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Recent Submissions

Predictors of prolonged decision-to-delivery interval in emergency caesarean section in Northern Uganda: a historical cohort study
(Journal of Obstetrics and Gynaecology, 2026) Henry Ochola; Ronnie Omoro; Paul Buga; Emintone Ayella Odong; Oscar Ocaya; Rogers Kajabwangu; Nelly Atim; Harriet Akello; Judith Praiselyn Acayo; Doris Ekwem; Jovia Namuddu; Derrick Mukurasi; Enock Lukyamuzi; Hudson Onen; Maurine Lenia; Martha Gimono; Emily Webb; Oona Campbell; Ronald Komata; Jerom Okot; Emmanuel Ochola; Sande Ojara
Background: Delays in decision-to-delivery interval (DDI) during emergency caesarean section (CS) may increase the risk of adverse maternal and neonatal outcomes. Evidence on health-system and provider-related factors influencing DDI in low-resource settings remains limited. We examined whether surgeon cadre, operating theatre location, and the presence of intern healthcare professionals were associated with prolonged DDI in a tertiary hospital in Northern Uganda. Methods: We conducted a historical cohort study at St. Mary’s Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. Effect modification by emergency CS indication was assessed. Results: Of the 760 participants enrolled (median DDI was 51minutes [IQR: 36–67]), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to fully-licensed doctors (adjusted odds ratio [aOR]: 2.07; 95% CI: 1.38–3.10). Theatre location and presence of interns showed no association with prolonged DDI (aOR: 0.89; 95% CI: 0.61–1.28) and (aOR: 0.71; 95% CI: 0.50–1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication. Conclusions: Emergency CS performed by junior doctors was associated with increased odds of prolonged DDI compared with procedures performed by fully-licensed doctors. These findings highlight the importance of strengthening supervision, mentorship and emergency obstetric training for junior doctors in resource-limited settings. Operating theatre location and the presence of intern healthcare professionals were not significantly associated with prolonged DDI.
Operational Efficiency and Financial Performance of Agro Processing Firms in Acholi Sub-Region
(International Journal of Entrepreneurship, 2026) Gladys Angee; John Baguma Muhunga Kule; John Rwakihembo; Pereez Nimusima; Mshilla Maghanga; Moreen Niwaha
Purpose: Agro-processing enterprises constitute a vital component of Uganda’s industrial development agenda due to their contribution to value addition, employment generation, income creation, and economic growth. However, many firms continue to experience weak financial performance characterized by low profitability, liquidity constraints, and limited competitiveness. Since financial success is essential for firm survival, growth, and long-term viability, understanding the internal capabilities that drive superior performance remains imperative. This study examined the effect of operational efficiency on the financial performance of agro-processing firms in the Acholi Sub-region of Uganda. Methodology: The study employed a cross-sectional survey design within an explanatory mixed-methods framework. Data were collected from 242 respondents drawn from 70 agro-processing firms in the Acholi Sub-region of Uganda using structured questionnaires, complemented by 13 key informant interviews. Data analysis involved descriptive statistics, Pearson correlation analysis, and simple linear regression. Qualitative data were analyzed using thematic analysis to complement the quantitative findings. Findings: The study found a strong positive and statistically significant relationship between operational efficiency and financial performance among agro-processing firms (r = 0.840, p < 0.001). Regression results revealed that operational efficiency significantly predicts financial performance (β = 0.840, B = 0.738, p < 0.001), accounting for 70.5% of the variation in financial performance (R² = 0.705). Unique Contribution to theory, Practice and Policy: Given the significant contribution of operational efficiency to financial performance, agro-processing firms should prioritize capacity utilization and cycle time management as core strategic capabilities for achieving sustainable competitiveness. Firms should adopt lean operational practices, invest in modern processing technologies, and strengthen resource optimization systems to reduce production costs and improve financial outcomes. At the policy level, interventions aimed at improving infrastructure, technological upgrading, and managerial capabilities are necessary to address external constraints that may limit the financial gain.
