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

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Faculty of Medicine 2321
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Maternal Newborn and Child Health Institute 18

Recent Submissions

Unexpected detection of Mycobacterium tuberculosis DNA in US-born patients in putative association with clinical syndromes
(Nature Communications, 2026) Edward C. Jones-López; Nancy S. Miller; Beverley Orr; Laura F. White; Solange Vinhas; Moses Mpeirwe; Patrick Orikiriza; Juliet Mwanga-Amumpaire; Moises Palaci; Reynaldo Dietze; Yap Boum II; Guillermo Madico
Sequential inflammatory stages characterizing early tuberculosis (TB) disease and reports of differentially culturable M. tuberculosis have compounded existing gaps in the detection of paucibacillary TB disease, threatening global elimination goals. Here we report unanticipated results we encountered while conducting early development work for an ultrasensitive molecular TB assay that has been validated in various cohorts of patients with suspected TB disease. Detection of M. tuberculosis DNA (TB-DNA) was confirmed by an alternate molecular target and sequencing. Over a six-year period, we conducted three separate clinical studies (N = 297) that tested two sets of anonymized respiratory samples from patients hospitalized in two Boston hospitals, and a longitudinal observational study to determine clinical associations and outcomes. We found an unexpectedly high prevalence of TB-DNA in US-born patients and a potential association with acute chest syndrome in patients with sickle cell disease. These results are preliminary and will require further study in prospective studies that include clinical, radiological, immunological, and microbiological correlation.
The Incidence of Hemolytic and Serologic Transfusion Reactions Among Patients with Hematological Malignancies at Mbarara Regional Referral Hospital and the Uganda Cancer Institute, in Uganda
(Journal of Blood Medicine, 2026) Ivan Mugisha Taremwa; Nixon Niyonzima; Scholastic Ashaba; Deusdedit Tusubira; May Y Choi; Craig N Jenne; Guido van Marle; Bernard Natukunda
Background: Blood transfusions are essential in the supportive care of patients with hematological malignancies but carry a risk of adverse reactions. Data on the incidence of transfusion reactions remain scarce in Uganda. This study evaluated the incidence of hemolytic and serologic transfusion reactions among patients with hematological malignancies at Mbarara Regional Referral Hospital and the Uganda Cancer Institute in Uganda. Materials and Methods: This prospective cohort study enrolled hospitalized patients aged ≥2 years with hematological malignancies and a history of prior red blood cell (RBC) transfusions. Participants received additional transfusions and were monitored for up to 14 days. Blood samples were collected on day 0 (transfusion day), days 7, and 14 to assess hemoglobin (Hb) levels, lactate dehydrogenase (LDH), and perform direct and indirect antiglobulin tests. Participants’ medical records were also reviewed for transfusion and pregnancy histories. Repeated Measures-Analysis of Variance was used to compare mean Hb and LDH levels over time points. Results: Of the 467 participants enrolled (median age: 36.4 years, interquartile range: 27.3–46.9), 382 completed the follow-up period. A progressive increase in mean Hb levels (g/dL) was observed: 6.6 (95% confidence interval [CI]: 6.1–8.9) on day 0, 7.5 (7.3–10.1) on day 7, and 8.9 (8.4–10.6) on day 14. No acute or delayed hemolytic reactions occurred. The incidence of delayed serologic transfusion reactions (DSTRs) was 0.86 in 100 (95% CI: 0.02–1.69), while the overall RBC alloantibody prevalence was 2.4% (95% CI: 0.98–3.74). The identified alloantibodies were directed against antigens in the Rh, Kell, Lewis, and MNS group systems. Conclusion: Despite a low incidence of DSTRs, a notable prevalence of RBC alloimmunization was observed among patients with hematological malignancies. These findings underscore the need to strengthen pre-transfusion antibody testing to prevent hemolytic complications and improve transfusion outcomes in this population.
