswa; Joel Bazira
Background: Globally, 10.8 million people were diagnosed with tuberculosis during 2023 causing approximately 1.3 million deaths. This study aimed to assess the prevalence and characterization of pyrazinamide resistance by detecting the pncA gene among newly diagnosed Mycobacterium tuberculosis patients attending Bombo General Military Hospital, Central Uganda. Methods: Cross-sectional study looking at newly diagnosed TB patients in Bombo General Military Hospital. The sputum samples were confirmed TB positive using GeneXpert PCR technology, DNA extraction using the CTAB method, DNA amplification, and finally gel electrophoresis for pncA gene detection. Results: A total of 166 sputum-positive tuberculosis samples were analyzed. Males were 91/166(55%), while 115 (70%) of the positive sputum samples were positive HIV status. The majority (96%) of the newly diagnosed Mycobacterium tuberculosis patients showed no detection of rifampicin resistance, while the rest 6/160 (4%) showed indeterminate rifampicin resistance. Of the 52 (31%) patients with positive pncA gene, 29 (56%) had HIV positive status 18 (34%) had unknown HIV status and 5 (10%) had negative HIV status. It was observed that only one patient 1 (2%) showed both rifampicin and pyrazinamide resistance and was a female patient aged 42 years of age with positive HIV status and positive pncA gene status. Conclusion: This study reveals the important trends regarding drug resistance and its relationship with HIV status. The majority of patients (96%) did not exhibit rifampicin resistance, suggesting that multi-drug-resistant tuberculosis is not widespread among the newly diagnosed cases. The majority (56%) of the patients with the pncA gene mutation, were HIV-positive. This highlights the potential vulnerability of HIV-positive TB patients to multidrug resistance though the overall pyrazinamide resistance rate remains low.
Prevalence and Factors Associated With Antepartum Depression Among Pregnant Women in Latent Labor: A Multi-Facility Cross-Sectional Study in Rural Southwestern Uganda
(International Journal of Women's Health, 2025) Catherine Atuhaire; Kabanda Taseera; Daniel Atwine; Samuel Maling; Vikram Patel
Background: Despite limited studies on antepartum depression (APD) in Sub-Saharan Africa (SSA), it is suggested that the prevalence on the continent may be higher than the global average. This study aimed at determining the prevalence of APD and identifying its associated factors among pregnant women in latent labor in rural south western Uganda. Methods: The findings in this manuscript were part of a prospective cohort that aimed at investigating Social Support and Perinatal Depression among women in latent labor through six weeks postpartum. We conducted a multi-facility study enrolling women in latent labor to assess for APD and its associated factors from November 2023 to March 2024. The study was carried out in three health facilities in Mbarara District, rural southwestern Uganda. The prevalence of APD based on the Mini International Psychiatric Interview (M.I.N.I 7.0.2) using the depression module. Factors associated with APD were analyzed using bivariate and multivariate logistic regression. Variables with a p-value <0.2 in bivariate analysis were included in the multivariable model, with statistical significance set at p<0.05. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Data were analyzed using STATA software version 14.0. Results: Of the 448 enrolled participants, 37 had APD giving a prevalence of 8.2% (95% CI: 6.0–11.2%). Factors that were significantly associated with APD were Maternal age 30–49 years, bad health status before pregnancy, not happy about being pregnant, having had complications during pregnancy and having a history of stressful life events during pregnancy. Conclusion: This study reveals a very significant yet comparatively lower prevalence of antepartum depression among pregnant women in latent labor in rural southwestern Uganda. These insights highlight the persistent need for comprehensive mental health strategies especially the non-pharmacological approaches within antenatal care to enhance maternal and child health outcomes.
Protocol for the effectiveness of multimonth refill of antituberculosis drugs (MORAD) on treatment success among people with drug-susceptible tuberculosis in rural eastern Uganda: a non-inferiority randomised trial
(BMJ Public Health, 2024) Jonathan Izudi; Francis Bajunirwe; Adithya Cattamanchi
Introduction: Multimonth dispensing of antituberculosis (TB) drugs reduces frequent visits and costs associated with longer travel distances to a TB clinic. We will evaluate the effectiveness of multimonth dispensing of anti-TB drugs on treatment success in individuals with drug susceptible TB in rural eastern Uganda, and explore its relevance and appropriateness from the stakeholders’ perspectives. Methods and analysis: In this open-label, non-inferiority, individually randomised trial, we will randomise 260 participants to either the intervention (multimonth dispensing of anti-TB drugs) or control arm (routine care) and follow-up for 6 months. Intervention participants will receive monthly anti-TB refills for 2 months then a 2-month refill for 4 months, totalling four visits. Control participants will receive routine care comprising biweekly anti-TB refills for 2 months and monthly refills for 6 months, totalling eight visits. The primary outcome will be treatment success (treatment completion or cure) at month 6. Secondary outcomes will include adherence to anti-TB treatment over 6 months measured by self-report and pill counts, and sputum smear conversion at months 2 and 6 defined as a change in sputum smear status from positive to negative among bacteriologically confirmed individuals. Data will be analysed using a generalised linear mixed model at a 5% significance level, reported as a risk difference with a 95% CI. A formative qualitative study will be conducted among stakeholders at the national, district and health facility levels and people with TB including their treatment supporters to inform the intervention’s relevance, appropriateness and implementation. Qualitative data gathered through focus group discussions and indepth and key informant interviews will be transcribed and analysed using content analysis. Ethics and dissemination: The Infectious Diseases Institute Research Ethics Committee and the Uganda National Council for Science and Technology approved the protocol. Findings will be disseminated to all stakeholders through presentations, synthesised reports and manuscript publication.
Where Do We Belong: Rwanda or Uganda? The Conceptualization of “Home” by the Rwandan Refugees in Uganda
(Journal of Modern Education Review, ISSN 2155-7993, USA, 2017-06) Cleophas Karooma
This article focuses on the conceptualization of “home” by the post-genocide Rwandan refugees in Uganda. Since 2002, the governments of Uganda, Rwanda and UNHCR have been actively promoting the repatriation of the Rwandan refugees. Despite attempts to return Rwandan refugees to their “homeland”, considerable numbers are reluctant to return and yet voluntary repatriation has been flagged as the only primary durable solution available for them in Uganda. Although the question of “home” has been studied by different scholars, little attention has been paid to the conceptualization of “home” when refugees are in a protracted situation and are unwilling torepatriate like the case of Rwandan refugees in Uganda. After two decades of exile, the Rwandan refugees have lost interest in returning home and the concept of “home” has been transformed to mean the country of asylum-Uganda where they have peace. Therefore, this article disagrees with the notion that “repatriation equals home coming model”. The argument is that home and the country of origin do not have to be the same.