Cost Management Practices and Financial Performance of Agro-Processing Firms in Acholi Sub-Region
(American Journal of Accounting, 2026) Gladys Angee; John Baguma Muhunga Kule; John Rwakihembo; Pereez Nimusima; Mshilla Maghanga; Charles Kaggwa
Purpose: Value addition in terms of agro-processing has played a big role in the economic development in emerging markets. This is visible in terms of rural transformation, industrialization, job creation all this significantly making a contribution to achievement of Sustainable Development Goals. Even when the contribution of agro-processing firms is eminent, they have remained financially stressed. Consequent to this reality, this study picked interest in examining the relationship between cost management practices and financial performance of agro-processing firms in the Acholi sub-region. The study specifically investigated the direct relationships among the variables. Methodology: The study was grounded on pragmatic paradigm which allows for triangulation of methods thus mixed-methods approach was used. A cross-sectional design helped in collecting data at one point in time from 242 respondents using questionnaires and interview guides. Both random and non-random techniques were used in selection of agro-processing firms and respondents. Descriptive and inferential techniques were used in data analysis. Findings: The findings revealed that cost management practices significantly and positively influence financial performance of agro-processing firms in the Acholi sub-region (β = 0.642, t = 12.972, p < 0.001) indicating that improvements in cost management practices are associated with enhanced financial performance. Unique Contribution to theory, Practice and Policy: In line with this finding, the study recommends that agro-processing firms should strengthen cost management systems to enhance their financial performance. In line with the theories underpinning this study management of agro-processing firms should constantly aim at enhancing not only their internal capabilities, or even ensuring a fit between internal structures and external environmental conditions, but also aim at economizing on the transaction costs incurred without neglecting the benefits inherent in continuous sensing, seizing, and transforming their resource base to remain viable. The study cautions on the managerial sensitivity on how environmental conditions shape the cost structures and efficiency dynamics of agro-processing firms
Association Between Angiotensin Converting Enzyme Insertion / Deletion Genotypes and Diabetic Nephropathy Defined by Urinary Albumin-to-Creatinine Ratio: A Systematic Review and Meta-Analysis
(F1000Research, 2025) Ritah Kiconco; Robert Kalyesubula; Jazira Tumusiime; Raymond Atwine; Charles Nkubi Bagenda; Simon Peter Rugera; Bosco Bekiita Agaba; Erick Nyakundi Ondari; Deusdedit Tusubira; Martha Lyaka; Moses Ocan; Alison Annet Kinengyere; Ekwaro A. Obuku; Gertrude N. Kiwanuka
Background: Diabetic nephropathy (DN) is a major complication of type 2 diabetes mellitus (T2DM) and a leading cause of kidney failure. Evidence on the influence of ACE I/D polymorphisms in DN risk is inconsistent across populations. Methods: A systematic review and meta-analysis was conducted following the PRISMA 2020 guidelines. Studies published between January 1990 to February 2025 were retrieved from PubMed, EMBASE and Web of Science. Eligible observational studies reported the frequency of ACE genotypes with DN in T2DM. Independent reviewers screened studies using Rayyan software, extracted data, and assessed risk of bias using the ROBINS-E tool. Reporting on the quality of studies was determined using the STREGA guidelines. Pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated using random-effects models in R version 4.4.2. Subgroup, meta-regression, and sensitivity analyses addressed heterogeneity; Egger’s test assessed publication bias. Registered in PROSPERO (CRD42024577680). Funding from Fogarty International Center of the National Institutes of Health (D43TWO11632). Results: Of the 46 studies included in this review, the combined sample size was 16,322 participants. The majority of studies (29 out of 46) were conducted in Asia. Only 5 studies reported DN–related comorbidities by ACE genotypes and one assessed mortality. Twenty-five of the included 46 studies contributed data to the meta-analysis. The ACE II genotype was protective against DN; II vs. ID [OR= 0.70 (CI: 0.63–0.77)] and II vs. DD [OR= 0.68 (CI: 0.55–0.84)]; Heterogeneity was (I2 = 71.7%, τ 2 = 0.1776, p < 0.0001). Stronger associations were observed in studies using urinary Albumin-Creatinine-Ratio over Albumin Excretion-Rate. Egger’s test showed no publication bias (p = 0.55). Conclusion: The ACE II genotype is significantly protective against DN risk in T2DM. Standardization of urinary albumin measurement and further genotype-phenotype studies are needed to strengthen clinical utility of the ACE I/D polymorphisms.
Strengthening research regulatory capacity in the East African community: a multi country training program on emerging and complex study designs
(BMC Medical Ethics, 2026) Mathius Amperiize; Belinda Twesigye; Beth Mutumba; Hellen Opolot; Soazic Gardais; Steve Wandiga; Helen Ndagije; Jeremiah Kidola; Vincent Mutabazi; Ramadhan Nyandwi; Lina S. Mathew; Novat Twungubumwe; Barbara Castelnuovo; Joseph Walter Arinaitwe; Stephen Okoboi; Provia Ainembabazi; Pauline Byakika-Kibwika
Background: The East African Community (EAC) has experienced a significant increase in volume and complexity ofclinical research driven by the epidemics of emerging and re-emerging infectious diseases such as HIV, Ebola, COVID-19, and mpox. This demands for robust research, scientific, and ethical oversight. We aimed to strengthen the capacity of national research regulatory authorities (NRRA), research ethics committees (RECs), and researchers for review and oversight of studies with complex and emerging designs. Methods: We implemented a blended training program from February 2024 to February 2025 in six EAC partner states, including; republic of Burundi, republic of Kenya, republic of Rwanda, republic of South Sudan, republic of Tanzania, and republic of Uganda. Trainees were evaluated using pre and post-training assessments, and also provided qualitative responses. Results: A total of 186 participants completed the training, of which 59.0% (110/186) were males. Participants demonstrated a marked improvement in knowledge, with mean scores increasing from 52.9% at pre-test to 84.0% at post-test, and the proportion of participants that passed increased from 18.1% (34/186) at pre-test to 84.2% (157/186) at post-test. Three main themes emerged from the open-ended response evaluations: (1) enhanced understanding of emerging and complex study designs, (2) relevance to professional roles and practice, and (3) demand for advanced methodological training. Conclusions: There was a substantial shift in knowledge on emerging and complex research study designs. We recommend regular training of NRRA and REC members to improve the quality of review of research protocols with complex and emerging study designs.
