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Recent Submissions

Evaluation of antimycobacterial activity of Zanthoxylum leprieurii guill. & Perr. and Rubia cordifolia l and their interaction with conventional anti- tuberculosis drugs used for the treatment of tuberculosis in Uganda
(Mbarara University of Science and Technology, 2024-09) Mpeirwe, Moses
Background: Tuberculosis (TB) remains a public health challenge and one of the leading causes of death worldwide. TB is preventable and curable. However, treatment of tuberculosis has continued to be difficult as a result of rapid emergence of multidrug resistant (MDR) and extensively drug resistant (XDR) strains of Mycobacterium tuberculosis (MTB). Medicinal plants have for centuries been traditionally used in treatment Of tuberculosis and similar ailments globally. They possess antimicrobial properties which render them a new hope as a source of novel bioactive leads in the development of antimycobacterial agents. Additionally, despite the increasing acceptance of medicinal plant use in combination with conventional antituberculosis drugs in treatment Of tuberculosis (TB) in Uganda, there is paucity or knowledge On their combination effect. Methods: Two plant species commonly used traditionally for the treatment Of tuberculosis in Uganda, Zanthoxylum leprieurii Guill- & perr. and Rubia cordifolia L. were screened for in vitro antimycobacterial activity against Mycobacterium tuberculosis strains; pan sensitive MTB H37Rv, Rifampicin resistant TMC 331 strain and two wild strains (one rifampicin resistant and another one rifampicin susceptible). Antimycobacterial activity of aqueous, ethanolic and methanolic plant extracts was determined using Resazurin Microtiter Assay (REMA). We also determined the combination activity of both medicinal plant extracts at varying concentrations and standard antituberculosis drugs against H37Rv and MDR (TMC 331) strains. cytotoxic effect of the active plant extracts was determined against the mouse BALB/C monocyte-macrophage (J774.2) cells using Microculture Tetrazolium (MIT) assay. Results: Both plant extracts exhibited significant in vitro antimycobacterial activity against all MTB strains. Minimum inhibitory concentrations (MIC) of methanolic crude extracts of both plants ranged from 23.4gg/mL to 187.5gg/mL. Comparatively, methanol extracts of both plants possessed superior antimycobacterial activity against all the strains. Drug-extract combinations showed good combination activity against Mycobacterium tuberculosis Strains when compared with individual Standard anti-TB drugs especially against MDR-MTB strain. All extracts exhibited moderate to weak cytotoxicity against J774.2 mouse macrophage monocyte cell line in a dose dependent manner. Conclusions: Our findings indicated that both plants exhibited activity against susceptible and resistant strains Of Mycobacterium tuberculosis. While antimycobacterial activity Of Z leprieurii confirms results from previous studies, activity of the extracts Of R. cordifolia is reported for the first time in East Africa. Zanthoxylum leprieurii and Rubia cordifolia in combination with standard anti-TB drugs exhibited increased in vitro activity against Mycobacterium tuberculosis especially MI)R-MTB strain. This verifies the local use of these plants in traditional treatment of tuberculosis in Uganda.
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(2026) kim, kimm
High Rates of Atrial Fibrillation among Inpatients with Heart Failure or Ischemic Stroke in Southwestern Uganda
(Annals of Global Health, 2026) Olds, Peter K.; Twesigye, Precious; Nakawesa, Lydia; Kasomba, Ivan; Haberer, Jessica E.; Fardous, Abeya
Background: Atrial fibrillation (AF) affects over 37 million people worldwide, and its prevalence is projected to increase by 60% by 2050. Addressing AF is critical in Uganda and elsewhere in sub-Saharan Africa, where data are lacking despite the high prevalence of AF risk factors, comorbidities, and sequelae. Objectives: To evaluate AF prevalence among inpatients with acute heart failure or acute ischemic stroke in Uganda. Methods: Between November 4, 2024 and November 30, 2025, we recruited a cohort of inpatients at the Regional Referral Hospital in Mbarara, Uganda with either acute heart failure or acute ischemic stroke. We collected baseline clinical data and hospital outcomes, performed a transthoracic echocardiogram, and equipped participants with a 24-hour Holter monitor. A multivariable logistic regression model was fitted for a primary outcome of AF detection. Results: Among 250 individuals, mean age was 61.7 years (SD 20.5), of whom 175 (70.0%) were women. 123 (49.2%) had acute heart failure; 127 (50.8%) had acute ischemic stroke. Holter monitors detected AF in 105 (42.0%), with a mean AF duration of 11.0 hours (IQR 1.0–21.9) with a bimodal distribution. Mean stroke risk (CHA2 DS2 VA) was 3.5 (SD 1.6). Factors associated with AF included increasing age in years (OR 1.04, 95% CI 1.02–1.06) and left atrial volume index (mL/m2) (OR 1.02, 95% CI 1.01–1.03). Conclusions: We found high rates of AF among inpatients with acute heart failure or acute ischemic stroke, comparable to studies from the United States and Europe. These findings highlight the need to address AF in Uganda, with improved screening using long-term monitors, updated treatment protocols, and broadened access to cardiac care.
