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

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Annual Research Dissemination Conference 3
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Faculty of Applied Sciences and Technology 54
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Faculty of Medicine 2212
Faculty of Science 532
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Maternal Newborn and Child Health Institute 18

Recent Submissions

Perspectives of Primary Health Facility Leaders on the Contributions of Clinical Residents During Community Placement in Southwestern Uganda
(Advances in Medical Education and Practice, 2026-01-08) Peter Chris Kawungezi; Moses Ntaro; Eleanor Turyakira; Andrew Christopher Wesuta; Angela Tushabe; Michael Matte; Ronnie Ndizeye; Fred Mwebembezi; Brian Turigye; Joseph Ngonzi; Edgar Mugema Mulogo
Background: The Mbarara University of Science and Technology (MUST)’s First Mile Community Health Program (FMCH) has facilitated community placement of clinical residents at Primary Healthcare (PHC) facilities within the MUST catchment area in southwestern Uganda. While community-based training of medical residents is common in sub-Saharan Africa, little is known about how PHC facility leaders perceive its effect on service delivery in Uganda. This assessment aimed to describe the perspectives of PHC facility leaders on the impact of clinical residents’ community placements on PHC services in southwestern Uganda between 2018 and 2023. Methods: From July 2018 to December 2023, 152 clinical residents from ten specialties were placed at PHC facilities in southwestern Uganda. This was a cross-sectional study based on qualitative data-collection techniques. This study focused on MUST clinical residents and PHC facilities in the MUST catchment in southwestern Uganda. We conducted KIIs with 15 health facility leaders until no new ideas emerged. Data were deductively analyzed using WHO’s five strategic directions. Transcripts were transcribed verbatim, repeatedly reviewed, and coded into predefined categories. Interviewers bracketed their own experiences to ensure facility leaders’ perspectives were accurately captured. Results: Of the 15 facility leaders interviewed, most were male and from government HC IVs. Leaders reported that resident placements improved health service delivery through community engagement, enhancing care models through training, mentorship and low-cost innovations, and improving service coordination, including establishing specialized clinics and promoting better use of equipment. Residents also supported advocacy and resource mobilization. However, short placements, inconsistent outreach, staff shortages and lack of specialists limited continuity and sustainability. Conclusion: Facility leaders reported perceived improvement in strengthening PHC services by the clinical residents. Sustaining these gains will require institutionalized partnerships and evaluation of long-term impact. This could contribute to the advancement of primary healthcare services.
Navigating forced migration in the Horn of Africa: a systematic review of IGAD’s strategic challenges and opportunities
(Cogent Social Sciences, 2025) Frank Ahimbisibwe; Cedric M. Nkiko
This systematic review examines how the Intergovernmental Authority on Development (IGAD) has responded to forced migration in the Horn of Africa, focusing on the legal, economic, and humanitarian challenges affecting its capacity for coordinated action. The review includes 22 studies published after 1995 that evaluate IGAD’s legal and policy frameworks, regional initiatives, and implementation practices. Sources were identified through systematic searches of Scopus, JSTOR, and Google Scholar, as well as official IGAD reports and regional policy documents retrieved in February and March 2025. Studies were screened for thematic relevance and geographic focus, and a qualitative thematic synthesis was used to identify core patterns. The analysis shows that IGAD has initiated meaningful regional frameworks, including the Nairobi, Kampala, and Djibouti Declarations, but the impact of these instruments is undermined by fragmented national legal systems that remain largely non-binding. As a result, displaced persons continue to face barriers to accessing basic rights such as employment, education, and freedom of movement. Financial constraints, infrastructure deficits, and inconsistent humanitarian coordination further impede effective responses. Many studies highlight the lack of inclusive, participatory mechanisms in both planning and delivery, especially in relation to vulnerable groups. While data limitations and methodological heterogeneity are acknowledged, the review identifies strategic pathways forward, including harmonisation of legal standards, investment in sustainable funding mechanisms, and strengthening of cross-border coordination through participatory governance.
