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

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Maternal Newborn and Child Health Institute 18
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Recent Submissions

Association between a high total cholesterol-to-high-density lipoprotein cholesterol ratio and hyperuricemia among patients with hypertension: A cross-sectional study from central Uganda
(Journal of International Medical Research, 2026) Ainebyoona,Blendar; Emorut,James; Emuru,Samuel; Nuwatuha,Simon; Omara,Joe; Nantongo,Carol; Mugisa,Michael Junior; Kaizirege,Fred; Tumusiime,Jazira; Kebba,John; Byaruhanga,Aggrey; Muwanguzi,Enoch; Sempijja,Fred; Nono,David; Nassali,Rose; Rugera,Simon Peter; Bagenda,Charles Nkubi; Gumisiriza,Robert
Background: Hyperuricemia is a cardiometabolic risk factor among patients with hypertension. A high total cholesterolto- high-density lipoprotein cholesterol ratio reflects atherogenic lipid imbalance and insulin resistance. This study investigated the association between a high total cholesterol-to-high-density lipoprotein cholesterol ratio and hyperuricemia among patients with hypertension at Uganda Heart Institute. Methods: We conducted a cross-sectional study among 277 consecutively recruited patients with hypertension aged ≥18 years from 4 August 2025 to 20 October 2025 at Uganda Heart Institute. Hyperuricemia was defined as a serum uric acid level of ≥7 mg/dL in men and ≥6 mg/dL in women, whereas a high total cholesterol-to high-density lipoprotein cholesterol ratio was defined as ≥5. Results: Among 277 participants, 89 had hyperuricemia, giving a proportion of 32.1% (95% confidence interval: 26.9– 37.9). Hyperuricemia was significantly more common in participants with a total cholesterol-to-high-density lipoprotein cholesterol ratio of ≥5 (53.8%) than in those with a ratio of <5 (25.5%) (p < 0.001). After adjustment for confounders, a high total cholesterol-to-high-density lipoprotein cholesterol ratio remained independently associated with hyperuricemia (adjusted odds ratio = 2.83, 95% confidence interval: 1.31–6.09, p=0.008). The total cholesterol-to-high-density lipoprotein cholesterol ratio demonstrated moderate predictive ability for hyperuricemia, with an optimal cutoff value of 4.33 (sensitivity, 58%; specificity, 71%) and an area under the curve of 0.68 (95% confidence interval: 0.61–0.75). Conclusion: Hyperuricemia is prevalent among patients with hypertension. A high total cholesterol-to-high-density lipoprotein cholesterol ratio is a potential predictor of hyperuricemia in this population
Urate dysregulation (hyperuricemia and gout) among people living with HIV: A protocol for a systematic review and meta-analysis
(PLOS one, 2026-07-31) Pitua,Ivaan; Otto,Kim Andrew; Lwembawo,Kiragga Denis; Nantalaga,Kaweesi Calvin; Nampiinga,Maria Gabriella; Okema,James Nelson
Introduction Approximately 39.9 million people are living with HIV worldwide, most in sub-Saharan Africa. Effective antiretroviral therapy has shifted attention to metabolic comorbidities, and emerging evidence links integrase inhibitors such as dolutegravir to elevated serum uric acid, yet the global burden of hyperuricemia and gout in this population is unquantified. Methods and analysis This protocol describes a systematic review and meta-analysis of observational stud¬ies (cross-sectional, cohort, and case-control) published from inception to May 2026. We will search PubMed/MEDLINE, EMBASE, Web of Science, and CINAHL. Studies involving adults (≥18 years) living with HIV that report the prevalence or incidence of hyperuricemia or gout will be included. Two independent reviewers will screen studies, extract data, and assess risk of bias using the Joanna Briggs Institute Prev¬alence Critical Appraisal Checklist and the Newcastle-Ottawa Scale (NOS). Primary outcomes are the pooled prevalence of hyperuricemia and gout in PLHIV. Secondary outcomes include risk factors associated with urate dysregulation (ART regimen, Cluster of Differentiation 4 [CD4] count, viral load, metabolic comorbidities, and HIV duration), and gout as an immune reconstitution inflammatory syndrome (IRIS) man¬ifestation. A random-effects meta-analysis using the DerSimonian-Laird method with Freeman-Tukey double-arcsine transformation for prevalence data will be performed in R software. Heterogeneity will be assessed using the I2 statistic and Cochran’s Q test. Subgroup analyses will explore variation by ART class (pre-ART, PI, NNRTI, INSTI/dolutegravir era), geographic region, CD4 category, and study quality
Mental health-related quality of life and associated factors among people living with severe mental illness in southwestern Uganda
(SSM - Mental Health, 2026-07-27) Kugonza,Tonny; Ndyomugabe,Michael; Atholere,Wilbrod Sikahwa; Ojuman,Philemon; Muwanguzi,Moses; Abel,Rubega; Ashaba,Scholastic
