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Recent Submissions

Prevalence and Factors Associated With Urogenital Bacterial Colonization Among Women With Preterm Labor at a Tertiary Hospital in Southwestern Uganda: A Cross-Sectional Study
(Cureus, 2026-07-03) Birungi,Wilson; Turanzomwe,Stuart; Byamukama,Onesmus; Bawakanya, M. Stephen; Kabanda,Taseera; Kayondo,Musa; Kajabwangu,Rogers
Introduction: Urogenital bacterial colonization is common during pregnancy and is associated with preterm labor and preterm births. Physiological, hormonal, and immunological changes of pregnancy increase the susceptibility to colonization of the urogenital tract by pathogenic bacteria, which may contribute to adverse pregnancy outcomes. This study aimed to estimate the prevalence of urogenital bacterial colonization and identify factors associated with it among women with preterm labor at Mbarara Regional Referral Hospital. Materials and methods: This was a cross-sectional study involving 156 women with preterm labor who were consecutively enrolled between November 2022 and April 2023. Data on independent variables were collected using an interviewer-guided structured questionnaire. Urine samples and endocervical and high vaginal swabs were collected and processed for microbiological culture to detect bacterial colonization. We used modified Poisson regression to identify factors associated with bacterial colonization. Results: Out of the 156 women with preterm labor enrolled in this study, 85 (54.5%) had urogenital bacterial colonization. The mean age of the participants was 25.5 ± 5.77 years. Most of the participants were referred from other health facilities (n = 120, 76.9%) and had a history of abnormal vaginal discharge (n = 117, 75%). Factors independently associated with bacterial colonization included age
High risk HPV genotypes: six year trends and distribution in South Western Uganda
(Infectious Agents and Cancer, 2026-08-29) Ssedyabane,Frank; Mudondo,Hope; Tusubira,Deusdedit; Muhumuza,Joy; Namuli,Alexcer; Mwesigwa,Geoffrey; Atuhumuza,Elly B; Castro, Cesar M; Lee,Hakho; Randall,Thomas C; Ngonzi,Joseph
Introduction: Persistent infection with High-Risk Human Papillomavirus (hrHPV) causes almost all cervical cancer cases, and the world is steadily moving towards primary HPV testing for cervical cancer screening. We determined the prevalence, distribution, and trends of hrHPV genotypes at Mbarara Regional Referral Hospital (MRRH), south western Uganda. Methods: In this retrospective study, we reviewed laboratory records at MRRH for a period of six years from January 2020 and July 2025. Data on age, district of residence, HIV status, HPV test result, HPV genotype and date of testing were collected and analyzed using STATA 17. Results: Out of the 4,852 HPV test results we retrieved, the overall prevalence of hrHPV infection was 28.52% (1379/4,852) with a gradual increase from the year 2020 to 2025. The prevalence of hrHPV was highest among women aged and it showed a steady decrease with increasing age of participants. More than half (65.12%, 898/1379) of all positive hrHPV tests were non-16/18/45 high-risk HPV genotypes categorized as “other hrHPV”, which also showed a persistent increase in prevalence from 61.04% in 2020 to 63.53% in 2025. “Other hrHPV” genotypes also showed a gradual decline in prevalence with increasing age. Within the HIV positive population, the prevalence of “other hrHPV” genotype group result was consistently high from 64.79% (46/71) in 2020 to 66.55% (189/284) in 2023 to 63.53% (54/85) in 2025. Also, mixed HPV genotype infections showed a steady increase from 11.27% (8/71) in 2020 to 21.18%. Conclusion: There is an elevated prevalence of hrHPV, especially those HPV genotypes categorized as “Other hrHPV,” and this prevalence is inversely proportional to age. As such, there is a need for implementation of extended hrHPV genotyping and more prospective studies to further describe individual hrHPV genotype prevalence, distribution, and trends
Discordant Gender Identity and Surgical Goals in Two Adults with Comparable Ambiguous Genitalia: Two Case Reports from a Resource Limited Setting
(Cureus, 2026-06-17) Ainomugisha,Brenda; Kajabwangu,Rogers; Byamukama, Onesmus; Kato, Kalyebara P.; Geissbuhler,Verena; Kayondo,Musa
Disorders of sex development (DSD) are rare congenital conditions characterized by discordance among chromosomal, gonadal, and phenotypic sex. Adult presentation of ambiguous genitalia is not uncommon, particularly in low-resource settings where delayed diagnosis, limited access to specialized care, sociocultural stigma, and financial barriers constrain evaluation and management. We present two adults with remarkably comparable external genital appearances but profoundly different gender identities, social roles, treatment interests, and therapeutic goals. The two patients, both aged 25 years, presented to our institution with comparable ambiguous external genitalia but different gender roles and concerns. Case one is a phenotypic female presenting with an enlarged clitoris and partially obstructed vaginal introitus, causing her severe psychosocial distress and inability to engage in sexual intercourse. She had normal female secondary sexual characteristics and regular menstruation. Imaging demonstrated normal internal female reproductive organs. Due to financial limitations, karyotyping was not performed. She desired vaginal opening and removal of the penile-like structure. She underwent examination under anesthesia, introital reconstruction, and clitoral reduction surgery, with good postoperative functional and psychological outcomes. Case two is an individual raised and socially recognized as male who presented with progressive abdominal distension and chronic pelvic pain. Despite a masculine gender identity and virilized phenotype, the patient reported menstruation since adolescence. Imaging demonstrated multiple abdominal masses suspicious for malignancy. He was desirous of the removal of the uterus to eliminate menstruation, which was a major source of his distress, irrespective of whether he would sexually perform as a male or not. Exploratory laparotomy revealed large intra-abdominal tumors, and histopathology confirmed dysgerminoma. The patient is currently undergoing chemotherapy. These cases highlight the complexity of adult DSD presentation in resource-constrained settings and underscore the importance of individualized, patient-centered management that prioritizes gender identity, psychosocial well-being, reproductive goals, and informed consent. The report further emphasizes the ethical and clinical challenges posed by limited diagnostic capacity and delayed presentation.