Integrative LC-HR-QTOF-MS and Computational Metabolomics Approaches for Compound Annotation, Chemometric Profiling and In Silico Antibacterial Evaluation of Ugandan Propolis
(Metabolites, 2026-02-03) Ivan Kahwa; Christina Seel; Ronnie Tumwesigye; Patrick Onen; Ramona Oehme; Susan Billig; Rapheal Wangalwa; Jonans Tusiimire; Claudia Wiesner; Leonard Kaysser
Background/Objectives: Propolis is a complex bee product with a composition that varies according to local vegetation, environmental conditions, and bee foraging behaviours. Recently, gas chromatography–mass spectrometry (GC–MS) has been employed in Uganda to analyse its volatile components. This study examined Ugandan propolis non-volatile metabolites to determine chemotypes and identify antibacterial compounds. Methods: Ethanolic extracts were analysed using liquid chromatography–high-resolution quadrupole time-of-flight mass spectrometry (LC-HR-QTOF-MS) in an untargeted MS/MS mode. Data processing was carried out using MZmine, then annotated with Global Natural Products Social Molecular Networking (GNPS) and SIRIUS. Chemometric methods assisted in identifying regional chemical signatures. Metabolites highlighted by the heat map were evaluated for antibacterial activity using molecular docking against bacterial targets, followed by ADMET (absorption, distribution, metabolism, excretion, and toxicity) assessments. Results: Out of 3252 features, 234 and 52 putative compounds were annotated in GNPS and SIRIUS, respectively, as indicated by molecular networking, suggesting high chemical complexity. The chemical space mainly comprises flavonoids (including glycosides, aglycones, methylated, and prenylated derivatives), phenolic acids, amides, hydroxycinnamate derivatives, lignans, megastigmanes, and various diterpenoid skeletons. Multivariate analyses clearly distinguish geographical chemotypes, separating flavonoid-rich regions from diterpenoid-rich regions. Docking studies revealed flavonoids, diterpenoids, and lignans with strong predicted antibacterial activities and favourable ADMET profiles. Conclusions: This study provides the first LC–MS characterisation of the non-volatile metabolome of Ugandan propolis, thereby expanding its chemical diversity. Metabolomics and computational approaches lay a foundation for future ecological, chemotaxonomic, and pharmacological research.
Isomorphic Forces and Tax Compliance in Developing Countries: A Systematic Review
(International Journal of Finance and Accounting, 2026-01-16) Naster Tumwebembeire; Nixon Kamukama; Nsambu Kijjambu Frederick; John Kule Baguma
Introduction: Tax compliance is a critical determinant of revenue mobilisation, especially in developing countries where governments face persistent challenges of informality, weak institutions, and low taxpayer morale. While coercive, normative, and mimetic forces have been theorised to shape compliance through neo-institutional perspectives, the extent and nature of their influence remain fragmented across contexts and methods. This systematic review synthesises empirical evidence on how isomorphic forces affect tax compliance. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) framework. Searches were conducted across Scopus, Web of Science, Google Scholar, and ProQuest, supplemented with citation chaining. Inclusion criteria restricted the corpus to peer-reviewed empirical studies published in English between 2016 and 2025 that explicitly operationalised coercive, normative, or mimetic forces in relation to tax compliance. Fifty eligible studies were identified from an initial pool of 208 records. Data were extracted into structured matrices and synthesised thematically. Results: The findings reveal that coercive forces generally improve compliance, but their effects are fragile if applied in isolation and may backfire in high-trust contexts. Normative forces consistently foster voluntary compliance and often outperform coercion in sustaining long-term adherence. Mimetic forces, though underexplored, appear significant in digital and uncertain environments, where peer imitation and benchmarking strongly influence tax compliance behaviours. Crosscutting evidence highlights that trust and coercion are complementary, compliance outcomes vary between filing and payment, and cultural and institutional settings condition the relative weight of different pressures. Conclusion: The review affirms the explanatory power of neo-institutional theory and extends the Slippery Slope Framework by demonstrating the interplay of coercive, normative, and mimetic influences. Policy implications point to the need for balancing enforcement with legitimacy-building, socialisation, and system design that makes compliance visible and easy to emulate. Key research gaps include the under-theorisation of mimetic mechanisms, the dominance of cross-sectional designs, and insufficient differentiation between compliance outcomes. Future studies should employ longitudinal approaches, develop clearer measures of peer influence, and investigate digital taxation as a new frontier for shaping taxpayer behaviour.
