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Recent Submissions

Lingering sex and age disparities in dolutegravir uptake among adults with HIV: a multicountry observational cohort study
(BMJ Global Health, 2026) Ellen Brazier; Matthew L Romo; Andrea L Ciaranello; Francesca Odhiambo; Sanjay Pujari; Gad Murenzi; Charles Kasozi; Sasisopin Kiertiburanakul; Dominique Mahambu Nsonde; Winnie Muyindike; Vohith Khol; Patricia Lelo; Rita Lyamuya; Man Po Lee; Denis Nash
Introduction: Since July 2019, the WHO has recommended dolutegravir (DTG)- based regimens as preferred first- line antiretroviral therapy (ART) for adults and adolescents living with HIV (DTG- for- All), a reversal of a 2018 safety alert on use of DTG- based regimens by women of reproductive age (WRA). We examined sex and age disparities in DTG uptake before and after DTG- for- All in the International epidemiology Databases to Evaluate AIDS. Methods: We included patients ≥16 years on or initiating treatment between January 2017 and July 2021 in 14 low- and middle- income countries where initial guidelines on DTG- based regimens for first- line ART either restricted use by WRA or had no such restrictions. We estimated the cumulative incidence of DTG uptake (CI- DTG) by sex and age group (aged 16–49 years vs 50+ years), stratified by patient, clinic and setting characteristics. Results: Among 177 706 patients on ART during the study period, 51% were females aged 16–49 years, with 25% males aged 16–49 and 13% and 11%, respectively, females and males aged 50+. At the time of DTG- for- All, overall CI- DTG was 29.6% (95% CI 29.4% to 29.8%); it was lower among females aged 16–49 (16.2%; 95% CI 16.0% to 16.5%) than males (41.1%; 95% CI 40.6% to 41.5%), with no sex disparities among patients aged 50+ (females: 46.0%; males: 47.0%). While DTG uptake subsequently increased among all groups, by July 2021, it remained substantially lower among females 16–49 (66.4%; 95% CI 66.1% to 66.7%), compared with males 16–49 and older females and males (75.8% to 77.5%). Concentrated in countries where initial guidelines on DTG restricted use by WRA, disparities in DTG uptake persisted at all health system levels and in both low- income and lower- middle- income countries. Conclusions: While sex- age differentials in DTG uptake narrowed after WHO’s DTG- for- All recommendation, lingering disparities in uptake underscore the difficulty of policy de- implementation when new evidence emerges.
Stakeholder Involvement, Resource Availability and Performance of Road Projects Under Kampala Capital City Authority, Uganda
(Journal of Social and Development Sciences, 2025) Junior Jim Mugisha; Alex Twinomuhwezi; Benjamin Musiita
This study examines the impact of stakeholder involvement and availability of resources on the performance of Kampala Capital City Authority (KCCA)-managed road works in Uganda. Road building is essential to the acceleration of economic growth and the quality of life, but delays and cost escalation threaten its success. The study aims to understand the extent to which the two variables contribute to ensuring the success of projects. Data were gathered over two months from 62 out of 76 road projects, including project managers, division councillors, and KCCA supervision team members. Qualitative and quantitative approaches were used, including surveys and questionnaires, and statistical analysis was done using SPSS. The findings reveal a positive correlation between stakeholder participation, available resources, and project performance. All these variables together explain 33.3% of the difference in the quality of the projects done. It emphasizes the importance of effective stakeholder engagement and adequate resources to ensure road projects are completed within time, budget, and quality. It proposes implementing formal policies for stakeholder interaction, improving accountability, encouraging public-private partnerships, and merging stakeholder feedback with resource planning. The study further calls upon additional research to facilitate comparison with other regions of the globe to determine better ways of improving project performance.
Procurement Practices and Supply Chain Performance Among Manufacturing Firms in Kampala
(Journal of Social and Development Sciences, 2025) Alex Twinomuhwezi; Benjamin Musiita
This study investigates the relationship between procurement practices and supply chain performance among manufacturing firms in Kampala, Uganda. Motivated by the operational challenges faced by the manufacturing sector, the study focuses on three key procurement practices: purchasing risk-taking, purchasing knowledge and skills, and strategic purchasing. The Resource-Based View (RBV) theory serves as the conceptual foundation, positioning procurement as a strategic internal resource capable of enhancing organizational performance. A cross-sectional, quantitative research design was employed, and data were collected from 327 manufacturing firms using stratified random sampling. Analysis was conducted using correlation and multiple regression techniques. Results indicate that both strategic purchasing and purchasing risk-taking are significant and positive predictors of supply chain performance (β = 0.449 and β = 0.295, respectively), while purchasing knowledge and skills showed a negative but marginally insignificant effect (β = -0.085, p = 0.051). Together, the procurement practices explained 31.5% of the variance in supply chain performance (Adjusted R² = 0.315). These findings underscore the importance of integrating procurement within long-term business strategy and embracing innovative procurement behavior while ensuring continuous application of practical skills. The study recommends investment in procurement training, digital systems, and risk-responsive strategies to improve supply chain efficiency in Uganda’s manufacturing sector.