Determinants of antenatal care service satisfaction among pregnant women at Kawaala Health Centre IV, Kampala City: a cross-sectional analytical study
(Frontiers in Reproductive Health, 2026-08-05) Nshabohurira,Elizabeth; Namanya,Eliot; Ouma,Ronald Omolo; Turyakira,Eleanor; Amutuhaire,Patience; Mbabazi,Scovia G.; Mugenyi,Nathan; Byakika-Kibwika,Pauline
Background: Antenatal care (ANC) in developing countries is among strategies aimed at reducing maternal mortality yet its quality and utilization are still low. Only about 60% of pregnant mothers in Uganda attend at least four ANC visits despite it being one of the strategies to curtail maternal mortality. The satisfaction of pregnant mothers with ANC services is associated with increasing their access and utilization. Therefore, there is need to evaluate the extent to which pregnant mothers are satisfied with ANC services and the associated factors. Methods: A cross-sectional analytical study employing quantitative methods of data collection and analysis was conducted. Data was collected from 384 participants using interviewer administered semi structured questionnaires. Bivariate analysis using the Pearson chi-square (χ2) test was conducted to determine the individual and health facility factors associated with satisfaction with ANC services among pregnant women. Multivariate analysis was performed on the variables that were statistically significant (p < 0.05) at bivariate analysis using logistic regression model to control confounding and determine independent factors associated with satisfaction with ANC services among pregnant women. Results: Of the 384 pregnant women enrolled, 259 (67.4%) were satisfied with ANC services. Multivariable logistic regression analysis revealed that knowledge about ANC services (AOR=4.2, 95% CI: 2.23–7.81; p < 0.001), waiting time of less than one hour (AOR=2.8, 95% CI: 1.30–5.99; p = 0.009), positive attitude of healthcare providers (AOR=5.9, 95% CI: 3.13–11.25; p < 0.001), and availability of ANC commodities (AOR=3.0, 95% CI: 1.53–6.06; p = 0.002) were independently associated with satisfaction with ANC services. Conclusion: Improving maternal knowledge on ANC services, reducing waiting times, ensuring availability of essential ANC commodities, and promoting respectful provider-client interactions may enhance women’s satisfaction with ANC services. Strengthening these aspects of care could improve ANC utilization and contribute to better maternal health outcomes
Comorbidities of Adolescent Pregnancy at a Tertiary Teaching Hospital in Southwestern Uganda
(Cureus, 2026) Byamukama,Onesmus; Tushabomwe-Kazooba,Charles; Kanyesigye,Michael; Amwikirize,Annah; Kamugisha,Arnold; Ntaro, Moses; Ochola, Henry; Ngonzi,Joseph
Background Adolescent pregnancy presents significant health challenges worldwide. Each year, millions of teenage girls in developing regions become pregnant. In Uganda, teenage pregnancy remains common, with marked regional variations. Adolescents in low socioeconomic situations, with limited education, or who face barriers to contraceptive access are more prone to unintended pregnancies. These pregnancies may result in multiple health complications, including premature births, small for gestational age babies, postpartum depression, anaemia, and urinary tract infections (UTIs). Methods A cross-sectional study was conducted at the tertiary institution of Mbarara Regional Referral Hospital, Mbarara, Uganda, from July to September 2024, including adolescent pregnant women who presented for antenatal care (ANC) attendance or delivery. Data collection involved clinical examinations (blood pressure and mid-upper arm circumference (MUAC)) and laboratory tests (haemoglobin, HIV, hepatitis B, random blood sugar, and urinalysis). Data on socio-demographic and obstetric characteristics were collected through a structured questionnaire. Data were analysed using STATA version 17 (StataCorp LLC, College Station, TX, USA), with comorbidities defined by clinical criteria such as hypertension, anaemia, HIV infection, pre-eclampsia, hyperglycaemia, and UTIs. Results Of the total, 252 participants were enrolled. The median age was 18.5 years. Most were married (81.7%), rural residents (54.5%), had completed primary education (52%), and had not used modern contraceptives (84.5%). Among participants, 10.4% were in arranged marriages, 31% had unplanned pregnancies, and 4% had engaged in transactional sex. The average ANC attendance was four visits. Notably, 99.6% of participants had at least one comorbidity, and 3.2% had two or more. The most common comorbidities included UTIs (53.0%), anaemia (34.8%), and HIV infection (8.7%). Less common conditions included hepatitis B (0.4%), hyperglycaemia (7.4%), and pre-eclampsia (1.2%). Conclusion Adolescent pregnancies show a high prevalence of comorbidities, particularly UTIs, anaemia, and HIV. Improved screening and management of these conditions could reduce maternal and neonatal morbidity and mortality.