Background: Severe mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, adversely affects multiple dimensions of quality of life, limiting individuals' ability to participate in everyday activities and maintain meaningful social and occupational roles. Globally, nearly one in seven people live with a mental disorder, and approximately 24.2% of Ugandan adults have at least one mental disorder. However, evidence on factors associated with mental health-related quality of life (MHQoL) among people living with SMI in Uganda remains limited. This study examined factors associated with MHQoL among adults living with SMI. Methods: A cross-sectional study was conducted among 422 adults with schizophrenia, bipolar disorder, or major depressive disorder attending the outpatient psychiatry clinic at Mbarara Regional Referral Hospital between May and June 2024. MHQoL was assessed using the Mental Health-related Quality of Life questionnaire. Sociodemographic, clinical, and psychosocial factors were measured using validated instruments. Bivariate and multivariable linear regression analyses identified factors associated with MHQoL. Results: Higher medication adherence (b = 0.96; 95% CI: 0.10–1.83), family support (b = 0.13; 95% CI: 0.05–0.22), friend support (b = 0.05; 95% CI: 0.004–0.10), religiosity (b = 0.13; 95% CI: 0.003–0.26), and stigma resistance (b = 0.16; 95% CI: 0.02–0.29) were independently associated with better MHQoL. Social withdrawal (b = 􀀀 0.13; 95% CI: 􀀀 0.26 to 􀀀 0.004) and stereotype endorsement (b = 􀀀 0.14; 95% CI: 􀀀 0.26 to 􀀀 0.02) were associated with poorer MHQoL. Conclusion: Greater perceived social support, religiosity, and stigma resistance were associated with better MHQoL, whereas social withdrawal and stereotype endorsement were associated with poorer MHQoL among people living with SMI. These findings highlight the importance of addressing psychosocial factors alongside pharmacological treatment. Longitudinal and intervention studies are needed to determine whether targeting these factors improves MHQoL.
Training needs of informal caregivers of persons with dementia in rural southwestern Uganda: A qualitative formative study
(Cambridge Prisms: Global Mental Health, 2026) Namwase,Joyce; Kyomya,Julius; Oyuru,Amos; Maleka,Emmanuel; Muhwezi,Abraham; Semuwemba,John; Karungi,Christine K.; Obua,Celestino; Wakida,Edith K.
Dementia is a global public health concern with increasing prevalence, especially in low- and middle-income countries (LMICs) where care is primarily provided by informal family caregivers. This study identified the specific training needs of informal caregivers of persons with dementia in rural southwestern Uganda to inform the development of contextually appropriate caregiver training interventions. We conducted 20 in-depth interviews with 17 caregivers and 3 key informants affiliated with Reach One Touch One Ministries (ROTOM), a community- based organization supporting older persons in Rukiga District, Uganda. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using an inductive approach. Caregivers demonstrated limited knowledge of dementia, often attributing it to normal aging, spiritual causes, or stress. They faced substantial physical, emotional, and financial burdens, and relied on faith, social support, and adaptive caregiving strategies. All expressed willingness to attend group-based, in-person training focused on practical skills, including communication, managing dementia-related behaviors, personal hygiene, nutrition, and medication administration. Key informants highlighted the importance of community awareness to address misconceptions. Informal caregivers in rural Uganda experience high caregiving burden and unmet training needs. The identified training priorities closely align with World Health Organization (WHO) Support domains, supporting adaptation of the program for rural Ugandan caregivers.
When coverage is high: rethinking the role of caregiver perceptions in childhood vaccination uptake in Uganda
(Transactions of The Royal Society of Tropical Medicine and Hygiene, 2026-04-27) Gunderson,Annika K.; Kwon,Taeim; Kumarasinghe,Yohhan; Yan,Yuanyuan; Choe,Joyce; Jiang,Qikai; Baguma, Emmanuel; Bwambale,Shem; Barber,John R.; Reyes,Raquel; Ntaro,Moses; Delamater,Paul L.; Mulogo,Edgar M.; Boyce,Ross M.
Background Beliefs of a child’s primary caregiver are known to influence immunization uptake. As coverage increases, the characteristics of households with under vaccinated children may be shifting. Methods We conducted a cross-sectional survey of households with a child 12–23 months of age. Vaccine status was verified by inspection of immunization cards or caregiver report. Composite scores captured caregiver beliefs and experiences with vaccination. Associations between these measures and vaccination status were evaluated using weighted logistic regression. Results Caregivers of 1689 children were surveyed. The odds of full vaccination were not associated with composite beliefs (adjusted odds ratio [aOR] 1.04 [95% confidence interval {CI} 0.95 to 1.14]) or experiences scores (aOR 1.04 [95% CI 0.96 to 1.13]). Specific beliefs that vaccines prevent severe disease (aOR 2.68 [95% CI 1.64 to 4.37]) and protect the community (aOR 1.67 [95% CI 1.10 to 2.53]) were positively associated, whereas beliefs that children receive too many vaccines (aOR 0.60 [95% CI 0.44 to 0.83]) were negatively associated with full vaccination. Positive experiences, including knowing someone affected by a vaccine-preventable disease (aOR 2.10 [95% CI 1.47 to 3.00]) were also linked to full vaccination. Conclusions Although composite scores were not associated with immunization status, individual beliefs and experiences may still factor into caregiver decisions to vaccinate their children.