The epidemiology of SARS-CoV-2, Influenza, and Respiratory Syncytial Virus circulation among adult patients with acute respiratory illness in Kampala Metropolitan Area in Uganda
(PLoS One, 2026) James Arinaitwe; Barnabas Bakamutumaho; Levicatus Mugenyi; Noah Kiwanuka; Patricia Alupo; Aida N. Kawuma; Karen Ndahura; Maria Sekimpi; Eva Akurut; Winters Muttamba; Moses Joloba; Moses Ocan; Eddie Wampande; Jacqueline Kyosiimire Lugemwa; Jane Nakibuuka; John Lusiba; Joseph Okia; Darius Owachi; Pauline Byakika-Kibwika; Bruce Kirenga
Background: Acute respiratory infections (ARI) caused by viruses such as SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) posed significant public health challenges, particularly in low-income countries. Understanding the co-circulation dynamics of these pathogens is crucial for effective public health monitoring, surveillance, and control interventions. This study aimed to characterize the epidemiology of SARS-CoV-2, influenza, and RSV co-circulation among patients with ARI in Uganda’s central business districts. Methods: A retrospective cohort study was conducted among 1,265 adult outpatients aged 18 years and older presenting with ARI in Kampala, Wakiso, and Mukono districts. Data were collected for the period from March 2023 through April 2024. Nasopharyngeal swabs were collected and tested for SARS-CoV-2, influenza A/B, and RSV using RT-PCR. Data on demographics, clinical presentation, and SARS-CoV-2 vaccination status were analyzed using descriptive statistics and time series analysis. Results: RSV was the most prevalent pathogen (5.5%), followed by SARS-CoV-2 (5.1%), Influenza A (4.4%), and Influenza B (1.7%). Individuals aged 45 and older were more likely to test positive for SARS-CoV-2. There was a significant difference in pathogen presence by occupation (p=0.03), with health workers showing the highest prevalence of SARS-CoV-2 infection, while prevalence did not differ significantly by sex. Seasonal trends showed bimodal peaks for SARS-CoV-2, influenza A, and RSV, with the highest frequency observed between April 2023 to June 2023 and November 2023 to February 2024. However, Influenza B exhibited a single prolonged peak. SARS-CoV-2 vaccination was associated with a higher prevalence of SARS-CoV-2 (8.7% vs. 2.8%, p=0.023) but not with influenza or RSV prevalence. Conclusion: The co-circulation of SARS-CoV-2, influenza, and RSV highlights Uganda’s ongoing respiratory virus burden. Seasonal patterns and recurrent outbreaks underscore the need for sustained surveillance, targeted vaccination, and public health interventions to mitigate the impact of these pathogens, particularly in vulnerable populations.
Determinants of Adverse Events in Patients with Cancer Who Practiced Self-Medication: A Cross-Sectional Study in Southwestern Uganda
(Cancer Management and Research, 2026) Godwin Nimusiima; Sarad Pawar Naik Bukke; Awad Osman Abdalla Mohamed; John Martin Tumwebaza; Radiana Makuza Kabera; Joel Sebisaalu; Amina Abubakar; Patrick Kitheka Muasya; Bayapa Reddy Narapureddy; Nyakato Caroline; Silas Ojuka; John Isiiko; Tadele Mekuriya Yadesa
Background: Cancer therapies have been the cornerstone in cancer care. Co-morbidities and Adverse Events (AEs) often encourage some patients with cancer to resort to self-medication in search of relief or better symptom management. While self-medication is a key aspect of self-care and may offer some relief, it also poses risks, especially the potential for AEs. Limited data exist in Uganda, particularly at the Mbarara Regional Referral Hospital (MRRH) Cancer Unit, regarding the prevalence and determinants of AEs. Objective: To determine the prevalence and factors associated with AEs among self-medicating cancer patients at the MRRH Cancer Unit. Methods: A cross-sectional study was conducted from 1st of February to 31st of March 2025, among patients with cancer attending the MRRH Cancer Unit. Using Cochran’s formula, the sample size was estimated to be 270 patients who were recruited using consecutive sampling technique. Data were collected using interviewer-administered questionnaires and patient records, with medica tion reconciliation performed to identify both prescribed and self-medicated drugs and herbal products. AEs were graded using the Common Terminology Criteria for AEs. Descriptive statistics and binary logistic regression tests were performed using STATA version 17.0 employing and binary logistic regression tests. Results: Out of 270 participants, 218 (80.7%) experienced AEs. Grade 1 was the most common (49.8%) followed by grade 2 (41.4%), and grade 3 (8.8%). The determinants of AEs included the use of alkylating agents (AOR=3.6, 95% confidence interval CI: 1.02–12.51; p-value= 0.046), self-medication with drugs for acid-related disorders (AOR=7.9, 95% CI: 1.79–35.41; p-value=0.006) and herbal medicines use (AOR=2.1, 95% CI: 1.09–4.22; p-value=0.026). Conclusion: AEs among self-medicating patients with cancer are highly prevalent at MRRH cancer unit. Therefore, implementing comprehensive medication review in this population, and applying active ADE risk classification and closer monitoring in high-risk patients, including those on any alkylating agents and those who use herbal products, is crucial to minimize the ADEs and ensure safe use these products.