Prevalence and associated factors of chorioamnionitis among women with preterm premature rupture of membranes at Mbarara Regional Referral Hospital, Southwestern Uganda
(BMC Pregnancy and Childbirth, 2026) Ochuga Patrick Olanya; Richard Migisha; Yarine Fajardo; Onesmus Byamukama; Musa Kayondo; Godfrey R. Mugyenyi; Joseph Ngonzi; Hamson Kanyesigye; Anisa Salad; Begumana Daniel; Mohamed Bashir; Kasyeba Sowed; Byaruhanga Norbert Musisi; Anyit Moses; Adupa Emmanual; Etwop Patrick; Leevan Tibaijuka
Background: Chorioamnionitis is a frequent complication of preterm premature rupture of membranes (PPROM) and contributes substantially to adverse maternal and neonatal outcomes. However, data on the burden and determinants of chorioamnionitis among women with PPROM in resource-limited settings, including Uganda, are limited. This study determined the prevalence and factors associated with chorioamnionitis among women admitted with PPROM at a regional referral hospital in southwestern Uganda. Methods: This hospital-based cross-sectional study was conducted from December 2024 to April 2025 among pregnant women admitted at 26 weeks to 36 weeks and 6 days of gestation, with a diagnosis of PPROM. Consecutive sampling was used to enroll participants. Data were obtained through structured interviews, review of clinical records, and laboratory investigations, including microbiological culture, to capture sociodemographic, obstetric, medical, and clinical information. Chorioamnionitis was defined as maternal fever (≥38 °C) with at least one additional clinical or laboratory sign (uterine tenderness, foul-smelling amniotic fluid, maternal or fetal tachycardia, leukocytosis, or elevated C-reactive protein) and a positive cervical or posterior fornix culture used to detect intra-amniotic infection. Associations were assessed using modified Poisson regression to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals. Results: A total of 324 women were enrolled with a mean age of 26.56 (±5.86) years. Most of the women had primary or no education (69.8%), and were unemployed (65.7%). The prevalence of chorioamnionitis was 39.8% (n=129/324, 95% Confidence Interval [CI]: 34.6–45.3%). The factors independently associated with chorioamnionitis were duration of PPROM (≥4 days) (aPR=5.85, 95% CI: 2.68–12.78) and undergoing≥4 digital vaginal examinations (aPR=3.25, 95% CI: 1.51–6.70). Conclusion: Chorioamnionitis was common, affecting approximately four in ten women with PPROM at MRRH, which may be influenced by delayed presentation and initiation of prophylactic antibiotics. Prolonged duration of membrane rupture and multiple digital vaginal examinations were associated with increased prevalence of chorioamnionitis. These findings underscore the importance of preventive practices during expectant management of PPROM, including minimizing unnecessary digital vaginal examinations and maintaining clinical vigilance for signs of chorioamnionitis. Future studies could evaluate the maternal and perinatal outcomes of chorioamnionitis among women with PPROM in this setting.
Reducing Iatrogenic Female Genitourinary Fistula: Impact of Short-Term Obstetric Training for Lower Cadre Surgeons in Uganda
(International Journal of Women's Health, 2026) Musa Kayondo; Onesmus Byamukama; Brenda Ainomugisha; Wilson Birungi; Rogers Kajabwangu; Paul Kato Kalyebara; Christopher M Tarnay; Verena Geissbühler
Background: In Uganda, almost 50% of genitourinary fistulae are iatrogenic, primarily resulting from inadvertent urinary tract injuries during obstetric and gynecologic surgeries. Cesarean sections (CS), often performed by less experienced providers at lower level facilities, account for 70% of these cases. In 2022, the Essential Training in Operative Obstetrics (ETOO) program was introduced to improve surgical skills among lower cadre surgeons. This study evaluated the program’s impact on iatrogenic fistula incidence at a tertiary teaching hospital in southwestern Uganda. Methods: A retrospective review was conducted on women who underwent fistula repair at a tertiary teaching hospital in south western Uganda between January 2020 and December 2024. Data from the pre-training period (2020–2021) were compared with post training data (2022–2024). Fistulae were classified as iatrogenic if caused by surgical error rather than obstructed labor. Anatomical subtypes included ureteric injuries, vault fistulas, and vesico-[utero]/-cervico-vaginal fistulas. The primary outcome was the annual number and proportion of iatrogenic fistula cases. Results: Among 102 fistula cases post-training, 57 (55.9%) were iatrogenic. Most followed CS (66.7%) and involved ureteric injuries (54.3%). A significant portion (34.8%) originated from private facilities. Following ETOO implementation, annual iatrogenic cases declined from 39 in 2020 to 19 in 2024. A marked drop occurred in late 2022, aligning with program rollout. The trend slope of −5.4 suggests a steady annual decline. Conclusion: The ETOO program is associated with a notable reduction in iatrogenic fistula incidence. Expansion to private and lower-level facilities is recommended to enhance nationwide surgical safety
In Vivo Imaging With a Low-Cost MRI Scanner and Cloud Data Processing in Low-Resource Settings
(NMR in Biomedicine, 2026) Teresa Guallart-Naval; Robert Asiimwe; Patricia Tusiime; Mary A. Nassejje; Leo Kinyera; Lemi Robin; Maureen Nayebare; Luiz G. C. Santos; Marina Fernández-García; Lucas Swistunow; José M. Algarín; John Stairs; Michael Hansen; Ronald Amodoi; Andrew Webb; Joshua Harper; Steven J. Schiff; Johnes Obungoloch; Joseba Alonso
The goal of this work is to demonstrate in vivo imaging with a low-cost, low-field MRI scanner built and operated in Africa and to show how systematic hardware and software improvements can mitigate the main operational limitations encountered in low-resource environments. To this end, a 46-mT Halbach scanner located at the Mbarara University of Science and Technology (Uganda) was upgraded through a complete reorganization of grounding and shielding, installation of new control electronics, and open-source user-interface software. Noise performance was quantified using a standardized protocol and in vivo brain images were acquired with three-dimensional RARE sequences. Distortion correction was implemented using cloud-based re constructions incorporating magnetic field maps. The revamped system reached noise levels routinely below three times the thermal limit and demonstrated stable operation over multi-day measurements. Three-dimensional T1- and T2-weighted brain images were successfully acquired and distortion-corrected with remote GPU-based reconstructions and near real-time visualization through the user interface. The results show that low-cost MRI systems can achieve clinically relevant image quality when electromagnetic noise and power-grid instabilities are properly addressed. This work highlights the feasibility of sustainable MRI development in low-resource settings and identifies stable power delivery and local capacity building as the key next steps toward clinical translation.
