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

MUST-IR preserves research output from the MUST Community

Communities in MUST-IR

Select a community to browse its collections.

Now showing 1 - 10 of 10

Central Administration 132
This community will contain collections from the general Administrative staff
Faculty of Applied Sciences and Technology 66
Faculty of Business and Management Sciences 121
Faculty of Computing and Informatics 151
Faculty of Interdisciplinary Studies 223
Faculty of Medicine 2426
Faculty of Science 573
Institute of Tropical Forest Conservation 127
Maternal Newborn and Child Health Institute 18
MUST Research Institute 3

Recent Submissions

Work Team Stability and Quality of Health Care in Uganda; Evidence from Health Centre IVs in South Western Uganda
(East African Journal of Business and Economics, 2026-08-04) Bangirana, Sephas; Mulogo, Edgar Mugema; Mucunguzi, Charles; Musiita, Benjamin; Bakashaba, Rennie
Purpose: Given the critical role of quality of health care in promoting a healthy population, this study examined the relationship between work team stability and quality of health care in Health Centre IVs in South Western Uganda. Design/methodology/approach: A cross-sectional design using a mixed-methods approach was adopted. Data were collected from health care workers in selected Health Centre IVs using questionnaires, key informant interviews, and document review. Quantitative data were analysed using descriptive statistics, Pearson correlation, and regression analysis, while qualitative data were analysed thematically. Findings: The findings revealed a positive and statistically significant relationship between work team stability and quality of health care (r = 0.440, p < 0.01). Consistent with this, regression results showed that work team stability significantly predicted quality of health care (β = 0.352, p = 0.003), with the model explaining 19.4% of the variation in quality of health care (R² = 0.194). Originality/value: This study provides empirical evidence on the role of work team stability in influencing quality of health care in public health facilities in Uganda, highlighting workforce stability as a critical factor in improving service delivery
When policy meets practice: enacting WHO global standards for adolescent reproductive health services in Uganda
(Reproductive Health, 2026-07-08) Asiimwe, Susan; Michielsen, Kristien; Nyakato, Viola Nilah
Background: Adolescent pregnancy remains a major public health concern in sub-Saharan Africa. In Uganda, about one in four girls becomes pregnant before age 19, a rate unchanged for more than a decade. Although national adolescent reproductive health policies broadly align with the World Health Organization Global Standards for Quality Health Care Services for Adolescents, important implementation gaps persist. This study examined how these standards are enacted in routine health facility and school settings. Methods: A qualitative study was conducted in eight public health facilities and eight secondary schools in south-western Uganda. Data were collected through structured observations and exit interviews with 80 adolescent girls aged 15-19 years and 20 accompanying caregivers. Health facility findings were organised using the eight World Health Organization Global Standards, while school observations were assessed against national school health and teenage pregnancy guidelines and interpreted alongside the World Health Organization framework. Data were analysed thematically in NVivo using Braun and Clarke’s framework, with Street-Level Bureaucracy theory informing interpretation of how standards were enacted in practice. Results: Implementation was partial and uneven across both settings. Some facilities provided respectful and confidential care, while others had stock-outs of essential commodities, reported out-of-pocket purchases, limited adolescent-friendly spaces, and judgemental or dismissive treatment, particularly toward unmarried adolescents. School-based reproductive health activities were largely abstinence-oriented and often donor-dependent, with weak curriculum integration, referral systems, monitoring, and evaluation. Community engagement and adolescent participation were limited in both settings. Several donor-supported activities became inactive after funding ended because they had not been absorbed into routine institutional systems. The findings indicated alignment in policy intent but weak embedding of adolescent-responsive components in routine institutional systems. Conclusion: Uganda’s adolescent reproductive health policy framework is broadly aligned with World Health Organization Global Standards, but implementation remains uneven because adolescent-responsive components are not sufficiently institutionalised within routine financing, supervision, school programming, data use, and accountability systems. Closing this gap requires embedding adolescent-responsive services in routine institutional systems and strengthening adolescent-specific supervision and accountability.
The Moderating Role of Government Regulations Compliance in the Relationship between Capacity Building, Firm Capabilities and Local Content Consumption in Uganda's Oil and Gas Sector
(East African Journal of Business and Economics, 2026-07-16) Mugisa, Samuel; Bagira, Vincent; Tumuhimbise, Manasseh; Twinematsiko, Ivan
Purpose: This study examined the moderating role of government regulations compliance in the relationship between capacity building, firm capabilities, and local content consumption among firms operating in Uganda’s oil and gas sector. The study adopted a mixed methods cross-sectional research design. Data was collected from 280 firms registered on the National Supplier Database of the Petroleum Authority of Uganda. Data was obtained from Procurement Officers, Accountants, and National Content Officers using questionnaires. Data were analysed using descriptive statistics, Pearson correlation, hierarchical regression, and Structural Equation Modelling (SEM). The findings revealed that capacity building (β = 0.444, p < 0.001) and firm capabilities (β = 0.343, p < 0.001) have positive and statistically significant effects on local content consumption. Hierarchical regression results indicated that capacity building and firm capabilities jointly explained 36.1% of the variation in local content consumption (Adjusted R² = 0.361). The findings further revealed that government regulations compliance positively and significantly moderates the relationship between capacity building and local content consumption (β = 0.273, p < 0.001), while negatively and significantly moderating the relationship between firm capabilities and local content consumption (β = -0.128, p = 0.008). The study recommends strengthening capacity-building programmes through training, knowledge transfer, supplier development initiatives, and improved access to finance for local firms. Regulatory institutions should also enhance monitoring and enforcement of local content requirements to increase the participation of Ugandan firms in oil and gas supply chains. The findings highlight the importance of investing in capacity building, strengthening firm capabilities, and ensuring compliance with local content regulations to enhance the participation of domestic firms in oil and gas procurement activities and increase local content consumption.