Identification of urological anomalies associated with anorectal malformation in southwestern Uganda: limitations and opportunities
(J Pediatr Urol., 2026) Felix Oyania; Nnaemeka Eze; Mercy Aturinde; Sarah Ullrich; Marvin Mwesigwa; Doruk E. Ozgediz
Introduction: Anorectal malformations (ARMs) may be associated with congenital anomalies affecting other body parts namely vertebral, anorectal, cardiac, tracheoesophageal, renal, and limb (VACTERL) with varying incidences of 7% - 60% [1-10]. Genitourinary defects might occur approximately in 50% of all patients with anorectal malformations [11] hence patients should be evaluated from birth to rule out these defects. Objective: To identify urological anomalies associated with anorectal malformation in southwestern Uganda Study design: This was a descriptive retrospective cohort study conducted at our regional referral hospital in Southwestern Uganda involving patients who have undergone surgical correction of ARMs between June 2021 and July 2023 Results: The overall prevalence of renal anomalies in our study patient population was 18.05%. Of those with ARM-associated renal anomalies, Specific anomalies included; renal agenesis (6.8%), hydronephrosis, (4.5%), duplex collecting system (3.8%), crossed fused kidney (1.5%), and ectopic kidney (0.75%). (Table) Author Manuscript Author Manuscript Author Manuscript Discussion: We found that the prevalence of ARM-associated renal anomalies was 18.05%, and the commonest anomaly was unilateral agenesis (6.8%) similar to other studies [12]. Previous data have shown renal anomalies are common anomalies in ARM[13]. While the exact values vary across studies, they all concluded that the rate of associated anomalies is extremely high in ARMs and warrants a thorough preoperative investigation once the ARMs are detected. This finding therefore underscores the importance of thorough evaluation and a multidisciplinary approach of care and follow-up system for ARM management including urologists even when the children are asymptomatic now. The main limitation of our study was missing information on patients' charts; we were not able to get the diagnosis since most patients didn’t have their discharge forms at the time of evaluation. Conclusion: ARM associated with renal anomalies may remain undiagnosed and asymptomatic. Those identified as asymptomatic need to be followed in a multidisciplinary fashion including pediatric urologists.
Prevalence, Morphological Types, and Associated Factors of Neonatal Anemia at a Rural Referral Hospital, Ugand
(Journal of Blood Medicine, 2026) Martha Amoding; Joachim Ndawula; Bright Hajusu; Isaac Morunyang; Christopher Lakwera; Robert Wagubi; Clinton Olong; Elizabeth A John; Enoch Muwanguzi; Benson Okongo
Purpose: This study aimed to determine the prevalence, morphological classification, and factors associated with anemia among neonates at Soroti Regional Referral Hospital neonatal unit. Patients and Methods: We conducted a hospital-based cross-sectional study among 239 neonates between June and August 2025. Data on sociodemographic characteristics of neonates and mothers were collected using structured questionnaires and a review of medical records. Venous blood was collected from mothers during labor and cord blood was collected within 30 minutes of delivery or in situation where cord blood was not collected, then venous blood was collected from neonates. Hemoglobin estimation was done using a Nihon Kohden automated analyser. Neonates with umbilical cord hemoglobin< 11 g/dL were classified as anemic. For anemic neonates, Giemsa-stained blood smears were examined to determine morphological type of anemia and screen for malaria parasites. Bivariate and multivariate logistic regression analysis were employed to identify factors associated with neonatal anemia, with a p-value ≤0.05 considered statistically significant. Results: The median age for neonates in days was 1 day and ranged from 0 to 27 days. The prevalence of neonatal anemia was 11.7% (95% CI: 7.6–15.8). Normocytic normochromic anemia was the most frequent morphological type (78.6%), followed by normocytic hypochromic (10.7%) and microcytic hypochromic anemia (10.7%). Multivariate analysis identified four factors independently associated with neonatal anemia: maternal history of anemia (AOR: 5.39 [95% CI: 1.15–25.32], p=0.033), lack of iron-folate supplementation during pregnancy (AOR: 6.62 [95% CI: 2.23–19.7], p=0.001), infrequent consumption of fruits and vegetables (AOR: 6.52 [95% CI: 1.23–34.48], p=0.027), and the presence of maternal anemia at delivery (AOR: 5.48 [2.11–14.21], p< 0.001). Conclusion: This study confirms that neonatal anemia is a persistent health issue in eastern Uganda. The identified risk factors are primarily rooted in maternal health and nutrition. Our findings underscore the imperative for integrative antenatal strategies that combine nutritional education, promotion of iron-folate supplementation, and proactive management of maternal anemia to effectively reduce the burden of neonatal anemia.