Facilitators and Barriers to Discharge Education for Puerperal Sepsis Prevention After Caesarean Section: A Qualitative Study at a Tertiary Health Facility in Southwestern Uganda
(International Journal of Women's Health, 2026-10-28) Luwaga, Rachel; Ngonzi, Joseph; Bajunirwe, Francis; Shindell, Deborah
Introduction: Maternal mortality remains a major global health concern, disproportionately affecting low- and middle-income countries. Puerperal sepsis remains an important contributor to maternal morbidity and mortality, with caesarean delivery increasing women’s risk of infection. As caesarean deliveries increase, strengthening strategies to prevent puerperal sepsis throughout the continuum of care is increasingly important. Although prevention efforts have focused largely on antenatal and intrapartum care, post- discharge self-care and education remain insufficiently emphasized. Evidence from Mbarara Regional Referral Hospital indicates gaps in women’s knowledge and practices regarding post-caesarean self-care, highlighting the need for effective discharge education to support prevention, early recognition, and timely care-seeking for puerperal sepsis. However, the effectiveness of discharge education depends not only on the information provided but also on healthcare providers’ ability and willingness to deliver it within the available health-system environment. The COM-B framework provides a useful lens for understanding these influences by examining providers’ capability, opportunities within the health system, and motivation to deliver discharge education. Understanding these factors is therefore important for identifying barriers and facilitators that can be addressed to strengthen puerperal sepsis prevention after discharge. The study aimed to explore the facilitators and barriers to the provision of discharge education for puerperal sepsis prevention following caesarean delivery. Methods: This study employed an exploratory qualitative design at Mbarara Regional Referral Hospital. A total of 12 healthcare providers, comprising six senior house officers and six midwives, were purposively selected, provided informed consent, and participated in in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by systematically coding statements from the transcripts, organizing similar codes into subthemes, and subsequently synthesizing the subthemes into overarching themes. Results: Twelve healthcare providers (six midwives and six senior house officers) participated in the study. Under Capability, knowledge, clinical experience, and awareness of puerperal sepsis and its prevention facilitated discharge education. Opportunity was facilitated by the availability of discharge forms and opportunities to provide education, but barriers included limited post- caesarean-specific information, inconsistent timing and content of instructions, language barriers, inadequate staffing and time, fatigue, limited space and privacy, and gaps in coordination and teamwork. Under Motivation, professional commitment, passion for patient care, and awareness of the consequences of inadequate education facilitated discharge teaching, whereas patient disengagement, heavy workload, and other demotivating factors hindered it. Conclusion: Discharge education for puerperal sepsis prevention following caesarean section was influenced by interacting provider and health-system factors. While providers’ knowledge, experience, commitment, and available resources supported education, workload, staffing constraints, limited privacy and space, language and literacy barriers, inadequate post-caesarean materials, inconsistent timing, and gaps in teamwork constrained its consistent delivery. Strengthening discharge education therefore requires a multi-level approach that addresses both providers’ capability and motivation and the health-system opportunities needed to deliver effective education.
Living as citizens, governed as foreigners: recognition strategies and intergenerational invisibility among abavandimwe in Uganda
(Citizenship Studies, 2026-10-28) Nkiko, Cedric Marvin; Ahimbisibwe, Frank; Asasira, Justus
This article examines ‘unrecognised refugees’ through the experiences of second- and third-generation abavandimwe: people of Rwandan descent born and raised in Uganda to forebears who fled successive waves of violence in Rwanda from 1959 onwards and who remained outside formal recognition regimes across generations. Drawing on qualitative interviews with second- and third- generation abavandimwe, Ugandan host community members, and selected government officials, we analyse how belonging and exclusion are produced through everyday social relations and state documentation practices. Conceptually, the article distinguishes everyday recognition, expressed through local acceptance, schooling, work, and community ties, from juridical recognition, expressed through nationality law, identity documentation, and naturalisation procedures. The findings show that intergenerational invisibility is actively reproduced when administrative encounters deny nationality claims, even for individuals who have lived in Uganda their entire lives, including cases where parents are absent or deceased. Everyday recognition enables participation in social life, but its protections collapse during legal and bureaucratic verification, especially when seeking national identity cards, passports, or mobility. By theorising this invisibility as a structural gap between lived citizenship and juridical recognition, the article contributes to debates on citizenship, statelessness risk, and intergenerational displacement, with implications for protection and durable solutions in protracted displacement contexts.
Health facility readiness to provide quality emergency obstetric and newborn care in rural Uganda: a cross- sectional study
(BMJ Public Health, 2026) Turigye, Brian; Macharia, Peter M.; Mugema, Mulogo Edgar ; Ngonzi, Joseph; Kanyesigye, Michael; Benova, Lenka
Introduction Despite efforts to improve maternal and newborn care services, maternal and newborn mortality in Uganda remains high. Over half of births occur in lower- level health facilities, where limited readiness and suboptimal quality of care may hinder the provision of emergency obstetric and newborn care (EmONC). This study aimed to assess health facility readiness to provide quality EmONC in Kasese and Bundibugyo districts, midwestern Uganda. Methods A cross- sectional survey was conducted in all 42 district- level public health facilities (health centre (HC) IIIs, HC IVs and general hospitals) offering childbirth services in Kasese and Bundibugyo districts. We used a facility assessment questionnaire based on the WHO’s Service Availability and Readiness Assessment and the Averting Maternal Death and Disability tool. Composite readiness scores were calculated across five domains (human resources, physical resources, referral, equipment and drugs and supplies) and signal functions by health facility level. HCIII facilities were considered Basic EmONC (BEmONC), while HC IVs and general hospitals were considered comprehensive EmONC (CEmONC) facilities. Results The overall mean availability of expected signal functions was 42.3%, and overall readiness was 53.3%. These were lowest in HCIIIs. The least provided CEmONC signal function was blood transfusion, available in 83.3% (n=5) of the CEmONC- designated facilities, and assisted vaginal delivery was the most frequently missing BEmONC signal function, with no facilities reporting its provision. Staffing and training were most available at 70.6%, while physical resources (44%) and functional referral system (44.7%) were least available. Conclusions EmONC signal function availability and overall readiness were suboptimal, particularly at HC IIIs. Strengthening the capacity and readiness of HC IIIs, improving essential resources and enhancing referral systems should be prioritised to improve access to quality EmONC.