Farmers’ social networks and adoption of disaster risk reduction measures: An experimental study in Uganda
(International Journal of Disaster Risk Reduction, 2026) Rodgers Mutyebere; Ronald Twongyirwe; John Sekajugo; Clovis Kabaseke; Mercy Gloria Ashepet; Grace Kagoro-Rugunda; Matthieu Kervyn; Liesbet Vranken
Action against the severe impacts of climate change requires strengthening the local community’s resilience to hazards such as landslides and flash floods. Therefore, improving farmers' knowledge to adopt farm-based Disaster Risk Reduction (DRR) measures is key. In addition, mountainous areas limit accessibility by external, less-facilitated government extension workers mandated for information transfer. Other informal, local social networks can play a role to promote DRR measures' adoption, but their effectiveness remains unclear. Using an experimental study involving 533 rural households, we investigated the effectiveness of different channels of information transfer: we tested whether a network of Citizen Scientists (CS) - an example of local social networks, can promote adoption of tree planting and diversion channels as DRR measures in the disaster-prone Western Uganda region. We also examined whether the CS network was more effective, than conventional outreach formal extension workers in influencing farmers' behaviour. Analyzing the treatment effect using the Analysis of Covariance, findings indicate that knowledge transfer through CS – either in one-on-one or group sessions - is more effective in enhancing tree adoption than transfer through external agents. For diversion channels, only group sessions facilitated by CS significantly increased their adoption but not the sessions by external agents or CS-facilitated one-on-one sessions. Therefore, social networks promise a bright future for knowledge transfer but may not be a ‘silver bullet’ to information access problems. Long-term impact of knowledge transfer, adoption by others in the farmers' networks, and integrating social networks like CS into the formal extension programs should be investigated.
Knowledge, attitudes, and practices of community health workers regarding Mpox in Mbarara City, Uganda, February 2025
(J. Interv. Epidemiol. Public Health, 2026) Patrick Kwizera; Richard Migisha; Hannington Katumba; Charity Mutesi; Emmanuel Mfitundinda; Owens Joyce Kobusingye; Loryndah Olive Namakula; Emmanuel Okiror Okello; Abraham Muhwezi; Dansan Atim; Ivan Lukabwe; Lilian Bulage; Benon Kwesiga; Alex Riolexus Ario
Introduction: Mpox is a re-emerging zoonotic viral disease with significant public health implications due to its potential for human-to-human transmission and outbreaks in urban areas. Community health workers (CHWs) play a critical role in surveillance, case detection, and health education; however, their preparedness for mpox control is not well documented. This study assessed the knowledge, attitudes, and practices (KAP) of CHWs regarding mpox transmission, detection, reporting, and referral in Mbarara City, February 2025. Methods: We conducted a cross-sectional study in Mbarara City, southwestern Uganda, from February 1–15, 2025. Eligible participants were CHWs aged ≥18 years with at least one year of experience. Those unavailable during data collection were excluded. Using simple random sampling, CHWs were selected from a list of all CHWs across city wards. A self-administered, researcher-developed questionnaire comprising 26 mpox-related KAP items was used. Knowledge was assessed using 11 items, attitude with 5 items, and practice with 7 items, each worth 1 point. Scores >60% were classified as good knowledge, positive attitude, or good practices. Multivariate logistic regression was used to identify KAP-associated factors. Results: Among 206 CHWs, 159 (77%) were female, and 127 (62%) had >10 years of experience. Four participants had not heard about mpox. In total, 64% (129/202) of participants had good knowledge, 90% (181/202) had positive attitudes, and seven (3%) demonstrated good practices. Regarding practices, 143 (73%) engaged in health education, 55 (28%) referred suspected cases, and 51 (26%) consistently reported to health authorities when a suspected case was identified. Having attended mpox-specific training (aOR=5.0; 95%CI: 2.2–11) and having good knowledge (aOR=9.0, 95%CI: 2.6–30) were significantly associated with a positive attitude. Conclusions: While most CHWs showed positive attitudes about mpox, just about two-thirds had good knowledge. Serious gaps remain in case referral and reporting. Targeted CHWs training and mentorship could improve outbreak response effectiveness.
