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Recent Submissions

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.
“Injectable ARVs will give me peace” women’s acceptability of injectable antiretroviral therapy in prevention of HIV vertical transmission in Uganda
(Scientific Reports, 2025) Deborah Ekusai -Sebatta; Eva Laker Agnes Odongpiny; Agnes N. Kiragga; Pauline Byakika-Kibwika; Rachel King
A third of women who initiate or continue antiretroviral (ARV) treatment during pregnancy are lost- to- follow-up (LTFU) within six months in sub-Saharan Africa. Clinical trials of long acting injectable Antiretroviral Therapy (LA-ART) are ongoing, including for pregnant women. The study explored women’s acceptability and attitudes towards- the use of potentially discreet LA-ART in Uganda for Prevention of Vertical Transmission Program (PVT). Understanding women’s perspectives of LA ART before its introduction is critical in answering questions about acceptability and identifying interventions for future implementation and uptake. In May 2022, we purposively selected participants for eight focus group discussions (FGDs) in 5 health facilities in Kampala: 5 with retained mothers and 3 with disengaged mothers from the PVT. A woman was categorized as retained if she had at least one clinic encounter within her last visit. A total of two in-depth interviews were conducted with disengaged mothers. Luganda, the most widely spoken language in Kampala was used to conduct the FGDs and interviews. Recordings were transcribed and translated into English. Themes were mapped onto some components of the health belief model. NVivo version 14 software was used for data management. A thematic approach was used for analysis and a team-based approach was utilized. The data realized three broad themes (1) Perceived benefits from the use of the LA-ART like emotional relief from daily drugs, effective viral load suppression, reduction on stigma and discrimination, reduction of LTFU, (2) potential threats to rollout due to fear of side-effects from monthly injections, drug stock outs, the cost of LA-ART, myths about LA-ART that it cures HIV and (3) Approaches to increase access to LA-ART like prior investigations, providing bridging treatments and use peer-peer approaches. Most women in this study appeared to have positive attitudes towards the rollout of the LA-ART. LA-ART is a potential solution to LTFU which could improve retention in care for women living with HIV. To optimize the acceptability, health programs should ensure strengthened counseling and create awareness of LA-ART and use of peer- peer approaches with expert women using educational initiatives to raise awareness among other women.
Assessment of different genotyping markers and algorithms for distinguishing Plasmodium falciparum recrudescence from reinfection in Uganda
(Scientific Reports, 2025) Alex Mwesigwa; Alex Mwesigwa; Sam Jones; Sara L. Cantoreggi; Benson Musinguzi; Joaniter I. Nankabirwa; Everd Maniple Bikaitwoha; Joan N Kalyango; Charles Karamagi; Mateusz Plucinski; Samuel L. Nsobya; Christian Nsanzabana; Pauline Byakika-Kibwika
Antimalarial therapeutic efficacy studies are vital for monitoring drug efficacy in malaria-endemic regions. The WHO recommends genotyping polymorphic markers including msp-1, msp-2, and glurp for distinguishing recrudescences from reinfections. Recently, WHO proposed replacing glurp with microsatellites (Poly-α, PfPK2, TA1). However, suitable combinations with msp-1 and msp 2, as well as the performance of different algorithms for classifying recrudescence, have not been systematically assessed. This study investigated various microsatellites alongside msp-1 and msp-2 for molecular correction and compared different genotyping algorithms across three sites in Uganda. Microsatellites 313, Poly-α, and 383 exhibited the highest diversity, while PfPK2 and Poly-α revealed elevated multiplicity of infection (MOI) across all sites. The 3/3 match-counting algorithm classified significantly fewer recrudescences than both the ≥ 2/3 and Bayesian algorithms at probability cutoffs of ≥ 0.7 and ≥ 0.8 (P < 0.05). The msp-1/msp-2/2490 combination identified more recrudescences using the ≥ 2/3 and 3/3 algorithms in the artemether-lumefantrine (AL) treatment arm, while msp-1/msp 2/glurp combination classified more cases of recrudescence using the ≥ 2/3 in the dihydroartemisinin piperaquine (DP) arm. Microsatellites PfPK2 and Poly-α, potentially sensitive to detecting minority clones, are promising replacements for glurp. Discrepancies in recrudescence classification between match-counting and Bayesian algorithms highlight the need for standardized PCR correction practices.
