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Recent Submissions

Adolescent Parenthood and Mental Health in South-Western Uganda: Psychosocial Vulnerabilities, Depression Prevalence, and Associated Factors
(Cureus, 2026) Atwiine, Scovia; Nyakato, Viola Nilah; Atwine, Daniel; Kemigisha, Elizabeth
Background Adolescent parenthood is associated with adverse psychosocial, economic, and mental health outcomes; however, evidence on adolescent parents remains limited. This study investigated these factors among adolescent parents in South-Western Uganda. Methods A cross-sectional study was conducted among 195 adolescent parents, including 155 (79.5%) adolescent mothers and 40 (20.5%) adolescent fathers in South-Western Uganda. The participants were aged 15-19 years. Data were collected using structured interviewer-administered questionnaires. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) with a score ≥10 indicating depressive symptoms, while common mental disorders (CMD) were assessed using the Shona Symptoms Questionnaire 14 (SSQ-14) with a score ≥8 indicating CMDs. Sociodemographic, socioeconomic, psychosocial, and attitude-related information was also collected. Descriptive statistics were used to summarize participant characteristics. Modified Poisson regression with robust standard errors was used to identify factors independently associated with depressive symptoms. Results Participants experienced substantial social and economic vulnerability characterized by school discontinuation, unstable livelihoods, low household assets, food insecurity, and limited support systems. The prevalence of depressive symptoms was 48.2% (n=92), while 72.6% (n=138) screened positive for other common mental disorders. Adolescent mothers had significantly higher depressive symptom prevalence than adolescent fathers (n=79, 52.0% vs n=13, 33.3%; p = 0.048), and severe depressive symptoms were observed only among adolescent mothers. Exposure to violence and mistreatment was common, with many adolescents reporting humiliation, threats, assault, and forced sex/rape. In multivariable analysis, unemployment (adjusted prevalence ratio (aPR) = 2.90, 95% CI: 1.17-7.14), household asset count = 0 (aPR = 2.57, 95% CI: 1.10-6.00), mistreatments by relatives (aPR = 1.52, 95% CI: 1.14-2.02), and mistreatment by neighbours (aPR = 1.43, 95% CI: 1.06-1.95) were independently associated with depressive symptoms. Conclusion Adolescent parents in South-Western Uganda experience a high burden of depressive symptoms and common mental disorders within contexts of poverty, violence, stigma, and limited social support. Adolescent mothers appear particularly vulnerable to severe depressive symptoms and forced sex/rape. Comprehensive adolescent-responsive interventions integrating mental health services, economic empowerment, violence prevention, educational reintegration, and community stigma reduction are urgently needed.
Knowledge, attitude, and practice of antifungal resistance and stewardship among pharmacy students in Zambia: a cross-sectional study to inform antifungal stewardship programs
(Frontiers in Education, 2026-08-16) Mudenda, Steward; Chibwe, Bweupe; Mukosha, Moses; Mufwambi, Webrod; Daka, Victor; Nachalwe, Precious Nkumbu; Kasanga, Maisa; Kamvuma, Kingsley; Mwaba, Martha; Fadare, Joseph; Lubanga, Adriano Focus; Mugenyi, Nathan; Gondwe, Moses; Chimbala, Adron Mweshi; Mohamed, Shafiq; Mukumbuta, Jean; Mwanza, Boris; Hampango, Muchindu; Muyenga, Tumelo; Chimombe, Tadious; Makasa, Mubanga
Background: Antifungal resistance (AFR) is a growing global health threat, particularly in low- and middle-income countries such as Zambia, where antifungals are often accessed without prescription. Antifungal stewardship (AFS) programs aim to optimise antifungal use, yet limited data exist on pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS. This study evaluated pharmacy students' knowledge, attitudes, and practices (KAP) toward AFR and AFS in Zambia. Methods: A descriptive cross-sectional survey was conducted among 288 randomly selected pharmacy students between August and September 2024 using a structured questionnaire. Descriptive statistics summarised demographics and KAP responses. Associations were analysed using Chi-square and Fisher's Exact Tests, while multivariable logistic regression identified predictors of good KAP (p < 0.05). Results: Among respondents (55.2% female; 76.7% aged 18–25 years), most students (94.1%) knew how to define AFR, and 90.3% recognized antifungal misuse as a factor driving resistance. Nevertheless, only 18.1% showed good knowledge, 67.7% held positive attitudes (especially among fourth-year students, p < 0.001), and merely 2.4% practiced appropriately. Multivariable analysis found that being a fourth-year student increased the likelihood of a good attitude (aOR = 5.10, 95% CI: 2.28–11.43). Married students were more likely to demonstrate good practices (aOR = 2.75, 95% CI: 1.13–6.68) towards AFR and antifungal stewardship (AFS) compared to unmarried ones. Additionally, age above 33 years was not significantly associated with better knowledge (aOR = 1.29, 95% CI: 0.32–5.18). Conclusion: Pharmacy students in Zambia demonstrated positive attitudes towards AFR and AFS, but significant gaps in knowledge and practice remain. Strengthening AFR and AFS-related content and experiential training within the pharmacy curriculum is urgently needed to improve preparedness for clinical practice.
Metabolic syndrome and cervical cancer among women utilizing cancer prevention and treatment services at Mbarara Regional Referral Hospital.
