Mbarara University of Science and Technology Institutional Repository (MUST-IR)

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Recent Submissions

Uneven hydroclimatic risk and land access constraints challenge refugee agricultural self-reliance in Uganda
(Journal of Agriculture and Food Research, 2026) Emnet Negash; Erin Coughlan de Perez; Laura E.R. Peters; Abena Boatemaa Asare-Ansah; Ronald Twongyirwe; Kwinten Van Weverberg; Catherine Nakalembe; Jamon Van Den Hoek
Uganda's refugee policy is widely regarded for promoting agricultural self-reliance among the country's nearly 2 million refugees, the largest in Africa. However, viability of this model is often challenged by how hydroclimatic shocks interact with household capacity to absorb them, an interaction that remain poorly understood. Here, we address a key gap by explicitly distinguishing unimodal and bimodal rainfall regimes and linking regime-specific drought and wetness dynamics to refugee livelihood exposure and household land access. We analyse 6-month Standardized Precipitation Evapotranspiration Index (1981-2024) and Vegetation Condition Index (2001-2024) anomalies, focusing on May-October main growing and harvest season. We find that the interannual extremes are highly episodic and often asynchronous between rainfall regimes. Only 2009, 2016, and 2023 exhibit widespread drought in both regimes, whereas only 2011 and 2012 are widely wet in both. Many large events are regime specific, producing spatially uneven exposure, and long-term trends in affected area are weak relative to year to-year variability. Major droughts are characterized by a late-season moisture deficit compounded by elevated atmospheric demand, with vegetation responses that are broadly consistent but spatially heterogeneous. We further show that hydroclimatic shocks intersect with rapidly rising refugee exposure in a small set of districts and with large structural constraints on land access and food-related outcomes. Notably, refugees typically hold one-eighth of the mean arable land as host households, a structural deficit suggesting that climate shocks rapidly and unevenly translate into production shortfalls rising market and aid dependence. These findings underscore the fragility of the self-reliance model under spatially uneven, episodic drought conditions. Sustaining refugee self-reliance will not only require spatially explicit climate monitoring but also need structural interventions in refugee-hosting regions where climatic, demographic, and land access pressures converge.
Invisible Yet Resilient: Understanding the Vulnerability and Integration Pathways of South Sudanese Older Refugees in Uganda
(Journal of Central and Eastern European African studies, 2026) Frank Ahimbisibwe; Samuel Opono; Specioza Twinamasiko; Kabasiita Maria Goretti
Forcibly displaced older persons in Africa have not largely been the object of academic research. Recent scholars conducted a scoping review about the situations of displaced older persons in Africa and identified several gaps in the literature, including paying attention to the displaced older persons’ integration in the host societies. Our current study contributes to filling this gap by examining the vulnerability of older refugees and identifying hidden opportunities for resilience and integration in the host communities. The study is based on the primary data collected from South Sudanese refugees in Pagirinya Settlement in Uganda, analysed in conjunction with the available literature. The study finds that despite the vulnerability of older refugees; windows of opportunities exist to develop their resilience and integrate them in the host communities. It concludes that leveraging skills of older refugees and social gatherings in the settlements helps them to curtail vulnerabilities, develop resilience and integrate in the host communities.
Organisational Commitment as a Mediator in the Relationship between Perceived Organisational Justice and Organisational Citizenship Behaviour among Teachers in Government-Aided Secondary Schools of Greater Bushenyi, Uganda
(East African Journal of Interdisciplinary Studies, 2026) Precious Natureeba; Aloysius Rukundo; Sudi Balimuttajjo
This study aimed to examine the mediating role of organisational commitment in the relationship between perceived organisational justice and organisational citizenship behaviour (OCB) among 314 teachers in 51 government-aided secondary schools in Greater Bushenyi. The study adopted a cross-sectional research design grounded in the positivist paradigm and utilised a quantitative approach. Teachers were selected using simple random sampling, while a census strategy was adopted for the schools. Data was collected using a self-administered questionnaire, coded, entered into SPSS version 30 and analysed using hierarchical regression analysis. The study findings revealed that organisational commitment significantly mediates the relationship between perceived organisational justice and OCB (β = 0.37, p < 0.001). The study concludes that organisational commitment is a critical psychological pathway through which perceived organisational justice translates into improved citizenship behaviour among teachers. Therefore, schools that foster fairness while simultaneously strengthening teacher commitment are more likely to achieve higher levels of OCB. School governing bodies, administrators, the Ministry of Education and other policymakers should promote fair decision-making processes, inclusive and transparent communication, and equitable treatment, while also implementing strategies that enhance teacher commitment, such as recognition, involvement in decision-making, and supportive leadership. This integrated approach will strengthen positive teacher behaviours and improve overall school effectiveness.