Capacity for glaucoma screening and treatment at primary and secondary level health centers in Uganda: Situational analysis
(Journal of Ophthalmology of Eastern, Central and Southern Africa (JOECSA), 2024) Onyango J; Kwaga T; Namwase S; Tusingwire P; Arunga VN; Atwine D; Arunga S
Objective: To measure the capacity for glaucoma screening and treatment at primary and secondary level health centers in southwestern Uganda. Methods: In a cross-sectional study, we used quantitative methods to conduct a situation analysis at primary (health center IVs, district hospitals) and secondary level health facilities (referral hospitals) within southwestern Uganda. Survey questionnaires were administered to eye health workers at the health facilities to ascertain glaucoma awareness. An inventory checklist was used to establish equipment and consumables available to screen, diagnose and treat glaucoma in the primary and secondary level setting. Results: There were 86 primary and secondary level health facilities enrolled in this study. Out of the 86 facilities, 45 (52.3%) did not have any eye care worker. Majority lacked functioning basic eye equipment and consumables for the diagnosis of glaucoma. Only 28 (32.6%) facilities had a direct Ophthalmoscope. Timolol was the most common eye drop and was available in 12 (14%) of the health facilities. The lowest level of knowledge about glaucoma was observed at health center IVs (34.6%), while the highest level of knowledge was observed at regional referral hospitals (82.7%). Conclusion: There is need to improve the availability of equipment, diagnostic consumables and essential medicines for glaucoma at health facilities in southwestern Uganda. Additionally, training and deployment of more eye care workers at the primary and secondary health facilities is necessary for quality access to eye care services.
Anemia in HIV-Infected Children on ART in Uganda: High Risk Associations with Malaria, Opportunistic Infections, and Poor Adherence
(HIV/AIDS-Research and Palliative Care, 2026) Christopher Lyatinga Anyelwisye; Jimmy Kata Ogwal; Simon Evarist Kadogosa; Rauben Timuzigu; Cricent Anyetaba; Robert Wagubi; Clinton Olong; Elizabeth A John; Enoch Muwanguzi; Benson Okongo
Purpose: This study aimed to determine the prevalence and associated factors of anemia among HIV-positive children receiving antiretroviral therapy (ART) at two urban clinics in Mbarara City, Southwestern Uganda. Patients and Methods: We conducted a cross-sectional study among 293 HIV-positive children (<18 years) attending ART clinics at Mbarara Municipal Health Center IV and Holy Innocent Children’s Hospital between July and September 2025. A structured questionnaire captured sociodemographic and clinical data. Venous blood were collected for complete blood count (CBC) analysis, and stool samples were examined for intestinal parasites. Data on CD4 count and viral load were abstracted from medical records. Anemia was defined using age-specific WHO criteria. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with anemia, with statistical significance set at p ≤ 0.05. Results: The overall prevalence of anemia was 6.14% (95% CI: 3.4% – 8.9%). Normocytic normochromic anemia was the predominant morphological type (72.2%). In the multivariate analysis, a recent episode of malaria (AOR = 9.61; 95% CI: 3.26–28.34), the presence of an opportunistic infection (AOR = 6.78; 95% CI: 1.28–35.83), and poor adherence to ART (AOR = 14.75; 95% CI: 1.31–165.65) were independently and significantly correlated with anaemia. Conclusion: While the prevalence of anemia in this cohort of HIV-infected children on ART was lower than global averages, it remains a significant clinical concern. The strong associations with malaria, opportunistic infections, and suboptimal ART adherence highlight critical areas for intervention. Targeted strategies, including integrated malaria control, enhanced prevention and management of OIs, and reinforced adherence support, are required to decrease the anaemia burden and optimize health outcomes in this at-risk population.