Genetic diversity and population structure of Plasmodium falciparum across areas of varied malaria transmission intensities in Uganda
(Malaria Journal, 2025) Alex Mwesigwa; Stephen Tukwasibwe; Bryan Cummings; Hakiimu Kawalya; Shahiid Kiyaga; Stephen Okoboi; Barbara Castelnuovo; Everd Maniple Bikaitwoha; Joan N. Kalyango; Samuel L. Nsobya; Charles Karamagi; Pauline Byakika-Kibwika; Joaniter I. Nankabirwa
Background: Malaria remains a significant global health threat, with sub-Saharan Africa (SSA) bearing the highest burden of the disease. Plasmodium falciparum is the predominant species in the region, leading to substantial morbidity and mortality. Despite intensified control efforts over the last two decades, P. falciparum genetic diversity and multiplicity of infections (MOI) continue to pose significant challenges to malaria elimination in the region. This study assessed P. falciparum genetic diversity and population structure in areas with low, medium, and high malaria transmission intensities in Uganda. Methods: A total of 288 P. falciparum-positive samples from children (6 months to 10 years) and adults (≥ 18 years) living in Jinja (low transmission), Kanungu (medium transmission), and Tororo (high transmission) were genotyped using seven neutral microsatellite markers. Genetic diversity was assessed based on the number of alleles (Na), allelic richness (Ar), and expected heterozygosity (He). Population structure was assessed using the fixation index, analysis of molecular variance (AMOVA), and clustering analysis. Results: High P. falciparum genetic diversity was observed across all study sites, with Kanungu exhibiting the highest mean He (0.81 ± 0.14), while Jinja and Tororo had lower mean He (0.78 ± 0.16). P. falciparum MOI varied significantly, with Tororo showing the highest mean MOI (2.5 ± 0.5) and 70% of samples exhibiting polyclonal infections, com pared to Jinja’s mean MOI of 1.9 ± 0.3 and 58% polyclonal infections. Significant multilocus linkage disequilibrium (LD) was noted (p < 0.01), ranging from 0.07 in Tororo to 0.14 in Jinja. Parasite population structure showed minimal genetic differentiation (FST ranged from 0.011 to 0.021) and a low AMOVA value (0.03), indicating high gene flow. Conclusion: This study demonstrates high P. falciparum genetic diversity and MOI but low population structure, suggesting significant parasite gene flow between study sites. This highlights the need for integrated malaria control strategies across areas with varying malaria transmission intensities in Uganda.
Bioethics training needs assessment for HIV research in vulnerable populations: a survey of trainees at college of health sciences, Makerere university
(BMC Medical Ethics, 2025-07-04) Josephine Nayiga; Stephen Okoboi; Grace Banturaki; Pauline Byakika-Kibwika; Barbara Castelnuovo
Background: Research involving vulnerable populations of people living with HIV (PLWH), such as children, adolescents, older adults, pregnant and lactating women, hospitalized patients, and key populations, presents complex bioethical challenges. We assessed bioethics training needs for trainees engaged in HIV research from the School of Medicine (SoM) of Makerere University and the Infectious Disease Institute (IDI) to inform the development of a comprehensive bioethics training program for trainees. Methods: A cross-sectional quantitative study was conducted from March to May 2024 using an online structured questionnaire distributed via Google Forms. Participants included former and current trainees who have conducted research with PLWH within the past five years. Data collected included self-rated bioethics knowledge, frequency of encountering bioethical challenges, confidence in addressing challenges across vulnerable populations, and preferred training topics and delivery formats. Descriptive data analysis was performed using STATA Version 17. Results: We attained a response rate of 67.5% (108/160). While 75.9% reported formal bioethics training, 58.3% rated their knowledge moderate. Frequently encountered challenges included maintaining confidentiality and privacy (61.1%), conducting informed consent processes (56.1%), applying bioethical principles, engaging with communities (54.6%), and selecting appropriate research participants (51.4%). Confidence in addressing bioethical challenges was notably lower for vulnerable populations than for general HIV research. Confidence of the trainees was higher in research involving older PLWH and pregnant/lactating women, moderate with children/adolescents and hospitalized individuals, and very low with key populations. Trainees expressed limited confidence in addressing cultural sensitivity, stigma, coercion, community engagement, harm monitoring, and compensation for research-related harm across all the populations. Top training priorities included ethical issues with research involving vulnerable populations (97.2%), reporting ethical concerns (94.4%), community engagement (93.6%), research on stored samples/data (94.5%), and stigma/discrimination (92.6%). Preferred formats were in-person workshops, interactive case-based scenarios, and online courses. Conclusion: Trainees faced diverse bioethical challenges and exhibited varying confidence levels in addressing these issues across different vulnerable populations. These findings underscore the need for targeted, context-specific bioethics training tailored to conducting research with vulnerable PLWH. This study has informed the development of a comprehensive training program to improve the ethical conduct of HIV research in Uganda.