Lightning-caused disturbance frequency and severity varies with topography in an Afromontane forest
(Journal of Ecology, 2026) Evan M. Gora; Alain Senghor K. Ngute; Rodrigue Batumike; Aida Cuni-Sanchez; Gerard Imani; Beth A. Kaplin; Drew Bantlin; Robert Bitariho; Bianca Zoletto; Nikolaos Petridis; Douglas Sheil; Martin J. P. Sullivan
1. Lightning is an important agent of tropical tree mortality, but field data on lightning-caused disturbances is largely restricted to one lowland tropical forest in Panama. 2. Here we quantified variation in the frequency and severity of visually detectable lightning-caused disturbances across topography in the montane forests of Nyungwe National Park, Rwanda. This was the first systematic assessment of lightning-caused disturbance in any African tropical forest and a preliminary exploration of the association between lightning disturbance frequency and forest tolerance to lightning. 3. Lightning-caused disturbances were observed six times more frequently on ridges (19 strikes across 4.5 km of transects) than in valleys (2 strikes across 2.9 km), but lightning-caused disturbances in valleys tended to cause more tree-level damage than those on ridges (and also kill a higher proportion of the trees affected within each lightning disturbance, although the rarity of disturbances in valleys meant the latter effect was not statistically significant). Overall, lightning disturbances tended to kill a lower proportion of trees in this Afromontane forest than in previously documented lightning disturbances in tropical America. 4. We also observed less tree-level damage to ridge-dominant Syzygium spp. (Myrtaceae) compared to the community-wide average, providing support for taxonomic differences in lightning tolerance. 5. Synthesis. Our results indicate that lightning disturbance severity differs within and among sites, potentially mediated by differences in lightning tolerance among tree species and provide preliminary support for the hypothesis that disturbance severity declines with disturbance frequency.
Level of Emergency Preparedness and Associated Barriers at the Accident and Emergency Ward of a LMIC Hospital: A Cross-Sectional Assessment Using the WHO HEAT Tool
(Open Access Emergency Medicine, 2026) Joel Nabeshya; Elizabeth Atiang; Charity Kwarikunda; Rachel Luwaga; Vallence Niyonzima
Background: Emergency preparedness is a challenge for hospital emergency departments (EDs). In the USA, over 68% of 983 EDs were not emergency prepared, while in Ghana, one hospital’s emergency preparedness level was only 57.4%. At the health facility level, several barriers to emergency preparedness have been reported, including poor access to medical supplies, medications, and equipment; deficits in medical training; and the absence of formal clinical management protocols. Methodology: A cross-sectional study was conducted at the Accident and Emergency (A&E) Ward of Mbarara Regional Referral Hospital (MRRH). Data was collected using the modified WHO HEAT checklist, completed by three (3) key hospital informants, who were preferred for their key insights over a large sample of general staff. Data fell into 11 variables with items in each variable scored between 0 and 2, then the total scores generated percentages. By univariate analysis, the level of emergency preparedness and the associated barriers at the A&E Ward of MRRH were determined. Results: The overall emergency preparedness score at the A&E ward of MRRH was 62.6%, with the human resources category under ED capacity scoring the lowest (37.5%), while the consulting services category under ED resources scored the highest (71.4%). The two most common associated barriers to emergency preparedness in the A&E were medicine stockouts (35.0%) and missing emergency equipment (29.2%), while the least reported barriers were user fees (2.2%), and opening hours (0.7%). Conclusion: According to this study, the level of emergency preparedness in the A&E ward of MRRH was weak, with low level of human resource, and weak quality improvement checks the most contributing factors. The highest reported barriers to strong emergency preparedness in the A&E ward of MRRH were medication stockouts and the absence of emergency equipment.
Geochemistry, Speciation, and Health Risks from Potentially Toxic Elements in Street Dust of Mbarara City, Uganda
(Journal of Xenobiotics, 2026) Hassan Omary Kumenya; Irene Nalumansi; Christopher Angiro; Ivan Kiganda; Timothy Omara; Emmanuel Ntambi
In equatorial Africa, rapid urbanization has increased city populations and particulate matter emissions. Street dust is a visual indicator that can be used to track urban pollution. In the present study, the total concentration and speciation of 10 potentially toxic elements (PTEs; As, Cd, Cu, Cr, Ni, Mn, Fe, Pb, Co, and Zn) in dust (n = 36) sampled from three streets of Mbarara City, Uganda, were determined using Energy Dispersive X-ray Fluorescence and Inductively Coupled Plasma-Optical Emission Spectrometry. The concentration of PTEs (0.27–36,401.50 mg/kg) geostatistically indicated moderate to extremely high enrichment of Cd, Cu, and Co in street dust. According to principal component and hierarchical cluster analyses, As, Pb, Cu, Zn, and Cd originated mainly from anthropogenic inputs, Fe and Mn came from geogenic sources, while Cr, Ni, and Co were from both natural and anthropogenic contributions. The mobility of the PTEs followed a general trend, Zn > Co > Cd > Ni > Cr, with Zn and Co being more environmentally mobile. Human health risk assessments indicated that discernible non-carcinogenic health risks may result from ingestion of dust by both children and adults. Children could also experience cancer health effects through the same exposure pathway.