Quality of life and associated factors among cancer patients receiving palliative care in Western Uganda: a cross-sectional study
(BMC Palliative Care, 2026) Ndinawe,John Bosco; Kabakyenga,Jerome; Namukwaya,Elizabeth; Mulogo,Edgar Mugema
Background Quality of life (QoL) is a vital outcome of palliative care for cancer patients, yet in a number of Sub Saharan settings, including Western Uganda, there is a dearth of evidence on the level of quality of life and its correlates. Our goal therefore, was to assess the level of quality of life and associated factors among cancer patients receiving palliative care in Western Uganda. Methods A cross-sectional study was conducted using a pretested questionnaire that included socio-demographics, clinical information and the MissoulaVitas Quality of Life Index (MVQOLI-15R), a tool that measures quality of life of patients with advanced, incurable and progressive disease such as cancer. It is a 16-item instrument comprising of f ive subscales of: function, symptom, interpersonal, well-being and transcendence that encompass physical, social, psychological and spiritual dimensions. This tool was previously validated for a similar segment of patients. The above data collection instrument was translated into Runyoro and Runyankore and administered to consecutively enrolled cancer patients at Mobile Hospice Mbarara and Little Hospice Hoima, both of which are found in Western Uganda. Results Two hundred four patients were recruited. They had a mean age of58.8 ± 15.2 years and 154 (75.5%) of them were female. The commonest diagnosis was cancer of the cervix, 101(49.5%). The mean global QoL score was 3.47 ± 0.88 (possible range 0[worst] to 5[best]). The mean total QoL score was 13.44 ± 1.62 (possible range 0[worst] to 30[best]). Patients scored most poorly on symptoms (-6.78±), followed by Interpersonal (-4.01), transcendence (-3.53), function (-2.50) and well-being (1.31). The possible ranges for the subscales is (-30[worst] to 30[best]). With regard to factors associated with QoL, stage of disease, treatment with radiotherapy and pain intensity were found to have statistically significant associations with QoL of cancer patients receiving palliative care in this context. Conclusion QoL of cancer patients under palliative care in Western Uganda was found to be low. Treatment with radiotherapy, pain intensity and stage of disease were established to key predictors of QoL of these patients. Therefore, it is vital for cancer patients to be diagnosed with early stage, have their pin well controlled and get treated with radiotherapy where appropriate in order to harness better outcomes such as QoL for them
Prevalence and Associated Factors of Self-Medication Among Adults With Hypertension in Central Uganda: A Cross-Sectional Study
(International Journal of Hypertension, 2026) Kakuru,Charity; Kyomya, Julius; Muhwezi,Abraham; Murungi,Tom; Ochola,Henry; Turyakira, Eleanor; Migisha,Richard; Kawungezi,Peter Chris
Background: Self-medication is a widespread practice among individuals with chronic conditions such as hypertension. It can lead to poor blood pressure control and an increased risk of complications. However, little is known about its prevalence and associated factors among patients with hypertension in Uganda. This study aimed to determine the prevalence and associated factors of self-medication among adults with hypertension at Masaka Regional Referral Hospital (MRRH), Central Uganda. Methods: A cross-sectional study was conducted during August and September 2024 among patients with known hypertension aged ≥18years attending the MRRH Hypertension Clinic. Systematic sampling was used to recruit participants. Data were collected using a structured questionnaire, capturing sociodemographic and clinical characteristics. We defined self-medication as the use of antihypertensive medicines by individuals to treat hypertension without a formal prescription or guidance from a healthcare professional within the last 90days before the survey. Modified Poisson regression was used to identify factors associated with self-medication. Results: We enrolled 192 participants, with a mean age of 58 (�14) years; 143 (75%) were female. The prevalence of self- medication with antihypertensive drugs was 47% (95% confidence interval [CI]=40%–54%). Factors associated with self -medication were low monthly income. Conclusion: The prevalence of self-medication among hypertensive patients at MRRH was high. Self-medication was associated with low monthly income, medication gap, and familial pressure. The findings suggest that interventions addressing financial barriers, medication availability, and family influence warrant further evaluation as potential strategies to reduce self-medication.
Pioneering urogynecology fellowship training in a low resource setting, East- Africa, and its short- term impact: A mixed- methods implementation and program evaluation study
(International Journal of Gynecology & Obstetrics, 2026) Kayondo,Musa; Tarnay,Christopher; Kalyebara, Paul Kato; Byamukama,Onesmus; Ngonzi,Joseph; Njagi, Joseph; Ainomugisha,Brenda; Mwesigwa, Richard; Kajabwangu,Rogers; Margolis,Michael Thomas; Geissbühler,Verena
Objective: This study describes the establishment and assesses the early outcomes of a novel urogynecology fellowship training program in a low- resource setting at Mbarara University of Science and Technology (MUST), with the aim of informing similar efforts in other low- resource settings. Methods: We conducted a mixed- methods implementation and program evaluation study. Quantitative service delivery indicators were assessed using a quasi- experimental before–after design, and qualitative data were derived from descriptive trainee narratives. The intervention consisted of a competency- based 2- year, part- time modular fellowship integrating supervised clinical and surgical apprenticeship. It blended local and international didactic instruction that required scholarly output. Fellows' competencies were assessed using the Performance- Based Assessment method from the FIGO Global Competency- Based Fistula Surgery Training Manual. Primary outcomes included changes in fellows' competencies, urogynecology surgical volumes, geographical service coverage, and research output. Quantitative outcomes were summarized descriptively, and qualitative data were analyzed using inductive thematic analysis. Results: Five fellows (four from Uganda and one from South Sudan) were selected from 22 applicants. At evaluation, fellows had completed 25% of the curriculum. Performance- based assessments demonstrated progressive improvement in fellows' clinical and surgical competencies. Training sites expanded from four to 11, and annual urogynecology surgical volume increased from 300 procedures in 2024 to 548 in 2025. Program- associated research output rose from two to eight peer- reviewed publications. Infrastructure upgrades were achieved at some of the training sites. Conclusion: The MUST urogynecology fellowship demonstrates that partnerships enable establishment of subspecialty training programs addressing workforce gaps and improving access to specialized surgical care in low- resource settings.