(Mbarara University of Science and Technology, 2024-08) Kajabwangu, Rogers
ABSTRACT Background: Low and middle-income countries (LMICs) experience three times the number of new cases and six times the number of deaths from cervical cancer compared to high income countries (HICs). Additionally, up-to-date data to inform improvements in cervical cancer prevention is scarce in most LMICs. Since HPV is a necessary but not sufficient cause of cervical cancer, there's need to explore other factors like metabolic syndrome (MetS) that may potentially modify the risk for cervical cancer. The objectives of this study were i)To determine the magnitude and trends of cervical cancer in comparison to other gynecological malignancies at Mbarara regional referral hospital between 2017 and 2022; ii)To determine the association between metabolic syndrome and cervical cancer among women utilizing cervical cancer prevention and treatment services at Mbarara regional referral hospital and ; iii) To compare the histological findings ,stage at diagnosis and the mortality within one year after diagnosis among cervical cancer patients with and without MetS at Mbarara regional referral hospital. Methods: For Objective 1, a retrospective records review of charts of patients admitted with gynecological malignancies on the gynecological ward of Mbarara Regional Referral Hospital (MRRH) between January 2017 and December 2022 was conducted. For objective 2, We conducted an unmatched case-control study 470 participants (157 cervical cancer cases and 313 controls. We assessed for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We used a multivariable binary logistic regression analysis to determine the association between MetS and its components with cervical cancer. For objective 3, we conducted a prospective cohort study for one year on 132 women with a new diagnosis of cervical cancer. Results: Over a 6-year period, 82.4% (721/875) of the patients admitted with gynecological malignancies had cervical cancer. Cervical cancer cases increased proportionately by 17% annually compared to other gynecological cancers (OR:1.17; 95% CI 1.06-1.28, p = 0.0046); with the majority of patients cervical cancer patients (92.7%, n=668) having squamous cell carcinoma. Most patients (87.9%, n=634) had late-stage disease. MetS was independently associated with cervical cancer (aOR 1.66; 95% CI 1.07-2.57). Age ≥ 50 years (aOR:2.20; 95% CI 1.35-3.56), HIV infection (aOR 2.51, 95% CI 1.56-4.05), increasing parity (aOR 1.16, 95% CI 1.06-1.26), and a lack of formal education (aOR 6.41, 95% CI 1.33-30.86) were also associated with cervical cancer diagnosis. None of the individual components of MetS was associated with cervical cancer. There was no difference in histology, stage at diagnosis in patients with and without MetS. The overall cumulative incidence of mortality in cervical cancer patients at one year following diagnosis was 42.3% (95% CI: 34.2-51.4). The cumulative incidence of mortality in cervical cancer patients with and without MetS was 44.1% (95% CI: 33.4-57.2) and 39.9% (95% CI: 28.9-53.2), respectively. There was no difference in cumulative incidence of mortality at one year following diagnosis in patients with and without MetS (Log-rank statistic =0.13, p=0.720). Conclusions and recommendations: The burden of cervical cancer among women at MRRH is high compared to other gynecological malignancies, with a significant annual increase. Majority of the cervical cancer patients at MRRH have squamous cell carcinoma and present with the late stage of the disease at diagnosis. Close to half of the patients diagnosed with cervical cancer at MRRH die within one year after diagnosis. MetS increases the risk of cervical cancer but does not affect the histology, stage at diagnosis and one-year mortality. We recommend scaling up of cervical cancer screening services with incorporation of screening for metabolic syndrome to reduce the burden of both morbidities.
Perceived norms, social network exposure, and physical discipline of children: Sociocentric network study of caregivers in rural Uganda
(Child Abuse & Neglect, 2026) Satinsky, Emily N.; Kakuhikire, Bernard; Baguma, Charles; Dyk, Sarah Sowell Van; Namara, Elizabeth B.; Ahereza, Phionah; Ayebare, Patience; Ashaba, Scholastic; Comfort, Alison B.; Tsai, Alexander C.; Perkins, Jessica M.
Background: Physical discipline is associated with negative developmental, social, and emotional outcomes in children. However, social influences on caregivers' use of physical discipline, including perceived norms and social network exposure, remain understudied. Objectives: To assess whether caregivers' use of physical discipline was associated with perceived norms and social network exposure to physical discipline. Participants and setting: Adult caregivers (N = 1026) in rural Uganda. Methods: In this sociocentric study, participants reported their past-week use of physical discipline and perceptions of how often most caregivers in their villages used physical discipline. Partici pants also named other caregivers with whom they interacted across life domains. We compared perceived norms with aggregated self-reports of behavior and used multivariable Poisson regression models with cluster-robust standard errors to estimate associations between perceived norms, social network exposure to caregivers who used physical discipline, and personal engagement in physical discipline. Results: Most caregivers overestimated the prevalence and frequency of physical discipline among other caregivers in their villages. Misperceiving physical discipline as normative was positively associated with personal physical discipline behavior. For example, women who (mistakenly) perceived that most other women used physical discipline multiple times in the past week were almost twice as likely to use physical discipline themselves (adjusted relative risk [aRR] = 1.97, 95% confidence interval [CI] 1.40–2.77, p < .001). Network exposure to caregivers who used physical discipline was not associated with physical discipline use among women and was negatively associated with physical discipline use among men. Conclusions: Interventions that correct misperceived norms may be used to reduce physical discipline behaviors.
Patient Perspectives on Patronage of Traditional Bone Setting: A Systematic Review
(Annals of Global Health, 2026) Flynn, Sarah Elizabeth; Rajaratnam, Sumner; Kruse, Colin; Kisitu, Daniel K.; Petrisor, Bradley A.