From Policy to Practice: Evaluating Governance Wellbeing Nexus of Oil and Gas Policy Implementation in Uganda’s Albertine Graben
(East African Journal of Environment and Natural Resources, 2026) Vincent Kisembo; Tom Ogwang; Grace Kagoro Rugunda; Siri Ericksen
The discovery of commercially viable oil and gas in Uganda’s Albertine Graben in 2006 raised expectations for socio-economic transformation in the host districts of Buliisa, Hoima, and Kikuube. In response, the Government of Uganda established an extensive policy and legal framework to regulate exploration, production, environmental protection, and petroleum revenue management. However, the extent to which these frameworks have translated into improved human wellbeing for host communities remains unclear. The objective of this study was to examine how Uganda’s oil and gas governance arrangements have influenced human well-being outcomes in the three districts. A qualitative research design, guided by an interpretivist paradigm, was employed to explore lived experiences and institutional dynamics. Data were collected from 150 participants through focus group discussions, key informant interviews, and documentary reviews involving community members, district officials, civil society organisations, and technical staff from regulatory bodies and oil and gas companies. The results indicate that although Uganda has established strong statutory and policy provisions, their implementation has yielded limited well-being gains. Communities reported restricted access to employment and training opportunities due to affordability constraints, distance to training centres, and inadequate information flow. Environmental and public health concerns persisted, including water contamination, occupational risks, and inadequate health facility capacity. Social safeguards such as valuation transparency, compensation timeliness, livelihood restoration, and grievance handling were inconsistently implemented. Petroleum revenue management systems existed, but host communities had not yet received direct fiscal benefits because production royalties had not commenced. The study concludes that Uganda’s governance framework is robust in design but suffers from implementation gaps. Strengthening institutional capacity, improving transparency, and ensuring the timely delivery of safeguards are critical for enhancing human wellbeing in oil and gas-host communities.
Exploring community perceptions of gender roles as a predisposing factor in schistosomiasis infection in southwestern Uganda
(Global Public Health, 2026) Faith Mugabi; Maxson Kenneth Anyolitho; Tine Huyse; Elizabeth Kemigisha; Viola Nilah Nyakato
Schistosomiasis, a neglected tropical disease, affects people of all genders and ages. However, few studies have examined how communities in endemic areas perceive gender roles as factors influencing infection and control. This study explored the perceptions of farming (Kyaterekera) and fishing (Ndaiga) communities along Lake Albert in Uganda's Kagadi District regarding gender roles and their role in schistosomiasis infection. Using an ethnographic design, we conducted 10 key informant interviews and 18 focus group discussions with 150 participants. Data were analysed thematically. Participants from both settings recognised that gender roles influence infection risk differently for men and women. Societal expectations and gender stereotypes were seen as contributing factors. Farming men often perceived bilharzia as a lake-side issue. Drug side effects were a shared concern, but women in fishing communities preferred using herbs and prayers, while men favoured hospital visits. Gender roles and perceptions of schistosomiasis risk vary by gender and location. Common themes include societal expectations, stereotypes and concerns about treatment. Gender-specific interventions, such as gender-sensitive campaigns and inclusive decision-making, could help effectively control the disease.
Co-designing eCap-CoDe: A mobile health application for primary health care-based dementia care in rural Uganda
(PLOS Digital Health, 2026) Edith K. Wakida; Christine K. Karungi; William Wasswa; Recho Katusabe Ajok; Godfrey Z. Rukundo; Ou Zhang; Alexandra Lopez-Vera; Zohray M. Talib; Celestino Obua
Dementia is an emerging public health challenge in low- and middle-income countries (LMICs), yet it remains underdiagnosed in rural Uganda, where primary health care (PHC) providers often lack tools, training, and data systems for early detection and management. Mobile health (mHealth) applications can enhance provider capacity, improve data capture, and strengthen feedback systems. This study explored the perspectives of PHC providers and District Health Teams (DHTs) to inform the co-design of eCap-CoDe, a mobile application for community-based dementia care in rural Uganda. We conducted in-depth interviews with 31 participants from two rural districts: 23 PHC providers (medical/clinical officers and nurses) and 8 DHT members. Participants were purposively sampled for diversity in cadre, experience, and facility type. Data were thematically analyzed using the Consolidated Frame work for Implementation Research (CFIR), with four a priori domains, i.e., content, user experience, organizational, and service delivery, guiding coding and analysis. Content requirements - included dementia-specific screening and management tools, modular in-app training aligned with the WHO mhGAP Intervention Guide, and structured data capture integrated with Uganda’s Health Management Information System (HMIS). User experience needs: emphasized simple, intuitive interfaces with dropdown menus, checkboxes, audio-visual decision support, and offline functionality to address connectivity gaps. Organizational requirements: prioritized interoperability with District Health Information System 2 (DHIS2), integration with supervisory work flows, and dementia-specific performance indicators. Service delivery needs: focused on real-time feedback loops, reducing duplicate documentation, and potential expansion to other common conditions to enhance utility and uptake. Co-designing mHealth tools with end-users ensures alignment with the realities of workflows, systems, and infrastructure. eCap-CoDe addresses capacity, data, and feedback gaps in rural dementia care and offers a scalable model for integrating digital tools into PHC in Uganda and similar LMICs. Pilot testing will assess the feasibility, usability, and impact before scaling up.