Human Capital and Graduate Employability in Public Universities in South- Western Uganda
(Journal of Economics and Behavioral Studies, 2025) Alex Twinomuhwezi; Nixon Kamukama; Charles Tushabomwe-Kazooba
This study investigates the relationship between human capital and graduate employability in public universities in South-Western Uganda. It aims to provide empirical evidence on how university human capital influences graduates’ labor-market readiness. Guided by a positivist paradigm, a cross-sectional design was employed. Data were collected from 377 graduates and 122 academic and administrative staff across three public universities. Structural Equation Modelling (SEM) was used to test the hypothesized relationship between human capital and graduate employability. Results indicate a significant positive relationship between human capital and graduate employability. Universities with skilled, motivated, and professionally competent staff enhance graduates’ employability by developing relevant skills and supporting processes that ensure these skills are effectively acquired. Deficiencies in human capital constrain the development of employability outcomes. University leaders should strategically invest in human capital through targeted recruitment, continuous professional development, and performance management linked to employability outcomes. Curricula should embed employer-valued skills such as critical thinking, communication, adaptability, and problem-solving. Strengthening institutional employability support, including career services and industry engagement, is critical for translating staff capacity into labor-market-ready graduates. The study contributes to the literature by highlighting the central role of academic and administrative staff in shaping graduate employability in resource-constrained public universities. It provides context-specific evidence from Uganda, clarifying how staff competence, motivation, and leadership collectively influence labor-market outcomes.
Elements of Collaborative Relationships and Supply Chain Performance Of SMEs in Bushenyi District
(Journal of Social and Development Sciences, 2025) Alex Twinomuhwezi; Benjamin Musiita
The research investigated how incentive alignment, together with information sharing and joint decision-making, impacts the supply chain performance of small and medium enterprises in Bushenyi District, Uganda. The study employed Relational Exchange Theory to analyze the supply chain performance of SMEs through a cross-sectional quantitative design, which collected data from 327 owners/managers using structured questionnaires. The results from Pearson correlation and multiple regression analysis showed that information sharing and joint decision-making positively affected supply chain performance but incentive alignment failed to produce a significant impact. The research results showed information sharing produced the most significant impact (β = 0.559, p < 0.01) followed by joint decision-making (β = 0.073, p < 0.05) yet incentive alignment did not produce a significant effect (β = –0.068, p > 0.05). The model explained 29.5% of the variance in supply chain performance (Adjusted R² = 0.295). The research indicates that better communication and collaborative planning serve as essential factors for achieving supply chain efficiency among rural SMEs. The study reveals that informal SME networks face specific challenges when attempting to establish formal reward systems because incentive alignment shows minimal impact. The research demonstrates that Bushenyi requires improved information systems together with enhanced participatory planning and digital infrastructure development to enhance supply chain outcomes. The recommendations include supporting digital communication platforms and providing institutional backing for collaborative decision-making processes and educating stakeholders about incentive-based partnership models.
A survey of Ugandan skilled birth attendants regarding beliefs and management of gastroschisis
(BMJ Global Health, 2026) Anthony N Eze; Oyinoluwa G Adaramola; Daphine Kyasimire; Ivan N Nuwagaba; Gift Atuheire; Olivia Kapera; Shannon Barter; Wigdan S Hissein; Felix Oyania; Tamara N Fitzgerald
Introduction: Gastroschisis mortality is disproportionately high in Africa due in part to delayed presentation and limited surgical capacity. Skilled birth attendants (SBAs) are often the first to encounter these babies and can be an important part of their stabilisation. We assessed baseline Ugandan SBA knowledge of gastroschisis and interest in a training course. Methods: Southwestern Ugandan SBAs were surveyed regarding practice patterns, common beliefs and training course interest. Data were analysed with descriptive statistics. Results: We recruited 121 participants (70 midwives, 51 nurses). Most had a certificate or diploma (n=117, 97%) and 85% had more than 3 years of experience (n=103). Eighty- seven (72%) SBAs had cared for babies with gastroschisis. Most reported that communities stigmatised families (n=67, 55%), saw the child as cursed (n=74, 61%), blamed the mother (n=69, 57%) and advised parents to kill (n=30, 24%) or abandon the child (n=55, 45%). Barriers to families seeking care included healthcare mistrust (n=3, 2%), hopelessness (n=37, 31%), lack of knowledge (n=51, 42%), transportation difficulties (n=54, 45%) and fear of impoverishment (n=84, 69%). Most SBAs were unsure of the cause of gastroschisis and only 6% (n=8) recognised fetal vascular interruption as the cause. While 57% (n=69) prioritised intestinal coverage, only 7% (n=9) and 5% (n=6) would place a nasogastric tube or fast the baby. Three midwives encouraged immediate breastfeeding. Antibiotics (n=22, 18%) and fluid resuscitation (n=19, 16%) were sometimes recommended. Most participants (n=119, 98%) desired a course on gastroschisis management, but 41% (n=50) reported time constraints as a barrier. Conclusions: Southwestern Ugandan SBAs encounter gastroschisis babies, have limited training in its management and desire a training course. Engaging SBAs into a task- sharing role on delivery is a promising next step. Additional studies will be needed to determine if this can improve gastroschisis survival by reducing delays in care and improving community awareness.