Pediatric Colorectal Cancer in Africa: A Multicenter Study on Epidemiology, Management, and Outcomes Between 2000 and 2023
(JGH Open, 2026) Heerden,Jaques van; Balagadde-Kambugu,Joyce; Nyakato, Veronica; Mwa, Pamela; Geriga, Fadhil; Atwiine,Barnabas; Katasi, Victoria Mwebe; Benmiloud, Sarra; Hessissen,Laila; Chabchoub, Imène; Katsidzira,Leolin; Bassey,Eno-Obong; Arega, Gashaw; Büchner, Ané; Obat,Michelle; Muma,Sarah; Adefehinti, Olufemi; Akinsete,Adeseye Michael; Fagbemide,Oluwafunmilayo Toyin; Ngom,Ndeye Khady; Ali,Amany Mohamed; Abdelkeriem,Esraa; Mohamed,Yomna; Elayadi,Moatasem
Introduction: Colorectal cancer (CRC) is increasing in Africa, yet reports in children and adolescents are limited. We describe the epidemiology, management, and survival outcomes of CRC in African children. Methods: Retrospective data of children under 19 years diagnosed with CRC between 2000 and 2023 were collected from 14 African countries. Patient and tumor characteristics and treatment data were described and survival outcomes analyzed. GLOBOCAN data were used to evaluate age- related geographical distribution of CRC. Results: Hundred- and- eight patients, 57.4% males, were diagnosed with a mean age of 14.9 (range 5–18) years. The mean symptom- onset- to- diagnosis duration was 90 days (range 2–1200). Most common symptoms were abdominal discomfort (70.6%) and change in bowel habits (57.8%). The commonest primary site was the ascending colon (30.6%) with a mean tumor size of 64.3 mm (range 30–150 mm) and 37% presenting in stage III and 36.1% in stage IV. Most (83.3%) tumors were confirmed on his tology, of which 78.7% were adenocarcinoma. Carcinoembryonic antigen was performed in 38.9% of patients. Complete resection was achieved in 55.6% of cases, while 18.5% received radiotherapy. Folinic acid, Fluorouracil, Oxaliplatin (FOLFOX) was the first line chemotherapy in 48.1% of patients. A third of patients were lost to follow- up while 25.6% experienced disease progression. The 2- year and 5- year overall survival rates were 40.0% and 16.9%, respectively. Disease stage (p = 0.07) and degree of resection (p = 0.02) predicted outcomes. Conclusion: Pediatric CRC is characterized by delayed diagnosis and advanced stage presentation, contributing to a signifi cantly lower overall survival compared to adults. Focused research and multidisciplinary management are needed to understand pediatric CRC and improve outcomes.
Assessing the feasibility of interactive voice response-based depression screening for adolescents and young people living with HIV in Uganda: protocol for a formative mixed-methods study
(Sexual Health, 2026-07-30) Kihumuro,Raymond Bernard; Ochen,Eric; Nabifo,Patricia Manana; Kintu,Timothy Mwanje; Mirembe,Grace
Background. Depression is common among adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa, and is associated with poor antiretroviral therapy adherence, reduced retention in care and poorer health outcomes. In Uganda, routine depression screening using brief tools, such as the Patient Health Questionnaire-2, is recommended, but inconsistently implemented due to overburdened healthcare workers and limited mental health workforce capacity. Scalable approaches to improve early identification of depression among AYPLHIV are needed to bridge this implementation gap. We describe a protocol for a formative mixed-methods study designed to generate the contextual, user-level and health-system evidence needed to inform the design, feasibility and acceptability of an interactive voice response (IVR)-based depression screening intervention for AYPLHIV in Uganda. Methods. We will conduct a convergent parallel mixed-methods study at Makerere University Walter Reed Program (MUWRP) HIV clinics in Central Uganda. The quantitative arm will survey 133 AYPLHIV aged 18–24 years on mobile phone access, digital habits and IVR preferences; the qualitative arm will run focus group discussions with healthcare workers to probe barriers to depression screening, whether the system can absorb the extra cases screening would find and how IVR could fit existing HIV care. The two strands will be triangulated to guide IVR design and implementation. Expected outcomes and implications. The study will generate context-specific evidence on user-level access and preferences, health-system readiness, and referral pathway capacity to support a future IVR-based depression-screening intervention for AYPLHIV. These findings inform tailoring of a youth-centered IVR intervention aligned with national HIV and mental health guidelines.