Prevalence of Unintended Pregnancy and Associated Factors Among Women Enrolled in the Support-Moms Study in Southwestern Uganda: A Cross-Sectional Analysis of Baseline Data
(Cureus, 2026) Julius Mugisha; Stuart Turanzomwe; Mugyenyi R. Godfrey; Angella Musiimenta; Micheal Kanyesigye; Henry Ochola; Elly Atuhumuza; Esther C. Atukunda
Unintended pregnancies and unmet need for contraception continue to be a public health concern in Sub-Saharan African countries. This potentially contributes to the high maternal mortality rate in these countries. This study highlights the burden and the context-specific factors associated with unintended pregnancy in Southwestern Uganda. This was a secondary analysis of baseline data from pregnant women enrolled in the Support-Moms trial, which was a community-based randomized controlled trial. The Support-Moms trial recruited 824 pregnant women who had not started antenatal care visits, and these were randomly assigned (1:1) into two groups: the control group, which received standard of care, and the intervention group that received health information messages in the form of Short Messaging Service (SMS) or audio from the Support-Moms App. Participants were recruited from Mbarara City, Mbarara District, and Mitooma District. Enrolled women completed an interviewer-administered questionnaire to collect data on sociodemographic characteristics, reproductive history, prior birth and pregnancy outcomes, household food security, and pregnancy intention. Women who had unwanted or mistimed pregnancies were collectively regarded as having an unintended pregnancy. Data analysis was done using Stata version 19 (StataCorp LLC, College Station, TX), and a modified Poisson regression analysis was employed to document the factors associated with unintended pregnancy. Statistical significance was set at a p-value < 0.05. To assess the prevalence of unintended pregnancy and the associated factors, a total of 818 women were included in the final analysis. The median age was 27 years. Overall, 296 (36.2%) women reported an unintended pregnancy. In multivariable analysis, moderate (adjusted prevalence ratio (aPR) = 1.55; 95% CI: 1.02-2.36) and severe food insecurity (aPR = 1.96; 95% CI: 1.25-3.06), grand multigravidity (aPR = 1.64; 95% CI: 1.11-2.41), and lack of awareness of the partner’s desired number of children (aPR = 1.22; 95% CI: 1.01-1.47) were independently associated with unintended pregnancy. Over one-third of pregnant women in the Support Moms trial, Southwestern Uganda, had unintended pregnancy, largely driven by food insecurity, grand multigravidity, and inadequate partner communication. Context-specific interventions are critical to mitigating this high burden.
Prediction of maize yield in Uganda using CNN-LSTM architecture on a multimodal climate and remote sensing dataset
(Springer, 2026-01-29) Taremwa,Danison; Ahishakiye,Emmanuel; Obbo,Aggrey; Kisozi , Paul Kategaya; Kaggwa , Fred
Maize is a staple crop in Uganda, underpinning both food security and rural livelihoods. Accurate forecasting of maize yields is therefore crucial for guiding agricultural planning, resource allocation, and policy design. Yet traditional statistical methods are often limited by low accuracy, poor scalability, and weak integration of diverse inputs, leaving them unable to capture complex, nonlinear, and spatiotemporal dynamics of crop growth. To overcome these constraints, we developed a hybrid convolutional neural network and long short-term memory (CNN-LSTM) model. This model integrates remotely sensed climatic variables and vegetation indices with biannual maize yield records from Uganda’s Zonal Agricultural Research and Development Institute (ZARDI) zones for the period 2018–2020. Due to the scarcity of high-quality yield data, we applied the Synthetic Minority Oversampling Technique for Regression (SMOGN) alongside feature selection to balance the dataset and improve predictive robustness. The CNN-LSTM model’s ability to select features and perform extensive hyperparameter tuning enabled it to outperform baseline models. It achieved a Mean Squared Error (MSE) of 0.107 tonnes2, a Mean Absolute Error (MAE) of 0.267 tonnes, a Root Mean Squared Error (RMSE) of 0.327 tonnes, and an R2 score of 0.783. A comparative analysis revealed that the CNN + Random Forest (RF) model achieved an MSE of 0.137 tonnes2, a MAE of 0.281 tonnes, an RMSE of 0.370 tonnes, and an R2 score of 0.722. These results outperformed the standalone CNN (MSE = 0.216, R2 = 0.562) and RF (MSE = 0.211, R2 = 0.573) models, underscoring the advantage of combining spatial–temporal learning for improved predictive accuracy. Residual analysis further confirmed the model's stability, showing minimal bias and close agreement between observed and predicted yields. These findings highlight the potential for integrating spatial–temporal deep learning and ensemble methods to deliver accurate crop yield forecasts in data-limited smallholder systems. By offering a scalable framework for evidence-based farm planning and food security policy, our study demonstrated that advanced machine learning can directly support sustainable development in sub-Saharan Africa. Future research will extend the framework to incorporate Transformer architectures, high-resolution satellite imagery, and explainable AI, further enhancing accuracy, interpretability, and decision-support capacity.