Incidence, patterns of clinical presentation, and haematological characteristics of paediatric acute myeloid leukaemia in Uganda: a retrospective analysis
(BMC cancer, 2026) Richard Nyeko; Mariana Kruger; Nixon Niyonzima; Barnabas Atwiine; Jennifer Zungu; Joyce Balagadde Kambugu; Stijn Verhulst; Jaques van Heerden
Background: Current understanding of paediatric acute myeloid leukaemia (AML) in Africa is limited. This study investigated the incidence, presentation pattern, and haematological profiles of paediatric AML in Uganda. Methods: This retrospective cohort study examined the medical records of children under 18 years of age who were diagnosed with acute myeloid leukaemia (AML) at three cancer centres in Uganda from 2016 to 2022. Data included demographics, clinical features, and laboratory findings. Frequencies, bivariate analyses, and regression models were performed, with statistical significance set at p < 0.05. Results: The study included 159 children diagnosed with AML, with a median age of 9.0 years (IQR 3.0–12.0). The incidence was 7.0/million children 0–17 years. The most common presenting symptoms were fever (84.3%), weight loss (44.0%), fatigue (40.9%), bleeding (35.8%), and bone pain (28.9%). Clinical findings at diagnosis included splenomegaly (40.9%), lymphadenopathy (39.6%), myeloid sarcoma (39.6%), and hepatomegaly (37.7%). The median (IQR) white blood cell (WBC) count at diagnosis was 32.0 × 10⁹/L (0.3–81.8). The predominant FAB subtype was M7 (n = 22, 24.4%), followed by M5 (n = 20, 22.2%). Acute promyelocytic leukaemia was seen in 13 (8.2%) patients, while 11 (6.9%) patients had myeloid leukaemia of Down syndrome. Cytogenetic analysis was limited to only 10 patients. There were significant differences in clinical characteristics by age with respect to splenomegaly, central nervous system involvement, and FAB subtype. Conclusions: The incidence of paediatric AML in this study mirrors global patterns, with a higher-than-expected prevalence of the M7 subtype noted. In settings with limited resources, diagnosis relies mainly on clinical and morphological assessment. Broader access to cytogenetic and molecular testing could improve subtype identification and risk profiling.
Repeat adolescent pregnancies in Southwestern Uganda: A cross-sectional study
(Women's Health, 2024) Rupa Ramachandran; Shakillah Namatovu; Daniel Atwine; Jackline Tumuhairwe; Viola Nilah Nyakato; Elizabeth Kemigisha; Olena Ivanova
Background: Pregnancy in adolescents continues to remain a significant public health challenge, with repeat pregnancies in this age group often receiving insufficient attention. In Uganda, repeat adolescent pregnancy varies between 26.1% and 55.6%. Evidence shows that repeat pregnancy in adolescence is more common in settings of high poverty, low educational attainment and low use of long-acting reversible contraceptives among others. Objectives: The main aim of this study is to determine the underlying risk and protective factors of repeat adolescent pregnancy in Uganda. Design: This was a cross-sectional study among adolescent girls and young women aged between 13 and 22 years with single and repeat pregnancies in four districts in Southwestern Uganda. Methods: The questionnaire was administered on a portable PC to collect information on socio-demographic characteristics, sexual behaviours, sexual and reproductive health (SRH) knowledge, pregnancy outcome, experience of violence and mental health. Descriptive statistics and logistic regression were performed. Results: A total of 115 girls with single and 93 with repeat pregnancies participated in the survey. Of these, 42 (20.2%) were 18 years and younger. The majority (92%) had dropped out of school, having achieved primary-level education (67%). The mean age of sexual debut (15.6 versus 16.4 years) and the mean age at first pregnancy (16.4 versus 17.3 years) were lower among those in repeat-pregnancy group compared to those in single-pregnancy group. The odds of having repeat pregnancy were higher among participants who engaged in risky behaviour (AOR 3; 95% CI (1.28–7.37)) and experienced any form of violence (AOR 4.67; 95% CI (1.5–16.56)). Being single, having the first pregnancy in older age (16 and above) and having a positive first pregnancy outcome (live birth) served as protective factors for repeat pregnancy. Conclusions: Adolescents with repeat pregnancies have significantly more SRH risks compared to those with single pregnancies. These findings underscore the importance of multi-faceted and timely interventions for adolescent girls in this setting, with an emphasis on the mitigation of violence, and enhancing access to comprehensive sexuality education, and SRH services.