Quality of informed consent for research participation obtained during labor versus mid-pregnancy in Uganda
(BMC Medical Ethics, 2026-07-23) Kihumuro, Raymond Bernard; Zhang, Cindy; Zaigham, Mehreen; Haberer, Jessica E.; Byamukama, Anacret; Tindimwebwa, Edna; Asiimwe, Stephen; Gelaye, Bizu; Bajunirwe, Francis; Boatin, Adeline A.; Ngonzi, Joseph; Bebell, Lisa M.
Background: Obtaining high-quality informed consent for research is an ethical imperative and crucial for protecting participants’ rights. For vulnerable populations, including pregnant women, this concern becomes even more paramount. We evaluated the quality of informed consent for research participation obtained at different times during pregnancy in Uganda. Methods: This study was a nested prospective observational birth cohort study within the Placentas, Antibodies, and Child Outcomes (PACO) birth cohort. A total of 216 pregnant women were enrolled either during the second trimester (gestational weeks 16-24) or during labor at Mbarara Regional Referral Hospital and Kabwohe Clinical Research Centre in Uganda. The primary outcomes were objective (Quality of Informed Consent [QuIC]-A) and subjective (QuIC-B) informed consent scores. At the time of consent, we also assessed anxiety (Spielberger State-Trait Anxiety Inventory), pain (Wong-Baker Faces scale), and trust in medical researchers (Medical Researcher Trust scale, see Appendices for tools). We performed multivariable linear regression analyses to examine the association between consent timing and objective and subjective quality of informed consent for research participation. Results: Of 216 participants, 134 (62%) were enrolled during mid-pregnancy and 82 (38%) during early active labor. Consent obtained during labor was associated with significantly lower objective (mean difference -12.9; 95% CI -18.3 to -7.4; Both pain and trust in medical researchers were not associated with subjective or objective consent quality. Conclusions: The quality of informed consent obtained during labor was significantly lower than consent obtained during mid-pregnancy, highlighting the need for strategies to optimize informed consent timing and processes.
Land, informal employment, and fertility preferences in rural southwestern Uganda: A qualitative study
(Global Public Health, 2026) Atahigwa, Catherine; Coene, Gily; Murembe, Clementia Neema; Dirk, Lafaut
Land and informal work remain central to rural livelihoods in Uganda, yet their role in shaping fertility preferences is not well understood. This qualitative study examined how land ownership and informal livelihoods influence men’s and women’s fertility decision-making in rural southwestern Uganda. We conducted 15 focus group discussions and 30 in-depth interviews with women (18–49) and men (18–54) of reproductive age in Rubirizi district. Interviews were conducted in the local language, audio recorded, transcribed, translated into English, and thematically analyzed. Findings show that participants often linked land ownership to men’s preferences for large families, grounded in lineage continuity, provision, and social standing, even as land availability declined. Women described limited land rights under customary tenure as constraining their economic security and bargaining space in fertility-related decisions. Informal livelihoods were portrayed as enabling household survival, but were financially unstable, shaping many women’s preferences for smaller families, while limiting their ability to act on these preferences. This study highlights how participants described land relations and livelihood insecurity as gendered influences on the formation and negotiation of fertility preferences in agrarian settings.