Genomic Characterization of Selected ESKAPEEE Clinical Isolates From Mbarara Regional Referral Hospital, Southwestern Uganda: Resistome, Multilocus Sequence Typing, Mobilome, and Virulome
(Cureus, 2026) Judith Owokuhaisa; Joel Bazira; Moses Mpeirwe; Godwin Tusabe; Edgar Mulogo
Background: The global dissemination of Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus faecium, Enterococcus faecalis, and Enterobacter cloacae pathogens is increasingly driven by the convergence of multidrug resistance (MDR) and hypervirulence. These opportunistic pathogens are characterized by their ability to "escape" the bactericidal effects of conventional antibiotics through a refined repertoire of resistance mechanisms. Infections related to these pathogens are responsible for the majority of hospital-acquired infections (HAIs) globally, leading to increased morbidity, mortality, and healthcare costs. Methods: This study used whole-genome sequencing to identify the resistome, virulome, mobilome, and multilocus sequence types of selected clinical Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterobacter cloacae pathogens. Results: Molecular profiling revealed a diverse virulome, with Pseudomonas aeruginosa (ST244) exhibiting the most expansive repertoire (>130 virulence factors (VFs)), including type III secretion system effectors (exoS, exoT) and complete alginate biosynthesis (alg) clusters. S. aureus (ST1) demonstrated a potent toxigenic profile characterized by the Panton-Valentine Leukocidin (lukF/S-PV) and toxic shock syndrome toxin-1 (tsst-1) genes. Among the Enterobacteriaceae, virulence was dominated by the yersiniabactin ( ybt) and enterobactin (ent/fep) iron-acquisition systems, which were notably conserved across Klebsiella pneumoniae (ST307) and E. coli (ST448). Furthermore, the presence of the Escherichia coli common pilus (ecp) and curli fimbriae (csg) across multiple species suggests that mobile genetic elements (MGEs) facilitate the horizontal transfer of "survival packages" that combine colonization and persistence traits. In addition, these isolates also revealed diverse plasmids varying significantly in size (1,570 bp to 235,562 bp) and GC content (0.28 to 0.65). Conjugative plasmids were exclusively large (>60 kb) and characterized by the presence of both a relaxase (primarily MOBH or MOBP) and a mate-pair formation (MPF) system (predominantly MPF_F and MPF_T). Conclusion: These findings identify a critical genetic variation where high-risk bacteria combine multidrug resistance with an enhanced ability to cause disease. The emergence of these multidrug-resistant bacteria highlights an urgent need for genomic tracking in clinical settings to monitor and prevent their spread.
Uneven hydroclimatic risk and land access constraints challenge refugee agricultural self-reliance in Uganda
(Journal of Agriculture and Food Research, 2026) Emnet Negash; Erin Coughlan de Perez; Laura E.R. Peters; Abena Boatemaa Asare-Ansah; Ronald Twongyirwe; Kwinten Van Weverberg; Catherine Nakalembe; Jamon Van Den Hoek
Uganda's refugee policy is widely regarded for promoting agricultural self-reliance among the country's nearly 2 million refugees, the largest in Africa. However, viability of this model is often challenged by how hydroclimatic shocks interact with household capacity to absorb them, an interaction that remain poorly understood. Here, we address a key gap by explicitly distinguishing unimodal and bimodal rainfall regimes and linking regime-specific drought and wetness dynamics to refugee livelihood exposure and household land access. We analyse 6-month Standardized Precipitation Evapotranspiration Index (1981-2024) and Vegetation Condition Index (2001-2024) anomalies, focusing on May-October main growing and harvest season. We find that the interannual extremes are highly episodic and often asynchronous between rainfall regimes. Only 2009, 2016, and 2023 exhibit widespread drought in both regimes, whereas only 2011 and 2012 are widely wet in both. Many large events are regime specific, producing spatially uneven exposure, and long-term trends in affected area are weak relative to year to-year variability. Major droughts are characterized by a late-season moisture deficit compounded by elevated atmospheric demand, with vegetation responses that are broadly consistent but spatially heterogeneous. We further show that hydroclimatic shocks intersect with rapidly rising refugee exposure in a small set of districts and with large structural constraints on land access and food-related outcomes. Notably, refugees typically hold one-eighth of the mean arable land as host households, a structural deficit suggesting that climate shocks rapidly and unevenly translate into production shortfalls rising market and aid dependence. These findings underscore the fragility of the self-reliance model under spatially uneven, episodic drought conditions. Sustaining refugee self-reliance will not only require spatially explicit climate monitoring but also need structural interventions in refugee-hosting regions where climatic, demographic, and land access pressures converge.
Invisible Yet Resilient: Understanding the Vulnerability and Integration Pathways of South Sudanese Older Refugees in Uganda
(Journal of Central and Eastern European African studies, 2026) Frank Ahimbisibwe; Samuel Opono; Specioza Twinamasiko; Kabasiita Maria Goretti
Forcibly displaced older persons in Africa have not largely been the object of academic research. Recent scholars conducted a scoping review about the situations of displaced older persons in Africa and identified several gaps in the literature, including paying attention to the displaced older persons’ integration in the host societies. Our current study contributes to filling this gap by examining the vulnerability of older refugees and identifying hidden opportunities for resilience and integration in the host communities. The study is based on the primary data collected from South Sudanese refugees in Pagirinya Settlement in Uganda, analysed in conjunction with the available literature. The study finds that despite the vulnerability of older refugees; windows of opportunities exist to develop their resilience and integrate them in the host communities. It concludes that leveraging skills of older refugees and social gatherings in the settlements helps them to curtail vulnerabilities, develop resilience and integrate in the host communities.