Predictors of mortality and short- term outcomes after emergency pediatric abdominal surgery in South- Western Uganda
(World Journal of Pediatric Surgery, 2026) James Alfred Okello; Felix Oyania; Carlos Cabrera Dreque; David Mutiibwa; David Komakech
Background: Emergency abdominal surgeries (EASs) in children are often necessary to address life- threatening congenital and acquired conditions. This study aimed to determine short- term outcomes and predictors of in- hospital mortality after EAS in children at Mbarara Regional Referral Hospital (MRRH), South- Western Uganda. Methods: This prospective study was conducted from June to September 2024 and included children aged 0–17 years who underwent EAS at MRRH. Outcomes measured were 30- day in- hospital mortality, complications, and length of hospital stay. Overall survival after EAS was plotted using Kaplan- Meier curves. Cox regression analysis was used to determine predictors of in- hospital mortality after EAS. Results: The 30- day mortality rate for all pediatric abdominal surgery was 152 per 10 000 person- days of hospitalization. Among 96children who required EAS at MRRH, the risk of death was significantly increased in those who had hypoxemia (adjusted hazard ratio (aHR) 12.4, p=0.011) and hypokalemia (aHR 5.02, p=0.044). Forty- one patients (42.7%) developed postoperative complications, the most common being surgical site infection (14.58%) and pneumonia (5.2%). Conclusion: The 30- day mortality rate after pediatric EAS in our setting is high and children who present with hypokalemia and hypoxemia are at increased risk of mortality after EAS.
Factor structure, reliability, and validity of the 10-item HIV stigma scale for adolescents and youth living with HIV in rural, southwestern Uganda
(AIDS and Behavior, 2025) Scholastic Ashaba; Alain Favina; Charles Baguma; Patricia Tushemereirwe; Denis Nansera; Alison Comfort; Jessica M. Perkins; Maling Samuel; Brian C. Zanoni; Alexander C. Tsai
Background: HIV stigma undermines HIV treatment outcomes for adolescents and young adults living with HIV. However, there are few stigma measures that are appropriate for this age and the Ugandan cultural context. Methods: Between October and December 2021, we administered the 10-item stigma scale for adolescents living with HIV (ALHIV-SS) to 300 adolescents and young adults (aged 15–24 years) with perinatally-acquired HIV in Mbarara, Uganda. Results: Exploratory factor analysis of the ALHIV-SS revealed three factors corresponding to internalized, anticipated, and enacted forms of stigma. The ALHIV-SS was internally consistent overall (Cronbach’s alpha=0.78) and for each of the subscales: internalized stigma, 0.76; enacted stigma, 0.68; and anticipated stigma, 0.57. The ALHIV-SS was strongly correlated with depression (Spearman’s =0.44; p< 0.001). Mean stigma scores were also higher among study participants who had thoughts of self-harm (6.5 vs. 3.0, t=5.7, P< 0.001), those who reported sometimes forgetting to take their ART (4.0 vs. 2.8, t=3.3, P=0.001), and among those who reported any days in the past 2 weeks on which they took no ART (3.9 vs. 3.2, t=1.59, P=0.11). Author Manuscript Author Manuscript Author Manuscript Conclusions: Taken together, the findings suggest that the 10-item ALHIV-SS is a valid, reliable, and coherent measure of HIV stigma among adolescents and young adults living with perinatally acquired HIV in Uganda.
Molecular characterization of extended- spectrum beta- lactamase- producing bacteria isolated from pregnant women’s urine at Itojo Hospital, South Western Uganda
(Access Microbiolog, 2026) Muzafaru Twinomujuni; Benson Musinguz; Moses Asiimwe; Stephen Samuel Mpiima; Henry Zamarano; Isaac Orikushaba; Deus Muhanguzi; Crinad Twinamatsiko; Sarapia Paul Mallya; Jamiru Samiri; Joseph Kamugisha; Pauline Petra Nalumaga; Taseera Kabanda; Kennedy Kassaza; Charles Nkubi Bagenda; Barbra Tuhamize; Joel Bazira; Rosemary Ricciardelli; Moses Mpeirwe
Background: Extended- spectrum β- lactamase (ESBL)- producing bacteria pose a global challenge because of resistance devel oping against a wide range of antimicrobial agents, complicating available treatment options. Thus, identifying the prevalent bacterial species producing ESBL enzymes and understanding how they are susceptible to antibiotics is necessary to inform effective treatment guidelines. Objective: We sought to characterize ESBL- producing bacteria isolated from pregnant women’s urine at Itojo Hospital, Ntungamo district, Southwestern Uganda. Methods. We conducted a cross- sectional study where we collected and analysed 340 urine samples from 340 pregnant women. We did antimicrobial susceptibility testing using the Kirby–Bauer disc diffusion method. Isolates were screened for ESBL production and confirmed using the combination disc test. Genotypic characterization was confirmed using multiplex PCR to detect blaTEM, blaCTX- M and blaSHV genes. Results: The prevalence of ESBL- producing bacteria was 29.7% (101/340). Escherichia coli 36/101 (35.6%) and Klebsiella species 33/101 (32.7%) were predominant ESBL producers. Genotypic analysis revealed blaTEM 50/101 (49.5%) and blaCTX- M 31/101 (30.7%) as the most prevalent genes, while blaSHV was less common, 8/101 (7.9%) Conclusion: The high prevalence of ESBL- producing bacteria and their resistance to commonly used antibiotics highlighted the need for targeted antibiotic therapy, antimicrobial stewardship and regular molecular surveillance.