Agronomic Practices, Favored Traits and Constraints of Cocoyam Production in the Southwestern Highlands Agro ecological Zone of Uganda
(International Journal of Agronomy, 2026) Baguma, Deus Bagambana; Nakintu, Justine; Kagoro-Rugunda, Grace
Although often neglected in agricultural research and development, Cocoyam (Xanthosomasagittifolium) possesses considerable potential to improve household food and nutrition security while strengthening the resilience of small holder farming systems. However, empirical evidence on farmers’ production practices, preferred production traits, and production constraints remains limited in Uganda. This study assessed production practices, preferred production traits, and production constraints among cocoyam farmers in the Southwestern Highlands Agro ecological Zone of Uganda. Across sectional survey involving 317 cocoyam farmers was conducted in Kabale and Kanungu districts using a multi stage sampling approach. Data were collected using semi structured questionnaires and analyzed using descriptive statistics, Pearson’s chi-square tests and binary logistic regression. Cocoyam was predominantly cultivated in mixed cropping systems, mainly intercropped with banana, beans, and coffee under low-input smallholder agriculture. Suckers were the most preferred planting material, although farmers relied primarily on their own gardens and farmer-to-farmer exchange, highlighting the dominance of informal seed systems. Preference for large planting materials reduced the likelihood of selecting suckers (AOR=0.09, 95%CI:0.03–0.29) but increased the likelihood of selecting headsets (AOR=3.29,95%CI:1.45–7.51). Production practices difered significantly between the two agro ecological zones, with Kanungu characterized by greater use of wetlands, dry-season planting, ridge and line planting, mono cropping and corms and cormelsas planting materials, whereas Kabale exhibited greater fertilizer use, mixed cropping, and reliance on suckers. Larger cocoyam land size increased the likelihood of intercropping with coffee (AOR=3.82,95%CI: 2.15–6.78) but reduced the likelihood of intercropping with beans (AOR=0.36,95%CI:0.21–0.61). Pest and disease incidence was generally low, while piece meal harvesting and prolonged in-soil storage after maturity reflected the crop’s importance as a living food reserve. Farmers prioritized drought tolerance, intercropping suitability, extended field longevity, and tolerance to poor soils as the most desirable production traits. The principal constraints were land shortage, lack of improved varieties, and limited access to quality planting materials, declining soil fertility, and inadequate extension services. This study provides the first comprehensive empirical assessment of cocoyam production systems across contrasting agro ecological environments in southwestern Uganda. The findings demonstrate that cocoyam is well adapted to diversified, low-input farming systems but that its productivity is constrained by a weak seed and extension systems and limited varietal improvement. The results provide evidence to guide farmer-oriented breeding, formal seed system development, and extension interventions aimed at improving cocoyam productivity and resilience in smallholder farming systems.
Womens’ experience on barriers and facilitators for implementation with Kangaroo Mother Care at Mbarara Regional Referral Hospital, Uganda: a qualitative study
(Global Health Action, 2026-10-01) Santorino, Data; Svensson, Tilda; Tushemereirwe, Patricia; Kreyenbaum, Lea; Ashish, KC
Background: Kangaroo Mother Care (KMC) is a proven cost-effective intervention for preterm and low-birth-weight infants, to provide warmth and secondary health effects. In Uganda, despite a high burden of prematurity, resource constraints limit the delivery of cost-effective interventions. Objective(s): This study aimed to identify barriers and enablers for implementing KMC, explore mothers’ experience of KMC and apply the-i-PARIHS framework to understand why implementation was, or was not, successful at Mbarara Regional Referral Hospital. Methods: This study was conducted in a rural referral hospital in Uganda with semi-structured interviews with mothers (n = 14) in the KMC ward. Interviews were then translated into English, and the transcripts were subjected to qualitative content analysis using inductive coding. Each code was further grouped into subcategories corresponding to barriers or facilitators. The results were interpreted using the-i-PARIHS framework to evaluate why treatment implementation was or was not successful. Results: Kangaroo Mother Care was found to be largely acceptable and implemented by most participants. Barriers and facilitators were identified within the areas of i) healthcare system, social support, finances, knowledge and beliefs as well as the health of newborns and motivation. Primary barriers included insufficient healthcare facilities, lack of material resources, lack of education on KMC, and lack of adaptation to twins. Facilitators included supportive healthcare staff, learning tools, and the positive effects of KMC as motivation. Conclusions: Barriers and facilitators for Kangaroo Mother Care are multifaceted. To increase implementation for all patients, targeted interventions may need to reach beyond the hospital, addressing social and financial factors.