Training needs of informal caregivers of people with dementia in rural Southwestern Uganda
(Alzheimer’s Dement, 2025) Namwase,Joyce; Kyomya,Julius; Oyuru,Amos; Muhwezi,Abraham; Semuwemba,John; Maleka,Emmanuel; Karungi,ChristineK; Obua,Celestino; Wakida,Edith
Background: Dementiaisaglobalpublicconcernwithincreasingprevalenceespecially in low- and middle-income countries. The burden associated with caring for people with dementia relies on informal caregivers who are usually family members. The aim ofthisstudythereforewastoidentifythespecifictrainingneedsofinformalcaregivers ofpatientswithdementiainruralsouthwesternUgandatobettertheircaregivingroles and improve their own psychosocial health. Methods: We conducted 20 in-depth interviews with 17 informal caregivers and 3 key informants who are workers from an elderly care home (Reach One Touch One Ministries) in Rukiga district, southwestern Uganda. The interviews were audio recorded and transcribed verbatim. A coding matrix was formulated and used to generate the appropriate codes from the transcripts. Results: The key findings from this study include caregivers’ limited knowledge of dementia, with the condition being attributed to aging and stress. The informal caregivers face challenges such as physical, emotional, and financial burden due to the caregiving demands. The coping mechanisms included relying on faith, social support, and adapting their caregiving practices. Caregivers expressed a strong willingness to attend in-person training sessions focusing on communication with people with dementia, managing dementia-related behaviors, personal hygiene, and nutrition. The key informants highlighted the need for increased community awareness to address misconceptions about dementia and improve caregiving outcomes. Conclusion: Informal caregivers in rural Uganda face various challenges while caring for persons with dementia. Equipping them with skills in communication, dementia related behavior management, hygiene, and nutrition could enhance the quality of care for dementia patients while alleviating the physical and emotional burden on This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Additionally, increasing community awareness to tackle misconceptions about dementia is essential for a supportive environment for caregivers and persons with dementia. These findings highlight the need for the integration of caregiver training and education into broader public health initiatives for dementia care
Prevalence and Characteristics of Prescription Errors in Community Pharmacies in Mbarara City, South Western Uganda
(AUIQ COMPLEMENTARY BIOLOGICAL SYSTEM, 2026-01-05) Yadesa, Tadele Mekuriya; Comfort, Ashaba; Marvel,Komukyeya Esther; Angela, Namakula; Nancy, Tikolu Hope; Goruntla, Narayana; Bukke, Sarad Pawar Naik; Abebe, Bontu Aschale; Shegena, Efrata Ashuro
Background: A prescription error is a failure in the prescription writing process that results in a wrong instruction about one or more of the standard features of a prescription. Most adverse drug events are preventable through promoting rational drug use; primarily by mitigating the outstanding high burden of prescribing errors. The main aim of this study is to assess the prevalence and characteristics of prescription errors in the community pharmacies in Mbarara, Uganda. Methods: A cross-sectional study was conducted in selected community pharmacies in Mbarara City, South Western Uganda. Consecutive sampling of all prescriptions availed at the selected pharmacies was conducted until the total sampling target was achieved. A structured checklist adopted from the standard prescription guidelines according to the Uganda Clinical Guidelines was used to abstract data from the prescriptions. Results: The study included 420 prescriptions from eleven community pharmacies in Mbarara City. The overall prevalence of prescription error was 64.3%. Out of 420 prescriptions analysed, 270 prescriptions had a total of 412 prescribing errors. Illegible or wrong drug name was the most prevalent form of prescription error (170, 40.48%) followed by missing or wrong route of administration (113, 26.9%). On the other hand, out of 985 prescription writing errors, 703 (71.4%) were errors of omission. The errors of commission accounted for 282 (28.6%) of the prescription writing errors: 156 (38.4%) had errors in name of the drug, and 58 (14.3%) had errors in prescriber’s name among others. Conclusion: The current prevalence of prescription errors is much higher compared to previously reported findings. This translates to suboptimal patient care and heightened risk of adverse drug events including the risk of antimicrobial resistance. This calls for strengthening health care systems to reduce prescription errors and prevent adverse drug events, including incorrect prescribing, drug interactions, antibiotic resistance, and treatment failure.