How digital capabilities and credit access influence green innovation performance in small and medium enterprises in resource constrained settings
(Discover Sustainability, 2025) Dedrix Stephenson Bindeeba; Eddy Kurobuza Tukamushaba; Rennie Bakashaba
This study investigates how small and medium-sized enterprises (SMEs) transform digital capabilities into green innovation within volatile, uncertain, complex, and ambiguous (VUCA) markets, and how access to credit shapes that process. Guided by the Technology–Organization–Environment framework, the Resource-Based View, and Dynamic Capabilities Theory, the study surveyed 428 Ugandan SMEs and analyzed the data using covariance-based structural equation modeling (SEM) and multi-group analysis for credit access using SPSS AMOS Version 26. Green Technical Know-How, Process Compatibility with Green Technologies, Green Digital Readiness, ICT Infrastructure, Green Digital Orientation, and Firm Size all enhance digital value realization capability (DVRC), which emerged as the sole direct driver of green innovation performance (GIP). Competitive Pressure was the strongest antecedent of DVRC, while Observability and Government Green Policy Support showed no significant effects. Credit access operates as a critical boundary condition. Without credit, readiness factors (process compatibility and digital readiness) substitute for liquidity and are the only technological paths that raise DVRC. With credit, specialized know-how, and competitive pressure become decisive, the ICT → DVRC effect strengthens, and DVRC’s impact on GIP nearly doubles. Five indirect capability-to performance paths via DVRC are significant only, or much larger, for credit-enabled f irms. The findings position DVRC as the conversion engine that turns digital inputs into green outcomes, but show that its payoff is unlocked only once a minimum liquidity threshold is crossed. Policymakers should couple digital capability programs with inclusive green finance, while SME managers should emphasize readiness under constraint and invest in know-how when financing becomes available.
Digital levers for sustainability: a meta-analytic review of digital transformation’s influence on ESG performance
(Cogent Business & ManageMent, 2025) Dedrix stephenson Bindeeba; Eddy Kurobuza tukamushaba; Rennie Bakashaba
Digital transformation (Dt) is reshaping how firms meet environmental, social, and governance (esg) expectations. this meta-analysis pools 59 studies (2015–2025) covering 835,000 firm-year observations to quantify Dt’s esg impact. anchored in resource-Based view, stakeholder, and Dynamic capabilities theories, the effects of esg pillar and Dt typologies are separated. Dt raises esg scores; among technologies, business-process digitization delivers the largest gains, followed by data-infrastructure upgrades, while ai adds value only where ethics and oversight are mature. environmental metrics improve most consistently; social and governance benefits appear but hinge on firm capabilities and regulatory context. subgroup and meta-regression tests show stronger Dt–esg links in manufacturing and service sectors and in post-2022 samples, suggesting curves and tightening standards. results guide managers to sequence investments process first, analytics later and urge policymakers to link incentives to verifiable digital disclosures. Future work should extend evidence to under-studied regions and next-wave tools such as blockchain and digital twins.