Onychomycosis prevalence etiology and associated factors in women using nail cosmetics attending Mbarara regional referral hospital dermatology clinic Uganda
(Scientific Reports, 2025) Ronnie Mayengo; Nalumaga Pauline Petra; Oloro Joseph; Edward Ogwang; Grace Mulyowa Kitunzi; Aloyo Gladys Onguti; Stephen Kizito Mirembe
Onychomycosis is a fungal infection of the nails caused primarily by dermatophytes, Non-Dermatophyte Moulds (NDMs) and yeast species. Fungal transmission occurs through direct contact with contaminated objects. Nail cosmetic treatments involve using tools that may be contaminated with fungus and can traumatize the nail, potentially increasing the risk of infection. However, little is known about its prevalence, etiology and associated factors among women using nail cosmetics in Uganda. A cross-sectional study at Mbarara Regional Referral Hospital (MRRH) skin clinic (January March 2025) enrolled 273 women with a history of nail cosmetic use. Nail clippings of participants underwent direct microscopy and fungal culture to assess the prevalence and etiology. Fungal isolates were identified morphologically using lactophenol cotton blue staining. Data collected using a structured questionnaire were analyzed in STATA 12.0. Univariate and multivariate logistic regression identified associated factors; adjusted odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated using Wald’s test (p < 0.05 significant). The prevalence of onychomycosis among women using nail cosmetic was 57.5%. Dermatophytes were the most frequently isolated organisms, with Trichophyton mentagrophytes being predominant, followed by NDMs and Candida species. Frequent nail polish application, nail trauma and sales/retail occupations showed a statistically significant association with onychomycosis (p < 0.05). Onychomycosis was prevalent among women using nail cosmetics, with predominance of Trichophyton mentagrophytes. And associated with nail trauma, frequent application, and sales/retail occupation. These associations suggest that trauma and frequent application may elevate infection risk, while henna offers potential protection with antifungal properties. These findings highlight the need for public awareness and improved hygiene standards in nail care practices.
HIV care interruptions, mental health, and the potential for mHealth interventions among adolescents and young adults with HIV in Uganda
(AIDS Research and Therapy, 2026) Julian Adong; Nicholas Musinguzi; Denis Nansera; Henrietta Nayiga; Angella Kankunda; Lisa M. Bebell; Jessica E. Haberer; Elias Kumbakumba
Objective: HIV care interruptions contribute to adverse outcomes among adolescents and young adults with HIV (AYWH) and may occur due to structural barriers as well as comorbidities (e.g., mental health issues). This study characterizes a cohort of AYWH, examines the frequency of care interruptions, and assesses mental health issues during and after the COVID-19 pandemic while exploring mobile health (mHealth) potential. Methods: Using a retrospective and prospective cohort study design, we enrolled AYWH at Mbarara Regional Referral Hospital and assessed missed visits using the timeline follow-back method (24 months). Mental health was evaluated using the Centers for Epidemiological Disease Scale-Depression (CES-D; >15 considered significant) and a locally validated anxiety/psychosocial distress scale (score 0–100) at enrolment, three and six months. Access to mobile phones, smartphones and internet was also assessed. Results: Of 86 participants (mean age 18.6 years, 51.2% male), 89.5% had a viral load of< 400 copies/ml. At enrolment, 53% had depression, with mean anxiety/psychosocial distress of 36.7. AYWH missed 19.0% of clinic visits, 3.2% of ART pickup visits, and 5.1% of laboratory visits, with no clear variation by pandemic phase. Depression and anxiety decreased significantly over 6-months (β=– 0.46; 95% CI – 0.73, – 0.19; p< 0.001) and (β=– 1.25; 95% CI – 1.65, – 0.86; p=0.001) respectively. Most AYWH (59%) had mobile phone access, with 67% of those owning a smartphone and 71% having daily internet access. Discussion/conclusion: AYWH frequently missed clinic appointments, regardless of pandemic phase. Mental health symptoms were initially high, but decreased over time. Most AYWH had access to phones and the internet. Conclusion: To ensure continuity of HIV care and mental health support even during such disruptions, mHealth interventions may offer a viable solution and warrant further research.