Burnout and associated factors among postgraduate students at Mbarara University of Science and Technology in Southwestern Uganda
(Discover Education, 2026-07-25) Namwase,Joyce; Omolo,Ronald Ouma; Katushabe,Glorious; Turyamusiima,Rodgers; Byaruhanga,Timothy; Ruyonga,Marven Robert; Maling,Samuel; Rukundo,Godfrey Zari
Background: Burnout is a growing concern among postgraduate students due to sustained academic and clinical demands. Characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, burnout negatively affects mental well-being, academic performance, and quality of patient care. Although high levels of burnout have been reported among postgraduate trainees globally, evidence from Uganda, particularly at Mbarara University of Science and Technology (MUST), remains limited. This study aimed to determine the prevalence of burnout and identify associated factors among postgraduate students at MUST, Uganda. Methods: A cross-sectional study was conducted among 193 postgraduate students. Burnout was measured using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS), comprising emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) subscales. Burnout syndrome was defined as high EE (>26), high DP (>9), and low PA (≤33) according to established MBI cut-offs. Bivariable and multivariable logistic regression analyses were performed to identify factors independently associated with burnout, with results reported as odds ratios (ORs) with 95% confidence intervals and statistical significance set at p < 0.05. Results: The prevalence of burnout syndrome among postgraduate students was 13.5% (95% CI: 8.9–19.8). Burnout was independently associated with a history of academic retakes (AOR = 7.85; 95% CI: 2.43–27.84. Conclusion: Burnout was observed among a notable proportion of postgraduate students at MUST and was significantly associated with academic retakes and employment without study leave, highlighting the impact of academic progression challenges and work–study imbalance on student well-being. Early identification and
Strengthening capacity for clinical trial monitoring in the East African community: a multi-country training programme
(BMC Medical Education, 2026-06-16) Twesigye,Belinda; Amperiize,Mathius; Wandiga,Steve; Castelnuovo,Barbara; Okoboi,Stephen; Mutumba,Beth; Opolot,Hellen; Ndagije, Helen; Gardais,Soazic; Kidola,Jeremiah; Mutabazi,Vincent; Nyandwi,Ramadhan; Mathew,Lina S.; Twungubumwe,Novat; Ainembabazi,Provia; Byakika-Kibwika,Pauline
Background The expanding volume and increasing complexity of clinical research in East Africa, driven by emerging and re-emerging infectious diseases, has increased the need for strong regulatory monitoring systems. Clinical trials must be monitored to ensure regulatory compliance and participant safety. Despite strengthened regulatory and ethical frameworks in the region, gaps in trial monitoring persist due to a shortage of adequately trained monitors. This paper describes the design, implementation, and outcomes of a regional capacity-building initiative aimed at strengthening clinical trial monitoring capacity across six East African Community partner states. Methods We implemented a multi-country capacity-building project across six East African Community partner states: Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda. We conducted stakeholders’ consultations to identify the training needs that informed development of a tailored curriculum on clinical trial monitoring comprised of six modules, and approved by the Training Advisory Committee (TAC). We trained National Research Regulatory Authority (NRRA) personnel, Research Ethics Committee (REC) members, clinical researchers, and clinical trial monitors. The programme was implemented between February 2024 and February 2025, with one group per partner state. Each cohort completed a five-week blended learning programme comprising a two-day in-person workshop, four weeks of self-paced online learning, and a two-day virtual wrap-up session. Pre- and post-training assessments were administered to measure knowledge gain. Data were downloaded as CSV files, cleaned in Microsoft Excel, and exported to STATA 15.0 for analysis. Descriptive analyses were conducted and data summarized. Results We trained 200 participants, majority 30.5% (n=61) of whom were from Uganda and 50.5% (n=101) were female. Overall, mean knowledge scores increased significantly from 61.8% at pre-test to 84.3% at post-test (22.5% point improvement). The proportion of participants achieving the 60% pass mark increased from 37.5% (75/200) at pre-test to 95.6% (191/200) at post-test. Conclusion This capacity-building project showed a marked improvement in knowledge of clinical trial monitoring among NRRA personnel, REC members, clinical researchers, and clinical trial monitors across the EAC. Further studies should evaluate whether this knowledge gain translates into enhanced clinical trial monitoring and oversight practices
Barriers and facilitators to linkage to HIV care after hospital discharge among adults living with advanced HIV disease in Uganda: a COM-B–guided qualitative study
(HIV Research & Clinical Practice, 2026) Katuramu,Richard; Semitala,Fred C.; Neumbe,Irene Mildred; Nekaka,Rebecca; Nangendo,Joan; Namuwenge,Proscovia M.; Katahoire,Anne R.; Byakika-Kibwika,Pauline; Kamya,Moses R.; Matovu,Joseph K. B.