Beyond market penetration: leveraging brand capital for competitive advantage in digitally driven SMES in resource-constrained settings
(Future Business Journal, 2025) Rennie Bakashaba; Dedrix Stephenson Bindeeba
Digital commerce activation (DCA) has enabled SMEs to broaden market reach, yet market penetration (MP) alone often fails to create sustainable competitive advantage (CA). Drawing on the Resource-Based View and Dynamic Capabilities Theory, this study examines how brand capital (BC) mediates the relationship between DCA and CA while assessing MP’s parallel role. Survey data were collected from 405 digitally active SMEs in Kampala and Wakiso, Uganda, and analyzed through structural equation modeling. Findings indicate that DCA significantly enhances both BC and MP; however, MP neither directly influences CA nor transmits DCA’s effects into CA. In contrast, BC dem onstrates a strong positive influence on CA and fully mediates the DCA–CA relationship. These results confirm that BC, encompassing brand awareness, perceived quality, loyalty, and associations, functions as a valuable, rare, inimitable, and non-substitutable (VRIN) resource that converts digital investments into enduring advantage. The study contrib utes by (1) extending RBV to position BC as the primary intangible conduit for digital strategy, (2) clarifying the micro foundations of BC formation via dynamic digital routines, and (3) offering context-specific insights for resource-con strained SMEs. Practically, managers should prioritize brand-building routines over reach-seeking, and policymakers should support digital branding initiatives to strengthen SME competitiveness.
Amniotic Fluid Bacterial Colonization, Antibiotic Susceptibility, and Associated Factors Among Women With Premature Rupture of Membranes at Mbarara Regional Referral Hospital, Southwestern Uganda
(Cureus, 2024-10-23) Brenda Ainomugisha; Richard Migisha; Collins Agaba; Leevan Tibaijuka; Asiphas Owaraganise; Joy Muhumuza; Joel Bazira; Musa Kayondo; Joseph Ngonzi
Background: Amniotic fluid bacterial colonization in premature rupture of membranes (PROM) is known to initiate labor and lead to postpartum endometritis and early-onset neonatal sepsis. We determined the prevalence and factors associated with amniotic fluid bacterial colonization, described bacterial isolates and examined antibiotic susceptibility patterns among women seeking care at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: We conducted a cross-sectional study from December 21, 2020 to June 12, 2021. We consecutively enrolled women with PROM at ≥24 weeks of gestation and aseptically picked two endo-cervical swabs. Aerobic cultures were performed on blood, chocolate, MacConkey agars, and polymerase chain reaction on culture-negative samples. Antibiotic susceptibility was performed via the Kirby-Bauer disk diffusion and dilution method. Interviewer-administered questionnaires were used to obtain participants’ sociodemographic, medical, and obstetric characteristics. We performed multivariable logistic regression to determine factors associated with bacterial colonization. Results: We enrolled 144 participants with a mean age of 26.5±6.2 years. The prevalence of cervical amniotic bacterial colonization was 35.4% (n=51; 95% confidence interval (CI): 28.0-43.7). Six bacteria were isolated: Klebsiella pneumoniae, Staphylococcus aureus, Enterobacter agglomerans, Escherichia coli, Streptococcus spp., and Enterococcus faecalis. Ciprofloxacin exhibited the highest sensitivity (88.6%), followed by cefuroxime (75%), while all isolated bacteria demonstrated resistance to ampicillin. Factors independently associated with cervical amniotic fluid bacterial colonization were prime gravidity (aOR=2.69; 95%CI: 1.07-6.71, p=0.035), obesity (aOR=3.15; 95%CI: 1.10-9.11, p=0.024), and being referred-in (aOR=2.37; 95% CI: 1.04-5.3, p=0.038). Conclusion: Approximately one-third of the women had amniotic fluid bacterial colonization, and this was associated with being prime gravida, being obese, and being referred. The most common bacteria isolated was K. pneumoniae, followed by S. aureus. There was good sensitivity to quinolones and cephalosporins, and all bacterial isolates were resistant to ampicillin - the recommended first line of treatment for PROM by the Ministry of Health calls for revision of guidelines.