Health facility capacities for providing adolescent sexual and reproductive health services in Southwestern Uganda
(BMC Health Services Research, 2026-07-21) Atwine, Daniel; Nyakato, Viola Nilah; Birungi, Caroline; Namatovu, Shakirah; Munguciada, Esther Faith; Arinaitwe, Rinah; Ivanova, Olena; Kemigisha, Elizabeth
Background: Provision of adolescent-friendly Health services (AFHS) at lower primary health care centres (PHCs) is a core strategy for improving access and health outcomes of adolescents. In this study we assessed the health facility-based prevalence of repeat adolescent pregnancies and the capacity of PHCs (Health centres (HC) level III and IV) to provide AFHS in Uganda. Methods: We conducted a cross-sectional study between April and May 2023 involving 43 healthcare facilities (33 HC III and 10 HC IV) across 4 districts in Southwestern Uganda. Using pretested structured questionnaires, we interviewed the health facility in-charges or their delegates. We extracted the 6-month information from registers on: number of repeat adolescent pregnancies, post-abortion, and post-natal adolescents attending each facility. With a checklist, we assessed the availability of family planning materials/services and other medical equipment. Descriptive statistics were generated. Results: Adolescent contributed 4.9%, 16.3% and 14.8% of all repeat pregnancy, post-abortion and postnatal consultations documented at all PHCs. We noted a low perinatal care staffing with the majority of HC IIIs lacking adolescent peer educators (n=34; 79%), and counsellors (n=26; 60.5%). The need for training in the provision of adolescent-friendly services, post-natal or post-abortion care in adolescents (>90%) was high. PHCs were inadequately supplied with equipment for post-abortion care and IUD insertion. Female and male sterilization and emergency contraception were less offered. Health workers were willing to give family planning to previously pregnant adolescents (90.7%), without parental consent (65.2%), but did not support contraceptive administration to adolescents who had formerly been pregnant in fear of promoting sexual promiscuity (41.9%). A quarter of the PHCs had a dedicated clinic for adolescents and had a day in the week for adolescent services. Conclusions: This study reveals major gaps in adolescent perinatal care in Southwestern Uganda, including limited peer educators, inadequate post-abortion care, and poor healthcare worker training. Strengthening services requires interactive, peer-based training and addressing staffing shortages through peer educators and community health workers. Equipping Health Centre IIIs to deliver comprehensive, adolescent-friendly care is essential to improving access and closing these critical service gaps
Community-Based Tourism Enterprises Performance and Community Attitudes Amidst Changing Demographics: Implications for Community Conservation Outcomes of Bwindi Impenetrable National Park
(African Journal of Tourism and Hospitality Management, 2026) Kyarikunda, Monica; Kagoro-Rugunda, Grace; Ogwang, Tom
The study examined the influence of Community-Based Tourism Enterprises (CBTEs) performance on community attitudes towards community conservation outcomes like reduced illegal resource use, reduced poaching, protection of gorillas and collaborative wildlife management around Bwindi Impenetrable National Park (BINP). A mixed-methods research design was adopted, combining quantitative and qualitative approaches. Data were collected using semi-structured questionnaires, key informant interviews and Focus Group Discussions involving CBTE owners, CBTE members, Uganda Wildlife Authority Staff and local leaders. Quantitative data were analysed using descriptive statistics, correlation and multiple regression, while qualitative data were analysed thematically. Results revealed that CBTEs positively influence community attitudes towards conservation, when communities receive tangible benefits such as income, employment, infrastructure development and social services, they are likely to support conservation efforts. Community involvement in decision-making and equitable benefit sharing were found to significantly enhance positive conservation attitudes, but unequal distribution of tourism benefits and persistent human-wildlife conflicts contributed to negative attitudes among residents. The study concludes that community conservation depends on the good performance of CBTEs through providing socio-economic and environmental benefits, which strengthens positive conservation attitudes. There is a need to strengthen CBTE performance through capacity building, access to conservation benefits, community participation and conservation education to achieve sustainable conservation outcomes.
Assessing the Recognition, Documentation, and Promotion of Local Community Rights Around Bwindi Impenetrable National Park, Uganda
(East African Journal of Interdisciplinary Studies, 2026) Ainomujuni, Junior; Twinamatsiko, Medard; Smis, Stefaan; Muchunguzi, Charles
Recognition and respect for community rights are essential for equitable conservation, particularly for those living near protected areas. However, despite their critical role in natural resource management, indigenous communities continue to face persistent exclusion, which remains a significant challenge. This study investigated how community rights are recognised, defined, documented, and promoted around Bwindi Impenetrable National Park (BINP), Uganda. A mixed methods approach was employed, combining surveys of 120 households with interviews, workshops, documentary reviews, and observations involving 30 key informants across the districts of Kisoro, Rubanda, and Kanungu. Data were analysed using SPSS and NVivo. Findings show that economic and cultural rights, including revenue sharing, cultural practices, and access to medicinal plants, are the most widely acknowledged. However, participatory rights such as access to information, employment opportunities, and involvement in park protection remain limited. Rights are primarily defined through Memoranda of Understanding, strategic plans, and Uganda’s Constitution, though community awareness of these instruments is limited and uneven. Efforts to promote rights, such as sensitisation, human-wildlife conflict mitigation, NGO support, and the Community Conservation Department (UWA), have had some impact, but challenges of transparency, inclusivity, and fair compensation persist. The study recommends equitable governance frameworks that emphasise fair benefit-sharing, inclusive participation, and transparent enforcement to strengthen trust, community engagement, and sustainable conservation outcomes in Bwindi and beyond.