Background: Hospital discharge represents a high-risk transition period for people living with HIV, particularly those with advanced HIV disease. In low-resource settings, substantial gaps persist in linking these individuals to outpatient HIV care following hospitalisation. This study explored barriers and facilitators to post-discharge linkage to care from the perspectives of patients and healthcare workers (HCWs) in Eastern Uganda. Methods: We conducted a descriptive qualitative study at Mbale Regional Referral Hospital between May and October 2025. Guided by the capability, opportunity, motivation, and behaviour (COM-B) model, we conducted 20 in-depth interviews with adults with advanced HIV disease who had recently been discharged from the medical ward (10 who successfully linked to care and 10 who did not), alongside 10 key informant interviews with HCWs involved in their care. Data were analysed using a thematic framework approach aligned with the COM-B constructs. Results: Patient-reported barriers included physical weakness (physical capability), limited knowledge of the linkage process (psychological capability), high transport costs and long travel distances (physical opportunity), and stigma or non-disclosure of HIV status (social opportunity). HCWs identified the absence of standardised linkage protocols, post-discharge follow-up mechanisms, and incentive structures as key systemic barriers (physical opportunity). Facilitators reported by patients included initiation or resumption of antiretroviral therapy (ART) before discharge (physical opportunity), support from peer supporters and disclosure to caregivers (social opportunity), and fear of clinical deterioration (reflective motivation). HCWs identified the existing TB–HIV linkage system (reflective motivation) and the presence of ward-based linkage counsellors (physical opportunity) as enabling factors. Conclusion: People living with advanced HIV disease face multiple, interrelated barriers to linkage with HIV care following hospital discharge, including physical debility, limited knowledge of the linkage process, financial and geographic constraints, and stigma. Conversely, pre-discharge ART initiation, peer support, and disclosure facilitate successful linkage. Strengthening post-discharge care will require standardised linkage protocols, structured follow-up mechanisms, and expanded use of peer supporters within health systems.
Bacterial Profile and Antibiotic Susceptibility Patterns of Urogenital Isolates Among Women With Preterm Labor at a Tertiary Hospital in Southwestern Uganda
(Cureus, 2026) Birungi,Wilson; Turanzomwe,Stuart; Byamukama,Onesmus; Bawakanya,Stephen; Orishaba,Francis; Kabanda,Taseera; Kayondo,Musa; Ngonzi,Joseph; Kajabwangu,Rogers
Background: Pathogenic bacterial colonization of the urogenital tract during pregnancy may lead to infection and inflammation, contributing to adverse obstetric and neonatal outcomes such as preterm labor, preterm premature rupture of membranes, chorioamnionitis, neonatal sepsis, and perinatal mortality. Early identification of bacterial isolates and their antibiotic susceptibility patterns is essential for guiding appropriate antimicrobial therapy, reducing maternal and neonatal morbidity, and informing local treatment guidelines. This study aimed to determine the bacterial isolates colonizing the urogenital tract and their antibiotic susceptibility patterns among women presenting with preterm labor at Mbarara Regional Referral Hospital. Methods: This cross-sectional study consecutively enrolled 156 women with preterm labor between November 2022 and April 2023. Midstream urine samples, endocervical swabs, and high vaginal swabs were collected for bacterial culture, identification, and antibiotic susceptibility testing. Data were analyzed descriptively, and bacterial isolates and antibiotic susceptibility patterns were summarized as frequencies and percentages. Results: Bacteria were isolated from urine samples in 43/156 (27.6%) participants and from genital tract specimens in 75/156 (48.1%). The predominant urinary isolates were Klebsiella spp. (20/43, 46.5%) and Staphylococcus aureus (16/43, 37.2%), while Escherichia coli accounted for 4/43 (9.3%) of urinary isolates. In the genital tract, S. aureus was the most frequently isolated organism (43/75, 57.3%), whereas Proteus spp. (1/75, 1.3%) and Pseudomonas spp. (1/75, 1.3%) were the least common. The predominant urinary and genital tract isolates demonstrated high resistance to ampicillin and azithromycin but were generally susceptible to ceftriaxone, gentamicin, and ciprofloxacin. Conclusion: Staphylococcus aureus and Klebsiella spp. were the predominant urogenital bacterial isolates among women with preterm labor. Most bacterial isolates were susceptible to gentamicin, ciprofloxacin, ceftriaxone, and ceftazidime but demonstrated high resistance to ampicillin and azithromycin. These findings highlight the need for routine culture and antibiotic susceptibility testing and may inform future updates of empirical antibiotic treatment guidelines in Uganda.