Longitudinal Variation of Ionospheric Irregularities and Response of the Ionosphere During 10–13 May and 10–13 October 2024 Geomagnetic Storm
(Journal of Geophysical Research: Space Physics, 2026) Habyarimana,Valence; Moldwin, Mark B.; Habarulema,John Bosco; Aol,Sharon; Uwamahoro,Jean Claude; Dugassa,Teshome; Okoh,Daniel; Lomotey,Solomon Otoo
We examine the response of the ionosphere to the 10–13 May 2024 and 10–13 October 2024 geomagnetic storms, the two recent great geomagnetic storms of solar cycle 25. We identified the occurrence of ionospheric irregularities during the two geomagnetic storms. We used percentage change in vertical total electron content (ΔVTEC%) computed using VTEC data from three equatorial ground‐based global navigation satellite system (GNSS) receivers in the American, African, and Asian sectors, to study the ionospheric response. In order to determine the occurrence of ionospheric irregularities, we employed the rate of change of electron density (Ne) index (RODI) from Swarm‐Asatellite (Sw‐A) and the rate of change of TECindex(ROTI) from the GNSS TEC. Our results revealed a positive ionospheric storm over the African sector during the main phase of May storm; whereas a negative ionospheric response was recorded over the American sector. In contrast, during the October storm, a positive ionospheric storm effect was observed over the American and African sectors and a negative over the Asian sector. Additionally, we identified that the October storm had a higher percentage irregularity occurrence rate than the May storm. During the main phases of the two storms, irregularities were triggered over the African sector and inhibited over the American and Asian sectors. Sw‐A showed a longitudinal trend in the occurrence rate of irregularities during the May storm, with America having the lowest rate, followed by Africa and Asia. During the October storm, this longitudinal dependence is reversed
From Denial to Near Blindness: Overcoming Herpes Zoster Ophthalmicus in a Rural Ugandan Man with HIV and Alcoholism
(HIV/AIDS-Research and Palliative Care, 2026-07-31) Okongo,Benson; Amuge,Gladys; Adong,Ruth Lucy; Okengo,Anthony O; Muwanguzi,Enoch
Introduction: In remote Ugandan settings, HIV care retention remains poor among men and pastoralists. Despite progress toward UNAIDS 95–95–95 targets, structural barriers, geographic isolation and stigma continue to undermine long-term retention. Case Presentation: In 2022, a male pastoralist in his early forties with heavy alcohol use presented to a rural health center in Karamoja with fever and weight loss, and was diagnosed with HIV. He declined antiretroviral therapy (ART) believing the drugs were “poisonous” and was lost to follow-up for 48 months. He re-presented in March 2026 with a one-year history of a scaly, pruritic lesion on his right hand extending to the face and neck, unresponsive to antifungal creams. Two days prior, he developed an acutely painful vesicular eruption in the right V1 trigeminal distribution, along with oropharyngeal candidiasis. CD4 count was 120 cells/μL and urine TB LAM was positive, indicating disseminated tuberculosis. While LAM is highly suggestive and warrants immediate empirical treatment, definitive diagnosis of dissemination ideally requires clinical and radiological correlation. He was treated with oral acyclovir (800 mg five times daily for 10 days), topical acyclovir, ibuprofen, intensive-phase anti-TB therapy, and fluconazole (200 mg daily for 14 days). ART was deferred for two weeks to manage acute opportunistic infections and monitor for IRIS. At two weeks, the zoster lesions had crusted, oral candidiasis cleared, and pain reduced to 2/10. ART was initiated on day 14 with village health team support. At three months, he remained adherent with no new opportunistic infections. Conclusion: Delayed ART initiation caused years of preventable suffering. This case highlights the urgent need in low-income settings for community re-engagement strategies, integrated HIV/co-infection screening, point-of-care diagnostics, and culturally tailored care. As the patient stated: “I was sick, and now I am well. The science of HIV treatment is a miracle, and I am living proof.”