Beyond Borders: Migration Patterns and Surveillance Gaps at the West Nile Uganda-Democratic Republic of the Congo Border Entry Points
(East African Journal of Interdisciplinary Studies, 2026-06-04) Birungi, Spencer; Mulogo, Edgar Migema; Muchunguzi, Charles
Transboundary migration across the Uganda–Democratic Republic of the Congo (DRC) border remains a defining feature of population mobility and border governance in Uganda’s West Nile region. Daily cross-border movements support trade and social ties, and are predominantly circular and repetitive rather than permanent. Such high-frequency mobility places sustained pressure on surveillance systems that are often designed for occasional travellers, creating gaps in routine monitoring at border entry points. This study examined transboundary migration patterns in terms of volume, direction, frequency, and demographic profiles, and assessed how existing migration surveillance controls at West Nile, Uganda–DRC points of entry aligned with and responded to these movements. A cross-sectional mixed-methods study was conducted across six West Nile border districts. Quantitative data were collected through structured interviews with 292 adult cross border travellers at gazetted and porous entry points. Qualitative 03 FGDs, 02 community in-depth individual interviews, 05 policy level executive interviews, and 05 field observations at both gazetted and porous border points of entry. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed thematically. Findings indicated that cross-border mobility was characterised by frequent and repetitive movement: 45.9% of respondents crossed the border 2–10 times in the previous three months, and 39.0% crossed more than 10 times. Although 75.7% used gazetted points of entry during their most recent crossing, 23.3% used ungazetted routes. Surveillance controls were inconsistently experienced, and only 40.4% reported observing migration-related checks. Perceived effectiveness of infectious disease monitoring was significantly associated with experiencing health checks and the presence of cross-border monitoring mechanisms, but not with general awareness of infectious diseases. In conclusion, frequent circular mobility and uneven enforcement of surveillance controls remain central challenges to effective border migration surveillance in the West Nile. Aligning migration surveillance systems with the realities of high frequency movement is critical to strengthening routine infectious disease monitoring at both formal and informal border crossings.
Adolescent mothers’ second chance education: A systematic review of school re-entry and continuation policies in sub-Saharan Africa
(South African Journal of Education, 2026) Nyakato, Viola Nilah; Kemigisha, Elizabeth; Kools, Susan
School re-entry and continuation policies are widely promoted in sub-Saharan Africa (SSA) as a means of safeguarding adolescent mothers’ educational participation, yet their practical effects remain inconsistently documented. With this systematic review we synthesised evidence on national policy and programme responses governing re-entry and continuation for adolescent mothers in SSA, drawing on academic and grey literature published between 2000 and March 2022. Following multi-database searching and screening, 63 sources were included and analysed thematically, guided by African feminism, agency theory, and the positive youth development framework. Across contexts, policy commitments commonly articulate educational rights but fall short at the level of operationalisation: guidance on implementation is often vague, resourcing limited, and accountability mechanisms weak. The evidence shows that re-entry decisions and persistence in school are shaped by intersecting constraints: stigma and moral surveillance, gendered expectations of motherhood, inflexible schooling arrangements, inadequate childcare, and household poverty, alongside uneven school-level interpretation of policy. However, promising practice is visible in alternative and second chance initiatives that combine flexible learning pathways with psychosocial support and childcare or caregiving accommodations, enabling re-engagement and completion where mainstream systems remain exclusionary. Overall, the review indicates that policy expansion has outpaced implementation capacity and social norm change. Advancing adolescent mothers’ educational inclusion requires gender-responsive implementation strategies that translate policy into enforceable procedures, strengthen school and community support structures, and institutionalise cross-sector collaboration to address childcare, stigma, and economic barriers.
Digital Financial Innovation Adoption and SME Financial Performance: The Mediating Role of Financial Inclusion in Developing Economies
(International Journal of Finance, 2026) Aliija, Ronald; Nsambu, Kijjambu Frederick; Kule, John Baguma; Rwakihembo, John; Bakashaba, Rennie; Tumuhimbise, Manasseh
Purpose: This paper develops a theory-driven conceptual framework that explains this relationship by positioning financial inclusion as a mediating mechanism. Methodology: The study employs a structured review of relevant literature and integrates insights from the Resource-Based View (RBV), the Unified Theory of Acceptance and Use of Technology (UTAUT), and Financial Intermediation Theory. DFI adoption is conceptualized as a multidimensional construct comprising the decision to adopt, integration into business operations, and diversity of digital financial innovations utilized. Findings: The review suggests that DFI adoption improves operational efficiency, liquidity management, and business growth. These benefits are largely achieved through enhanced financial inclusion, which strengthens SMEs' access to, usage of, affordability of, and quality engagement with formal financial services, thereby improving financial performance. Unique Contribution to Theory, Policy and Practice: The study contributes to theory by integrating RBV, UTAUT, and Financial Intermediation Theory in to a unified conceptual framework explaining how DFI adoption influences SME financial performance through financial inclusion. It further advances knowledge by proposing a multidimensional conceptualization of DFI adoption and identifying financial inclusion as the key transmission mechanism. The framework offers practical guidance for policymakers, financial institutions, and SME managers seeking to promote financial inclusion and sustainable SME growth through digital financial innovations.