Introduction: Traditional bone setters (TBS) treat orthopedic injuries using natural remedies and traditional medicine. These practices can result in complications, including malunion, non-union, or gangrenous extremities. Despite these complications, communities in low- and middle-income countries trust and rely on TBS for musculoskeletal injuries and pathologies. Understanding patients’ motives for patronizing TBS is necessary to work with TBS to reduce complications. Objectives: The objectives of this study were to assess the reasons patients patronize TBS, identify demographic trends associated with TBS usage, and evaluate how patient perspectives inform an understanding of TBS patronage. Methods: Four electronic databases, MEDLINE and Embase (via Ovid), Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), were searched prior to April 2025. Primary studies examining reasons and patient perspectives on visiting TBS were included. Studies not reporting patient perspectives regarding TBS use were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tools. A narrative synthesis was conducted, with pooled descriptive statistics where appropriate. Results: A total of 28 studies involving 8,147 participants were included. A total of 5 articles directly included patients’ perspectives, while 24 articles reported themes among reasons for the patronage of TBS. The main reasons cited for patronizing TBS were the belief in TBS and affordability. Recommendations from family/friends and negative perspectives on allopathic medicine were both frequently cited. No consistent association between participant demographics and TBS patronage was identified. Conclusions/Discussion: The reasons for patronizing TBS are multifaceted, extending beyond pure affordability and accessibility. The analysis showed that the general preference for TBS over allopathic practitioners and the belief in TBS practices are strongly rooted in the individuals and communities that TBS serve. Despite differing recommendations, collaboration with TBS to improve access to care and reduce complication rates was identified as a future direction.
Hypocalcemia in traumatic brain injury: Pooled prevalence and narrative synthesis of associations with injury severity and early clinical outcomes - a systematic review and Meta-analysis
(Interdisciplinary Neurosurgery, 2026-09-21) Fillie, Paul Clement; Mukiibi, Enock; Bukyana, Sedrick; Kakooza, Jackson; Lewis, Catherine R.; Kazigo, Ahmed Kiswezi; Akankwasa, Prosper; Turyagumanawe, John; Oguttu, Benson; Ayesiga, Innocent; Balondemu, Evelyn Njawuzi; Hakizimana, Theoneste; Mumbere, Bienfait V.; Emeka, Anyanwu Godson; Mugenyi, Michael
Objective: To determine the prevalence of hypocalcemia and synthesize its reported associations with injury severity and early clinical outcomes in patients with traumatic brain injury (TBI). Methods: A systematic review and exploratory meta-analysis of observational studies reporting hypocalcemia in TBI was performed. A random-effects meta-analysis using restricted maximum-likelihood estimation was per formed on logit-transformed proportions. Because substantial clinical and methodological heterogeneity was anticipated, the pooled estimate was interpreted as exploratory. Publication bias and small-study effects were assessed using Egger's regression, Kendall's Tau, and funnel-plot inspection. Prespecified subgroup analysis by geographic region and leave-one-out sensitivity analysis were conducted. Associations between hypocalcemia, injury severity, and early clinical outcomes were synthesized narratively. Results: Twelve studies comprising 3485 TBI patients met the inclusion criteria. The exploratory pooled prevalence of hypocalcemia was 39.80% (95% CI: 23.78%–58.35%). Between-study heterogeneity was substantial (I2 =89.86% Q[11] =110.625, Pooled prevalence varied across geographic subgroups, from 29.34% in South Asia to 74.29% in the Qatar/ Romania subgroup. Leave-one-out estimates ranged from 35.40% to 44.96%. Narrative synthesis indicated that hypocalcemia was frequently associated with greater injury severity and adverse early clinical outcomes, although independent prognostic evidence was limited. Conclusions: Hypocalcemia is frequently reported in patients with TBI, but the available evidence is heterogeneous and geographically uneven. The pooled estimate should therefore be considered exploratory rather than a precise global prevalence. Associations with greater injury severity and adverse outcomes were reported in several studies, but causal or independent prognostic conclusions remain uncertain. Future prospective studies should use standardized calcium definitions, report total and ionized calcium separately, obtain serial measurements, and apply multivariable outcome models.