Organisational Commitment as a Mediator in the Relationship between Perceived Organisational Justice and Organisational Citizenship Behaviour among Teachers in Government-Aided Secondary Schools of Greater Bushenyi, Uganda
(East African Journal of Interdisciplinary Studies, 2026) Precious Natureeba; Aloysius Rukundo; Sudi Balimuttajjo
This study aimed to examine the mediating role of organisational commitment in the relationship between perceived organisational justice and organisational citizenship behaviour (OCB) among 314 teachers in 51 government-aided secondary schools in Greater Bushenyi. The study adopted a cross-sectional research design grounded in the positivist paradigm and utilised a quantitative approach. Teachers were selected using simple random sampling, while a census strategy was adopted for the schools. Data was collected using a self-administered questionnaire, coded, entered into SPSS version 30 and analysed using hierarchical regression analysis. The study findings revealed that organisational commitment significantly mediates the relationship between perceived organisational justice and OCB (β = 0.37, p < 0.001). The study concludes that organisational commitment is a critical psychological pathway through which perceived organisational justice translates into improved citizenship behaviour among teachers. Therefore, schools that foster fairness while simultaneously strengthening teacher commitment are more likely to achieve higher levels of OCB. School governing bodies, administrators, the Ministry of Education and other policymakers should promote fair decision-making processes, inclusive and transparent communication, and equitable treatment, while also implementing strategies that enhance teacher commitment, such as recognition, involvement in decision-making, and supportive leadership. This integrated approach will strengthen positive teacher behaviours and improve overall school effectiveness.
Lightning-caused disturbance frequency and severity varies with topography in an Afromontane forest
(Journal of Ecology, 2026) Evan M. Gora; Alain Senghor K. Ngute; Rodrigue Batumike; Aida Cuni-Sanchez; Gerard Imani; Beth A. Kaplin; Drew Bantlin; Robert Bitariho; Bianca Zoletto; Nikolaos Petridis; Douglas Sheil; Martin J. P. Sullivan
1. Lightning is an important agent of tropical tree mortality, but field data on lightning-caused disturbances is largely restricted to one lowland tropical forest in Panama. 2. Here we quantified variation in the frequency and severity of visually detectable lightning-caused disturbances across topography in the montane forests of Nyungwe National Park, Rwanda. This was the first systematic assessment of lightning-caused disturbance in any African tropical forest and a preliminary exploration of the association between lightning disturbance frequency and forest tolerance to lightning. 3. Lightning-caused disturbances were observed six times more frequently on ridges (19 strikes across 4.5 km of transects) than in valleys (2 strikes across 2.9 km), but lightning-caused disturbances in valleys tended to cause more tree-level damage than those on ridges (and also kill a higher proportion of the trees affected within each lightning disturbance, although the rarity of disturbances in valleys meant the latter effect was not statistically significant). Overall, lightning disturbances tended to kill a lower proportion of trees in this Afromontane forest than in previously documented lightning disturbances in tropical America. 4. We also observed less tree-level damage to ridge-dominant Syzygium spp. (Myrtaceae) compared to the community-wide average, providing support for taxonomic differences in lightning tolerance. 5. Synthesis. Our results indicate that lightning disturbance severity differs within and among sites, potentially mediated by differences in lightning tolerance among tree species and provide preliminary support for the hypothesis that disturbance severity declines with disturbance frequency.
Level of Emergency Preparedness and Associated Barriers at the Accident and Emergency Ward of a LMIC Hospital: A Cross-Sectional Assessment Using the WHO HEAT Tool
(Open Access Emergency Medicine, 2026) Joel Nabeshya; Elizabeth Atiang; Charity Kwarikunda; Rachel Luwaga; Vallence Niyonzima
Background: Emergency preparedness is a challenge for hospital emergency departments (EDs). In the USA, over 68% of 983 EDs were not emergency prepared, while in Ghana, one hospital’s emergency preparedness level was only 57.4%. At the health facility level, several barriers to emergency preparedness have been reported, including poor access to medical supplies, medications, and equipment; deficits in medical training; and the absence of formal clinical management protocols. Methodology: A cross-sectional study was conducted at the Accident and Emergency (A&E) Ward of Mbarara Regional Referral Hospital (MRRH). Data was collected using the modified WHO HEAT checklist, completed by three (3) key hospital informants, who were preferred for their key insights over a large sample of general staff. Data fell into 11 variables with items in each variable scored between 0 and 2, then the total scores generated percentages. By univariate analysis, the level of emergency preparedness and the associated barriers at the A&E Ward of MRRH were determined. Results: The overall emergency preparedness score at the A&E ward of MRRH was 62.6%, with the human resources category under ED capacity scoring the lowest (37.5%), while the consulting services category under ED resources scored the highest (71.4%). The two most common associated barriers to emergency preparedness in the A&E were medicine stockouts (35.0%) and missing emergency equipment (29.2%), while the least reported barriers were user fees (2.2%), and opening hours (0.7%). Conclusion: According to this study, the level of emergency preparedness in the A&E ward of MRRH was weak, with low level of human resource, and weak quality improvement checks the most contributing factors. The highest reported barriers to strong emergency preparedness in the A&E ward of MRRH were medication stockouts and the absence of emergency equipment.