Factors influencing antibiotic prescription for respiratory tract infections among prescribers in Jinja City, Uganda: A qualitative study
(BMC Pulmonary Medicine, 2026-01-03) Igirikwayo, Zablon K; Byamugisha, Edison; Kabakyenga, Jerome
Background: Inappropriate antibiotic prescription for respiratory tract infections (RTIs) is a major driver of antimicrobial resistance (AMR). In Uganda, 40-80% of RTI patients receive antibiotics (ABs) despite most of them being viral and self-limiting. Few studies have explored the multifaceted factors influencing prescribing behavior among Ugandan healthcare providers. This study aimed to identify factors influencing antibiotic prescription (ABP) for RTIs among prescribers in Jinja City, Uganda. Methods: We conducted an exploratory qualitative study using face-to-face in-depth interviews with 16 prescribers (10 medical clinical officers, 5 nurses, 1 medical officer) from 10 purposively selected public health facilities in Jinja City during June-July 2023. Interview topics included knowledge of RTI etiology, antibiotic (AB) prescribing practices, availability of standard treatment guidelines (STGs) and diagnostics, and continuous education on AB use. Audio-recorded responses were transcribed verbatim, coded, and analyzed thematically using the Social Ecological Model to identify multilevel factors influencing prescribing decisions. Results: The factors influencing ABP for RTIs were categorized into individual, interpersonal, institutional, community and ministry of health (MOH) and government policy factors. Individual level factors included prescriber related factors and state of the patient considerations. Interpersonal factors involved prescriber-patient relationship and interactions with drug sales representatives. Institutional factors included initiatives to promote rational AB use by the facility’s management. Community-level factors included AB access and socioeconomic environment. Ministry of health and government policy factors included healthcare delivery infrastructure, educational and training programs, STGs, enforcement of regulations for prescription and dispensing. ARTICLE IN PRESS Conclusions: Multiple interrelated factors at individual, interpersonal, institutional, community, and policy levels contribute to inappropriate AB prescribing for RTIs in Jinja City. Addressing this challenge requires multipronged interventions. These findings provide actionable evidence for 1 ARTICLE IN PRESS developing context-specific interventions to promote rational AB use and combat ABR in Uganda and similar low-resource settings.
Magnitude, Presentation, and Management of Pelvic Organ Prolapse at a Tertiary Referral Hospital in Southwestern Uganda: Retrospective Medical Records Review (2014–2018)
(Cureus, 2026-01-26) Kayondo Musa,; Kajabwangu Rogers ,; Kaye Dan,; Migisha Richard,; Ainomugisha Brenda,; ,Byamukama Onesmus,; Paul Kato Kalyebara,; Lugobe M . Henry ,; Geissbüehler Verena
Purpose: This study sought to determine the burden, clinical characteristics, and management approaches of pelvic organ prolapse (POP) among women admitted to the gynecology unit at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: A retrospective review was conducted of medical records for women treated for pelvic floor disorders (PFDs) at the gynecology unit of MRRH between January 2014 and December 2018. The PFDs evaluated included POP, genitourinary fistulas, anosphincter injuries, and other forms of urinary incontinence. For women diagnosed with POP, additional information regarding the type, stage, treatment modality, and postoperative complications was extracted. Descriptive statistics were summarized using frequencies, and comparisons were made using the chi-square test, with statistical significance set at p < 0.05. Results: During the study period, 9,109 women were admitted to the gynecology unit, of whom 674 (7.4%) were diagnosed with PFDs. POP accounted for 210 (31.2%) of these cases, yielding a POP prevalence of 2.3% (95% CI: 2.0-2.61%). Uterine prolapse was the predominant type, observed in 77.1% of cases. The majority of patients (86.2%) presented with advanced disease (stage III or IV), and most (94.2%) received surgical treatment. Early postoperative complications occurred in 7.1% (14/198) of surgically managed patients, with vaginal cuff sepsis being the most frequent complication (5.1%; 10/198). Conclusion: POP represents a significant proportion of gynecological admissions at MRRH and is predominantly treated surgically with a low rate of early postoperative complications. Preventive strategies should be strengthened to reduce the occurrence of POP, and greater emphasis should be placed on promoting less invasive treatment options, including the use of pessaries.