Association Between Advanced Age and Perioperative Complications Among Women Operated for Pelvic Organ Prolapse in Urogynecology Camps in Uganda
(Cureus, 2026) Kalyebara, Paul Kato; Ngonzi,Joseph; Byamukama,Onesmus; Ainomugisha,Brenda; Birungi,Wilson; Kajabwangu,Rogers; Geissbuehler,Verena; Kayondo,Musa
Background: The burden of pelvic organ prolapse (POP) is the highest among elderly women compared to their young and middle-aged counterparts. These women are also faced with various medical comorbidities. Surgery in these women presents a challenge due to the increased risk of perioperative complications, especially in low-resource settings. Therefore, this study aimed to determine the association between advanced age and perioperative complications among women undergoing POP surgery in a resource-limited setting. Methods: This was a retrospective review of records for women who had surgery for POP during urogynecology camps conducted over a four-year period from January 2022 to December 2025 at eight centers in Uganda. A woman was considered elderly if she was aged 70 years and above. Perioperative complications assessed included intraoperative injury to pelvic viscera, duration of hospital stay, and in hospital adverse events. We compared the proportions of perioperative complications in the elderly and nonelderly using a chi-square test. Cramér's V coefficient was used to assess effect size. Bivariate and multivariate modified Poisson regression analyses were done to determine the association between advanced age and perioperative complications. The level of statistical significance was set at < 0.005). The overall prevalence of perioperative complications was 14.26% (n = 78, CI: 11.57-17.46). There was no significant difference in the proportion of perioperative complications between the two groups (10/63, 15.9% vs. 68/484, 14.1%) (p = 0.697). At the multivariate analysis, advanced age was not associated with perioperative complications (aPR 1.07; CI: 0.57- 2.03; p = 0.828). Conclusions: Advanced age was not associated with perioperative complications. We recommend that surgery be offered as a viable option to elderly women with POP in urogynecological surgical camps and enhanced recovery after surgery measures be implemented by POP surgeons
Assessment of Immediate Postpartum Contraception Uptake Among Women Delivering by Cesarean Section in Southwestern Uganda
(Cureus, 2026) Ainomugisha,Brenda; Kayondo,Musa; Owaraganise,Asiphas; Ngonzi,Joseph
Introduction The immediate postpartum period represents a critical opportunity to initiate contraception to prevent short interpregnancy intervals and associated adverse maternal and neonatal outcomes. However, uptake of postpartum contraception remains low in many low-resource settings despite increasing rates of caesarean delivery. This study assessed the uptake and determinants of immediate postpartum contraception (IPPC) following cesarean delivery in Uganda. Objectives To determine the prevalence of IPPC uptake and factors associated with IPPC among women delivering by cesarean section (CS) at Mbarara Regional Referral Hospital, Mbarara, Uganda. Methods Between November 2024 and February 2025, we conducted a cross-sectional study and systematically sampled mothers who delivered by CS. Data were collected through structured electronic surveys and medical records abstraction. IPPC uptake was defined as a mother who took on a contraceptive method within the first 72 hours following a CS. We estimated the prevalence of IPPC and used logistic regression to identify sociodemographic, medical, obstetric, and contraceptive factors associated with IPPC. Results A total of 429 women were enrolled, with a mean age of 27 years. The prevalence of IPPC uptake was 6.8% (95% CI: 4.7-9.6). The commonest contraceptive method taken up was bilateral tubal ligation (75.8%, 22/29). The reasons for IPPC non-uptake were preference to first heal (238/400, 59.5%), chose natural methods (92/400, 23%), lack of awareness (42/4000, 10.5%), needed partner consent (14/400, 3.5%), and unavailability of the methods (7/400, 1.75%). Factors associated with immediate postpartum uptake were no formal education (adjusted odds ratio (aOR) = 8.52, 95% CI: 1.88-38.5; p < 0.005) and having ever used postpartum contraception (aOR = 5.08, 95% CI: 1.32-19.44; p < 0.018). Conclusion and recommendation Uptake of immediate postpartum contraception remains suboptimal among women undergoing cesarean delivery. Having no formal education and prior postpartum contraception use were independently associated with IPPC uptake. Strengthening the integration of contraceptive counseling and method provision during the antenatal, intrapartum, and postpartum periods may substantially improve uptake and improve maternal and neonatal outcomes.
A Comparative Analysis for Inhospital and Postdischarge Puerperal Sepsis (Readmissions) Among Mothers Admitted in Mbarara Regional Referral Hospital
(Cureus, 2026) Luwaga,Rachel; Shindell,Deborah; Bajunirwe,Francis; Ngonzi,Joseph
Introduction: Puerperal sepsis is defined as an infection of the genital tract occurring within 42 days after delivery. It is characterized by symptoms such as chills, fever, foul-smelling vaginal discharge, pelvic pain, and delayed uterine involution. The condition is more prevalent in low-income countries, with Uganda among those reporting higher rates. Puerperal sepsis can be acquired either during the initial birth hospital admission or after discharge, resulting in readmission. Although the risk of infection exists during the antenatal period, it increases significantly during delivery and remains elevated throughout the postnatal period. Knowledge of self-care and use of postnatal care services are often limited in low-resource settings, increasing the risk of infection. Understanding the differences between mothers readmitted and those who acquire puerperal sepsis while hospitalized provides information for designing targeted interventions in its prevention. Therefore, we compared the magnitude, maternal characteristics, and associated factors among mothers who developed puerperal sepsis during their initial admission and those readmitted with post discharge puerperal sepsis at Mbarara Regional Referral Hospital. Methods: A retrospective chart review was conducted on a total of 316 files from 2017 to 2024 of mothers diagnosed with puerperal sepsis who had been admitted to the maternity and gynecology wards of Mbarara Regional Referral Hospital. Information was extracted using a predesigned checklist. The data were then cleaned, entered into MS Excel (Microsoft Corporation, Redmond, Washington, United States), and imported into IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States) for analysis. Readmissions were summarized as proportions, and binary logistic regression was performed for both bivariate and multivariate analyses. Additionally, the Mann-Whitney U test was used to assess differences in length of hospital stay. Results: The proportion of readmissions (66.8%, n = 211) was higher than that of mothers who acquired puerperal sepsis while still hospitalized. Most readmitted mothers had delivered by cesarean section (86.5%, n = 186) and were from rural areas (67.3%, n = 142). Factors significantly associated with readmission included age 15-19 years (adjusted odds ratio (AOR): 6.815; 95% CI: 1.786-26.018) and being prim parous (AOR: 0.424; 95% CI: 0.186-0.968). There was also a significant difference in length of hospital stay between readmitted and non-readmitted mothers (Mann-Whitney U: 7974; Z: −4.085; p < 0.001). Conclusion and recommendation: Despite the observed reduction in admissions due to puerperal sepsis, the predominance of post discharge cases, particularly among mothers who underwent cesarean section and younger mothers, remains a significant challenge to achieving Sustainable Development Goal 3. Targeted interventions focusing on the prevention of puerperal sepsis, with emphasis on post discharge self-care, are therefore essential.