Evidence-Based Intrapartum Care: A Retrospective Descriptive Assessment of Facility Based Births in Rural Public Health Facilities in Midwestern Uganda
(Cureus, 2025-08-07) Brian Turigye; Joseph Ngonzi; Jonathan Kajjimu; Arnold Kamugisha; Edgar M. Mulogo
Introduction: Efforts to reduce maternal and newborn deaths, especially in sub-Saharan Africa, have not been sufficient to achieve Sustainable Development Goal (SDG) 3 for 2030. The quality of care around childbirth is critical for both mothers and newborns, and the use of evidence-based practices (EBPs) is vital in ensuring optimal outcomes. However, there is a paucity of recent research on the use of evidence-based practices in childbirth health facilities. Aims: This study aimed to describe the use of intrapartum evidence-based practices for facility-based births in rural lower public health facilities in Midwestern Uganda. Methods: A descriptive retrospective chart review was conducted of mothers who delivered at all public health facilities in the Kasese and Bundibugyo districts. Mothers who had given birth in 42 health facilities two months preceding the study period were systematically sampled using probability proportionate to the size of expected respective facility births. Data was collected between November and December 2024. A structured questionnaire adopted from the World Health Organization (WHO) Quality Maternal and Newborn Care (QMNC) was used to extract data on the use of EBPs. A descriptive analysis was done, and the results were presented as frequencies and percentages. Results: Of the 353 mothers, 73.1% (n=258) were monitored using a partograph. Blood pressure (BP) was the least monitored at only 23.6% (n=83). At admission, apart from Leopold’s examination, which was performed and recorded in 86.7% (n=306) of the charts, all other practices were below 50%. About 32.3% (n=114) of the charts had a documented management plan, and all expected laboratory investigations were in less than 2% of the charts. The record of the examination of newborns prior to discharge was low, at 15.6% (n=55). The coverage of EBPs was lowest in hospitals and highest in facilities at the health center 3 (HCIII) level. Conclusions: The findings indicate a need for strategies and research to improve the implementation of evidence-based practices in rural public health facilities, especially in hospitals
Effectiveness of the Modified WHO Labour Care Guide to Detect Prolonged and Obstructed Labour Among Women Admitted at Eight Publicly Funded, Midwife-Led Community Health Facilities in Rural Mbarara District, Southwestern Uganda: An Ambispective Cohort Study
(International Journal of Women's Health, 2025-02-04) Godfrey R Mugyenyi; Wilson Tumuhimbise; Esther C Atukunda; Leevan Tibaijuka; Joseph Ngonzi; Musa Kayondo; Micheal Kanyesigye; Angella Musimenta; Fajardo T Yarine; Josaphat K Byamugisha
Background: Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low resource settings. Objective: We evaluated the modified WHO labour care guide (LCG) in detecting prolonged/obstructed labour compared to the traditional partograph at publicly funded maternity centers in Southwestern Uganda. Methods: LCG was deployed to monitor labour by trained health care providers in 2023. We reviewed all patient labour monitoring records for the first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction) from eight randomized maternity centers. Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Secondary outcomes included: mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage and tool completion. Data was collected in REDcap and analyzed using STATA v17; statistical significance was p < 0.05. Results: A total of 991 (49.3%) and 1020 (50.7%) women were monitored using the LCG and partograph, respectively. The mean maternal and gestation ages were similar between the two groups, reported at 25.9 (SD=5.6) years, and 39.4 (SD=1.8) weeks, respectively. Overall, 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph); LCG had six times higher odds of diagnosing prolonged/obstructed labour compared to the partograph (aOR = 5.94;CI 95%3.63–9.73, P < 0.001). Detection of obstructed labour alone using LCG increased 12-fold compared to the partograph (aOR = 11.74;CI 95%3.55–- 38.74, P < 0.001). We observed increased Caesarean section rates (aOR=6.12;CI 95%4.32–8.67, P < 0.001), augmentation of labour (aOR = 3.11;CI 95%1.81–5.35, P < 0.001), Apgar Score at 5 minutes (aOR = 2.29;CI 95%1.11–5.77, P = 0.025) and tool completion rate (aOR = 2.11;CI 95%1.08–5.44, P < 0.001). We observed no differences in stillbirths, maternal deaths, postpartum haemorrhage and uterine rupture. Conclusion: Our data shows that LCG diagnosed more cases of prolonged and obstructed labour compared to the partograph among women delivering at rural publicly funded midwife-led facilities in Southwestern Uganda. More controlled and powered studies should evaluate the two tools in different facilities and sub-populations.