IoT Adoption for Agricultural Transformation in Developing Countries: Challenges and Opportunities - A case of Uganda
(VFAST Transactions on Software Engineering, 2026-03-31) Obbo,Aggrey; Ogot,Bernard
70% of Uganda’s workforce is employed in agriculture, which accounts for 26.2% of the country’s GDP and is a fundamental pillar of the country’s economy. Nevertheless, the sector is increasingly hampered by the unpredictability of the climate, traditional farming inefficiencies, and serious information gaps that jeopardize local food security. The potential of Internet of Things (IoT) technology to address these issues through data-driven resource management and precision farming is examined in this paper. Primary data was gathered from 116 smallholder farmers in Eastern Uganda using a descriptive study approach and the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. Performance Expectancy (Mean = 4.19) and Behavioral Intentions (Mean = 4.11) emerged as the strongest drivers in the quantitative results, indicating a high readiness for adoption. Additionally, 95.7% of respondents reported severe crop losses due to drought, confirming the urgent need for technical intervention. Despite this incentive, Facilitating Conditions such as technological infrastructure and government support scored far lower (Mean = 3.17), indicating a crucial structural barrier. The study offers a strategic framework for policymakers to use the suggested IoT-enabled soil productivity monitoring model to strengthen smallholder resilience and revolutionize Uganda’s agricultural productivity, concluding that although farmer intent is high, sustainable adoption necessitates targeted investment in infrastructure and technical assistance.
Dyslipidemia and Associated Factors Among a High-Risk Population for Stroke: A Cross-Sectional Study
(Stroke Research and Treatment, 2026) Mark Kaddumukasa; Scovia Nalugo Mbalinda; Josephine Nambi Najjuma; Martin Kaddumukasa; Jane Nakibuuka; Doreen Birungi; Carla Conroy; Joy Yala; Levicatus Mugenyi; Christopher J. Burant; Shirley Moore; Elly T. Katabira; Martha Sajatovic
Aims: Dyslipidemia is a major modifiable risk factor for stroke; however, it is poorly understood among patients at risk of stroke in Uganda. This study is aimed at determining the prevalence of dyslipidemia and identifying associated factors among a Ugandan sample at risk for stroke. Methods: This was a hospital based cross-sectional study conducted across three Ugandan sites. The serum lipid levels were determined following the National Cholesterol Education Program guidelines. Data were analyzed with STATA employing un invariable and multivariable logistic regression. Statistical significance was set at p < 0.05. Results: We enrolled 247 study participants with a mean age (SD) of 55.4 (12.0) years. Majority of the participants were female, n = 168 (68%). About 81% (N = 199) had elevated serum lipid levels. Sixty-one (24.7%) had elevated levels of total serum cholesterol, whereas half of female participants had abnormally low levels of HDL cholesterol. About a third (N = 82 and 84, respectively) had elevated serum LDL and triglycerides. Nearly 40% (N = 98) were obese and 23.5% had a sedentary lifestyle (N = = 58). Only 20.2% (N = 50) were receiving lipid lowering drugs. Prior family stroke history and personal history of stroke had lower odds of 58% (AOR = 0.42, 95% CI: 0.20–0.88, p = 0.022); and 64% (AOR = 0.36, 95% CI: 0.17–0.76, p = 0.008), respectively, of having dyslipidemia. Conclusions: Approximately four in five Ugandans at risk of stroke have dyslipidemia. The majority also have low HDL-c levels. Implementation of systematic screening and provision of statin therapy among those at high risk for stroke is urgently needed to reduce stroke burden in Uganda.