User perceptions of a point-of-use water filtration device: Qualitative, focus group study
(PLoS, 2026) Fuller,Martha Grant; Najjuma,Josephine N.; Jacobitz,Frank G.; Macdonald,Keith; Ruzaaza Ndaruhutse,Gad
Universal access to clean water is sixth of the United Nations sustainable development goals. It has not yet been achieved. Boiling water, for water purification, is cost prohibitive and polluting. Diarrheal diseases linked to unsafe water cause morbidity and mortality in young children in Uganda, where most if the rural population lacks access to treated water. Bacterial water contaminants include Escherichia coli and Salmonella Typhi. Community perceptions of water quality and mitigation efforts in rural Uganda is unknown. In the absence of safe drinking water, a low-cost method of water purification is needed. In vitro studies of plant xylem filtration found this technique successful in removing coliform bacteria and other pollutants. The purpose of this study was to explore perceptions of water quality impact on the lives and health of residents in a rural community in Southwestern Uganda and obtain reactions to a prototype point-of-use water filtration device to determine the possibility of implementing its use in this community. Qualitative descriptive analysis of translated transcripts of purposefully designed focus groups was conducted. Participants included 36 adult residents of a rural community in Uganda. Groups led by experienced Ugandan facilitators in the local language, no researchers from the USA were present. No participants had access to treated water, past efforts to improve water failed due to lack of follow-up. Community members were aware of the poor quality of their water and described water associated illnesses in family members. Obtaining and boiling water required time, money, and resources with households using an average of 142 liters of water/day. Response to the device was mixed, with some excited at the possibility of using it and others expressing concerns regarding durability and cost. Future efforts must address concerns about costs and durability of any point-of-use device and will require extensive planning for sustainability
Use of artificial neural network optimization for MHD and non-Newtonian peritoneal Jeffery nanofluid dynamics on female reproductive health
(Journal of Biological Engineering, 2026-05-12) Anuradha,Keerthi Devarajan; Dhinakaran,Vedhesh; Viharika,J. U.; Sreesai, V; Khan, Umair; Khashi’ie,Najiyah Safwa; Nakintu,Justine
The dynamics of peritoneal fluid has vital applications in various physiological functions, particularly in female reproductive physiology, which modulates the transport of gametes within the fallopian tubes. This research aims to study the interactive operating factors of peritoneal fluid flow, heat transfer, and mass transport under various physiological and pathological conditions. In this regard, the Jeffrey fluid model is applied to examine the non-Newtonian behavior of peritoneal fluid and its responses to thermal and magnetic influences. The study extends to consider thermophoresis and Brownian motion of nanoparticles in Nano fluids with the purpose of enhancing thermal conductivity and optimizing fluid properties toward better reproductive health. Magnetic field effects on fluid dynamics, using magneto hydrodynamics, are also explored in relation to possible therapeutic interventions for endometriosis and tubal factor infertility. Numerical solutions and graphical interpretations are used to illustrate the impact of salient parameters such as Grashof numbers, Brownian motion, and shear-dependent viscosity on the fluid behavior. The results deepen the current understanding of the mechanics of peritoneal fluids and provide potential improvements in fertility treatments and biomedical applications. The proposed model can be applied to develop a non-invasive diagnostic technique for detection of endometriosis, to optimize infertility treatments and to design biomedical devices for peritoneal fluid manipulation in female reproductive therapy
Twelve Years of Managing Female Urogenital Fistula in Uganda: Characteristics, Repair Outcomes, and Predictors for Success in a Multicentre Cohort Study
(International Urogynecology Journal, 2026-07-08) Kayondo,Musa; Margolis,Thomas; Byamukama,Onesmus; Ainomugisha,Brenda; Kajabwangu,Rogers; Kalyebara,Paul Kato; Tabaijuka,Leevan; Ochola,Henry; Lugobe,Henry Mark; Geissbühler,Verena
Abstract Introduction and Hypothesis to describe the characteristics and aetiology of urogenital fistula, and to determine the predictors for successful repair. Methods We conducted a multicentre retrospective cohort study using prospectively collected data of women who underwent urogenital fistula repair at four regional repair centres between 2010 and 2021. The fistulae were classified as ischaemic (urethrovaginal and vesicovaginal), iatrogenic (vesico-cervical, vesico-uterine, vaginal vault fistula, and ureteric fistula) and congenital. The patients were followed up at 3 months postoperatively to assess surgical outcomes. Successful repair was defined as fistula closure with urinary continence, while unsuccessful repair included failed fistula closure or residual urethral incontinence. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for predictors of successful repair. Results A total of 510 women were included. The mean age was 32.7±12.5 years. The most common fistula type was urethrovaginal (34.9%). Successful repair was achieved in 80.8% (95% CI 77–84). Women with urethrovaginal fistula (aRR 0.18; 95% CI 0.1–0.4; p =0.009) were less likely to have successful repair. In contrast, grand multiparity was associated with a higher likelihood of success (aRR 2.4; 95% CI 1.08–5.2; p=0.03). Conclusion Fistula repair outcomes were favourable, with a high success rate. Urethrovaginal fistula, previous repair, and divorce were associated with lower likelihood of success. These findings highlight the need for careful patient selection and specialised expertise in the management of complex fistulae
Death after discharge among children living with HIV admitted with suspected sepsis in Uganda: A secondary analysis of two prospective observational studies
(HIV medicine, 2026) Mackenzie,O.; Zhang,C.; Kissoon,N.; Ford,N.; Sugandhi,N.; Kumbakumba,E.; Kabakyenga, J.; Komugisha,C.; Mugisha,N. K.; Wiens,M. O.