External validation of a treatment decision algorithm for tuberculosis in children living with HIV: a diagnostic cohort study
(medRxiv, 2026) Khosa, Celso; Nguyet, Minh Huyen Ton Nu; Mwanga-Amumpaire, Juliet; Chabala, Chishala; Raoul, Moh; Roucher, Clementine; Nansera, Denis; Nduna, Bwendo; Macassa, Eugenia; Folquet, Madeleine Amorissani; Rego, Dalila; Mundundu, Gae; Natukunda, Naome; Shankalala, Perfect; Cumbe, Saniata; Komena, Eric; Steenhoff, Andrew P.; Hesseling, Anneke C.; Seddon, James A.; Wobudeya, Eric; Maryline, Bonnet; Marcy, Olivier
Background Tuberculosis is the leading cause of death in children living with HIV, and is challenging to diagnose owing to the limitations of microbiological approaches. The Pediatric Asian African Network for Tuberculosis and HIV Research (PAANTHER) treatment decision algorithm (TDA) was previously developed to improve the diagnosis of tuberculosis in children living with HIV, but has not yet been validated. We aimed to externally validate this TDA in a prospective cohort of children from four countries in Africa. Methods The TB-Speed HIV study was a prospective diagnostic cohort study conducted in seven tertiary hospitals: two in Côte d’Ivoire, two in Mozambique, one in Uganda, and two in Zambia. Eligible participants were children living with HIV, aged 1 month to 14 years, with presumptive tuberculosis. Children who were currently receiving tuberculosis treatment, or who had received treatment within the past 3 months, were excluded. At enrolment, children were evaluated for suggestive tuberculosis symptoms (fever for >2 weeks, unremitting cough, haemoptysis and/or weight loss in the past 4 weeks, and tachycardia) and underwent Xpert MTB/RIF Ultra testing on respiratory and stool samples, chest radiography, and abdominal ultrasonography. Children were given a PAANTHER TDA score, with a score of less than 100 defined as negative and a score of 100 or higher defined as positive and prompting the initiation of treatment. At the end of the study, children were retrospectively classified by an endpoint review committee as having confirmed, unconfirmed, or unlikely tuberculosis, forming the composite reference standard against which diagnostic accuracy was assessed. The primary outcome was the proportion of children with missed tuberculosis (false negatives) among those who were not initiated on treatment as per the PAANTHER TDA. We assessed the diagnostic accuracy (sensitivity, specificity, and negative and positive predictive values) and feasibility (uptake and time to treatment initiation) of the PAANTHER TDA. The protocol-defined negative predictive value threshold for validation was 75%. This study is registered at ClinicalTrials.gov, NCT04121026, and is complete. Findings From Oct 2, 2019, to Dec 31, 2021, 1706 children were prescreened for eligibility, of whom 713 children living with HIV were screened for tuberculosis symptoms; 423 were eligible for the study and 277 were enrolled. Of these 277 children, 272 (98%) had a complete TDA evaluation: 215 (79%) had a score of 100 or higher, including 24 (9%) with a positive Xpert MTB/RIF Ultra test. Treatment was initiated in 185 (86%) of 215 children with a positive score and 12 (20%) of 60 children with a negative score, at a median of 1 day [IQR 0–4] after inclusion. After assessment by the endpoint review committee, the proportion of children with tuberculosis in the classifiable study population (n=273) was 56⋅8% (95% CI 50⋅9–62⋅5), with 131 having unconfirmed tuberculosis and 24 having con firmed tuberculosis. Four (7%) of the 60 children with a negative score were subsequently classified as having tuberculosis by the endpoint review committee (missed tuberculosis). The TDA had a negative predictive value of 93⋅3% (95% CI 84⋅1–97⋅4), a positive predictive value of 70⋅9% (95% CI 64⋅5–76⋅6), a sensitivity of 97⋅4% (95% CI 93⋅6–99⋅0), and a specificity of 47⋅5% (95% CI 38⋅7–56⋅4). Interpretation The PAANTHER TDA was externally validated in a cohort of children living with HIV as per the study protocol. The high sensitivity of this TDA and its potential to enable rapid treatment initiation could contribute to the reduction of mortality in children living with HIV
Enhancing Cognitive Achievement Through Gami fied Mobile Learning-Support ed Problem-Based Learning in Informatics Education
(Journal of Education Culture and Society, 2026) Fadhilah, Fadhilah; Diati, Lili Safitri; Husin, Muhammad; Giatman, Muhammad; Irfan, Dedy; Almaaytah, Shahab Ahmad; Setyawan, Herlin; Omenyo, Laban; Luthf, Afdal; Hashi, Abdinasir Ismael
Aim. This study examines the effectiveness of integrating gamified mobile learning with Problem-Based Learning (PBL) in improving cognitive achievement in secondary Informatics education. It explores students’ learning progress across different cognitive levels. Methods. A quasi-experimental pretest–posttest design with two comparison groups was employed. The participants were 72 tenth-grade Informatics students. The experimental group learned through PBL supported by a gamified mobile learning platform, whereas the control group received conventional instruction. Learning outcomes were analyzed using descriptive and inferential statistics. Results. The experimental group achieved significantly greater learning gains than the control group, with higher normalized gain scores and significantly better posttest performance (t = 3.880, p < .001). The large effect size (d = 0.91) indicates a substantial difference between the groups. Improvements were also observed across all assessed cognitive levels (C1–C5). Conclusions. Integrating gamified mobile learning with Problem-Based Learning was associated with improved cognitive achievement in Informatics education, including gains across both lower- and higher-order cognitive levels. Research Restrictions. The study was conducted in a single secondary school and focused only on Algorithms and Programming, limiting the generalizability of the findings. Practical Application. Teachers can integrate gamified mobile learning into PBL to promote active engagement, independent learning, and improved academic performance in Informatics classrooms. Cognitive Value. This study provides empirical evidence that combining gamification, mobile learning, and PBL enhances cognitive development across multiple cognitive levels in technology-enhanced learning
An echocardiographic appreciation of rheumatic heart disease: phenotypic variability of valvular involvement and its prognostic implications
(The Lancet Regional Health–Americas, 2026-08-31) Nunes, Maria Carmo P.; Chillo, Pilly; Klassen, Sheila; Nampijja, Dorah; Figueiredo, Fernanda de Azevedo; Gomes, Nayana Flamini Arantes; Carvalho, Adson Patrik Vieira; Soares, Carolina K.; Rodrigues, Estela Fofano; Mutarelli, Antonio; Pantaleão, Alexandre; Díaz, Juan Manuel; Dal-Bianco, Jacob P.; Hung, Judy; McCormick, John K.; Levine, Robert A.
Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity and premature mortality in low and middle-income countries. This review examines RHD from an echocardiographic perspective, emphasizing how valve-specific phenotypes, hemodynamic burden, and disease progression shape clinical presentation, prog nosis, and management. The evolution of echocardiography, from M-mode and two-dimensional imaging to Doppler, strain, and three-dimensional techniques, has transformed understanding of rheumatic valve disease and established imaging as central to diagnosis, risk stratification, and therapeutic guidance. Rheumatic mitral stenosis, in particular, served as a model for the development of key echocardiographic principles in valve morphology, he modynamics, and intervention planning. Beyond anatomical severity, physiological variables such as exercise-induced pulmonary pressure changes and net atrioventricular compliance provide important prognostic information and better reflect functional impairment. Across the spectrum of disease, echocardiography remains fundamental for early detection, phenotypic characterization, longitudinal surveillance, and individualized management of RHD.