The application of artificial intelligence in surveillance and control for antimicrobial resistance in hospital-acquired infections
(Discover Public Health, 2026) Innocent Ayesiga; Michael Oppong Yeboah; Jonathan Mawutor Gmanyami; Ahgu Ovye; Naya Gadzama Bulus; Lillian Edith Nalwanga; Gerald Mawanda; Tom Didimus Ediamu; Lenz Nwachinemere Okoro; Juliet Sylivia Nalugya; David Tenywa; Colleen M. Farrelly; Sheba G. Nakacubo
Antimicrobial resistance (AMR) continues to undermine the effectiveness of modern medicine, with hospital-acquired infections (HAIs) as major contributors to morbidity and mortality. Traditional surveillance systems for AMR in HAIs are often fragmented, delayed, and reactive, limiting their ability to inform timely interventions. Emerging evidence demonstrates that artificial intelligence (AI) can transform AMR surveillance and control. AI can enable predictive modelling, risk stratification, and outbreak forecasting. This narrative review describes various AI applications for monitoring and evaluating antimicrobial resistance (AMR) among HAIs in hospital settings. We begin by discussing how machine learning models can predict the emergence and spread of antibiotic-resistant pathogens. This is achieved through the analysis of various datasets, including microbiological results, electronic health records, and hospital workflows. Patient-level risk scoring systems are examined, demonstrating their ability to identify individuals at increased risk of multidrug-resistant infections. We describe AI-powered early-warning systems that provide outbreak alerts, enabling timely infection prevention and control measures. Hospital applications, including predictive resistance models validated in European hospitals, such as those in Lower Saxony, Germany, and early-warning dashboards tested in Asia and Africa, illustrate the potential impact of these approaches. However, these studies vary substantially in their designs, validation methods, and implementation contexts. To ensure sustainability, we propose a roadmap for integrating AI into AMR programs. We discuss ethical, legal, and regulatory frameworks. We also discuss strategies for capacity building, cost-effectiveness, and scalability, particularly in low- and middle-income countries. Our findings suggest that AI has the potential to strengthen infection control, enhance stewardship, and provide resilient defences within hospital environments.
Third trimester maternal anemia is associated with fetal cardiovascular compromise in Southwestern Uganda
(Discover Medicine, 2026) John Semuwemba; Silvia Lopez Miranda; Yarine Leodnell Fajardo Tornes
Background: Maternal anemia is still a global public health burden during pregnancy. It impairs fetal placental perfusion leading to fetal hypoxia, that disrupts vital physiological and biochemical pathways. This affects fetal growth and developmental programming, resultant into advance. perinatal outcomes and susceptibility to various non-communicable diseases later in life. This study set out to established how clinical Doppler and other physiological cardio, cerebral and peripheral vascular parameters vary at various grades of maternal anemia. Methods: A cross-sectional study was conducted among women aged 20–35 years, with singleton third trimester pregnancies attending Mbarara Regional Referral Hospital between March 2023 and August 2023. These were grouped into non-anemic with Hemoglobin concentration≥11 g/dL, while mild anemia (Hb:10–10.9 g/dL), moderate anemia (7–9.9 g/dL), and severe anemia Hb<7 g/dL. Resistance to flow and flow distribution were assessed by Doppler-derived indices and ratios of the fetal middle cerebral artery (MCA) and umbilical artery (UA). Physiological parameters like volumetric flow were calculated from measurements. We compared means using ANOVA and evaluated the relationships between flow parameters and the severity of anemia using Spearman’s correlation coefficient. Results: We enrolled 288 participants with a mean age of 27±4.3 years. The UA resistance indices among the non-anemic were significantly lower than among the anemic and significantly escalated from among the mild to the severely anemic, for instance, UA-PI increased from (0.88±0.18) among the mild, moderate (0.92±0.24) to (1.09±0.34) severe anemia, (p<0.001), while the mean flow velocity decreased as anemia severity increased (F [3,284]=3.44, p=0.017). The mean cerebral flow velocity demonstrated an increasing trend with the severity of anemia (p=0.042). Similarly a lower mean Cerebral placental Ratio was noted in the anemic group (1.87±0.49) compared to the non-anemic group (2.15±0.53), (p<0.001), while as maternal Hb concertation reduced, the CPR significantly decreased, (r=0.31, F[3,284]=12.64, p<0.001). As the maternal hemoglobin concentration reduced, the fetal heart rate increased (r= -0.06, p=0.308). Conclusion: Anemic women exhibited higher UA flow resistance, lower Cerebral placental ratio, suggestive of altered flow patterns with increasing severity of maternal anemia. These findings suggest that maternal anemia influences umbilical artery hemodynamics, potentially responsible for compromised fetal well-being. Understanding these associations could contribute to enhanced antenatal care strategies, emphasizing the importance of monitoring maternal anemia and its potential implications on fetal cardiovascular health.