Adolescent Parenthood and Mental Health in South-Western Uganda: Psychosocial Vulnerabilities, Depression Prevalence, and Associated Factors
(Cureus, 2026) Atwiine, Scovia; Nyakato, Viola N.; 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
Competitive Sorption and Retention of Chromium, Copper, Lead, and Zinc in Brewery Biosolid-Amended Ferralsol (Oxisol): Selectivity, Mechanisms, and Environmental Implications
(Journal of Encapsulation and Adsorption Sciences, 2026) Ntambi, Emmanuel; Mukasa, Paul; Nalumansi, Irene; Nakiguli, Caroline K.; Cherop, Tony; Ntale, Muhammad; Tenywa, John Stephen
This study investigated the competitive sorption and desorption behaviour of potentially toxic elements (PTEs) or trace metals (chromium, copper, lead, and zinc) from brewery biosolid-amended Ferralsol (Oxisol), addressing critical gaps in understanding metal mobility and retention in tropical agricultural soils receiving industrial organic amendments. Batch equilibrium experiments were conducted using Ferralsol amended with brewery biosolid at application rates of 0, 2.5, 5.0, and 7.5 tons∙ha−1, with single superphosphate (SSP) at 0, 25, 50, and 75 kg∙ha−1. Multi-metal nitrate solutions (25 - 500 mg∙L−1) containing equal concentrations of Cr3+, Cu2+, Pb2+, and Zn2+ were equilibrated with sorbents for 1 day (24 hours) at pH 4.5 (buffered with 0.02 M acetic acid/sodium acetate). Metal concentrations were determined by atomic absorption spectrophotometry. Sorption and desorption data were fitted to Langmuir and Freundlich isotherms, and distribution coefficients (Kd) were calculated to establish selectivity sequences. Chromium (Cr3+) exhibited the highest sorption and retention capacity across all treatment rates, with Kd values 2 - 3 orders of magnitude greater than those of other metals. The selectivity sequence for adsorption followed Cr > Zn > Pb > Cu at 100 mg∙L−1, shifting to Zn > Cr > Pb > Cu at 7.5 metric tons∙ha−1 brewery biosolid application. Desorption studies revealed near-irreversible binding for chromium (retention Kd = 14.2 - 33.4 L∙g−1), while zinc demonstrated the greatest reversibility (retention Kd = 0.09 - 0.27 L∙g−1). Langmuir and Freundlich models showed limited applicability (only 43.6% of potential isotherms fitted r2 > 0.75), with Freundlich providing superior fits for most metal-sorbent combinations. The high charge-to-radius ratio of Cr3+ (49.2 against 16.8 - 27.4 for other metals) drives its preferential retention through inner-sphere complexation and possible surface precipitation. Brewery biosolid addition increased organic matter content (from 2.51% to 4.5%) and cation exchange capacity (from 8.7 to 17.6 cmol∙kg−1), enhancing overall metal retention capacity. The S-type isotherms observed indicate cooperative adsorption mechanisms. These findings demonstrate that brewery biosolid-amended Ferralsol (Oxisol) effectively immobilizes chromium, reducing its bioavailability and leaching potential, while zinc remains comparatively mobile. Application rates above 5.0 tons∙ha−1 optimize metal retention without compromising soil quality.
Cost and Cost-Effectiveness of mHealth Interventions to Promote Uptake of Antenatal Care (ANC) in Low- and Middle-Income Countries: A Scoping Review
(Cureus, 2026) Atuhumuza, Elly; Atukunda, Esther C; Tumuhimbise, Wilson; Mugyenyi, R. Godfrey; Musiimenta, Angella; Batwala, Vincent
Mobile health (mHealth) innovations are increasingly being considered to improve antenatal care (ANC) uptake in low- and middle-income countries (LMICs). However, there is limited evidence of their value for money, which limits policymakers' ability to make decisions about sustainability and scale. This scoping review synthesizes available evidence on the cost and cost-effectiveness of mHealth interventions aimed at promoting ANC uptake in LMICs. Following the Arksey and O’Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we searched PubMed, Science Direct, and Google Scholar databases for peer-reviewed studies reporting economic evaluations. These included studies reporting cost-effectiveness, cost-benefit, or costing analyses of mHealth interventions targeting ANC, published between 2010 and 2025. Screening and data extraction were performed by two independent reviewers. Data was charted and synthesized narratively, and findings were presented in tables. From the 1,249 records screened, 10 studies met the inclusion criteria: seven cost-effectiveness analyses and three costing studies. Studies were from South Asia and sub-Saharan Africa, including India (n=3), Bangladesh (n=2), and one each from Nigeria, South Africa, Ghana, Iraq, and Malawi. Interventions included short message service (SMS) reminders, mobile job aids for community health workers, and integrated digital platforms. Improvements were reported in ANC outcomes such as early registration, four or more visits, and iron-folic acid consumption. Costs ranged from $0.0225 per SMS in Iraq to $29.33 per user in Malawi. Incremental cost-effectiveness ratios varied from $21 to $568 per disability-adjusted life year averted and were below prevailing country specific gross domestic product (GDP) per capita thresholds, though direct cross-study comparison is limited by differences in analytical perspective, time horizon, and modelling assumptions. Four studies adopted a societal perspective, four a program perspective, and one a health system perspective; five of the seven cost effectiveness analyses used the Lives Saved Tool for modelling. Evidence gaps identified included a lack of equity analyses, limited long-term sustainability data, and a need for standardized methodological approaches. Reviewed evidence suggests that mHealth interventions for ANC promotion in LMICs are a cost-effective approach to improving ANC uptake, although evidence is largely modelled rather than empirically observed and hence calls for cautious interpretation. The common use of the Lives Saved Tool across most cost-effectiveness studies suggests an emerging standardization in how mHealth cost-effectiveness is assessed. Some gaps remain, including the absence of equity analyses, limited long-term sustainability evidence, and underrepresentation of sub-Saharan Africa. Standardized cost-effectiveness analyses with a focus on equity are needed to ensure future mHealth investments align with universal health coverage goals and benefit women across all socioeconomic groups.