Design and simulation of a fuzzy-PI based bidirectional converter for HESS applications
(Discover Applied Sciences, 2026) Bruce Akatwijuka; Jimmy Nabende Wanzala; Michael Robson Atim
In response to increasing energy demands, renewable energy sources (RES) are gaining popularity throughout the world. This is as a result of the need to reduce emission of pollutants and dependency on fossil fuels. In order to improve efficiency and maintain grid dependability, modern energy management systems are employed. Different control strategies for DC-DC bidirectional converters have been designed. However, the controllers have drawbacks of high peak overshoot values and increased settling times whenever there is a step change in PV generation. This study develops a fuzzy-PI control method for PV-based DC microgrid systems that employ SCs and batteries. The suggested technique increases the HESS’s overall effectiveness by utilizing the battery pack’s imbalanced energy. The suggested fuzzy PI controller was able to restore the voltage to the appropriate level when abrupt changes in irradiance take place with a transient response of 0.035s settling time and 14.6% overshoot value. In terms of time response, power production, extending battery life, and guaranteeing a steady supply of the PV system, the results show that the suggested approach is more efficient.
Risk factors for cryptococcal infection among people with HIV receiving care at a referral hospital in Uganda: a nested case–control study
(BMC Infectious Diseases, 2026) Sarah Namuyanja; Saidi Appeli; Jonathan Izudi
Background: Cryptococcal infection is a major cause of morbidity and mortality among people with HIV (PWH), particularly those with advanced immunosuppression. Cryptococcal infection, detected by a laboratory-confirmed positive serum cryptococcal antigen (CrAg) test (cryptococcal antigenemia), typically precedes cryptococcal meningitis and provides a critical window for prevention. However, recent data on its risk factors in Uganda are limited. We assessed the risk factors for cryptococcal infection among PWH with non-suppressed viral load and severe immunosuppression receiving care at a referral hospital in midwestern Uganda. Methods: We conducted a facility-based nested case-control study among PWH with non-suppressed viral load (viral load≥1,000 copies/mL) and severe immunosuppression (CD4<200 cells/µL) at the Fort Portal Regional Referral Hospital in midwestern Uganda. Cases were PWH with a positive serum CrAg test, and controls were those with a negative serum CrAg test in a 1:2 case-to-control ratio, respectively. Socio-demographic and clinical data were retrospectively extracted from routine records. Multivariable binary logistic regression analysis was used to identify factors independently associated with cryptococcal infection. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results: We included 89 cases and 178 controls, with comparable mean age between the groups: 40.3±12.4 years vs. 40.4±11.7 years, respectively; p=0.952. In the multivariable analysis, PWH with advanced World Health Organization (WHO) clinical stages III/IV compared to WHO clinical stages I/II (aOR 3.45, 95% CI 1.28–9.97), and those with missed clinic visits within three months before the serum CrAg testing compared to those without any missed clinic visits (aOR 2.39, 95% CI 1.14–5.02) had higher odds of cryptococcal infection. Conclusion: This study showed that among PWH with non-suppressed viral load and severe immunosuppression, cryptococcal infection is strongly associated with markers of advanced HIV disease and gaps in care engagement. Strengthening retention in care, improving clinic appointment tracking, and ensuring timely serum CrAg screeningamong PWH with non-suppressed viral load may reduce cryptococcal disease burden through early diagnosis and treatment.
Clinical Features and Risk Factors of Dermatitis Cruris Pustulosa et Atrophicans in Southwestern Uganda: A Cross-Sectional Study
(Clinical, Cosmetic and Investigational Dermatology, 2026) Grace Kitunzi Mulyowa; Tonny Engwau; Martin Galiwango; Francis Kamuganga; Stephen Kizito Mirembe; Gladys Onguti Aloyo; Rogers Mwavu; William Wasswa; Fred Kaggwa; Celestino Obua
Background: Dermatitis cruris pustulosa et atrophicans (DCPA), a chronic skin inflammatory condition involving the shins, is a marginally recognized disorder in Uganda. Purpose: To describe the clinical manifestation of DCPA and risk factors among populations in southwestern Uganda.Patients and Methods: The study was conducted in Mbarara and Kabale Regional Referral Hospital Skin Clinics. Demographic data and digital images of affected shins were taken and stored on remote server. In a descriptive cross-sectional study, data was collected from 405 participants from 02/November/2022 to 04/January/2024 and was analyzed using R, a data visualization and statistical computing programming language. Results: Most patients (74.9%) were aged 0–25 years, with a mean age of 21.6 years (SD = 15.1). Females constituted 71.9% of cases. Patients were almost evenly distributed between Mbarara (46.2%) and Kabale (53.8%) Hospitals. The largest affected groups were students (38%) and pupils/infants (25.4%) followed by Farmers (16%) and semiskilled laborers (8.9%). Petroleum jelly was the most topical application (28.6%) while herbal remedies (11.9%), Systemic antibiotics (8.9%) and topical antifungal treatments (5.2%) were less frequently used. Conclusion: DCPA presents with itching, pus discharge, and atrophic skin changes. In southwestern Uganda, it mainly affects young females. In its multifactorial etiopathogenesis oily cosmetic products is a contributory factor.These findings, supported by Mbarara University Data Science Research Hub (MUDSReH), highlight the need for improved diagnostic tools and targeted interventions for DCPA. Further research is needed to assess the broader impact of DCPA in Uganda.