HIV and Syphilis Coinfection in Pregnancy and Adverse Birth Outcomes in Uganda
(The Journal of Infectious Diseases, 2025-08-30) Mehal Churiwal; Timothy Mwanje Kintu; Onesmus Byamukama; Ingrid V. Bassett; Mark J. Siedner; Anacret Byamukama; Edna Tindimwebwa; Pooja Chitneni; Julian Adong; Elias Kumbakumba; Stephen Asiimwe; Joseph Ngonzi; Lisa M. Bebell
Background: Despite increasing global syphilis incidence, little is known about the combined impact of maternal HIV and syphilis coinfection. We evaluated effects of HIV/syphilis coinfection in pregnancy on birth outcomes. Methods: We conducted 2 prospective birth cohort studies in Uganda from 2017 to 2023. Our primary outcome was birthweight. Our secondary outcome was a composite adverse birth outcome (birthweight<2.5kg stillbirth, early neonatal death, or 5-min APGAR<7). We compared outcomes by HIV and Treponema pallidum particle agglutination assay (TPPA) seropositivity and fitted multivariable regression models. Results: Treponema pallidum particle agglutination assay seroprevalence was 12% (118/967); 19% (94/483) among WHIV and 5% (24/484) among women without HIV. Only 48% of TPPA-seropositive women reported syphilis testing during antenatal care. Stillbirth and early neonatal death were higher among TPPA seropositive (12%, 15/118) than seronegative (4%, 32/849) participants. Low birthweight was associated with HIV seropositivity (−0.1 kg, 95% CI −0.15, −0.04), younger maternal age (0.01 kg per year, 95% CI 0.01, 0.02), and lower gestational age (0.07 kg per week, 95% CI 0.06, 0.09) but not TPPA serostatus. The composite outcome was associated with lower maternal and gestational age. Conclusions: We report high TPPA seroprevalence, low syphilis testing rates, and associations with adverse birth outcomes, emphasizing the need to improve prenatal syphilis testing and treatment.
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 delib erately enhance the quality of care if Uganda is to meet the 2030 global targets.
From green HRM to sustainable business performance: a two-Stage meta-analytic SEM of the mediating role of green innovation
(Cogent Business & Management, 2025) Dedrix stephenson Bindeebaa; Rennie Bakashaba; Eddy Kurobuza tukamushaba; Susan atuhaire
This study examines the impact of green Human Resource management (gHRm) on sustainable Business Performance (sBP) through the mediating role of green innovation (gi). using a two-stage meta-analytic structural equation modeling approach, we synthesize 210 effect sizes from 137 empirical studies across 43 countries and over 167,000 firm observations. Results show that gHRm directly improves economic, environmental, and social performance and strongly predicts gi, which in turn enhances each performance dimension. mediation analysis confirms that gi partially transmits gHRm’s influence across all three sBP pillars. we integrate ability–motivation opportunity theory, the theory of Planned Behavior, and the Resource Based view to explain how human resource practices build capabilities that drive sustainable innovation. these findings provide clear guidance for managers and policymakers in designing HR policies that foster green innovation and support sustainability goals.
Entrepreneurial Networking and Performance of Ugandan Manufacturing SMEs: The Mediating Role of Innovation Capabilities
(Journal of Economics and Behavioral Studies, 2024-06) Rennie Bakashaba; Benjamin Musiita; Sarah Nabachwa
This study investigates the potential impact of innovation capacities on the relationship between entrepreneurial networking and the performance of small and medium-sized manufacturing enterprises (SMEs) in Mbarara City. The target population of the study was 248 SMEs, according to MoFPED (2022). 205 SMEs were obtained when the sample size was calculated using Krejcie and Morgan's (1970) tables. With 186 respondents and SMEs, the response rate was 91%. Data was collected using a cross-sectional research design. To determine the mediating link, the four stages of Baron and Kenney (1986) was completed and every direct influence of the research variables had to meet a substantial requirement. The prerequisites were met and there was a significant direct association (Beta=0.673; p<.01) between entrepreneurial networking and SMEs' performance. Furthermore, there was a direct substantial association (Beta=0.437; p<.01) between innovation capabilities and the performance of SMEs, and a significant correlation (Beta=0.166; p<.01) was found between entrepreneurial networking and innovation capabilities. The association between entrepreneurial networking and the performance of SMEs decreased from Beta=0.673 to Beta=0.617 when innovation capabilities were taken into account, although the relationship remained statistically significant. This suggests that the relationship between entrepreneurial networking and performance of SMEs is mediated by innovative capabilities. The model's indirect outcome is given by the percentage of 8.32%, indicating that 91.68% explains the direct effect. The study advises policymakers to encourage SMEs to innovate and promote entrepreneurial networking by organizing workshops/seminars where entrepreneurs can interact with each other and thus boost their innovativeness which will enhance SME performance.