Vaccination Status of OPV0 and BCG in Preterm Infants and Associated Factors in Southwestern Uganda:
(Pediatric Health, Medicine and Therapeutics, 2026) Namiiro,Agnes; Ochora,Moses; Keneema,Olive; Muwanguzi,Moses; Tugumenawe,Darius; Faith, DoreenLonges; Yusuf,Ibrahim; Tagema, Fiona; Mwinike ,Yusuf; Kumbakumba, Elias
Background: Despite the high Uganda National target of 90% for Bacillus Calmette-Guerin (BCG) and birth dose Oral Polio Vaccine (OPV0), preterm infants in Uganda remain at increased risk for vaccine preventable diseases due to delayed or missed early vaccination. The delay may be a result of poor understanding of the safety and effectiveness of vaccines. The exact estimate of preterm infants vaccinated, the vaccines missed or delayed and drivers of this vaccination status are not well studied in Southwestern Uganda. This study therefore determined the vaccination status of BCG and OPV0 in preterm infants and associated factors in the Southwestern region. Methods: We conducted a cross-sectional quantitative study between May and September 2023 at Mbarara Regional Referral Hospital and Holy Innocent Children’s Hospital. We consecutively recruited 350 preterm infants and their caretakers as they attended the newborn follow-up clinic and extracted data from their medical records. We described the vaccination status and used logistic regression model to determine associated factors. Results: The median age of preterm infants was 13 weeks Interquartile range (IQR), 4–26 and the median birth weight was 1.6kg, IQR, 1.3–1.8 at the time of the study. Two-thirds 66.6% (233/350) of our preterm infants had received both BCG and OPV0. More preterm infants 65.4% (229/350) had received BCG than OPV0 28% (98/350). Increasing preterm infant age, regular maternal antenatal care attendance and hospital discharge recommendation of vaccination increased the likelihood of vaccinating a preterm infant. However, denial of vaccination at first presentation negatively influenced vaccination of preterm infants. Conclusion: The vaccination status of BCG and OPV0 among preterm infants in the greater part of Southwestern Uganda is below the national target. Consequently, interventions are needed to improve timely vaccination rates among preterm infants before hospital discharge.
Lab tests can be used to predict phosphatidylethanolmeasured high-risk alcohol use among people with HIV:
(Alcohol and Alcoholism, 2025-10-31) Silva,C. Espinosa da ,; Scheffler.A,; Fatch.R,; Muyindike.W,; Emenyonu N.I,; J. Adong .J,; Chamie .G; Ngabirano.G; Kekibiina.A,; Tumwegamire.A,; Marson.K,; Beesiga.B,; Kindoli.E,; Allen I.E,; Hah J.A,
Background: Unhealthy alcohol use is prevalent among persons with HIV (PWH) and is associated with adverse outcomes, but is underestimated partly due to use of self-reported measures prone to underreporting. Phosphatidyl ethanol (PEth) is a direct measure of past month alcohol consumption but is costly. We assessed whether lab and health data representing alcohol-associated physiologic changes could be leveraged with machine learning to predict PEth-measured high-risk alcohol use among PWH. Methods: We pooled baseline data from two studies among PWH in Uganda that measured PEth (N = 988), and classified PEth as no/low/moderate (Peth)
Application of AI to Ultrasonographic Images to Aid the Clinical Care of Pregnant Women With Pre-eclampsia in Uganda: A Protocol for a Pilot Study
(Cureus, 2026-01-12) Godfrey, Mugyenyi R.; Atwiine, Fredrick; Atukunda, Esther C; Anthony Celi, Leo; Mwavu, Rogers; Kaggwa, Fred; Haberer, Jessica E; Wasswa, William
Background: intelligence (AI) refers to computer systems designed to perform tasks requiring human intelligence, including medical diagnosis. AI methods have enhanced diagnostic processes across various diseases. In obstetrics, conditions such as pre-eclampsia are typically assessed using USG, yet access to these services and trained sonographers remains limited. Automated diagnosis using AI applied to stored images offers an opportunity to improve maternal and fetal outcomes. In Uganda, progress in integrating AI into obstetric care has been minimal, despite the high burden of complications. This study aims to create a Doppler USG image database, annotated for machine Artificial learning models to predict pre-eclampsia complications. Methods: This cross-sectional study will enrol 150 pregnant women seeking obstetric USG services at Divine Mercy Hospital, Mbarara City, Uganda. Participants will be recruited consecutively from the outpatient department, with half expected to have pre-eclampsia. Sociodemographic, obstetric, and clinical data will be systematically collected, de-identified, and linked to corresponding Doppler ultrasonographic images. Data elements will include acquisition parameters, key Doppler indices, and anonymized demographic information. All data will be securely stored in a structured repository hosted by the Data Management and Analysis Core (DMAC) of the Mbarara University Data Science Research Hub. Images will be annotated using a standardized protocol by trained experts and linked with structured clinical metadata. The dataset will be partitioned into training, validation, and test subsets. Machine learning approaches will include convolutional neural networks, ensemble learning, and transfer learning. Performance will be evaluated using cross-validation, area under the receiver operating characteristic (ROC) curve (AUC), precision, recall, and F1-score, with hyperparameter optimization via grid and Bayesian search. Results: The primary outcome will be a de-identified, annotated dataset of obstetric Doppler ultrasonographic