Exploring the relationship between religiosity and coping strategies among individuals with mental illness in Uganda: a cross sectional study
(BMC Psychology, 2026) Joan Abaatyo; Godfrey Zari Rukundo; Samuel Maling; Emmanuel Alol
Background: Mental illnesses are leading causes of disability worldwide, and individuals often turn to religion as a source of support and resilience. In Uganda, where religious participation is deeply embedded in society, the influence of religiosity on coping strategies among individuals with mental illnesses remains underexplored. This study examined the relationship between religiosity and coping strategies among people with mental illnesses at Mbarara Regional Referral Hospital in southwestern Uganda. Methods: A cross-sectional study was conducted among 400 adult outpatients at Mbarara Regional Referral Hospital. Religiosity was assessed using the Duke University Religion Index (DUREL), and coping strategies were measured using the Brief Coping Orientation to Problems Experienced (Brief COPE) scale. Exploratory factor analysis was used to classify coping strategies into positive and negative. Multivariable logistic regression examined associations between religiosity dimensions and positive coping while adjusting for socio-demographic and clinical factors. Results: Negative coping strategies were more prevalent (61.2%) than positive strategies (38.8%). In adjusted analyses, higher organizational religious activity was associated with increased odds of positive coping (adjusted odds ratio [aOR]=1.32, 95% CI: 1.10 to 1.57), while higher non-organizational religious activity was associated with reduced odds of positive coping (aOR=0.69, 95% CI: 0.60 to 0.81). Family history of mental illness (aOR=1.67, 95% CI: 1.06 to 2.26) and a diagnosis of bipolar disorder (aOR=1.95, 95% CI: 1.01 to 3.76) were also associated with greater use of positive coping. Conclusion: Organizational religious activity is independently associated with adaptive coping among individuals with mental illness, whereas non-organizational religious activity is linked to reduced likelihood of positive coping. The high reliance on maladaptive coping strategies underscores the need for comprehensive, culturally sensitive mental health interventions that integrate psychosocial and faith-based support. Further longitudinal research is needed to clarify causal pathways
Association between non-high-density lipoprotein cholesterol and non-alcoholic fatty liver disease among people living with HIV on dolutegravir-based antiretroviral therapy: A cross-sectional study in Southwestern Uganda
(BMC Research Notes, 2026) Charles Nkubi Bagenda; Carol Nantongo; Elastus Ssemwanga; Michael Junior Mugisa; Jesca Wafwoyo Akoth; Daniel Nzaramba; Rogers Kalyetsi; Elizabeth A. John; Jazira Tumusiime; Blendar Ainebyoona; Shadrach Omara; Vicent Mwesigye; Sylvia Achieng Lumumba; Conrad Lubwama; Benson Musinguzi; Lucas Ampaire; Rose Nassali; Herbert Itabangi; Lawrence Obado Osuwat; Brian Ssenkumba; Ronald Ouma Omolo
Objective: Non-high-density lipoprotein cholesterol, an aggregate marker of atherogenic lipoproteins, has been implicated in metabolic dysfunction and may predict non-alcoholic fatty liver disease risk. Our study investigated the association between non-high-density lipoprotein cholesterol and non-alcoholic fatty liver disease among people living with Human Immunodeficiency Virus on dolutegravir-based antiretroviral therapy in southwestern Uganda. We conducted a secondary analysis of data obtained from a cross-sectional study of 377 adults who had been on dolutegravir-based antiretroviral therapy for ≥12 months at Ruhoko Health Centre IV, southwestern Uganda. Results: Of the 377 participants, 42(11.1%; 95CI: 8.3–14.8) had non-alcoholic fatty liver disease. We observed a significant association between high non-high-density lipoprotein cholesterol and non-alcoholic fatty liver disease; second tertile (aOR=3.08, 95% CI: 1.06–8.99, p=0.039) and third tertile (aOR=4.46, 95% CI: 1.25–15.88, p=0.021). At an optimal cut-off of ≥113.4 with a sensitivity of 69% and specificity of 48%, non-high-density lipoprotein cholesterol had a significant discriminative ability; AUC=0.654(95%CI:0.561–0.747) to distinguish participants with from those without non-alcoholic fatty liver disease. Therefore, High non-high-density lipoprotein cholesterol is a potential predictor for non-alcoholic fatty liver disease.