Lived experiences of women prescribed low dose aspirin for preeclampsia prevention: a phenomenological study
(BMC Pregnancy and Childbirth, 2026-05-30) Asiimwe,Prisca; Nambozi,Grace; Brennaman, Laura; Ngonzi,Joseph; Ruzaaza, Gad
Background Preeclampsia is a prevalent issue causing significant suffering and deaths in Uganda. The Ministry of Health has introduced a policy mandating the use of low-dose aspirin for its prevention. Being a new intervention, the acceptability of this drug among the women for whom it is prescribed is still unexplored in Southwestern Uganda. This study aimed to explore the lived experiences of women on low-dose aspirin during their most recent pregnancy, identify any challenges encountered and recommend appropriate solutions. Methods We used a descriptive phenomenological design to explore the lived experiences of women. Data was collected using purposive sampling from women in the antenatal clinic and postnatal units of a tertiary hospital in Southwestern Uganda. A self-developed interview guide and an audio recorder were used to collect data. Data collection continued until saturation was reached at 16 participants. Participants provided narratives about their knowledge of preeclampsia, their perceived susceptibility, severity, benefits, barriers and their experiences with aspirin prescription (use, or non-use). Analysis was done using the Colaizzi’s’ method of analyzing qualitative data. Data was collected in two months between the 4th of October and the 20th of December 2025. Results The study included 16 participants (mean age, 31 years; SD, 6.3; range, 22–43). Most participants were married, residents of Mbarara city and had attained secondary education. The parity ranged from 1 to 8 (mean = 4, SD = 2). Half of the participants had experienced an abortion, and 5 (31.3%) had lost 75% or more of their previous pregnancies. Aspirin 75mg and 150 mg were initiated at a mean gestation age of 20 weeks (SD 1.8), and 81% (95% CI: 0.53-0.94) of those who used aspirin progressed to preeclampsia. This study generated five themes: perceived clinical benefit and self-efficacy, suboptimal provider guidance, delayed LDA initiation, resilient therapeutic optimism and side effects-based non-adherence. Conclusion This study highlights perceived barriers and implementation challenges that may contribute to suboptimal uptake of aspirin prophylaxis and the high prevalence of preeclampsia in Southwestern Uganda. Mitigating these challenges requires consistent capacity building for maternal healthcare providers, robust community sensitization, and incorporating a screening tool within the antenatal card. In addition, improving medication adherence through active follow-up and strengthening health systems are essential to promote early antenatal care utilization. Future research can establish the population-specific risk factors for southwestern Uganda to adjust the general screening tool provided by the Ministry of Health so as to address preeclampsia at the regional level.
Dialogues of delivery: a multilingual question answer dataset for maternal healthcare in East African languages
(BMC Research Notes, 2026-06-02) Kimera,Richard; Kuyeso, Rogers; Maleka,Emmanuel; Tukamushaba,Fortunate; William,Wasswa; Mwavu,Rogers; Bamutura,David Sabiiti; Ngonzi, Joseph; Ainomugisha, Brenda; Namuli,Alexer; Namiiro,Proscovia; Nyakato, Clare; Celi,Leo Anthony; Kaggwa,Fred
Objective There is a critical scarcity of domain-specific, clinically grounded Natural Language Processing (NLP) resources for African languages. In Western Uganda, linguistic diversity creates a barrier to maternal healthcare, as mothers lack access to health information in their native languages. The objective of this dataset is to provide a high quality, in-language medical corpus to enable the development and fine-tuning of Large Language Models (LLMs) and conversational AI tools for maternal health in resource-constrained settings. Data description The “Dialogues of Delivery” dataset is a multilingual, parallel corpus comprising 3,694 question and-answer pairs presented in four languages: English, Luganda, Runyankore, and Swahili (14,800 total entries). Using facility-based convenience sampling at two health facilities in Western Uganda, primary data was collected via structured, open-ended questionnaires from 150 participants (expectant/postpartum mothers and maternal healthcare providers). The dataset underwent a rigorous forward-backward translation protocol by certified linguists and human-in-the-loop clinical validation by independent medical professionals. The dataset captures core maternal health domains, providing a culturally and clinically validated foundation for Afrocentric AI development
Delayed Vesicocutaneous Fistula 18 Years After Tension-Free Vaginal Tape: A Rare Case Report
(International Medical Case Reports Journal, 2026-08-05) Bashir,Mohamed; Kajabwangu, Rogers; Nadkarni, Aditi; Alkinani, Anfal Zuhair; Nadkarni,Akshay
Background: Synthetic mid-urethral slings are widely used for female stress urinary incontinence and are generally safe. However, complications such as erosion, infection, bladder or urethral perforation, vascular or bowel injury, and postoperative voiding difficulties have been reported. Very rarely, vesicocutaneous fistulas may occur due to bladder erosion resulting from mesh-related reactions, which begin with chronic inflammation and weakening of the bladder wall, then extend to the perivesical tissues and the anterior abdominal wall, forming a fistulous tract to the skin. Case Presentation: We report a 65-year-old woman, para 4, with multiple comorbidities, including diabetes mellitus and hypertension and a history of total abdominal hysterectomy for adenomyosis 20 years earlier, who developed anterior vaginal wall prolapse and stress urinary incontinence. She underwent a tension-free vaginal tape (TVT) procedure 18 years ago. Last year, she presented with urinary leakage from her abdominal incision. Computed tomography and cystoscopy confirmed a vesicocutaneous fistula secondary to erosion of the TVT. The tape was removed, and the fistula was repaired with a layered closure of the bladder and abdominal wall. She was discharged after two days with a Foley catheter, which was removed after two weeks. Four weeks later, she presented with a recurrence of stress urinary incontinence for which we planned surgical correction later. Anterior repair and Kelly plication were performed at 6 months after removal of the tape, resulting in urinary continence. The patient was reviewed 8 weeks later and remained continent with no major complications. Conclusion: Vesicocutaneous fistula after TVT is rare but serious; chronic mesh-tissue interactions, compounded by comorbidities such as diabetes and estrogen deficiency, can lead to delayed erosion and fistula years postoperatively. This case highlights the importance of early recognition of urinary symptoms, timely surgical management, and ongoing long-term surveillance, even when initial surgery is technically successful.