images linked to structured clinical metadata, including the amniotic fluid index, fetal heart rate, umbilical and cerebral arteries, uterine arteries, and placenta. Images will undergo standardized pre-processing and dual expert review, with discrepancies adjudicated by a third reviewer. The secondary outcome is a multimodal AI tool predicting maternal and fetal complications of pre-eclampsia. Data collection targets 150 participants, funded by the National Institutes of Health (NIH) Data Science Initiative for Africa. Discussion: In settings with limited access to expert imaging, this study will develop a high-quality annotated dataset and a context-specific machine learning model trained on images from pre-eclamptic and non-preeclamptic pregnancies. It will be among the first obstetric AI datasets derived entirely from an African population, addressing global gaps in representation. Aligned with Uganda’s Digital Health Strategy, the study supports innovative tools to strengthen clinical decision-making, improve maternal and perinatal outcomes, and advance AI integration into routine obstetric care in low-resource settings.
First Mile program: North-South partnership experience with health system strengthening in Mbarara, Uganda
(Global Health Action, 2026) Olds, Peter K.; Asiimwe, Stephen; Kembabazi ,Annet; Ainomugisha, Andrew; Jodi Ansel ,, , Moses; Joseph Ngonzi; Grace Nambozi; Mugema Mulogo, Edgar; Ntaro , Moses; Data, Santorino; Atwine, Raymond; Obunguloch, Johnes,; Muhindo, Rose,; Kansiime, Grace,; Nabulo, Harriet,; Namagga, Jane Kasozi; Mary, Sebert; Kawungezi, Peter Chris; Turigye, Brian; Wandera, Dennis Nelson; Nambogo, Nuriat; Birungi, Abraham; Ivers, Louise C.; Celestino Obua
Uganda’s public healthcare system faces significant systemic challenges in delivering care, contributing to poor health outcomes. In response, a North-South partnership between Massachusetts General Hospital (MGH), Mbarara University of Science and Technology (MUST), and Mbarara Regional Referral Hospital (MRRH) implemented the First Mile Project, a seven-year initiative (2018–2024) designed to strengthen the regional health system in southwestern Uganda. Guided by local priorities, the program aimed to improve access to care, enhance clinical capacity, expand medical education, and promote research and innovation. Project activities were devised collaboratively between investigators at MGH and MUST/MRRH, with robust local leadership and oversight. Key initiatives included clinical staffing in critical departments, construction of a regional isolation ward and oxygen plant. Additionally, the program provided scholarships for medical training, support for community-based care and continuing medical education, and provision of research and innovation grants. The program trained over 1500 health workers, supported 93 scholarships, increased access to specialized clinical services, and facilitated community outreach to thousands of households. The project also awarded 74 research grants and supported over 30 locally incubated innovations. Through this comprehensive, equity focused approach, First Mile demonstrated how collaborative, locally driven partnerships can effectively strengthen health systems in low-resource settings. Lessons from the initiative underscore the importance of sustained local leadership and integrated clinical and research efforts. A 20-year history of collaboration and mutual trust ensured open dialogue between partners and helped support the success of the project. The First Mile model provides a promising example for future health system strengthening initiatives globally
Intimate partner violence experience, support seeking and coping strategies among pregnant women in Southwestern Uganda
(PLOS Glob Public Health, 2026-01-05) Katushabe, Eve; Asiimwe, John Baptist; Ndinawe, John Bosco; Abeneitwe, Editor; Katusiime, Agnes; Nakidde, Gladys; Batwala, Vincent
Intimate partner violence (IPV) during pregnancy remains a global health challenge. This study aimed to explore pregnant women’s experiences of IPV, support seeking, and coping strategies in Southwestern Uganda. Pregnant women who had experienced IPV during pregnancy were purposively selected and completed in-depth interviews, with data saturation reached after 25 participants. Guided by the feminist theory, data were analyzed deductively and inductively using thematic analysis. Participating pregnant women were exposed to physical violence (e.g., the gravid abdomen being stepped on), psychological violence (e.g., verbal abuse), sexual violence (e.g., being forced into uncomfortable sexual positions), and financial control and manipulation (e.g., economic dependency used as a means of control). Pregnant women attributed IPV to intergenerational violence, unequal power dynamics in their households, and differences in traditional gender roles and social norms between men and women. Some pregnant women used active coping strategies to overcome effects of IPV, such as sharing their IPV experiences with a confidant. Other women accommodated abuse through passive coping strategies, such as keeping silent. Furthermore, identified barriers to seeking help after experiencing IPV included a lack of awareness, negative experiences with healthcare providers, partner dependence, and feelings of shame, guilt, and fear. This study’s findings suggest stakeholders need to prioritize IPV screening, care, referral, and sensitization in healthcare facilities and communities. In addition, rules and regulations that protect the rights of IPV survivors should be strengthened, and perpetrators held accountable for their actions.