Age-related disparities in viral suppression among older individuals living with HIV in rural Uganda
(AIDS research and therapy, 2026) Jonan Tumwesigyire; Eliza Passell; Flavia Atwiine; Edna Tindimwebwa; Zahra Reynolds; Godfrey Masette; Okello Samson; Crystal M. North; Robert Paul; Janet Seeley; Noeline Nakasujja; Susanne Hoeppner; Meredith Greene; Alexander C. Tsai; Deanna Saylor; Jeremy A. Tanner; Stephen Asiimwe; Francis Bajunirwe; Mark J. Siedner
Background: The number of people living with HIV (PLWH) in sub-Saharan Africa who are over 50 years old is increasing rapidly, and expected to triple by 2040. Yet, how older PLWH sustain access to care and viral suppression is not well known. We examined the prevalence and correlates of viral suppression in a cohort of older PLWH in Uganda. Methods: We analyzed data from the Quality of Life and Aging with HIV in rural Uganda study, which follows PLWH over 50 years old who are in care at public HIV clinics in Uganda. Our outcome of interest was viral suppression, defined as HIV-1 RNA viral load less than 200 copies/mL. We estimated the prevalence of viral suppression and fitted multivariable log binomial regression models to identify correlates of viral suppression. Results: The mean cohort age was 59.7 years (standard deviation [SD] 6) and participants had been taking HIV therapy for a mean of 13.3 years (SD 3). Viral suppression was relatively high overall (87%, 240/277). In multivariable models, people aged ≥ 60 years were less likely to be virally suppressed than those aged 50–59 years (78% vs. 93%, adjusted prevalence ratio [APR] 0.85, 95% CI: 0.76, 0.93, P = 0.001). By contrast, having one or more comorbidities was positively associated with viral suppression (APR 1.10, 95% CI: 1.01, 1.18, P = 0.021). Conclusion: We found a decreased prevalence of viral suppression among PLWH aged ≥ 60 years atleast in Uganda. Public health interventions that address the adherence support needs of older individuals should be evaluated and, if successful, incorporated into HIV care services, given the significant number of older people living with HIV in the region
Readiness of health public facilities to diagnose, manage, and prevent the Ebola epidemic along border districts in Southwestern Uganda
(BMC Health Services Research, 2026) Jonathan Sserunkuuma; Elizabeth Kemigisha; Raymond Bernard Kihumuro; Deo Benyumiza; Allan Komakech; Calorine Natuhwera; Ramecca Mugumya
Background: Ebola Virus Disease (EVD) outbreaks typically start from a single case of a probable zoonotic transmission and evolve into an epidemic because of the local and international movement of people, causing a global health security threat. This study aimed to assess the readiness of health facilities in the border districts of Southwestern Uganda towards prevention, diagnosis and management of EVD. Methods: This was a cross-sectional study conducted between July and September 2024. The study was conducted in the districts that share a border with the Democratic Republic of Congo, which were Kasese, Kanungu, and Kisoro districts. Data was collected using the World Health Organization Consolidated Ebola virus disease preparedness checklist, which was modified to suit the study objectives. Results: A total of 214 health facilities were surveyed, including 118 (55.1%) Health centre IIs, 76 (35.5%) health centre IIIs, 9 (4.2%) Health centre IVs and 11 (5.1%) Hospitals. The overall prevention capacity was moderate with a mean score of 62.0 (± 12.5), and only 88 (41.1%) had high prevention levels. Hospitals, 10/11 (90.9%) and Health centre IVs, 6/9 (65.2%) were more prepared to prevent EVD outbreaks as compared to lower-level facilities (p = 0.041). The mean score for facility readiness to diagnose EBV outbreak was 61.0% (± 13.2). Only half, 116 (54.2%), had trained laboratory personnel to handle an EVD outbreak. Management capacity was the weakest domain, with only one-third, 72/214 (33.6%) of all facilities rated high and a mean score of 55.0 (± 14.0). Major gaps were noted in the availability of burial/ decontamination teams, 85 (39.7%) and contingency funding, 74 (34.6%). Conclusion: The overall level of preparedness to manage EVD outbreak was moderate, with most facilities lacking essential preventive, diagnostic and treatment components, calling on the MoH and its partners to intensify cross border surveillance, coordination, and capacity-building efforts at the health facility level.
Adolescents’ perceptions and lived experiences of cancer patient-hood: a qualitative study
(BMC cancer, 2026) Mercy Akambasisa; Elizabeth Kemigisha; Kendall Carpenter; Godfrey Zari Rukundo; Barnabas Atwiine
Background: Adolescents’ perceptions and lived experiences regarding their cancer diagnosis significantly influence their quality of life and treatment adherence. To inform the formulation of tailored interventions, we explored these factors among adolescents receiving care at a sub-Saharan African health facility in Western Uganda. Methods: We conducted a qualitative study from July 2022 to December 2022 at Mbarara Regional Referral Hospital in western Uganda. In-depth interviews were held with 30 adolescents aged 10–17 years who had been diagnosed with cancer. NVivo 12 software was used to develop a codebook and coding framework to generate themes inductively emerging from the data that aligned with the study objectives. Ethical approval was obtained from the Research and Ethics Committee of Mbarara University of Science and Technology. Results: Participants had a median age of 13.5 years; 19 were male. The diagnoses included leukemia (n = 13), lymphoma (n = 10), and solid tumors (n = 7). Initial perceptions regarding their diagnosis were predominantly negative but improved over time as they received information and improved on treatment. Perceptions were poorer among those who responded poorly to treatment and those who had had extremely negative experiences. Negative experiences included body disfigurement, social challenges, emotional distress, physical pain, and interrupted education. Positive experiences included improvement in symptoms and support from health workers and their families. Conclusion: Adolescents initially exhibit poor perceptions towards their cancer diagnosis, which tend to improve with clinical improvement on treatment and support. Their experiences and perceptions are mixed, highlighting the need for specialized/ tailored education and counselling services to address knowledge gaps obtained from the research findings, and hence improve overall care outcomes among the study population.