Background: Children living with HIV in low-income countries contribute disproportionately to death after hospital discharge. This study investigates the effect of HIV on post-discharge mortality and readmission by exploring a wide range of clinical, maternal and socioeconomic variables. Methods: A secondary analysis of children under 5 years old admitted with suspected sepsis. Participants were enrolled from two multisite observational studies conducted from 2012 to 2013 and 2017 to 2020 across six hospitals in Uganda. Participants were excluded if admitted outside the catchment area, for trauma, short-term observation or if admitted immediately after birth without prior discharge. We used a robust Poisson regression to identify risk factors of post-discharge mortality for three separate HIV groups: children living with HIV (CLHIV), children HIV-exposed uninfected (CHEU) and children HIV-unexposed uninfected (CHUU). We implemented Kaplan Meier curves to compare rates of post-discharge mortality and readmission between the three groups. In addition, we compared the risk ratio of the two outcomes. Results: Of the 7658 children who were discharged alive and completed the 6-month follow-up, 266 (3.5%) were CLHIV, 458 (6.0%) were CHEU and 6934 (90.6%) were CHUU. Post-discharge mortality was statistically significantly higher in CLHIV compared to the CHUU, with rates of 12.8% (34/266) and 5.8% (402/6934), respectively. Contrastingly, readmission was higher in CHUU (17.7% (1227/6934)) compared to CLHIV (11.3% (30/266)). Severe malnutrition, indicated by a weight-for-age z-score of less than 3, was associated with post-discharge mortality among all three groups with aRRs of 4.32 (95% CI: 1.89– 9.81), 3.96 (95% CI: 1.75–8.95) and 4.84 (95% CI: 3.94–5.96) for CLHIV, CHEU and CHUU, respectively, compounded by the fact that severe malnutrition is disproportionately higher in those living with HIV. Variables associated with post-discharge mortality in this group were prior antimalarial use (aRR = 2.27 [95% CI: 1.16–4.47]) and moderate anaemia (aRR = 2.33 [95% CI: 1.12–4.89]). Conclusions: Children living with HIV represent an exceptionally vulnerable group following hospital discharge. Very low readmission rates alongside high mortality suggest that strategies to improve care transitions and follow-up in these children are essential to improving recovery and survival
Second-order variational analysis of PV–battery energy management using jacobi equations
(Scientific Reports, 2026-05-16) Mundu,M. M.; Basajja,Mariam; Kweyu,Emmanuel; Ssempewo,J. I.; Nnamchi,S. N.; Uti,Daniel Ejim
The increasing penetration of photovoltaic (PV) generation requires energy management strategies for PV–battery systems that are not only optimal but also stable and robust under variable solar generation and load demand. Classical optimal control approaches based on first-order optimality conditions ensure stationarity of solutions but provide limited observation into local stability and sensitivity to operational perturbations. This paper introduces a second-order variational framework based on Jacobi equations to analyze and design optimal PV–battery energy management trajectories. The proposed methodology quantifies state-of-charge (SOC) trajectory stability, explicitly identifies conjugate points that signal loss of local optimality, and characterizes time-dependent sensitivity to PV and load fluctuations through Jacobi fields. Numerical experiments on a representative 24-hour PV–battery system demonstrate the practical effectiveness of the approach, revealing critical periods of vulnerability and providing quantitative guidance for battery sizing, control-weight selection, and predictive operational planning. Results show that incorporating second-order optimality conditions enables rigorous stability verification and enhanced robustness compared with classical first-order methods. By extending conventional optimal control frameworks with stability-aware analysis, this work provides a mathematically grounded and practically relevant foundation for resilient energy management in renewable microgrids and residential PV–battery systems
Prevalence and genotypic distribution of high-risk human papillomavirus in primary breast tumors in Western Uganda: a case control study
(Scientific Reports, 2026-05-08) Birungi,Abraham; Kalyetsi,Rogers; Nalumaga,Pauline Petra; Tumwesigye,Habert; Ssedyabane,Frank; Tumwesigire,Samuel; Simeon,Eloba; Yekosani,Mitala; Atwine,Raymond; DiazAnaya,Amnia; Aisagbonhi,Omonigho
Although in vitro studies have demonstrated that HPV can immortalize mammary epithelial cells, its contribution to breast carcinoma development in living organisms remains debatable. Reports on HPV detection in breast tumors vary widely across regions, and data from East Africa are limited. This study investigated the prevalence and genotypic distribution of high-risk HPV in breast tumors in Western Uganda. This retrospective case-control study was conducted using archived formalin-fixed paraffin embedded tissue specimens from 66 breast carcinomas (cases) and 42 fibroadenomas (controls) diagnosed between 2012 and 2018 at Mbarara Regional Referral Hospital. High-risk HPV DNA was detected using real-time polymerase chain reaction (rRT-PCR), and genotyping was performed using the AmpliSens HPV HCR genotype-titre-FRT PCR kit. To validate the assay, cervical squamous cell carcinoma samples served as technical controls. Associations between HPV prevalence and breast carcinoma were assessed using chi-square tests and odds ratios. High-risk HPV DNA was detected in 25 of 108 breast tumor specimens (23.1%). The prevalence of HPV was 24.2% (16/66) in breast carcinomas and 21.4% (9/42) in fibroadenomas, with no statistically significant difference between cases and controls (p=0.735; OR=1.17, 95% CI: 0.46–2.97). Detected HPV genotypes included 16, 18, 33, 39, 45, 51, 56, and 58. HPV genotype 39 was the most frequently detected genotype in both breast carcinomas (50% of HPV-positive cases) and fibroadenomas (44.4% of HPV-positive cases). High-risk HPV was detected in all cervical cancer control specimens, confirming assay validity. These findings indicate that although high-risk HPV DNA was detected in breast tissue in this population, its presence alone does not support a primary causal role in breast carcinogenesis. Further studies incorporating viral load and transcriptional activity are needed to clarify the biological relevance of HPV in breast tissue.