Climate-driven maize yield prediction across Uganda’s ZARDI zones using pooled learning and uncertainty-aware modeling
(Discover Artificial Intelligence, 2026) Taremwa,Danison; Ahishakiye,Emmanuel; Obbo,Aggrey; Kisozi,Paul Kategaya; Kaggwa,Fred
Accurate maize yield prediction is essential for agricultural planning and food security, yet remains challenging in data-scarce, heterogeneous agroecological settings. This study investigates climate-driven maize yield prediction across Uganda’s Zonal Agricultural Research and Development Institute (ZARDI) regions using a pooled modeling framework that mitigates the problem of extremely small zone specific sample sizes. Seasonal climatic variables, including rainfall, temperature, solar radiation, and soil moisture, collected from 2018 to 2021, were integrated with zone indicators and evaluated under a strict leave-one-year-out (LOYO) cross-validation protocol to prevent temporal information leakage. Regularized linear regression (Ridge) achieved the most reliable generalization performance, with a root mean squared error (RMSE) of approximately 0.98 t ha−1 and mean absolute error (MAE) of 0.57 t ha−1, marginally outperforming global-mean (RMSE ≈ 0.99 t ha−1) and ZARDI-mean (RMSE ≈ 1.05 t ha−1) baselines. More complex models, including a constrained XGBoost regressor, did not yield consistent performance gains under LOYO evaluation. Zone-specific analysis revealed substantial heterogeneity, with some regions exhibiting moderate predictive skill (MAE < 0.25 t ha−1), while others showed weak climate–yield coupling and negative coefficients of determination. To address overconfidence in the face of data scarcity, prediction uncertainty was explicitly quantified using conformal prediction intervals based on out-of-fold residuals. Global prediction intervals achieved empirical coverage of 91.7% and 96.3% at the 90% and 95% nominal levels, respectively, indicating well-calibrated uncertainty estimates. Zone-specific interval widths varied markedly, ranging from approximately 0.84 t ha−1 in better-performing regions to over 4.6 t ha−1 in the most uncertain zones. Model interpretability analysis using Shapley Additive explanations identified rainfall, soil moisture, solar radiation, and seasonal timing as the dominant drivers of yield predictions, while zone identifiers contributed minimally. The proposed framework provides a transparent, defensible basis for yield assessment and underscores the need to integrate additional agronomic and remotely sensed data to improve predictive skill in regions with weak climate–yield relationships.
Association Between High Serum Aspartate Transaminase to Alanine Transaminase Ratio and Probable HIV Dementia Among People Living With HIV on Dolutegravir-Based Antiretroviral Therapy: A Cross-Sectional Study from Central Uganda
(Journal of the International Association of Providers of AIDS Care, 2026) Bagenda, Charles Nkubi; Nantongo, Carol; Mugisa, Michael Junior; Olwoch,Vincent; Naziiwa, Fauziya; Masereka,Christier; Bagambe,Bright; Somikwo,Godfrey; Sempijja,Fred; Tumusiime, Jazira; Tusubira, Deusdedit
Background: 5 Probable HIV dementia (PHD) remains a significant complication among people living with HIV(PLWH), particularly in resource-limited settings where access to comprehensive neurocognitive assessment is limited. This study investigated the association between AST-to-ALT ratio and PHD among PLWH on Dolutegravir-based antiretroviral therapy (DTG-based ART). Methods: We conducted a secondary analysis using a dataset generated from hospital-based cross- sectional study that consecutively recruited 235 PLWH on DTG-based ART at St. Francis Nsambya Hospital in Kampala, Central Uganda. PHD was defined as International HIV Dementia Scale score ≤10. Results: PHD prevalence was 22.1% (52/ 235; 95% CI: 17.3–27.9) and increased across AST-to-ALT ratio tertiles (13%, 23%, and 31%; p=0.023). Participants in the second and third tertiles had higher odds of PHD (aOR=2.85, 95% CI: 1.13–7.15; p=0.026 and aOR=4.28, 95% CI: 1.75–10.45; p=0.001). Each 0.5-unit increase in the AST-to-ALT ratio increased the odds of PHD by 40% (aOR=1.40, 95% CI: 1.02–1.92; p=0.036). An AST-to-ALT ratio cutoff of 1.26 showed modest discrimination for PHD (AUC=0.622), with 73% sensitivity, 51% and specificity, 29%. Conclusion: A higher AST-to-ALT ratio is a potentially useful screening predictor for PHD in PLWH on DTG-based ART in resource limited settings, pending validation in larger prospective studies.