Acute rheumatic fever and rheumatic heart disease in Latin America: a contemporary review of epidemiology
(The Lancet Regional Health–Americas, 2026-08-31) Mutarelli, Antonio; Pantaleao, Alexandre Negrao; Chillo, Pilly; Nampijja, Dorah; Campanati, Sara; Dutra, Walderez O.; Nunes, Maria Carmo P.; Levine, Robert A.
Rheumatic heart disease (RHD) remains a significant public health challenge in Latin America, disproportionately affecting vulnerable populations despite global declines in disease prevalence and mortality. It is known that RHD affects over 55 million individuals worldwide, accounting for more than 390,000 deaths annually. However, region specific RHD epidemiologic data are scarce, and most clinical studies on RHD epidemiology date back to the 1990s. On the other hand, the emergence of echocardiographic screening initiatives in the last decade reinforced the burden of the disease, revealing alarming rates of subclinical RHD in Latin American schoolchildren and young adults. This comprehensive review focused on epidemiologic data on RHD from Latin America and highlighted subgroups at highest risk for the disease.
Diagnostic Performance of Color Doppler Ultrasound for Detecting Nuchal Cord and Associated Immediate Neonatal Outcomes at Term in Uganda: A Prospective Diagnostic‐Accuracy Cohort Study
(Health Science Reports, 2026-10) Asiimwe, Fiona; Hakizimana, Theoneste; Ishimwe, Marie Pascaline Sabine; Kalyebara, Paul Kato; Tibaijuka, Leevan; Ngonzi, Joseph; Lugobe, Henry Mark; Twesigomwe, Godfrey; Kahimakazi, Irene; Jjuuko, Mark; Kayondo, Musa; Mugisha, Julius; Kajabwangu, Rogers
Background and Aims: Evidence on the diagnostic performance of color Doppler ultrasound for detecting nuchal cord and its association with immediate neonatal outcomes remains limited in sub‐Saharan Africa. We evaluated ultrasound detection of nuchal cord and compared immediate neonatal outcomes according to nuchal‐cord status. Methods: This prospective study included 246 women with singleton pregnancies at ≥ 37 weeks who were enrolled in early labor at Mbarara Regional Referral Hospital, Uganda, from February to July 2021. Two‐dimensional and color Doppler ultrasound was performed at enrollment, and direct examination of the umbilical cord at delivery was the reference standard. Diagnostic‐performance measures and unadjusted risk ratios (RRs) were reported with 95% confidence intervals (CIs). Results: Nuchal cord was confirmed at delivery in 88/246 participants in the sampled cohort. Ultrasound identified 76/88 participants with and 152/158 without a nuchal cord. Sensitivity was 86.4% (95% CI: 77.4–92.8), specificity 96.2% (95% CI: 91.9–98.6), positive predictive value 92.7% (95% CI: 84.8–97.3) and negative predictive value 92.7% (95% CI: 87.6–96.2). Overall accuracy was 92.7% (228/246), and the area under the receiver operating characteristic curve was 0.913. The composite immediate adverse neonatal outcome occurred in 18/88 neonates with a nuchal cord and 8/158 without one (20.5% vs. 5.1%; RR: 4.04, 95% CI: 1.83–8.91). Conclusion: Color Doppler ultrasound demonstrated good diagnostic performance for detecting nuchal cord at term. Nuchal cord was associated with higher unadjusted risks of immediate adverse neonatal outcomes, although residual confounding cannot be excluded. Sonographic detection may inform delivery‐room preparedness but should not, in isolation, determine the mode of delivery.
Wealth-related inequalities and correlates of malaria message exposure among pregnant women in four malaria high-burden countries in sub-Saharan Africa: evidence from recent malaria indicator surveys
(Archives of Public Health, 2026-10-21) Mwebesa, Edson; Musinguzi, Benson; Agbi, Delight Mawufemor; Bagenzi, Brenda; Mutale, Sampa; Izudi, Jonatha; Kerich, Gregory; Mwangi, Ann
Introduction Malaria remains a critical public health challenge in sub-Saharan Africa (SSA). Social and behav iour change communication (SBCC) is one of the cornerstones of effective malaria control strategies. Pregnant women are vulnerable to malaria compared to other sub-populations, and exposure to malaria messages is not evenly distributed in this sub-population, but the potential determinants are unclear. This study determined the prevalence of exposure to malaria messages among pregnant women in Uganda, Tanzania, Ghana, and Burkina Faso, including its wealth-related inequalities and the associated factors. Methods We utilised data from the Malaria Indicator Surveys in Burkina Faso, Ghana, Tanzania, and Uganda. Only women who were pregnant at the time of the survey were included in this study, resulting in a weighted sample of 2552 pregnant women. Equity plots and the concentration index were used to establish wealth-related inequalities. A multilevel mixed-effects logistic regression model was used to identify factors associated with exposure to malaria messages at the 5% significance level. Results Of 2,552 participants, 1,440 (56.4%) pregnant women reported exposure to malaria messages. By coun try, the highest rate was recorded in Ghana (88.4%), followed by Burkina Faso (63.9%), with Uganda and Tan zania showing similar levels of exposure to malaria messages (48.3% and 48.1%, respectively). Exposure to malaria messages was largely concentrated among rich women, with a significant unstandardized concentration index of 0.075 (p < 0.001). Women aged 35–49 years [Adjusted odds ratio (aOR) = 1.42; 95% confidence interval (CI): 1.16, 1.74] and women with secondary or higher level of education [aOR = 2.70; 95% CI: 1.17, 6.25] were associated with exposure to malaria messages. Conclusion Overall, less than three in five pregnant women are exposed to malaria messages in sub-Saharan Africa, with pregnant women aged 35–49 years, with secondary or higher levels of education, who are wealthier, and with a previous birth history mainly exposed to malaria messages. The study revealed considerable variation in factors at the community and country levels. Therefore, malaria communication strategies should be targeted for better reach and impact.