Multi country training to strengthen leadership among administrative staff of research ethics committees and national regulatory bodies in the East African Community
(BMC Medical Education, 2026-09-28) Byakika-Kibwika, Pauline; Amperiize, Mathius; Twesigye, Belinda; Mutumba, Beth; Opolot, Hellen; Gardais, Soazic; Wandiga, Steve; Ndagije, Helen; Kidola, Jeremiah; Mutabazi, Vincent; Nyandwi, Ramadhan; Mathew, Lina S.; Twungubumwe, Novat; Castelnuovo, Barbara; Arinaitwe, Joseph Walter; Okoboi, Stephen; Ainembabazi, Provia; Sebuyira, Lydia Mpanga
Background Clinical research in the East African Community (EAC) has expanded significantly in response to epidemics, increasing the complexity and workload. Research ethics committee (REC) and National research regulatory (NRA) members involved in leadership and administrative work play a vital role in managing daily operations, yet often lack adequate training and support in this area. Earlier capacity building efforts have largely overlooked these unique responsibilities. The training program aimed to strengthen the participant’s personal effectiveness and leadership skills (PELS). This study evaluated the early effectiveness of PELS by assessing changes in participants’ knowledge scores and exploring participants’ perceptions of applying the acquired skills in their work. Methods A four-month blended training program was implemented from March 2024 to March 2025 in six EAC partner states, namely, the Republics of Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda. We engaged stakeholders to inform curriculum development. Forty stakeholders from the six EAC partner states informed curriculum revision, and an eight-member Training Advisory Committee (TAC) reviewed and approved the revised curriculum. Participants were evaluated using pre- and post -training assessments. Data from the training assessments were downloaded as a Comma Separated Value (CSV) file, cleaned in Microsoft Excel, and exported to STATA 15 for analysis. We performed descriptive analyses and presented findings using percentages and frequencies. Paired t-tests were conducted to assess the significance of pre-test and post-test differences in knowledge scores, with p < 0.05 considered statistically significant. Participant feedback was collected during and after the training and analysed qualitatively using conventional content analysis identify recurring themes. Results One hundred twenty-nine (129) participants from six partner states participated in the training. Of these, 50.4% were females. Uganda had the highest participation (31.8%), while Tanzania had the lowest (10.1%). The overall mean score for foundational knowledge rose from 63.7% at pre-test to 84.4% at post-test, representing a 20.7% -point improvement. In addition, participant qualitative feedback revealed three key themes: ethical leadership and conflict management, teamwork and client service, and self-management and initiative. Conclusions The multi-country PELS training programme was associated with substantial improvement in participants’ foundational knowledge scores, with participant feedback also indicating perceived application of leadership, communication, conflict management, customer service, and self-management skills in the workplace. These findings suggest that a stakeholder-informed blended training approach can provide useful early capacity strengthening for personnel supporting research ethics and regulatory administration in the EAC. Continued institutional support, refresher training, and longer-term evaluation will be important to determine whether these early gains are sustained and translate into improvements in routine research administration.
Incidence and Predictors of Hyperglycemia Among Adults Receiving Dolutegravir-Based Antiretroviral Therapy at Mbarara Regional Referral Hospital HIV Clinic, Uganda: A Retrospective Cohort Study
(HIV/AIDS-Research and Palliative Care, 2026-10-01) Arinaitwe, Medard; Mwesigwa, Geoffrey; Asiimwe, Derrick; Ikiriza, Anthony; Muyindike, Winnie R.; Asiimwe, Stephen
Background: Dolutegravir (DTG)-based antiretroviral therapy is widely used in sub-Saharan Africa, but routine-care evidence on incident hyperglycemia after DTG initiation or substitution remains limited in southwestern Uganda. Purpose: To determine the incidence and predictors of documented hyperglycemia among adults receiving DTG-based antiretroviral therapy at Mbarara Regional Referral Hospital. Patients and Methods: We conducted a retrospective cohort study using routine clinical records of adults who initiated or switched to DTG-based ART between 1 January 2019 and 31 December 2023. Documented incident hyperglycemia was defined as fasting glucose ≥7.0 mmol/L or random glucose ≥11.1 mmol/L with documented classic symptoms. Cox proportional hazards regression estimated adjusted hazard ratios (aHRs); age was modeled per 10-year increase. The proportional-hazards assumption was assessed using Schoenfeld residuals. Results: Of 8,859 adults in the descriptive cohort, 8,856 contributed positive follow-up time. Seventy-four documented hyperglycemia events occurred over 29,157.74 person-years, an incidence rate of 2.54 per 1,000 person-years (95% CI 1.99–3.19). The smoothed hazard increased after DTG initiation/substitution, peaked at approximately 1.1 years, and declined thereafter. Higher hazard was associated with older age (per 10 years: aHR 1.70, 95% CI 1.33–2.18), prior thymidine analogue NRTI exposure (aHR 3.27, 95% CI 1.20–8.89), and ≥15 years of ART before DTG (aHR 5.63, 95% CI 1.39–22.77). The global proportional-hazards test was not significant (p=0.70). Conclusion: Documented hyperglycemia was uncommon but was associated with older age and markers of long-term ART exposure. Risk-stratified glucose monitoring should be considered, particularly during the first year after DTG initiation/substitution and among higher-risk patients.