Prenatal Diagnosis of Craniorachischisis Totalis Following an Initially Normal First-Trimester Ultrasound in a Woman With Two Previous Caesarean Births: A Case Report
(Cureus, 2026) Julius Mugisha; Stuart Turanzomwe; Ssewanyana Ernest; Charles Lugaaju; Esther C. Atukunda; Mugyenyi R. Godfrey
Craniorachischisis totalis is the most severe form of open neural tube defect and combines acrania/anencephaly with extensive open spinal dysraphism. It is rare, lethal, and usually identifiable prenatally, but diagnostic labeling may evolve across pregnancy as imaging findings become clearer. We report the case of a 33-year-old multiparous woman, gravida 4 para 2+1, with two previous caesarean births, whose booking ultrasound at 8 weeks and 4 days of amenorrhea showed a single live intrauterine embryo with no documented structural abnormality. She later underwent targeted fetal anomaly scanning at 21 weeks, which revealed absence of the calvarium and parenchymal tissue above the orbits, with findings interpreted as anencephaly. A repeat assessment confirmed anencephaly with spina bifida. After multidisciplinary counselling and because of the combination of a lethal fetal anomaly and two prior caesarean scars, termination was done by hysterotomy at 25 weeks of gestational age. The woman delivered a male fetus weighing 659 grams with Apgar scores of 1 and 0 at 1 and 5 minutes, respectively; operative documentation described anencephaly with an open spine and spina bifida, findings most consistent with craniorachischisis. The mother had an uncomplicated postoperative course and remained clinically well at follow-up. This case illustrates the evolution from an initially normal early pregnancy scan to a later lethal neural tube defect diagnosis, and it highlights the need for timely and targeted anomaly screening in resource-limited settings, careful phenotypic documentation, multidisciplinary counselling, and strong recurrence prevention advice after an affected pregnancy
Delayed repair of an anorectal malformation in a 12-year-old girl using perineal body– sparing technique in a resource-limited setting: A case report
(Journal of Pediatric Surgery Case Reports, 2026) Caroline Asiimwe; Denis Oluka; Yasin Ssewanyana; Eden Belay Tilahun; Felix Oyania
Background: Anorectal malformations (ARM) are congenital anomalies that require early surgicalcorrection to achieve optimal functional outcomes. However, in many resource-limited settings, restricted access to specialized care often delays definitive repair, leading to prolonged colostomy dependence and substantial psychosocial consequences. Case: A 12-year-old girl from northwestern Uganda presented for surgical evaluation during a pediatric surgical outreach. In her first week of life, she failed to pass meconium and developed progressive abdominal distension. At one week of age, she underwent a diverting colostomy at a regional referral hospital in northwestern Uganda. Before she turned one-year-old, her mother left her in her grandmother's care, later remarrying. She then lived with a colostomy for 12 years. This led to embarrassment, social withdrawal, and bullying at school, and she ultimately discontinued formal education shortly after enrolling at age five. She was later scheduled for definitive repair and underwent a perineal body–sparing posterior sagittal anorectoplasty (PSARP). During this procedure, the vestibular fistula was identified and closed from within the posterior sagittal incision, preserving the perineal body. At the two-week postoperative visit, the neo-anus was patent, and the wound was healing well. She subsequently underwent scheduled anal dilatations for eight weeks following the PSARP procedure, after which colostomy closure was performed. Her postoperative course was uneventful, and she continues to do well on follow-up. Conclusion: The perineal body–sparing PSARP technique seems to be a safe and effective option for the delayed repair of a rectovestibular fistula.
Remdesivir triphosphate as a potential repurposed drug against the emerging Bundibugyo Ebolavirus 2026
(Journal of Infection, 2026) Mansi Dutt; Misaki Wayengera; Gustavo Sganzerla Martinez; Anuj Kumar; Andrew Nsawotebba; Isaac Ssewanya; Suzan Nabadda; Barnabas Bakamutumaho; Bruce Kirenga; Charles Olaro; Winters Muttamba; Pauline Byakika; Jane-Ruth O. Aceng; Diana Atwiine; Henry Kyobe Bosa; David Kelvin; Wilber Sabiiti
Bundibugyo virus disease (BVD) is a rare and often fatal form of Ebola disease caused by the contagious Bundibugyo virus (BDBV), a member of the Orthoebolavirus (formerly Ebolavirus) genus within the family Filoviridae family.1 This zoonotic disease is a deadly illness with a reported morality rate range from 30 to 50%.2 Currently, two East-central African countries, namely, the Democratic Republic of Congo (DRC) and Uganda have had outbreaks of the rare BDBV. On 17 May 2026, World Health Organization (WHO) declared multiple Ebola outbreaks as a Public Health Emergency of International Concern (PHEIC) due to a surge in the number of confirmed deaths and cases. As of 23 May 2026, a total of the 83 confirmed cases, 9 confirmed deaths with 746 suspected cases and 176 suspected deaths, have been reported from the Ituri, Nord-Kivu, South-Kivu provinces of DRC with a Case Fatality Rate (CFR) of 11%. Uganda has reported 5 confirmed cases and 1 confirmed death.3 These confirmed cases reported from Uganda are linked to the people who have recent history of travel from the DRC or contact with confirmed travel cases of BDBV.