Knowledge of Hypertensive Disorders of Pregnancy and Associated Factors Among Antenatal-Care Attendees in Mbarara City, Southwestern Uganda: A Cross-Sectional Study
(International Journal of Women's Health, 2026-10-20) Lugobe, Henry Mark; Migisha, Richard; Wilkinson, Ian B.; Bajunirwe, Francis; Agaba, David Collins; Tibaijuka, Leevan; Babweteera, Alan; Tomusange, Simon; Tindiweegi, Praise; McEniery, Carmel M.; Najjuma, Josephine Nambi
Background: Hypertensive disorders of pregnancy (HDP) are important contributors to maternal and perinatal morbidity and mortality in sub-Saharan Africa. Women’s knowledge of warning signs, risk factors, diagnosis, and prevention may support earlier care-seeking and timely diagnosis, yet data from primary-level antenatal-care settings in Uganda remain limited. We assessed knowledge of HDP and associated factors among antenatal-care attendees in Mbarara City, southwestern Uganda. Methods: We conducted a cross-sectional study among pregnant women attending their third or later antenatal-care visit at six public health facilities in Mbarara City between January and March 2025. Participants were recruited by consecutive sampling. Knowledge was assessed using 41 scored knowledge items covering awareness, disease manifestations, risk factors, diagnosis, management, prevention, complications, and blood-pressure monitoring. Scores were expressed as percentages of correct responses; adequate knowledge was defined as ≥60%. Multivariable modified Poisson regression was used to estimate adjusted prevalence ratios. Results: Among 426 antenatal-care attendees, 271 had adequate knowledge, giving a prevalence of 63.6% (95% CI: 58.8–68.2). Knowledge was highest for timing or frequency of blood-pressure checks (86.2%) and complications (76.1%), but lower for diagnosis (51.4%), timing of occurrence (53.3%), treatment and management (53.4%), and risk factors (56.8%). Adequate knowledge was more prevalent among women with secondary education (aPR=1.34; 95% CI: 1.10–1.64) or tertiary education (aPR=1.36; 95% CI: 1.04– 1.78), compared with primary education or less; women with five or more pregnancies compared with primigravidas (aPR=1.77; 95% CI: 1.27–2.48); and women with family history of preeclampsia compared with those without (aPR=1.26; 95% CI: 1.06–1.50). Conclusions: Approximately two-thirds of antenatal-care attendees had adequate knowledge of HDP, but important gaps remained in diagnosis, timing of occurrence, treatment and management, and risk-factor recognition. Health education during antenatal care should prioritize practical messages for women with lower educational attainment, primigravidas or limited pregnancy experience, and women without a family history of preeclampsia.
Assessment of Millet Husk Ash - Cement Blended Concrete for Sustainable Rigid Pavement Applications
(Revista Ingeniería de Construcción, 2026) Terseer, Ako; Osugh, Sesugh Michael; Choji, Abraham Sheku; Ndyabijuka, Pathias
This study presents an evaluation of cement-millet husk ash (CMHA) concrete for sustainable rigid pavement applications using destructive and non destructive testing techniques. Millet husk ash (MHA), obtained from controlled burning of agricultural waste, was used to replace ordinary Portland cement (OPC) at 0-20% (at 5% increment) by weight in two nominal mix proportions of 1:2:4 and 1:1.5:3. Fresh concrete properties were examined through slump and setting time tests, while hardened performance was assessed using compressive strength testing at 3, 7, 14, and 28 days. Complementary non-destructive tests, including rebound hammer and ultrasonic pulse velocity (UPV), were employed to characterize surface hardness, internal concrete quality, and microstructural integrity. Results showed that MHA replacement between 5 -10% improved workability, densification, and strength development due to enhanced pozzolanic activity and matrix refinement. This improvement was consistently reflected in both destructive and non-destructive indicators. However, higher replacement levels resulted in reduced performance, attributed to excessive dilution of cementitious compounds. The findings showed that MHA is a viable supplementary cementitious material for rigid pavement concrete and supports sustainable construction through reduced cement consumption and effective waste utilization, and an optimal replacement range of 5-10% is recommended for structural pavement applications.