Impact of maternal anemia on neonatal outcomes: low birth weight and neonatal anemia in Uganda
(Journal of Hematology and Allied Sciences., 2026-09-24) Okongo, Benson; Amoding, Martha; Ndawula, Joachim; Hajusu, Bright; Morunyang, Isaac; Lakwera, Christopher; Muwanguzi, Enoch; Wagubi, Robert; John, Elizabeth A.; Clinton,, Olong
Objectives: e Objectives of this study were to determine the prevalence of anemia among women in their third trimester of pregnancy and establish its association with neonatal outcomes at Soroti Regional Referral hospital (SRRH). Material and Methods: is prospective cohort study enrolled 324 women in their third trimester at SRRH (June August 2025). Data on maternal and neonatal characteristics were collected via structured questionnaires and medical record review. Maternal venous blood and umbilical cord blood were collected at delivery and analyzed for hemoglobin using an automated hematology analyzer. Anemia was defined as hemoglobin < 0.001), and cesarean section (AOR = 2.82, 95% CI: 1.63–4.88, p < 0.001), which we conceptualize as an intermediate intervention-related event rather than a direct neonatal outcome. Conclusion: e findings demonstrate a high burden of maternal anemia, with a prevalence of 32.7%, and it is strongly associated with LBW and neonatal anemia. e association with cesarean section suggests that anemia may contribute to intrapartum complications requiring operative intervention. ese findings underscore the need for integrated screening, prevention, and management strategies to mitigate perinatal morbidity
Conversational themes and interaction patterns in peer support for adolescents and young people living with HIV: scoping review protocol
(Systematic Reviews, 2026-09-29) Kintu, Timothy Mwanje; Kyagambiddwa, Tonny; Ford, Stephanie Friree; Ngabirano, Derek; Haberer, Jessica E.; Jjingo, Daudi; Bebell, Lisa M.
Background Peer support for adolescents and young people living with HIV (AYPLHIV) has demonstrated effectiveness in improving clinical and psychosocial outcomes. However, the specific conversational content and interaction patterns that underpin successful peer support remain poorly characterized, limiting the evidence base for designing digital health tools and training curricula. This scoping review aims to systematically map the breadth and nature of documented conversational themes, topics, and interaction patterns in peer support programs for AYPLHIV aged 15–24 years. Methods The review will follow the JBI methodology for scoping reviews. Databases to be searched include MEDLINE via PubMed, EMBASE.com, Web of Science Core Collection, CINAHL, and PsycINFO. Sources will include qualitative studies, mixed-methods studies, process evaluations, training curricula, and program guidelines that describe or document the content of peer support conversations for AYPLHIV. No restrictions will be placed on geographic location, setting, or modality. The review will include literature published from 2015 to the present. Seven independent reviewers will screen titles/abstracts and full texts using Covidence. Data will be extracted using a standardized form and synthesized through descriptive mapping, inductive thematic development, and alignment analysis comparing intentional (curricula-based) and experiential (empirically observed) content. Discussion This scoping review will produce a map of conversational themes, topics, and interaction patterns documented in peer support for AYPLHIV globally. Findings will provide an evidence-based content framework for organizations revising peer support training and for developers designing digital tools such as chatbots and online peer communities for this population
Association of Helicobacter pylori Coinfection With Tuberculosis Disease Severity and Treatment Outcomes
(Journal of Tropical Medicine, 2026) Baluku, Joseph Baruch; Ichumar, Mary Magdalen; Zawedde, Daphine; Nabwana, Martin; Nanyanzi, Diana; Wanda, Harriet Yvonne; Namiiro, Sharon; Namanda, Brenda; Nabawanuka, Eva; Kikomeko, Sharif; Mutesi, Judith; Kansiime, Grace; Nuwagira, Edwin; Kraef, Christian; Rhein, Joshua; Seremba, Emmanuel; Munabi, Ian G.; Kiguli, Sarah
Background: Helicobacter pylori (HP) has immunomodulatory properties, but its relationship with tuberculosis (TB) severity and outcomes remains uncertain. We evaluated the association between HP infection and TB severity and explored factors associated with HP coinfection and TB treatment outcomes. Methods: We enrolled adults (≥18years) with drug-sensitive, newly diagnosed, bacteriologically confrmed pulmonary TB from two public clinics in Uganda. HP infection was determined using stool antigen testing. Severe TB was defned as GeneXpert cycle threshold < 16 or smear grade 3þ (microbiological), Bandim TB score ≥8 (clinical), and chest X-ray Timika score >71 (radio logical). Treatment outcomes were determined ≥7months after treatment initiation. Results: Among 200 participants, 67 (33.5%) were HP positive. Severe radiological TB was more frequent among HP positive participants (34.8% vs. 22.1%, p = 0.060). Severe clinical (14.9% vs. 11.3%, p = 0.549) and microbiological TB(40.0% vs. 33.8%, p = 0.856) were also more frequent in HP. HP was not signifcantly associated with severe radiological (adjusted prevalence ratio [aPR] 1.56; 95% CI 0.96–2.53, p = 0.074), clinical (aPR 1.17; 95% CI 0.53–2.60, p = 0.694), or microbiological TB (aPR 1.14; 95% CI 0.80–1.63, p = 0.462). HP coinfection was independently associated with rural residence (aPR 1.61; 95%CI1.04–2.47,p = 0.031),anorexia(aPR1.72;95%CI1.01–2.90,p = 0.045),and lower diastolic blood pressure(aPR 0.98; 95% CI 0.96–1.00, p = 0.013). TB treatment success was similar among those with and without HP (95.5% vs. 95.5%, p =0.180). Conclusion: HP was not signifcantly associated with TB severity or outcomes, though a trend toward greater radiological severity warrants further investigation in larger, prospective studies.