Design and Early Implementation Outcomes of a Mobile Health-Enabled Social Support Intervention for Adults Living With HIV and Type 2 Diabetes in Uganda
(Cureus, 2026) Kizza, Gerald; Musiimenta, Angella; Wasswa, William; Kimera, Richard; Tumuhimbise, Wilson
Background: Adults living with HIV and type 2 diabetes experience complex treatment demands that affect medication-taking, clinic attendance, privacy, social support, and engagement with care. Mobile health (mHealth)-enabled social support may help reduce treatment burden, but such interventions need to fit patients’ everyday realities, phone access, trusted support networks, and clinic workflow. Objective: This study aimed to describe the user-centered design (UCD) mechanisms of an mHealth-enabled social support intervention for adults living with HIV and type 2 diabetes in Uganda and assess perceived and self-reported early implementation outcomes, including acceptability, feasibility, and appropriateness, after one month of use. Methods: This mixed-methods formative study was conducted among 64 purposively selected participants from the HIV and diabetes clinics at Mbarara Regional Referral Hospital (MRRH), including 39 adults living with HIV and type 2 diabetes, 20 nominated social supporters, and five healthcare workers. Participants were oriented to an Mhealth-enabled social support intervention composed of short message service (SMS) reminders, educational messages, social supporter SMS prompts, discreet messaging, server-supported message routing, and clinic linkage. Patients used the intervention for one month. Post-trial interviews, focus group discussions (FGDs), brief feedback forms, observation notes, and intervention-use records were used to assess acceptability, feasibility, appropriateness, concerns, social support activation, and design refinements. Interview and focus group questions were informed by the Unified Theory of Acceptance and Use of Technology (UTAUT), and refinements followed a UCD approach. Qualitative data were analyzed thematically using NVivo, while quantitative intervention-use records and feedback responses were analyzed in Stata and summarized using frequencies, percentages, and counts. Results: Participants perceived the intervention as useful for supporting medication-taking, clinic appointment preparation, communication with nominated social supporters, and a sense of being supported beyond the clinic. During the one-month trial, 1,092 SMS medication reminders, 74 appointment reminders, 312 educational or supportive messages, and 280 social supporter SMS prompts were delivered. Privacy sensitive wording was strongly preferred because of the fear of unintended HIV status disclosure. The intervention was considered feasible because it used familiar channels, including SMS, voice calls, and simple app functions, although shared phone use, airtime costs, charging problems, network interruptions, language barriers, and possible clinic workload remained concerns. Participants considered the intervention appropriate because it addressed both HIV and diabetes, enabled patient-controlled social support, protected privacy, and fit existing social and clinical support practices. Conclusion: A privacy-sensitive, low-burden intervention that combines reminders, patient-controlled supporter prompts, short educational messages, and clinic linkage could support medication-taking and care coordination for patients managing both conditions. Further implementation research is needed to refine the intervention and assess longer-term adoption, fidelity, sustainability, and preliminary impact.