Geochemistry, Speciation, and Health Risks from Potentially Toxic Elements in Street Dust of Mbarara City, Uganda
(Journal of Xenobiotics, 2026) Hassan Omary Kumenya; Irene Nalumansi; Christopher Angiro; Ivan Kiganda; Timothy Omara; Emmanuel Ntambi
In equatorial Africa, rapid urbanization has increased city populations and particulate matter emissions. Street dust is a visual indicator that can be used to track urban pollution. In the present study, the total concentration and speciation of 10 potentially toxic elements (PTEs; As, Cd, Cu, Cr, Ni, Mn, Fe, Pb, Co, and Zn) in dust (n = 36) sampled from three streets of Mbarara City, Uganda, were determined using Energy Dispersive X-ray Fluorescence and Inductively Coupled Plasma-Optical Emission Spectrometry. The concentration of PTEs (0.27–36,401.50 mg/kg) geostatistically indicated moderate to extremely high enrichment of Cd, Cu, and Co in street dust. According to principal component and hierarchical cluster analyses, As, Pb, Cu, Zn, and Cd originated mainly from anthropogenic inputs, Fe and Mn came from geogenic sources, while Cr, Ni, and Co were from both natural and anthropogenic contributions. The mobility of the PTEs followed a general trend, Zn > Co > Cd > Ni > Cr, with Zn and Co being more environmentally mobile. Human health risk assessments indicated that discernible non-carcinogenic health risks may result from ingestion of dust by both children and adults. Children could also experience cancer health effects through the same exposure pathway.
From Policy to Practice: Evaluating Governance Wellbeing Nexus of Oil and Gas Policy Implementation in Uganda’s Albertine Graben
(East African Journal of Environment and Natural Resources, 2026) Vincent Kisembo; Tom Ogwang; Grace Kagoro Rugunda; Siri Ericksen
The discovery of commercially viable oil and gas in Uganda’s Albertine Graben in 2006 raised expectations for socio-economic transformation in the host districts of Buliisa, Hoima, and Kikuube. In response, the Government of Uganda established an extensive policy and legal framework to regulate exploration, production, environmental protection, and petroleum revenue management. However, the extent to which these frameworks have translated into improved human wellbeing for host communities remains unclear. The objective of this study was to examine how Uganda’s oil and gas governance arrangements have influenced human well-being outcomes in the three districts. A qualitative research design, guided by an interpretivist paradigm, was employed to explore lived experiences and institutional dynamics. Data were collected from 150 participants through focus group discussions, key informant interviews, and documentary reviews involving community members, district officials, civil society organisations, and technical staff from regulatory bodies and oil and gas companies. The results indicate that although Uganda has established strong statutory and policy provisions, their implementation has yielded limited well-being gains. Communities reported restricted access to employment and training opportunities due to affordability constraints, distance to training centres, and inadequate information flow. Environmental and public health concerns persisted, including water contamination, occupational risks, and inadequate health facility capacity. Social safeguards such as valuation transparency, compensation timeliness, livelihood restoration, and grievance handling were inconsistently implemented. Petroleum revenue management systems existed, but host communities had not yet received direct fiscal benefits because production royalties had not commenced. The study concludes that Uganda’s governance framework is robust in design but suffers from implementation gaps. Strengthening institutional capacity, improving transparency, and ensuring the timely delivery of safeguards are critical for enhancing human wellbeing in oil and gas-host communities.
Exploring community perceptions of gender roles as a predisposing factor in schistosomiasis infection in southwestern Uganda
(Global Public Health, 2026) Faith Mugabi; Maxson Kenneth Anyolitho; Tine Huyse; Elizabeth Kemigisha; Viola Nilah Nyakato
Schistosomiasis, a neglected tropical disease, affects people of all genders and ages. However, few studies have examined how communities in endemic areas perceive gender roles as factors influencing infection and control. This study explored the perceptions of farming (Kyaterekera) and fishing (Ndaiga) communities along Lake Albert in Uganda's Kagadi District regarding gender roles and their role in schistosomiasis infection. Using an ethnographic design, we conducted 10 key informant interviews and 18 focus group discussions with 150 participants. Data were analysed thematically. Participants from both settings recognised that gender roles influence infection risk differently for men and women. Societal expectations and gender stereotypes were seen as contributing factors. Farming men often perceived bilharzia as a lake-side issue. Drug side effects were a shared concern, but women in fishing communities preferred using herbs and prayers, while men favoured hospital visits. Gender roles and perceptions of schistosomiasis risk vary by gender and location. Common themes include societal expectations, stereotypes and concerns about treatment. Gender-specific interventions, such as gender-sensitive campaigns and inclusive decision-making, could help effectively control the disease.