Factors associated with occurrence of drug therapy problems among patients with neoplasms of s-sectional studydigestive organs at Uganda Cancer Institute, Mbarara: a cros
(BMC cancer, 2026) Silas Ojuka; Alex Duhimbaze; Samuel Michael Nono; Moses Nangosya; John Isiiko; Tadele Mekuriya Yadesa
Background: The global burden of neoplasms of digestive organs (NDOs) is on the rise. Various stakeholders have made significant efforts to ensure access to effective and relatively safe chemotherapy for the treatment of NDOs. However, the use of cancer chemotherapy has been associated with drug therapy problems (DTPs). These potentially compromise desired treatment outcomes. There is limited knowledge among stakeholders regarding the burden of DTPs among patients on cancer chemotherapy in Uganda. Method: This was a cross-sectional study which enrolled 196 participants with NDOs. It was conducted at Uganda Cancer Institute (UCI), Mbarara. Data was collected using a questionnaire and checklist. Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. The prevalence of DTPs was expressed as a percentage of the sample size. Factors associated with occurrence of DTPs were analyzed using logistic regression. Variables with p-values less than 0.25 at univariate analysis were subjected to multivariate analysis. Variables were considered statistically significant if p-values were less than 0.05 at 95% confidence interval. Results: Out of 196 participants 86 (43.9%) experienced DTPs. The most common DTPs were: need for additional therapy (135/535, 25.2%), unnecessary drug therapy (86/535, 16.1%) and adverse drug reactions (ADRs) (86/535, 16.1%). On performing logistic regression, female gender (aOR: 2.11; 95% CI: 1.01–4.42, p = 0.047), unemployment (aOR: 7.17; 95% CI: 1.31–39.02, p = 0.023) or older age (aOR: 2.67; 95% CI: 1.31–5.47, p = 0.007) were significantly associated with occurrence of DTPs Conclusion: This study demonstrates that the use of cancer chemotherapy to achieve desired therapy outcomes among patients with NDOs is still challenged by DTPs. The findings are suggestive of a gap in rational medicines use in the treatment of cancers in a LMIC setting.
Association of Atherogenic Combined Index, hs-CRP/HDL-C Ratio, and TC/ HDL-C-BMI Index with Low Vitamin D Levels among PLWH on Antiretroviral Therapy: A Cross-Sectional Study in Southwestern Uganda
(Journal of the International Association of Providers of AIDS Care (JIAPAC), 2026) Charles Nkubi Bagenda; Carol Nantongo; Jazira Tumusiime; Amos Oyuru; Doreen Nuwashaba; Michael Junior Mugisa; Bashir Ruzige; Isaac Kiwummulo; Vicent Mwesigye; Elizabeth A. John; Conrad Lubwama; Fred Sempijja; Lucy Grace Asio; Rose Nassali; Herbert Itabangi; Ronald Ouma Omolo
Background: Low Vitamin D levels are prevalent among people living with HIV (PLWH) on antiretroviral therapy (ART) and are associated with dyslipidemia and cardiovascular risk. This study examined the association between atherogenic indices and low vitamin D levels among PLWH in Southwestern Uganda. Methods: We conducted a cross-sectional study among 218 randomly selected PLWH who had been on ART for ≥6 months at Mbarara City Health Centre IV, Southwestern Uganda from August 13, 2024 to August 23, 2024. Low serum Vitamin D level was defined as serum 25-hydroxyvitamin D concentration <30 ng/mL. Results: Atherogenic combined index (ACI), high-sensitivity C-reactive protein (hs-CRP)/HDL-C ratio, and total chol esterol to high density lipoprotein cholesterol– body mass index (TC/HDL-C-BMI) index were independently asso ciated with low vitamin D. Compared to the first tertile, ACI second and third tertiles had higher likelihood of low vitamin D (aPR = 2.23, 95% confidence interval (CI): 1.28-3.89, P=0.005; aPR = 2.53, 95% CI: 1.05-6.05, P= 0.023). The high-sensitivity C-reactive protein to high-density lipoprotein cholesterol (hs-CRP/HDL-C) ratio third tertile was also significant (aPR = 1.44, 95% CI: 1.05-1.96, P=0.024). TC/HDL-C-BMI index third tertile showed nearly twice the prevalence (aPR = 1.95, 95% CI: 1.10-3.45, P=0.023). Conclusion: ACI, hs-CRP/HDL-C ratio, and TC/HDL-C-BMI index are potential predictors for Low serum Vitamin D levels among PLWH.