Environmental Uncertainty and Supply Chain Resilience among Manufacturing Firms in Uganda: The Mediating Role of Supply Chain Innovativeness
(Journal of Economics and Behavioral Studies, 2026) Aryatwijuka, Wilbroad; Mutebi, Henry; Twongyirwe, Ronald; Tumebembeire, Naster; Tugiramasiko, Miriam; Atwine, Aquilionus; Musoke, Hassan
This study examines the relationships between environmental uncertainty (EU), supply chain innovativeness (SCI), and supply chain resilience (SCRE) among manufacturing small and medium-sized enterprises (SMEs) in Uganda. Specifically, it investigates the mediating role of supply chain innovativeness in the relationship between environmental uncertainty and supply chain resilience. A cross-sectional quantitative survey was conducted using structured questionnaires administered to 400 manufacturing SMEs located in Kampala, Wakiso, Mukono, and Jinja districts. The data were analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM) with Smart PLS 4. The results reveal that environmental uncertainty positively influences both supply chain resilience and supply chain innovativeness. Supply chain innovativeness also exerts a significant positive effect on supply chain resilience and partially mediates the relationship between environmental uncertainty and supply chain resilience. These findings suggest that manufacturing SMEs enhance resilience by developing innovative capabilities that enable them to anticipate, adapt to, and recover from environmental disruptions. The cross-sectional design limits causal inference and the ability to capture resilience development over time. Future studies should employ longitudinal or mixed-methods approaches to examine the dynamic processes through which firms build resilience under environmental uncertainty. Manufacturing SMEs should strengthen innovation capabilities by investing in flexible production systems, digital technologies, collaborative relationships, and continuous product and process innovation to improve resilience against supply chain disruptions. This study contributes to the supply chain resilience literature by integrating Resource-Based Theory and Dynamic Capability Theory to explain how supply chain innovativeness transforms environmental uncertainty into resilience.
Health Worker Perspectives on the Screening and Management of Hypertensive Disorders and Diabetes in Pregnancy in Uganda: A Cross-Sectional Survey
(BMC Health Services Research, 2026) Tibaijuka, Leevan; Jacquemyn, Yves; Lugobe, Henry Mark; Mugyenyi, Godfrey R.; Kwikiriza,Peal A.; Bagala, John Paul; Mugahi, Richard; Boatin, Adeline A.; Atukunda, Esther C.; Matthews, Lynn T.; Bebell, Lisa M.; Ngonzi, Joseph; geertruyden, Jean-Pierre Van
Background Hypertensive disorders of pregnancy (HDP) and diabetes in pregnancy (DIP) are leading contributors to maternal and perinatal morbidity and mortality in sub-Saharan Africa, yet effective management depends on health workers having the knowledge, attitudes, and practices to screen, diagnose, and treat these conditions. Evidence on these provider-level factors remains limited in Uganda. Methods We conducted a descriptive cross-sectional survey among health workers in Uganda (November– December 2025), disseminating a structured questionnaire on HDP and DIP knowledge, attitudes, practices, prescribing, and task shifting via WhatsApp-based Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) networks and professional association platforms, hosted on REDCap. We analysed data in STATA 17 using descriptive statistics and comparisons across health worker groups. Results Of the 690 eligible health workers, 577 completed the survey (83.5%). Midwives comprised the largest group (341, 59.1%) and most worked in public facilities (425, 73.7%). Knowledge and protocol integration were substantially stronger for HDP than DIP: CPD attendance was 70.9% for HDP versus 36.4% for DIP, self-reported protocol familiarity was 90.1% versus 38.6%, and routine BP screening was near-universal (538, 93.2%) while only 122 (21.1%) always screened for diabetes in pregnancy. Correct oral glucose tolerance test (OGTT) thresholds were identified by only 186 (32.2%). Attitudes reflected strong support for patient involvement in treatment decisions and consistent treatment targets, with moderate confidence in guideline-based adjustments (279, 48.4%). Prescribing prioritised affordability (438, 75.9%) and reliable drug supply (473, 82.0%). Task shifting was widely accepted for basic functions including BP measurement (538, 93.2%) and lifestyle counselling (514, 89.1%), but less so for algorithm-based prescribing (170, 29.5%). Cadre differences were consistent across domains: for HDP, correct identification of severe preeclampsia features and use of advanced diagnostics were significantly lower among midwives than specialist cadres (p<0.001); for DIP, gaps were most pronounced among midwives, with the lowest DIP CPD attendance (105, 30.8%) and OGTT endorsement (186, 54.5%) of all cadres (p<0.001). Advanced diagnostic use and OGTT endorsement also increased progressively with facility level (p<0.001). Conclusions Health workers in Uganda demonstrate substantially stronger knowledge, attitudes, and practices for HDP than for DIP, with consistent cadre-related differences. Under-recognition of DIP likely contributes to missed opportunities for timely intervention. Targeted CPD on DIP, wider protocol dissemination , and system-level support for diabetes screening are urgently needed. Leveraging existing RMNCAH networks offers a practical pathway for integrating DIP into routine antenatal care.
Invisible Yet Resilient: Understanding the Vulnerability and Integration Pathways of South Sudanese Older Refugees in Uganda
(Journal of Central and Eastern European African Studies, 2026) Ahimbisibwe, Frank; Opono, Samuel; Twinamasiko, Specioza; Kabasiita, Maria Goretti
Forcibly displaced older persons in Africa have not largely been the object of academic research. Recent scholars conducted a scoping review about the situations of displaced older persons in Africa and identified several gaps in the literature, including paying attention to the displaced older persons’ integration in the host societies. Our current study contributes to filling this gap by examining the vulnerability of older refugees and identifying hidden opportunities for resilience and integration in the host communities. The study is based on the primary data collected from South Sudanese refugees in Pagirinya Settlement in Uganda, analysed in conjunction with the available literature. The study finds that despite the vulnerability of older refugees; windows of opportunities exist to develop their resilience and integrate them in the host communities. It concludes that leveraging skills of older refugees and social gatherings in the settlements helps them to curtail vulnerabilities, develop resilience and integrate in the host communities.