Use of antibiotics in newborns with infections at rural referral hospital in Uganda: compliance with empirical guidelines
(Frontiers in Pediatrics, 2026-09-08) Andersson, Ellen; Santorino, Data; Kreyenbaum, Lea; Shamusa, Khakusuma Shanita; Ashish, KC
Introduction: Despite global progress, neonatal infections remain a major cause of mortality in low- and middle-income countries. In Uganda, high neonatal mortality and rising antimicrobial resistance underscore persistent challenges in prescribing appropriate treatment. WHO developed a Global Action Plan to promote safe and effective antibiotic use, which forms the basis of Uganda’s National Action Plan. Limited evidence exists on how national guidelines are followed, particularly regarding first-line therapy and dosing. The aim is to assess adherence to national guidelines for inpatient use of antibiotics in neonates with suspected infections at Mbarara Regional Referral Hospital (MMRH), and factors affecting the adherence. Methods: This cross-sectional study included 300 neonates admitted to the Neonatal Intensive Care Unit at MRRH Uganda, between October and November 2024. Clinical records were analysed to summarize demographics, danger signs, diagnoses, and antibiotic use by WHO Possible Severe Bacterial Infection (PSBI) criteria. Logistic regression was done to assess the predictors for compliance for antibiotics. Results: Of the total population (n = 300), 125 (41.7%) had ≥2 DSs, 124 (41.3%) had 1 danger sign, and 51 (17%) had none. In total, 96.7% received antibiotics, and 16.6% of these had no danger sign. Among those who received antibiotics and had ≥1 danger sign, 58.3% received recommended type and dose. Among those with ≥ 2 danger sign, 98.4% received any antibiotic, 80% received the first-line combination, and 60.8% the correct dose. Higher number of danger sign (OR = 7.96, 95% CI 4.76-13.30, were associated with higher adherence. No blood cultures were performed. Discussion: Low compliance with guidelines in cases of PSBI and frequent use of antibiotics in neonates with no or only one danger sign was observed. However, only one danger sign is an indication for antibiotics in Uganda’s guidelines, indicating that national guidelines may lead to broader antibiotic use than WHO recommendations
Antibiotic residues and antimicrobial resistance patterns of bacteria isolated from beef at Ruti Rufura Slaughterhouse, southwestern Uganda
(Frontiers in Microbiology, 2026-09-03) Tuhamize, Barbra; Kica, Daniel
Background: Antimicrobial use in livestock contributes to the emergence of antimicrobial-resistant bacteria and the persistence of antimicrobial residues in foods of animal origin. The coexistence of antimicrobial residues and resistant bacteria in beef poses a major food safety and public health concern. However, data on these hazards in Uganda remain limited. This study assessed antibiotic residues and antimicrobial resistance among bacteria isolated from beef marketed in southwestern Uganda. Methods: A cross-sectional laboratory-based study was conducted from May to August 2025 using beef samples from 92 randomly selected cattle carcasses at Ruti Rufura Slaughterhouse, Mbarara City, Uganda. Antibiotic residues were screened by agar well diffusion and confirmed for penicillin and oxytetracycline using thin-layer chromatography. Bacterial isolates were identified using standard microbiological methods, and antimicrobial susceptibility was determined by the Kirby–Bauer disk diffusion method according to CLSI guidelines. Results: Antibiotic residues were detected in 86/92 (93.5%) samples. Thin-layer chromatography confirmed penicillin residues in 84 (97.7%) and oxytetracycline residues in 71 (82.6%) samples, with 73.1% containing both antibiotics. A total of 125 bacterial isolates representing seven genera were recovered, predominantly Proteus spp. (30.4%), Citrobacter spp. (26.4%), and Escherichia coli (16.8%). Among 75 viable isolates, resistance was highest to ampicillin (97.3%), chloramphenicol (86.7%), tetracycline (82.7%), ceftriaxone (57.3%), and ciprofloxacin (54.7%), while gentamicin showed the highest susceptibility (86.7%). Oxytetracycline residues were significantly associated with tetracycline resistance and penicillin residues with ampicillin resistance (both P < 0.001). Conclusion: Beef marketed in southwestern Uganda frequently contains antimicrobial residues and antimicrobial-resistant bacteria, posing a potential food safety risk. Strengthened antimicrobial stewardship, enforcement of withdrawal periods, and integrated surveillance of antimicrobial residues and resistance in foods of animal origin are needed to support One Health efforts against antimicrobial resistance.
Gendered Power Relations, Food Production and Socioeconomic Livelihoods of Female-headed Households in Mbarara District
(Mbarara University of Science and Technology, 2025-09) Mukundane, Charles Godfrey
This study examines the complex interplay between gendered power relations, food production, and socioeconomic livelihoods of female-headed households in Mbarara District, Southwestern Uganda. Despite global and national commitments such as the Sustainable Development Goal 5 (SDG 5) emphasizing gender equality and women’s empowerment, female-headed households in Mbarara continue to face structural barriers rooted in patriarchal norms and customary land tenure systems that limit their access to and control over productive resources like land, credit, and agricultural inputs. Using a mixed methods approach grounded in the Sustainable Livelihood Approach and Power Relations Theory, this study explores how this gendered power imbalances restrict female heads' decision-making autonomy in food production and resource utilization, leading to diminished agricultural productivity and persistent livelihood vulnerabilities. A concurrent triangulation mixed-methods design was employed, collecting quantitative data through structured surveys of 186 randomly selected female household heads and qualitative data via in-depth interviews with 10 key informants. The findings reveal that a significant proportion of female-headed households (75%) operate on land to which they lack formal title, limiting their investment in long-term food production strategies. Gendered roles and decision-making power within family and community structures were found to be major determinants of access to agricultural inputs. Specifically, only 28% of the surveyed households reported having full autonomy in deciding which crops to plant and where to sell their produce. Furthermore, the study found a strong correlation between food production autonomy and socioeconomic livelihood. Households with greater decision-making power showed a 45% higher average income from agricultural sales compared to those with limited autonomy. The research also found that while 85% of households were engaged in subsistence farming, only 15% had access to formal financial services or microcredit, further hindering their economic advancement. The findings reveal that a significant proportion of female-headed households (75%) operate on land to which they lack formal title, limiting their investment in long-term food production strategies. Gendered roles and decision-making power within family and community structures were found to be major determinants of access to agricultural inputs. Specifically, only 28% of the surveyed households reported having full autonomy in deciding which crops to plant and where to sell their produce. Furthermore, the study found a strong correlation between food production autonomy and socioeconomic livelihood. Households with greater decision-making power showed a 45% higher average income from agricultural sales compared to those with limited autonomy. The research also found that while 85% of households were engaged in subsistence farming, only 15% had access to formal financial services or microcredit, further hindering their economic advancement.