Co-designing eCap-CoDe: A mobile health application for primary health care-based dementia care in rural Uganda
(PLOS Digital Health, 2026) Edith K. Wakida; Christine K. Karungi; William Wasswa; Recho Katusabe Ajok; Godfrey Z. Rukundo; Ou Zhang; Alexandra Lopez-Vera; Zohray M. Talib; Celestino Obua
Dementia is an emerging public health challenge in low- and middle-income countries (LMICs), yet it remains underdiagnosed in rural Uganda, where primary health care (PHC) providers often lack tools, training, and data systems for early detection and management. Mobile health (mHealth) applications can enhance provider capacity, improve data capture, and strengthen feedback systems. This study explored the perspectives of PHC providers and District Health Teams (DHTs) to inform the co-design of eCap-CoDe, a mobile application for community-based dementia care in rural Uganda. We conducted in-depth interviews with 31 participants from two rural districts: 23 PHC providers (medical/clinical officers and nurses) and 8 DHT members. Participants were purposively sampled for diversity in cadre, experience, and facility type. Data were thematically analyzed using the Consolidated Frame work for Implementation Research (CFIR), with four a priori domains, i.e., content, user experience, organizational, and service delivery, guiding coding and analysis. Content requirements - included dementia-specific screening and management tools, modular in-app training aligned with the WHO mhGAP Intervention Guide, and structured data capture integrated with Uganda’s Health Management Information System (HMIS). User experience needs: emphasized simple, intuitive interfaces with dropdown menus, checkboxes, audio-visual decision support, and offline functionality to address connectivity gaps. Organizational requirements: prioritized interoperability with District Health Information System 2 (DHIS2), integration with supervisory work flows, and dementia-specific performance indicators. Service delivery needs: focused on real-time feedback loops, reducing duplicate documentation, and potential expansion to other common conditions to enhance utility and uptake. Co-designing mHealth tools with end-users ensures alignment with the realities of workflows, systems, and infrastructure. eCap-CoDe addresses capacity, data, and feedback gaps in rural dementia care and offers a scalable model for integrating digital tools into PHC in Uganda and similar LMICs. Pilot testing will assess the feasibility, usability, and impact before scaling up.
Prevalence of Unintended Pregnancy and Associated Factors Among Women Enrolled in the Support-Moms Study in Southwestern Uganda: A Cross-Sectional Analysis of Baseline Data
(Cureus, 2026) Julius Mugisha; Stuart Turanzomwe; Mugyenyi R. Godfrey; Angella Musiimenta; Micheal Kanyesigye; Henry Ochola; Elly Atuhumuza; Esther C. Atukunda
Unintended pregnancies and unmet need for contraception continue to be a public health concern in Sub-Saharan African countries. This potentially contributes to the high maternal mortality rate in these countries. This study highlights the burden and the context-specific factors associated with unintended pregnancy in Southwestern Uganda. This was a secondary analysis of baseline data from pregnant women enrolled in the Support-Moms trial, which was a community-based randomized controlled trial. The Support-Moms trial recruited 824 pregnant women who had not started antenatal care visits, and these were randomly assigned (1:1) into two groups: the control group, which received standard of care, and the intervention group that received health information messages in the form of Short Messaging Service (SMS) or audio from the Support-Moms App. Participants were recruited from Mbarara City, Mbarara District, and Mitooma District. Enrolled women completed an interviewer-administered questionnaire to collect data on sociodemographic characteristics, reproductive history, prior birth and pregnancy outcomes, household food security, and pregnancy intention. Women who had unwanted or mistimed pregnancies were collectively regarded as having an unintended pregnancy. Data analysis was done using Stata version 19 (StataCorp LLC, College Station, TX), and a modified Poisson regression analysis was employed to document the factors associated with unintended pregnancy. Statistical significance was set at a p-value < 0.05. To assess the prevalence of unintended pregnancy and the associated factors, a total of 818 women were included in the final analysis. The median age was 27 years. Overall, 296 (36.2%) women reported an unintended pregnancy. In multivariable analysis, moderate (adjusted prevalence ratio (aPR) = 1.55; 95% CI: 1.02-2.36) and severe food insecurity (aPR = 1.96; 95% CI: 1.25-3.06), grand multigravidity (aPR = 1.64; 95% CI: 1.11-2.41), and lack of awareness of the partner’s desired number of children (aPR = 1.22; 95% CI: 1.01-1.47) were independently associated with unintended pregnancy. Over one-third of pregnant women in the Support Moms trial, Southwestern Uganda, had unintended pregnancy, largely driven by food insecurity, grand multigravidity, and inadequate partner communication. Context-specific interventions are critical to mitigating this high burden.