Impact of Decentralization on HIV and TB Program Performance in the Rural Central Region of Uganda: The Mediating Role of Decentralized Monitoring and Accountability
(World Medical & Health Policy, 2025) Dedrix Stephenson Bindeeba; Semei Christopher Mukama; Rennie Bakashaba; Jane SenyondoNakawesi; Catherine Senyimba; Yvonne Karamagi
This study examines the impact of decentralization on HIV and Tuberculosis (TB) program performance in rural central Uganda, highlighting the mediating role of decentralized monitoring and accountability (DMA). Decentralization aims to improve service delivery through local governance, yet its effectiveness and underlying mechanisms remain underexplored. A cross‐sectional survey of 145 district leaders overseeing HIV and TB programs across eight districts utilized a structured questionnaire and SPSS Version 27. The reliability of decentralization constructs was verified using Cronbach's alpha, while principal component analysis confirmed their Validity. Five constructs emerged: local resource mobilization (LRM), decen tralized strategic resource allocation (DSRA), decentralized collaborative program governance (DCG), decentralized program administration (DPA), and DMA, alongside HIV and TB Program Performance (HPP). Regression and mediation analyses demonstrated that DSRA and DPA significantly enhanced HPP by promoting equitable resource allocation and administrative efficiency. DMA mediated the effects of DSRA, DCG, and DPA on HPP, reinforcing gains through transparency, reporting, and stakeholder oversight. However, LRM showed no significant direct or mediated impact, implying that fiscal autonomy alone may not drive program success. These findings suggest decentralization can strengthen health outcomes when supported by robust local planning, administrative capacity, and continuous monitoring. Policymakers should channel resources into local governance infrastructure, DMA included, to ensure that decentralized frameworks advance HIV and TB service delivery.
Green human resources management and green innovation: a meta-analytic review of strategic human resources levers for environmental sustainability
(Discover Sustainability, 2025) Dedrix Stephenson Bindeeba; Eddy Kurobuza Tukamushaba; Rennie Bakashaba; Susan Atuhaire
Green Human Resource Management (GHRM) has become a vital lever for driving organizational sustainability, yet the empirical relationship between GHRM and Green Innovation (GI) remains fragmented and inconclusive. This meta-analysis integrates findings from 52 peer-reviewed studies published between 2015 and 2025, encompassing 23,103 observations, to estimate the overall effect of GHRM on GI and to examine the influence of specific HR practices and contextual moderators. Grounded in the Ability–Motivation–Opportunity (AMO) framework, the Resource Based View (RBV), and the Theory of Planned Behavior (TPB), the study reveals a significant positive pooled effect, affirming that GHRM is a consistent and influential driver of GI. Among HR practices, green-linked compensation demonstrated the strongest impact, surpassing training and recruitment. Moderator analyses reveal that effect sizes differ meaningfully by industry type, firm size, and year of publication, but not by country development status or statistical method. These results contribute to theoretical advancement by integrating behavioral, strategic, and cognitive perspectives on sustainability-oriented innovation. Practically, the findings offer actionable insights for managers and policymakers on designing effective GHRM systems that stimulate eco-innovation. This study delivers the first quantitative synthesis clarifying when, where, and how GHRM enhances green innovation across diverse sectors and economies, providing a robust foundation for future research and strategy in sustainability-driven human capital development.