Antimicrobial resistance within the one health lens: global drivers, mechanisms and public health policy gaps in low resource settings
(Frontiers in Cellular and Infection Microbiology, 2026-06-24) Mugenyi, Nathan; Ouma,Ronald Omolo; Ahmed, Mohamed Mustaf; Lucero-Prisno, Don Eliseo
Background: Antimicrobial resistance (AMR) poses a significant threat to global healthcare systems in terms of poor clinical outcomes, reduced quality of life and economic burdens. It is therefore imperative to comprehend the impact of all One Health domains, such as humans, livestock, agriculture and ecosystems in the fight against AMR. This narrative review therefore aims to highlight the resistance mechanisms, AMR global burden and its contributing factors. Additionally, this review identifies currently existing information gaps, monitoring parameters and global AMR mitigation strategies. Methods: A structured literature search was conducted across multiple electronic databases, including PubMed, EMBASE, Science Direct, the Cochrane Library, and Google Scholar to identify relevant peer-reviewed studies on antimicrobial resistance (AMR). The search included articles published in English between January 2013 and January 2025. Additional references were identified through manual screening of reference lists and relevant global reports from organizations such as the World Health Organization (WHO) and the Global Antimicrobial Resistance and Use Surveillance System (GLASS). Studies were eligible for inclusion if they addressed AMR in human health, animal health, agriculture, food systems and environmental settings within a One Health framework with particular emphasis on low- and middle-income countries (LMICs) as classified by the World Bank. Articles focusing on AMR mechanisms, transmission pathways, surveillance systems, AMS, environmental dissemination, and public health consequences were considered for inclusion. Results: The review narrative identified five major themes: global AMR burden, resistance mechanisms, cross-sectoral drivers, surveillance gaps, and stewardship responses. Globally, AMR was linked to 4.95 million deaths in 2019, with 3.57 million deaths directly attributable to drug-resistant infections. The major pathogens included Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus, which exhibited alarming resistance to last-line antibiotics. The overuse of antibiotics in healthcare and agriculture, poor sanitation, unchecked use of biocides and heavy metals, and weak AMR surveillance were identified as the principal drivers. Data from the WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) confirmed the escalation of resistance among priority pathogens. Conclusion: AMR is a multifaceted One Health challenge that requires urgent and integrated efforts to be mitigated. Strengthening integrated One Health surveillance, AMS, wastewater monitoring, and LMIC laboratory capacity should become immediate global policy priorities. Without immediate and sustained interventions, AMR threatens to reverse decades of medical progress and compromise the achievement of global health objectives. AMR is spreading globally due to irrational (un-judicious) antimicrobial use, cross-sectoral contamination, and the genetic exchange of resistance determinants among bacterial populations. Resistance gene transfer, particularly via horizontal mechanisms, is most pronounced where human, livestock, and environmental (One Health) interfaces overlap
Green entrepreneurial orientation and its influence on green innovation, economic performance, and sustainable performance a meta‑analytic review
(Future Business Journal, 2026) Bindeeba, Dedrix Stephenson; Kembabazi, Owen; Tibihika, Amon
Green entrepreneurial orientation (GEO) is increasingly viewed as a strategic posture that helps firms remain competitive while responding to rising environmental pressures. This study synthesizes empirical evidence on how GEO relates to green innovation and whether these relationships extend to economic and broader sustainable performance outcomes. Using a meta-analytic approach, the review integrates evidence from 48 quantitative studies, comprising 56 effect sizes and 13,311 firms. Random-effects models show that GEO has its strongest association with green innovation (r=0.488), followed by economic performance (r=0.378), and a smaller but significant association with sustainable performance (r=0.294). Substantial heterogeneity indicates that GEO’s payoffs vary across contexts. Subgroup analyses show that industry context moderates the GEO–green innovation relationship, with stronger effects in mixed or multi-sector settings than in manufacturing or industrial contexts. Country development status does not differentiate the GEO–innovation relationship, but it does condition GEO’s associations with economic and sustainable performance, suggesting that value capture and stakeholder reward structures shape performance returns more than innovation initiation. Overall, the findings help reconcile mixed results in the GEO literature by showing that GEO is most reliably linked to innovation outcomes, while performance associations are more context-dependent and likely to materialize through effective implementation and stakeholder valuation. Practically, this implies that managers and policymakers should complement GEO promotion with support for green innovation capabilities and market mechanisms that recognize, reward, and scale green outcomes
Examining Secondary School Teaching Methods- Perspectives from the 2014 South Sudan National Curriculum Framework
(East African Journal of Education Studies, 2015-04-01) Kilonga, Rose Hezekiah Jonathan; Kemeza,Imelda; Mwesigwa,Alice
The global trend for educational reform is directed towards learner-centered pedagogy. Many Sub-Saharan countries have already resorted to this approach to teaching. South Sudan has taken this initiative by launching and implementing a competency-based curriculum from preschool through secondary level in 2018. The 2014 national curriculum framework philosophical strategy towards instruction is entrenched in a constructivist approach. The framework emphasizes learning to be extended beyond textbooks from teacher-directed lessons (teacher centred) to learner’s active engagement. This inspired the investigators to conduct an in-depth examination of the nature of instructional practices existent in secondary schools. The study employed mixed method convergent parallel design in 15 secondary schools purposefully selected within Juba city. Questionnaires were self-administered to 225 teachers, interviews and Focus Group discussions (FGD) were designed and conducted on 4 officials in the Ministry of General Education and Instruction (MoGEI) in departments of curriculum and inspection,13 head teachers and 12 teachers of the sampled schools. Findings demonstrate the application of both teacher-centred and learner-centred methods, challenges obstructing teachers from applying the learner-centred mode of instruction, lack of feasibility studies conducted before the inception of this reform, and high awareness possessed by teachers on instructional methods to be utilized. The investigators recommended that both teachers and students should endeavour collaboratively to improve their comprehension of learner-centred practices and the government should consistently support schools, evaluate field practices to minimize the policy practice gap then grant schools the opportunity to print authorized textbooks for teaching the South Sudan syllabus.