Building intercultural competence in Indonesian engineering education through faculty development, institutional support, and teaching innovation
(2026-09-30) Husin, Muhammad; Almaaytah, Shahab Ahmad; Ibrahim, Abdullateef Abdullahi; Hashi, Abdinasir Ismael; Omenyo, Laban
Globalization and increasing cultural diversity in higher education demand innovative teaching approaches that support the development of intercultural competence. This study develops and tests a process-oriented model examining how undergraduate engineering students’ perceptions of faculty development support and institutional support are associated with students’ cultural intelligence, intercultural competence, perceptions of interculturally informed teaching practices, intercultural student engagement, and student learning outcomes. Survey data were collected from 814 undergraduate engineering students in Indonesia and analyzed using Structural Equation Modeling (SEM). The findings indicate that students who perceived stronger faculty development support reported higher levels of cultural intelligence, which was positively associated with intercultural competence and greater perceived implementation of interculturally informed teaching practices. Students who perceived more interculturally informed teaching practices also reported higher intercultural student engagement, which was positively associated with higher self-reported student learning outcomes. These findings provide an integrated perspective on how undergraduate engineering students perceive the relationships among institutional support, faculty practices, intercultural development, and learning outcomes, offering practical insights for supporting more inclusive and globally responsive engineering education.
Peer assessment framework to support group-based Assessment in E-learning Environment for Higher Institutions of Learning
(Mbarara University of Science and Technology, 2025-08) Kalema, Job
Online learning in higher education races challenges in fostering meaningful student interactions. particularly in group-based assessments. Key issues include coordinating group participation. uneven student engagement, difficulty measuring individual contributions. High failure rates due to lack of material engagement. unclear instructions. and poor group relationships. Peer assessment is an effective approach to support group work but existing frameworks. primarily developed outside Uganda. have limitations. These include inadequate support for managing group assessments, addressing bias and fairness, providing effective feedback. and integrating with online learning platforms. These shortcomings hinder student engagement. feedback quality, and collaborative learning outcomes. This study proposes a new peer assessment framework to address these issues, enhance group-based assessments. And improve student interactions in online learning environments. The study applied ease study design and human-centered design approaches closely examine the data collected. The framework was evaluated using DeLone and Maclean model questionnaire on experts and to achieve the objectives. employed a mixed-methods research approach. The study revealed key obstacles faced by participants while conducting group-based assessment online and include; Technical problems were the most significant issue, affecting 62.8% of respondents, emphasizing the need for reliable technology. Communication tool limitations were reported by 23.5%. indicating that existing platforms may not fully support effective feedback and interaction. Additionally. 13.7% of students struggled with group coordination, often due to scheduling conflicts. fairness concerns. or differing communication styles. In conclusion this study contributes to the growing body of research The study highlights challenges in Uganda’s higher education institutions with group-based assessments in online learning. including low student engagement. difficulty measuring individual contributions, and high failure rates due to limited interaction with course materials. A new peer assessment framework was designed to address these issues. tailored to Uganda-s online learning context. with improved management tools. bias mitigation. and enhanced feedback mechanisms. The study recommends adopting a tailored peer assessment framework in Uganda's higher education to enhance group-based assessments by improving management, fairness, feedback, and collaboration. with suggestions tar training. scalable integration, and future research on its adaptability and AI augmentation.
Antimicrobial susceptibility patterns of bacteria isolated from infected wounds at Mbale regional referral hospital, Uganda
(Microbes and Infectious Diseases., 2026) Mabonga, Habert; Nalumaga, Pauline Petra; Byarugaba, Frederick; Bazira, Joel; Tuhamize, Barbra
Background: Wound infections are a major cause of morbidity and are increasingly complicated by antimicrobial resistance. This study determined the bacterial etiology and antimicrobial susceptibility patterns of wound infections at a regional referral hospital in Eastern Uganda. Methods: A laboratory-based cross-sectional study was conducted at Mbale Regional Referral Hospital between May and August 2023. Wound swabs from 210 patients with clinically suspected wound infections were cultured, bacterial isolates identified using standard microbiological methods, and antimicrobial susceptibility testing performed according to CLSI 2023 guidelines. Results: Bacterial growth was detected in 41.9% (88/210) of wound swabs. Gram-negative organisms predominated, accounting for 61.4% (54/88) of isolates. The most common pathogens were Escherichia coli (22/88, 25.0%), Staphylococcus aureus (18/88, 20.5%), coagulase-negative staphylococci (14/88, 15.9%), and Klebsiella pneumoniae (13/88, 14.8%). MRSA prevalence among S. aureus isolates was 61.1% (11/18; 95% CI: 35.8-82.7%). High resistance was observed to ampicillin, ceftriaxone, gentamicin, and ciprofloxacin. Overall, 28.4% (25/88) of isolates were multidrug resistant. Conclusion: Wound infections at Mbale Regional Referral Hospital were characterized by Gram-negative predominance and substantial antimicrobial resistance, including high MRSA and multidrug resistance rates. Routine microbiological testing, infection prevention measures, and antimicrobial stewardship are needed to support effective wound infection management.