Caregiving experiences, challenges, and coping strategies among caregivers of children with epilepsy and/or cerebral palsy in southwestern Uganda
(Discover Public Health, 2026) Angella Nanziri; Joan Abaatyo; Moses Muwanguzi; Gerald Wakweyika; Mark Mohan Kaggwa; Godfrey Zari Rukundo
Background: Caregivers of children with epilepsy, cerebral palsy (CP), or co-occurring epilepsy and CP in low-resource settings face substantial psychological, social, and economic challenges. Despite high caregiver burden in sub-Saharan Africa, limited qualitative research has explored how caregivers perceive their experiences, their children’s care needs, and the contextual factors shaping coping. This study examined caregivers’ lived experiences and coping strategies to inform interventions that strengthen caregiver well-being and capacity. Methods: A descriptive qualitative study was conducted at the paediatric neurology clinic of Mbarara Regional Referral Hospital in southwestern Uganda. Twenty in-depth interviews were held with primary caregivers of children with epilepsy, CP, or both. Purposive sampling ensured variation in caregiving duration, child diagnosis, and coping patterns. Interviews were conducted in English or Runyankore, audio-recorded, transcribed, translated, and analyzed thematically using Braun and Clarke’s six-step approach. Data collection and analysis occurred iteratively until saturation. Results: Caregivers described caregiving as intensive and continuous, with children requiring substantial assistance in daily activities, consistent medication adherence, physiotherapy, and coordinated school support. Access to hospitals, schools, and community resources was inconsistent, often leaving caregivers to bridge gaps in care. Financial strain, stigma, social isolation, and disruption of income-generating activities were pervasive challenges that compounded emotional distress. Despite these pressures, caregivers demonstrated adaptive coping strategies, drawing on hope, acceptance, faith, and social connectedness to sustain their roles. They reported emotional exhaustion and limited family or professional support, with minimal engagement in formal mental health services. At the same time, caregivers developed structured routines, environmental adjustments, and personalized problem-solving strategies to maintain stability and ensure continuity of care. Conclusion: This study demonstrates that caregiving for children with chronic neurological conditions, including epilepsy and CP, in low-resource settings is highly demanding, marked by substantial medical, emotional, social, and financial challenges. Despite these burdens, caregivers show notable resilience through faith, optimism, and adaptive coping strategies. The findings underscore the urgent need for comprehensive support, including reliable medication access, psychosocial services, assistive devices, and stigma-reduction efforts, to strengthen caregiver well-being and improve care for affected children.
The likely possibility of predicting treatment outcomes of cervical lesions using serum FOXP3 and P16INK4A as shown by a cohort study in South Western Uganda
(Discover Oncology, 2026) Frank Ssedyabane; Deusdedit Tusubira; Nixon Niyonzima; Josephine Nambi Najjuma; Thomas C. Randall; Rogers Kajabwangu; Cesar M. Castro; Hakho Lee; Joseph Ngonzi
Introduction: There is a need to assess the potential of blood-based biomarkers to detect treatment outcomes of cervical lesions. We determined the association between serum P16ink4A and FOXP3 concentrations and treatment outcomes of cervical lesions at a clinic in Southwestern Uganda. Methods: In this prospective cohort study, participants with cytologically and/or histologically confirmed cervical intraepithelial neoplasia (CIN) (n=90) and cervical cancer (CC) (n=90) were monitored for 12 months. After consent, clinical and demographic data were recorded, blood was collected, and serum P16ink4A and FOXP3 were measured (quantitative ELISA) at baseline and 12 months’ post-treatment. With multinomial logistic regression, we determined the association between treatment outcomes and serum P16ink4A and FOXP3 concentrations in STATA 17 using P-values of <0.05 as statistically significant. Results: Of the 180 participants initially enrolled, 62 returned for the 12-month follow-up assessment. At this time point, 47 participants presented with cleared lesions, 6 with persistent lesions, and 9 with progressed lesions. All participants exhibiting disease progression (n=9) were CC cases, while 82.98% (39/47) of those with cleared lesions had LSIL. For raised (>0.0545 ng/ml), relative to reduced serum FOXP3 (≤0.0545 ng/ml), the risk of progression relative to clearance of invasive cervical cancer would increase by 27.82. Also raised (>0.946 ng/ml) relative to reduced (≤0.946 ng/ml) serum P16INK4A, the risk of persistence relative to clearance of low grade cervical lesions would increase by 5.16 times, given other variables remain constant. Conclusion: Though results are not statistically significant and imprecise, serum FOXP3 and P16ink4A concentrations are likely associated with persistence and progression of cervical lesions. Their measurement may benefit the prognostic monitoring of cervical lesions.
Overcoming structural barriersto tuberculosistreatment in Africa through digital technologies
(The Lancet Microbe, 2026) Tsegahun Manyazewal; Russell R Kempker; Zelalem Temesgen; Catherine Orrell; Esther Ngadaya; Angella Musiimenta; Lilian N Njagi; Priashni Subrayen; Yimtubezinash Woldeamanuel; Hussen Mohammed; Abebaw Fekadu; Melanie J Newport; Vincent C Marconi
Millions of people still die from tuberculosis in Africa. The continent is home to 17 of the 30 countries with the highest tuberculosis burdens and 25% of all new cases worldwide. According to the WHO Global Tuberculosis Report 2025,1 the continent exceeded the first End TB Strategy milestones and recorded one of the strongest global recoveries in tuberculosis control; the efforts of African governments and their international partners have been instrumental in this progress. Despite these advances, the continent is still struggling with monitoring tuberculosis treatment adherence and completion, which directly affects cure, relapse, drug resistance, transmission dynamics, and economic wellbeing. In this Comment, we argue that evaluation of tuberculosis treatment adherence strategies in Africa, particularly digital adherence technologies (DATs), need to extend beyond biomedical treatment outcomes to include patient-centred, economic, health system, and transmission-related effects