Control Environment, Financial Accountability and Financial Reporting Quality in Uganda’s Public Sector
(International Journal of Finance and Accounting, 2026) Noowe Nelson; John Baguma Muhunga Kule; Sowedi Kambale; Angee Gladys
This paper investigates how Control Environment (CE) and Financial Accountability (FA) influence Financial Reporting Quality (FRQ) in the public-sector institutions in South-Western Uganda, a context where public institutions face persistent financial reporting inaccuracies and delays. This was a cross-sectional quantitative study involving structured questionnaires distributed to 96 public officials across various public sector entities in Uganda. Data were analysed through correlation and also regression analyses, employing Baron and Kenny’s (1986) four-step approach for mediation, with significance of indirect effect assessed using the Sobel test. The research study results show that CE plays a key strong CE have improved ethical leadership, audit oversight, and clearly defined roles that allow for accurate and timely reporting. The study results revealed that public sector institutions with strong governance structures were more likely to uphold transparency and responsible financial behaviour, highlighting the contingent role of CE in explaining FA to public stakeholders. The results indicated a positive association between FA and FRQ, implying that public sector institutions that practice expenditure tracking, documentation, and ethical compliance were likely to produce more credible financial reports. The mediation analysis revealed that FA partially mediated the association between CE and FRQ, which suggested that CE can accurately influence FRQ through FA. This study makes a unique contribution by incorporating the agency theory (AT) and also the stewardship theory (ST) in the examination of FRQ in public sector institutions, a sector where the quality of financial reports is inherently linked to managerial accountability towards organisational goals and the safeguarding of stakeholder interests. The research study demonstrates that CE not only enhance FRQ directly but also has an influence on the upholding of transparency and responsible financial behaviour that supports public sector institutions to prepare and present financial reports on an accurate, timely and consistent basis. The study advocates that public institutionsinvest in training programs that reinforce ethical leadership, effective audit committees and enhance FA mechanisms, ultimately improving public sector institution FRQ.
Short-Term Success Rate and Risk Factors for Failure of the Urethral Plication Procedure in the Management of Post-Obstetric Fistula Closure Stress Urinary Incontinence Among Ugandan Women: A Prospective Cohort Study
(International Journal of Women's Health, 2026) Musa Kayondo; Onesmus Byamukama; Brenda Ainomugisha; Rogers Kajabwangu; Paul Kato Kalyebara; Leevan Tibaijuka; Henry Mark Lugobe; Verena Alice Geissbuhler; Christopher Tarnay
Objective: To determine the six-month success rate and risk factors for failure of the urethral plication procedure in the management of post-obstetric fistula closure Stress Urinary Incontinence (SUI). Methods: This was a prospective cohort study of 70 women with moderate or severe SUI who underwent surgery for post-obstetric fistula closure SUI using the urethral plication procedure, managed at eight fistula repair sites in Uganda. Participants underwent clinical evaluation, methylene blue dye testing, post-void residual assessment, and single-channel cystometry to confirm stress urinary incontinence and exclude residual fistula, overflow incontinence, and urge incontinence. Urethral plication was the primary continence procedure; however, in some participants, concomitant reconstructive procedures, including urethral elongation and urethral reconstruction were performed based on intraoperative anatomical findings. The participants were followed up for a period of six months. Assessment for statistically significant changes in the grade of SUI at baseline and at six months post-surgery among the failures was done using Bowker’s test of symmetry and the Stuart–Maxwell test for marginal homogeneity. Descriptive analyses and multivariable log binomial regression were performed to determine risk factors for failure. Results: A total of 70 women were enrolled with a mean age of 34 (SD ±12.1) years. Concomitant reconstructive procedures were performed in 26/70 (37%) of participants. The success rate at six months post-surgery was 61% (43/70) dropping from 70% (49/70) at time of discharge. Of the 27 participants who remained incontinent, 15 (56%) demonstrated improvement in the grade of incontinence (Bowker’s test; χ2 = 20.0, df = 3, p = 0.0002, and Stuart–Maxwell test; χ2 = 17.9, df = 2, p = 0.0001). Severe vaginal scarring was the only independent risk factor (RR=3.77; 95% CI: 1.59–8.96; P=0.001). Conclusion: The short-term success rate of the urethral plication procedure is moderately high, and in carefully selected women, it appears to be a safe and effective option for managing post-obstetric fistula closure stress urinary incontinence. Although the procedure is more likely to fail in women with severe vaginal scarring, the severity of the incontinence improves in those that fail