Prevalence and associated factors of non-communicable diseases among men: A cross-sectional analysis of Kenya Demographic and Health Survey 2022 data
(PLoS One, 2026-07-20) Asiimwe,John Baptist; Nuwabaine,Lilian; Namulema,Angella; Sserwanja,Quraish; Kawuki,Joseph; Nambozi,Grace
Background Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, with low- and middle-income countries (LMICs) increasingly being disproportionately affected. Although anecdotal evidence or reports indicate an increasing number of Kenyan men having NCDs, the prevalence and associated factors are not well understood. Therefore, this study aimed to determine the prevalence and associated factors of non-communicable diseases among men in Kenya. Methods Secondary data comprising 14,439 men aged 15–54 years from the 2022 cross sectional Demographic and Health Survey (KDHS) in Kenya were analyzed using univariable and multivariable logistic regression analyses in SPSS, version 29. Results Overall, the percentage of men with at least one NCD was 9.4% (95% confidence interval [CI]: 8.7–10.2%). Whereas the proportion of participants with multiple NCDs was 1.9 (95% CI: 1.6–2.3). Across NCDs, the highest prevalent NCD was hypertension (3.5% 95%CI:3.1–3.9) followed by depression (2.2% (95%CI:1.9– 2.5), anxiety (1.6% (95%CI:1.3–1.9), arthritis (1.4% (95%CI:1.1–1.6), heart dis ease (1.2% (95%CI:0.9–1.5), diabetes (1% (95%CI:0.8–1.3), lung disease (1% (95%CI:0.7–1.3), and cancer (0.1% (95%CI:0–0.1). In terms of multiple chronic conditions (multimorbidity), the majority of the participants had diabetes and hypertension (0.5% (95%CI:0.3–0.7) followed by hypertension and depression (0.3% (95%CI:0.2–0.4), hypertension and anxiety (0.3% (95%CI:0.2–0.4), and arthritis and depression (0.2% (95%CI:0.1–0.2). Several factors, such as age, region, residence, ethnicity, education level, health status, wealth index, religion, media access, and living a sedentary lifestyle, were found to be significantly associated with the prevalence of NCDs. Conclusion The overall prevalence of NCDs among men is relatively low based on available national data. We found that sociodemographic and lifestyle factors were significantly associated with the prevalence of NCDs. Although causal relationships cannot be inferred from this study, the findings suggest that initiatives such as tailored health education, regular medical checkups, and the promotion of physical activity may be relevant components of broader efforts to support men’s health in relation to non-communicable diseases (NCDs). Region-specific policies and culturally sensitive approaches may help address variations in risk factors and observed ethnic disparities. Encouraging healthier lifestyle practices among men of all backgrounds and improving access to integrated healthcare in rural areas may also be important considerations. Further research is needed to explore how media exposure, media content, health messaging, and religious contexts may influence men’s exposure to NCDs in Kenya and other sub-Saharan countries
Predictors of extinction risk in large tropical forest mammals: From global to local
(Science Advances, 2026) Schowanek,Simon D.; Sheil,Douglas; Beaudrot,Lydia; Dupont,Pierre; Espinosa,Santiago; Estienne,Vittoria; Julia, E. Fa; Geldmann,Jonas; Jansen,Patrick A.; Johnson,Steig E.; Rovero,Francesco; Santos,Fernanda; Semper-Pascual,Asunción; Vargas,Andrea Fernanda Vallejo; Ahumada,Jorge A.; Akampurira,Emmanuel; Amin,Rajan; Bitariho,Robert; Fayolle,Adeline; Fonteyn,Davy; Greco,Ilaria; Lima,Marcela Guimarães Moreira; Luskin,Matthew Scott; Kenfack,David; Martin,Emanuel H.; Uzabaho,Eustrate; Vermeulen,Cédric; Bischof,Richard
Studies can only guide conservation if their findings are informative at the scales at which practitioners and policy-makers operate. Yet, it is rarely tested whether large-scale studies reach similar conclusions to the smaller scale studies on which conservation traditionally relies. We examine whether predictors of extinction risk are consistent across global, regional, and local scales, for 210 tropical forest mammal species (≥1 kg) that existed during the last 130,000 years, in 64 tropical forests, across three biogeographical realms. We found consistent predictors of extinction risk (body mass, generation length, diet, brain volume, and scansoriality) when analyses differed only in their spatial resolution. However, predictors differed when analyses also varied in their temporal extent. Macroecological findings about extinction risk can, thus, inform conservation at smaller scales, but they risk misidentifying threatened species if differences in temporal extent are not recognized.