Association of foxp3 and p16ink4a serum expression with grades and treatment outcomes of cervical squamous intraepithelial lesions in south western Uganda.
(Mbarara University of Science and Technology, 2024-08) Ssedyabane, Frank
Abstract Background: Immunohistochemical expression of P16ink4A and FOXP3 is associated with increasing grades of cervical intraepithelial lesions. We determined the prevalence of cervical intraepithelial lesions and associated factors, the association between serum biomarkers P16ink4A and FOXP3 concentrations and cervical intraepithelial lesions, and the diagnostic accuracy of serum biomarkers P16ink4A and FOXP3 in the detection of cervical intraepithelial lesions, and treatment outcomes among women attending the cervical cancer clinic at Mbarara Regional Hospital (MRRH), South Western Uganda. Methods: We conducted a cross sectional study (n=364), two case control studies (n=270 and n=279) and a 12 months prospective cohort study (n=180). Participants included women seeking cervical cancer screening and testing services at the cervical cancer clinic of MRRH, from April 1 2022 to March 30, 2024. We collected clinical and demographic data, collected blood samples and measured serum P16ink4A and FOXP3 concentrations using quantitative ELISA kits from Elabscience Biotechnology. All Pap smears were microscopically examined by a laboratory scientist together with a pathologist following the Bethesda grading system (2014). All cases were confirmed with cytology and/or histology and statistical analyses were done in STATA version 17. Results: The prevalence of cervical intraepithelial lesions was 6.6%. We observed increased odds of cervical intraepithelial neoplasia (CIN) for P16ink4A and a significant reduction in odds of cervical cancer (CC) for serum P16ink4A. Also, increased FOXP3 concentrations increased the chances of CC by 2 times. FOXP3 concentration of >0.0545ng/ml showed moderate sensitis (12.22% and 57.78%) and specificity (68.89% and 68.89%) for detection of CIN and CC from healthy controls respectively. P16ink4A concentration of >0.946ng/ml showed moderate sensitivities (50.00% and 60.00%) and specificities (56.67% and 55.56%) for the detection of CIN and CC from healthy controls respectively. A combination of elevated FOXP3 and P16ink4A showed high specificity of 83.33%. The mean relative risk for follow-up serum FOXP3 among participants with persistent and progressed lesions was 1.34 and 27.82 respectively while that of P16ink4A among persistent and progressed lesions was 5.16 and 0.44 respectively. Conclusions: The prevalence of cervical intraepithelial lesions was lower than global estimates. Serum P16ink4A and FOXP3 concentrations were observed to not only be associated with, but also highly specific for detection of cervical lesions and their persistence and progression. Quantitative measurement of circulating P16ink4A and FOXP3 may aid in diagnosis as well as prediction of persistence and progression of cervical lesions; and their combination has a high potential to be applied for diagnosis rather than screening for cervical lesions.
Design and simulation of an intelligent medical ventilator system for patient-ventilator synchrony and lung protection
(Mbarara University of Science and Technology, 2024-01) Wanzala, Jimmy Nabende
Respiratory failure can be life threatening for patients with hypoxemic and hypercapnic conditions, and the failure requires fast medical response to save the patient(s). Respiratory diseases such as acute respiratory distress syndrome (ARDS), pneumonia, and corona virus disease 2019 (COVID-19) have increased the need for mechanical ventilation (MV). Mechanical ventilators are devices that support patients in delivering oxygen to the lungs during inspiration and removing the carbondioxide during expiration. The ventilators are mostly controlled manually by physicians, in changing the ventilator settings, such as positive end expiratory pressure (PEEP). Physicians in most hospitals are few and the number of patients with respiratory failures is on the rise due to viruses, smoke inhalation, and injuries that cause fluids to collect in the air sacs of the lungs. The manual control of the ventilators comes with human errors caused by some physicians especially when they are overwhelmed with lots Of work, which may lead to inaccuracy or delay in the adjustments made on the mechanical ventilators; hence, resulting into delay in recovering of the patient or to the worst, increasing the death rate due to inaccurate ventilator setting adjustments. In this study, firstly, fuzzy logic method was used to develop a computer aided decision making to improve on the accuracy of the reasoning done during the ventilator setting adjustments. The ARDS Network (ARDSNet) PEEP values were used in building the fuzzy rules of the fuzzy algorithm and four algorithms were trained, that is: incremental high PEEP, decremental high PEEP, incremental low PEEP, and decremental low PEEP. The need for use of the fuzzy logic method to guide the physicians was with a purpose of reducing the physician's time spent in thinking on who parameters to adjust on the ventilator, especially during an emergency. Secondly, the fuzzy neural network model was further trained to increase the accuracy and reduce the time spent comparing the fuzzy logic algorithm output and the ARDSNet PEEP values. Thirdly, the convolutional neural network (CNN) was then used to classify the different brain and lung conditions, so as to add a variable and alarm to already existing ventilator variables and alarms respectively, Finally, a single lung compartment transfer function was derived and used to test the simulation of the fuzzy-image based system, with trained fuzzified PEEP and CNN algorithms connected to the derived lung transfer function. On testing the system, the first consideration was based on healthy brains after the brain medical scans, whereby the incremental high PEEP algorithm was selected for patients with pneumonia, and decremental high PEEP algorithm was selected for patients with COVID-19. The second consideration was based on healthy lungs after the lung medical scans in which incremental low PEEP algorithm was selected for patients with intracranial hemorrhage or acute ischemic stroke, and a decremental low PEEP algorithm was selected for patients with normal/ healthy brains. This guides the doctors in determining other causes of respiratory failure, hence, acting as an alarm on the ventilator. The neural fuzzy algorithm was able to mimic the ARDSNet PEEP values for high and low PEEP. The CNN algorithm had 97% validation accuracy for the three lung conditions, and validation accuracy for the three brain conditions. Three lung transfer functions were used in the simulation, that is: transfer functions for healthy lung, sick lung, and recovering lung. The lung residual volume (RV) and total lung capacity (TLC) values indicate that for healthy lungs, lower PEEP is desirable. For sick lungs, more PEEP is required to attain the recommended lung RV and TLC ranges. For recovering lungs, lower PEEP is required to balance the lung protection and oxygenation. The intelligent ventilator system can therefore, be applied as a physician-ventilator interface to guide the physician during the ventilation, so as to reduce on the human errors; ensure lung protection; and reduce on the time spent by physicians in making decisions. This can be achieved by the system, when it guides the physicians on what parameters to adjust at minimal possible time during the ventilation, and increase the possibility of patient survival. The efficiency of physicians that operate on the mechanical ventilators, especially during emergency times, can now be improved by not necessarily increasing the number of the physicians controlling one ventilator, but by adding the fuzzy-image reasoning to the mechanical ventilator systems, to help in providing suggestions to the physician(s).