Lived Experiences, Social Support Systems, and Coping Mechanisms Among Parenting Adolescents With Depression in Southwestern Uganda: A Qualitative Phenomenological Study
(Cureus, 2026) Atwiine, Scovia; Nyakato,Viola N.; Atwine, Daniel; Kemigisha, Elizabeth
Background: Parenting during adolescence is associated with significant emotional, social, and economic challenges that increase vulnerability to depression and psychological distress. In sub-Saharan Africa, adolescent parents frequently experience stigma, school dropout, poverty, weak social support systems, and limited access to adolescent-friendly mental health services. However, limited qualitative evidence exists regarding the lived experiences of adolescent mothers and fathers with depression in Uganda. This study explored the lived experiences, social support systems, and coping mechanisms of parenting adolescents with depression in southwestern Uganda. Methods: A qualitative phenomenological study was conducted between March 2025 and January 2026 in selected health facilities and neighboring communities in Mbarara District, southwestern Uganda. Purposive sampling was used to recruit adolescent mothers and fathers aged 10-19 years with depressive symptoms, as well as key informants, including caregivers, community leaders, Village Health Team (VHT) members, and health workers. Data were collected through in-depth interviews and key informant interviews using Semi structured interview guides. Interviews were audio-recorded, transcribed verbatim, translated into English, and thematically analyzed using both deductive and inductive coding approaches supported by NVivo version 12.2 (QSR International Pty Ltd., Melbourne, VIC, Australia). Bronfenbrenner's Ecological Systems Theory guided the interpretation of the findings. Results: A total of 33 participants were interviewed, including 12 (36.3%) adolescent mothers, six (18.2%) adolescent fathers, and 15 (45.5%) key informants. Three major thematic domains emerged: lived experiences, social support systems, and coping mechanisms. Parenting adolescents described significant emotional and psychological distress characterized by persistent worry, hopelessness, social isolation, and severe emotional pain. Depression was strongly linked to poverty, school dropout, unemployment, partner abandonment, stigma, and family rejection. Social support was obtained primarily from parents, grandparents, partners, health workers, and community leaders, although these support systems were inconsistent and often limited. Adolescents primarily relied on informal coping mechanisms, including prayer, peer support, casual labor, resilience, and acceptance of parenthood. Conclusion: Depression among parenting adolescents in southwestern Uganda is shaped by complex interactions among emotional distress, socioeconomic hardship, stigma, and limited psychosocial support systems. Strengthening adolescent-friendly mental health services, family support systems, community sensitization, educational reintegration, and economic empowerment programs may improve the psychosocial well-being of parenting adolescents.
Proportion of ocular hypertension from a community-based screening program in South-Western Uganda
(Journal of Ophthalmology of Eastern, Central and Southern Africa, 2025) Owiny, M; Arunga, VN; Kabunga, R; Arunga, S
Background: Glaucoma is the second leading cause of blindness globally. Africa has the highest burden of undetected cases of glaucoma and, the majority of patients present to the hospitals late with severe glaucoma partly due to the limited access to glaucoma screening equipment, and few trained eye care personnel. Ocular Hypertension (OHT), defined as an Intraocular Pressure (IOP) of >21 mmHg with normal optic nerve head findings and no other ocular disease is a risk factor for the development and progression of glaucoma. Uganda has limited data on the prevalence of OHT. Objective: We aimed to determine the proportion of OHT in South Western Uganda. Methods: This was a retrospective analysis of the IOP data of 5962 participants from a community-based outreach eye screening program. The IOP was measured using i-care100 rebound tonometer. The eyes were examined using a torch light and a direct ophthalmoscope. History of hypertension and diabetes treatment were obtained, and the blood pressure and random blood sugar measured. Data analysis involved a t-test, and logistic regression using STATA 7. Results: The mean age was 48.2 years. The majority, 56.2% were female. Systemic hypertension was present in 23.9% and diabetes in 2.3%. The mean IOP was 15.5 mmHg (SD ±4.9). The prevalence of OHT was 12.6% (n = 731). At bivariable analysis, female sex (OR 0.85, 95% CI 0.73–0.99, and p= 0.049), diabetes (OR 1.45, 95% CI 0.85–2.48, and p= 0.17) and systemic hypertension (OR 1.45, 95% CI 1.18–1.77, and p= 0.000) were associated with OHT, while systemic hypertension was the only factor associated with OHT at multivariable analysis (adjusted odds ratio 1.5, 95% confidence interval 1.23–1.92, and p-value = 0.000). Conclusion: We found a high prevalence of OHT in southwestern Uganda. OHT was associated with systemic hypertension.