Taenia solium development and host interactions in neurocysticercosis: a narrative mini review on mechanistic pathways to epileptogenesis
(Acta Epileptologica, 2026) Franck Katembo Sikakulya; Hervé Monka Lekuya; Larry Kasereka Kamabu; Mathieu Katembo Manzekele; Eric Ochen; Fatuma Djuma Sonia; Jeannot Munihire Baanitse; Furaha Nzanzu Blaise Pascal; Rishi A. Shah; Shitu Hauwa Balarabe; Olivier Kambere Kavulikirwa; David Kitya; Malcolm K. Jones
Neurocysticercosis (NCC), a central nervous system infection caused by the larval stage of Taenia solium, remains a leading cause of acquired epilepsy in endemic regions. Mounting evidence indicates that seizure development in NCC is not solely driven by host inflammatory responses but reflects complex, dynamic interactions between parasite development, host neuroimmune processes, and neuronal network remodeling. This narrative mini-review integrates experimental and clinical data to demonstrate that T. solium larvae actively shape the cerebral microenvironment through stage-specific immune modulation, blood–brain barrier disruption, and the release of neuroactive excretory–secretory products. During cyst degeneration, parasite antigens and excitatory amino acids drive microglial and astrocytic activation, amplify glutamatergic signaling, and destabilize inhibitory neurotransmission, collectively reducing seizure thresholds. These acute events are followed by chronic structural alterations, including perilesional gliosis, synaptic reorganization, and persistent network hyperexcitability, particularly around parenchymal and calcified lesions that serve as enduring epileptogenic foci. Integrating parasite developmental biology with neuroimmune and neuroexcitatory mechanisms, this review reconceptualizes NCC epileptogenesis as an active, multilevel dialogue between parasite, host, and neuron, rather than a passive, inflammation-driven consequence of infection. This integrated mechanistic framework highlights opportunities for biomarker discovery and therapeutic strategies that look beyond mere parasite eradication to address sustained neural dysfunction. It further underscores the critical need for One Health-oriented interventions to disrupt the T. solium transmission cycle and alleviate the long-term burden of NCC-associated epilepsy.
Depression and loss to follow-up among patients treated for premalignant cervical lesions at a tertiary hospital in Uganda: a cross-sectional study
(BMC Women's Health, 2026) Samuel Maling; Frank Ssedyabane; Hope Mudondo; Rogers Kajabwangu; Nathan Kakongi; Eleanor Turyakira; Alexcer Namuli; Wilfred Arubaku; Martin Galiwango; Randall C Thomas; Deusdedit Tusubira
Background Cervical cancer prevention relies on timely treatment and follow-up of premalignant cervical lesions, yet loss to follow-up (LTFU) remains common in many low-resource settings. Depression may be associated with poor engagement in care, but evidence among women treated for premalignant lesions in Uganda is limited. We assessed the prevalence of depression and its association with LTFU among women treated for premalignant cervical lesions at Mbarara Regional Referral Hospital in Uganda. Methods This was a retrospective cross-sectional study at the Cervical Cancer Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. Women treated for premalignant cervical lesions between January 2017 and December 2022 with complete records and active telephone contacts were enrolled (n = 112). Follow-up status was defined by clinic attendance on the scheduled review date or within three months thereafter. Depressive symptoms were assessed during telephone interviews (May–June 2023) using the Patient Health Questionnaire-9 (PHQ-9), categorized as moderate/severe (≥ 10) versus no/mild (< 10). sociodemographic and treatment-related data were collected using a separate structured questionnaire/clinical record abstraction. Logistic regression was used to assess the association between depression and LTFU, adjusting for district of residence, marital status, education level, and employment status. Results Of 112 participants, 75.0% (84/112) were LTFU. The mean age was 36.4 years (SD = 8.8). Moderate to severe depressive symptoms were present in 17.9% (20/112). Mean PHQ-9 scores were higher among participants who were LTFU than those retained in care (6.2 ± 5.2 vs. 0.7 ± 3.1; p < 0.001). Depression was associated with increased odds of LTFU (AOR = 9.697; 95% CI: 1.087–86.536; p = 0.042). Conclusion Women treated for premalignant cervical lesions at Mbarara Regional Referral Hospital had high LTFU, and depressive symptoms were strongly associated with disengagement from follow-up care.