Vasopressor Use Among Adults With Sepsis in Uganda and Rwanda: A Multicenter Retrospective Cohort Study
(Critical Care Explorations, 2026) Girard, William S.; Turkistani, Farah; Kakande, Reagan; Adejayan, Victor; Zulfiqar, Muhammad; Ndyomugabe, Michael; Gruccio, Phoebe; Ojuman, Philemon; Otoupalova, Eva; Banguti, Paulin R.; Hopkinson, Dennis; Mvukiyehe, Jean Paul; Syed, Aamer; Riviello, Elisabeth; Nuwagira, Edwin; Moore, Christopher C.
OBJECTIVES: Africa has the highest global sepsis burden. Yet, sepsis treatment guidelines, including those for vasopressor use, incorporate data from high income settings. We aimed to determine patterns of vasopressor use among adults admitted to hospital with sepsis in East Africa. DESIGN: Retrospective cohort study. SETTING: One hospital in Uganda and two hospitals in Rwanda. PATIENTS: Adults admitted to hospital with sepsis, defined as suspected infection and greater than or equal to 2 quick Sequential Organ Failure Assessment criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We performed an analysis of pooled data from two retrospective studies of adults with sepsis admitted to hospital in Rwanda or Uganda. Of 471 septic patients analyzed, 263 (57%) were female, the median (interquartile) age was 51 years (36–65), 121 (26%) were living with HIV, 113 (24%) received a vasopressor, and death occurred in 139 patients (30%). In the univariable logistic regression analysis, higher respiratory rate and Universal Vital Assessment (UVA) scores; lower blood pressure, oxygen saturation, and Glasgow Coma Scale score at the time of sepsis diagnosis; presence of abdominal infection; and receiving a greater volume of IV fluids predicted receipt of a vasopressor. In the multivariable analysis, higher UVA mortality risk scores (adjusted odds ratio 1.25; 95% CI, 1.14–1.27; p < 0.001) predicted vasopressor receipt. We replicated these findings in exploratory machine learning analyses. CONCLUSIONS: In patients with sepsis in East Africa, UVA score and hospitalization in Uganda were predictive of vasopressor administration. Further research is required to address existing knowledge gaps in the role, timing, and indications for vasopressors in sepsis management in Africa.
Vaccination coverage among migrant and refugee populations in Uganda: A narrative review of challenges and recommendations
(Global Public Health, 2026) Nakachwa, Sarah Marion; Okorobe, Pascal Mathew; Onama, John
Uganda hosts one of Africa’s largest refugee populations, yet displaced and migrant communities face persistent barriers to routine immunisation. Despite commitments to vaccine equity, many remain unprotected against preventable diseases. This narrative review synthesises evidence from peer-reviewed studies, national surveys, and institutional reports up to September 2025 to assess immunisation coverage, challenges, and potential solutions among refugees and migrants in Uganda. The findings indicate that vaccination rates in refugee communities are generally lower than national averages due to administrative barriers, vaccine shortages, long distances to health facilities, language difficulties, misinformation, and challenges intensified during the COVID-19 pandemic. Economic hardship further limits healthcare access. However, several strategies show promise: integrating refugees into national immunisation systems, simplifying registration processes, strengthening mobile outreach, engaging community health workers, and improving cross-border data coordination. Addressing these inequities requires both technical and social commitment through adequate financing, inclusive policies, and meaningful community engagement. Achieving equitable immunisation for refugees in Uganda is essential for public health protection and the realisation of universal health coverage.
Screening and Characterization of Antimicrobial peptides from fish mucus in three major Lakes of Uganda
(Mbarara University of Science and Technology, 2022-12) Okella, Hedmon
Background: Antimicrobial peptides (AMPs) constitute a broad range of bioactive compounds in diverse organisms, including fish. Currently, several peptide antibiotics have been approved for clinical use. Still, skin mucosal AMPs of African catfish and African lungfish are largely unexplored despite their potential in contributing novel drug candidates. Accordingly, the African Catfish Antimicrobial peptides (ACAPs) were investigated. Methods: Native peptides were extracted from fish mucus scrapings in IO % acetic acid (v/v) and ultra-filtered using a 5 kDa molecular weight cut-off membrane. The ultrafiltrate were purified using CIS Solid-Phase Extraction cartridges. Later, their antibacterial activity was determined using the Agar Well Diffusion and broth-dilution methods utilizing Staphylococcus aureus (ATCC 25923) and Eschenchia coli (ATCC 25922). Sephadex G-25 gel filtration was further utilized in bio—guided isolation Of the most active fractions prior to peptide identification using Orbitrap Fusion Lumos Tribrid Mass Spectrometry. Discriminant Analysis Machine and Deep learning algorithms were utilized in predicting antimicrobial scores of each peptide. Toxicity of thc AMPs was assessed using rabbit blood cells alongside HLPpred-Fuse and ToxinPred servers. The AMPs possible mode of action was assessed using SevenGo Duo SG-23 digital conductivity meter, QuantiChrom Alkaline phosphatase kit, and molecular docking engines prior to their chemical synthesis. Results: The skin mucus extracts from fish in three major lakes of Uganda exhibited antimicrobial activity on E. coli and S. aureus. Lake Albert's African catfish demonstrated the highest antimicrobial activity with the lowest MIC of 2.84 and 0.71 gg/mL on S aureus and E. coli, respectively. Sephadex G-25 peak I muss spectrometry revealed seven short peptides (11—16 amino acid residues) of high antimicrobial scores (0.561—0.905 units). In addition, these peptides had a low molecular weight (1005.57—1622.05 Da) and had a percentage hydrophobicity above 54%. Partially purified extracts were non-hemotoxic peptide ACAP-V demonstrated the highest binding and global energies against Monomeric sarcosine oxidase (PDB [d: 2gbO; - 9.40 kcal/mol) and NADH peroxidase (PDB Id: Inhp; BE: -88.84 kcal/mol) respectively. Synthesized ACAP-IV and ACAP-V had the MIC of 520.7 and 625.0 gg/mL on E. coli. Conclusion and Recommendation: Collectively, the 7 African catfish antimicrobial peptides were identified as potential novel drug candidates. Future research is recommended to validate their activity in vivo on a wider range of bacteria.
Test Performance of Expired Malaria Rapid Diagnostic Tests: A Pilot Diagnostic Accuracy Study Conducted in Western Uganda
(The Journal of Infectious Diseases, 2026-02-19) Ndizeye, Ronnie; Gunderson, Annika K.; Baguma, Emmanuel; Giandomenico, Dana A.; Ntaro, Moses; Mulogo, Edgar Migema; Boyce, Ross M.
We evaluated the diagnostic agreement of expired malaria rapid diagnostic tests (mRDTs) with non-expired mRDTs in a clinical setting in western Uganda. Expired mRDTs (SD Bioline Ag Pf/Pan and First Response Ag pLDH/HRP2) were administered to each participant in parallel with a non-expired mRDT serving as the reference. Of 200 participants, 21 (10.5%) tested positive and 179 (89.5%) tested negative for malaria. All tests up to 9 months post-expiration were valid and consistent with reference mRDTs. All mRDTs 10–12 months post-expiration were invalid. These preliminary findings support further research into the use of expired mRDTs in resource-limited settings.
Severity of maternal anemia and the risk of giving birth to a small vulnerable newborn: A cohort analysis of the WOMAN- 2 trial in four countries
(International Journal of Gynecology & Obstetrics., 2026) Ochola, Henry ; Roberts, Ian; Webb, Emily L.; Lieber, Judith; Lawn, Joy E.; Blencow, Hannah; Chaudhr, Rizwana; Kayani, Aasia; Javaid, Kiran; Olayemi, Oladapo; Bello, Folasade A.; Mugayizi, Projestine; Lubeya, Mwansa Ketty; Vwalika, Bellington; Shakur-Still, Haleema; Balogun, Eni; Prowse, Danielle; Brennerr, Amy
Objective: To investigate the association between maternal hemoglobin concentra tion and the risk of birth to a small vulnerable newborn (SVN). Methods: We conducted a cohort analysis of women with moderate or severe anemia enrolled in the World Maternal Antifibrinolytic Trial- 2 (WOMAN- 2) across Nigeria, Pakistan, Tanzania, and Zambia (August 2019 to September 2023). Maternal hemo globin concentration at admission for vaginal birth was categorized into six groups. Results: Among 14 444 women, the median hemoglobin level was 85 g/L (interquar tile range [IQR] 77–91 g/L), and 39.5% (5703/14444) of newborns were classified as SVNs. A strong inverse relationship was observed between maternal hemoglobin and SVN. Compared with women with hemoglobin of 90–99 g/L, aOR values for SVN were 1.06 (95% CI 0.97–1.16) for 80–89 g/L; 1.27 (95% CI 1.15–1.41) for 70–79 g/L; 1.44 (95% CI 1.26–1.64) for 60–69 g/L; 2.00 (95% CI 1.64–2.43) for 50–59 g/L; and 2.51 (95% CI 1.85–3.41). Conclusions: Increasing severity of maternal anemia is associated with a marked increase in the risk of giving birth to SVNs. The disproportionately higher risk observed at lower hemoglobin levels supports prioritization of women with more severe anemia for intensified monitoring and treatment in high- burden settings.