Harmful alcohol use in rural Uganda: a pilot study from the Kigezi sub-region
(BMC Public Health, 2026) Nazarius Mbona Tumwesigye; Vincent Mubangizi; Wilber Karugahe; Agnes Napyo; Sam Maling; Aggrey Mukose; Catherine Gitige; Mary Mbuo; Cissie Namanda; Merlin Willcox
Introduction Currently, Uganda has the highest per capita alcohol consumption in Africa, and the negative effects of harmful use of alcohol are quite prevalent. Some rural areas face a complex set of underlying factors that may be responsible for this trend, including unemployment and easy access to cheap alcohol. Kigezi sub-region is one of the areas most affected by the harmful use of alcohol. This paper characterizes harmful use of alcohol in form of patterns of use, timing for drinking, types of drinks; and identifies factors associated with it in the sub-region’s tourist area around Lake Bunyonyi. Methods This was a cross-sectional study. A two-stage stratified sample survey was carried out and yielded 339 participants from 34 villages. It had standard questions on alcohol use and included the WHO’s Alcohol Use Disorders Identification Test (AUDIT) score. Harmful alcohol use was assessed using two measures. First, we calculated the proportion of participants with AUDIT scores between 8 and 40, indicating medium- to very high-risk alcohol use (MHA). Second, we used a proxy measure for alcohol use disorder (AUD), defined as the proportion of participants who, in the past 12 months, reported experiencing at least monthly any of the following: loss of control over drinking, alcohol-related failure to meet obligations, or the need for a morning drink after heavy alcohol consumption. The inclusion criteria for participants were adults aged ≥ 18 years, who consented to the study, while the exclusion criterion was withdrawal of consent during the interview process. The factors associated with harmful use of alcohol were determined using multilevel mixed effects generalised linear models that account for the clustering at the village level. Results The prevalence of AUD was 17.7% and of MHA was 28%. The prevalence of MHA was significantly lower among women (APR = 0.47, 0.28–0.76) and higher among those whose relatives or friends condoned alcohol consumption (APR = 1.77, 95% CI: 1.12–2.81), and it increased with improved income level (p < 0.001). Other factors included being more educated, a reduced frequency of engagement with religious activities, and earning a living through skilled trades. Key reasons for stopping alcohol include religious commitment, family background, and observed negative experiences. Most drinkers drink local brew/unrecorded alcohol and prefer to drink at the weekend. Although a few drinkers start drinking before 8am, the number grows to 50% and 60% by 4pm and 5pm respectively. Conclusion Harmful use of alcohol prevalence is higher than what is found in the WHO’s recent nationwide study and other epidemiological studies. The drinking culture leans towards drinking at weekends and daytime drinking and consumption of local brew. The factors associated with harmful use of alcohol include family and friends’ influence, higher income level, and reduced religiosity.
Sex differences in alcohol use and perceptions of cognitive health in rural Uganda
(BMC geriatrics, 2026) Emmanuel Maleka; Julius Kyomya; Joyce Namwase; Humphrey Beja; Samantha Mary; Godfrey Zari Rukundo; Edith K. Wakida; Celestino Obua
Background Dementia is a significant public health issue affecting over 50 million people worldwide. Alcohol consumption has been identified as a modifiable risk factor for dementia and its progression. This study aimed to explore the sociocultural factors influencing sex differences in alcohol consumption and community perceptions of its potential cognitive effects, including dementia risk in rural Uganda, where alcohol use is prevalent. Methods We employed a qualitative study design in the Ibanda and Lira districts, guided by the Gender Analysis Framework (GAF). We conducted in-depth interviews with 20 older adults (aged 60 years or older) who consume alcohol and 10 key informant interviews with community leaders. We used a deductive thematic analysis approach to generate themes and sub-themes using GAF. Results Four main themes are presented in this study: Access to resources, Practices and participation, Beliefs and perceptions, and Institutions, Laws and Policies. We found that men had greater access to alcohol due to their economic independence and social norms, often drinking in social settings. This was facilitated by peer relationships and the acceptance of drinking as a social norm for men. Women’s access to alcohol is limited by household responsibilities and cultural expectations, with consumption mainly at home and in smaller quantities. Community norms discourage alcohol consumption by women and are associated with shame and family disruption. Most participants believed that alcohol could cause memory problems, although some felt that other factors, such as age, could contribute to cognitive decline. Weak enforcement of alcohol regulations and religious influences were noted, with women reported to be more receptive to religious guidance on quitting alcohol consumption. Conclusions Gender disparities exist in alcohol access, consumption patterns, and social norms in rural Uganda. Participants commonly associated alcohol use with forgetfulness and short-term memory problems, perceptions that are consistent with early cognitive effects of alcohol but not with later stages of dementia. There is a need for gender-specific interventions to address alcohol consumption and to raise awareness about its potential impact on cognitive health in this population.
High Prevalence of Unhealthy Alcohol Use Among Persons with HIV, Viral Non-suppression and Any Alcohol Use in Mbarara, Uganda: A Brief Report
(AIDS and Behavior, 2026) Rebecca J. Fisk-Hoffman; Allen Kekibiina; Winnie R. Muyindike; Huimin Cheng; Patrick Agumenaitwe; Ve Truong; Olivia Allison; Natalia Gnatienko; Judith I. Tsui; Judith A. Hahn; Nneka Emenyonu; Leah Forman; Wuji Shan; Lunze Karsten; Jeffrey H. Samet
Unhealthy alcohol use is associated with HIV viral non-suppression. It is unclear how common unhealthy alcohol use is among non-suppressed persons with HIV (PWH) who drink alcohol. We conducted chart reviews to recruit PWH in Uganda with recent viral non-suppression for a study on the efficacy of gabapentin for promoting viral suppression among those with unhealthy alcohol use. Of the 288 PWH screened, 87% self-reported unhealthy alcohol use on the Alcohol Use Disorders Identification Test-Consumption and 73% tested positive for urine ethyl glucuronide. These data suggest that alcohol interventions are needed among Ugandan PWH with viral non-suppression and who drink.