Factors influencing antibiotic prescription for respiratory tract infections among prescribers in Jinja City, Uganda: A qualitative study.
(BMC, 2026-01-03) Igirikwayo Zablon K ,; Byamugisha Edison,; Kabakyenga Jerome
Background: Inappropriate antibiotic prescription for respiratory tract infections (RTIs) is a major driver of antimicrobial resistance (AMR). In Uganda, 40-80% of RTI patients receive antibiotics (ABs) despite most of them being viral and self-limiting. Few studies have explored the multifaceted factors influencing prescribing behavior among Ugandan healthcare providers. This study aimed to identify factors influencing antibiotic prescription (ABP) for RTIs among prescribers in Jinja City, Uganda. Methods: We conducted an exploratory qualitative study using face-to-face in-depth interviews with 16 prescribers (10 medical clinical officers, 5 nurses, 1 medical officer) from 10 purposively selected public health facilities in Jinja City during June-July 2023. Interview topics included knowledge of RTI etiology, antibiotic (AB) prescribing practices, availability of standard treatment guidelines (STGs) and diagnostics, and continuous education on AB use. Audio-recorded responses were transcribed verbatim, coded, and analyzed thematically using the Social Ecological Model to identify multilevel factors influencing prescribing decisions. Results: The factors influencing ABP for RTIs were categorized into individual, interpersonal, institutional, community and ministry of health (MOH) and government policy factors. Individuallevel factors included prescriber related factors and state of the patient considerations. Interpersonal factors involved prescriber-patient relationship and interactions with drug sales representatives. Institutional factors included initiatives to promote rational AB use by the facility’s management. Community-level factors included AB access and socioeconomic environment. Ministry of health and government policy factors included healthcare delivery infrastructure, educational and training programs, STGs, enforcement of regulations for prescription and dispensing.Conclusions: Multiple interrelated factors at individual, interpersonal, institutional, community, and policy levels contribute to inappropriate AB prescribing for RTIs in Jinja City. Addressing this challenge requires multipronged interventions. These findings provide actionable evidence for developing context-specific interventions to promote rational AB use and combat ABR in Uganda and similar low-resource settings.
Acute Dermal Toxicity and Analgesic Effect of a Capsaicinoid Gel Against Formalin-Induced Pain in Wistar Rats
(cureus, 2026-11-01) Mwandah,Daniel Chans; Joshua,Kiprotich; Angupale,Jimmy; Nantogo,Hanifah; Timothy,Neeza; Terkimbi,Swase Dominic; Mujinya,Regan; Atwiine,Barnabas; Yadesa,Tadele Mekuriya; Tusiimire,Jonans; Ogwang,Patrick Engeu
Background: Pain is a major public health concern, often inadequately managed due to the limitations and side effects of conventional analgesics. Capsicum annuum, widely used in traditional medicine, contains capsaicin, a compound with known analgesic properties. Despite its therapeutic promise, data on the dermal toxicity and efficacy of capsaicin-based topical formulations remains limited. Objective: The main objective of this study is to evaluate the acute dermal toxicity and analgesic efficacy of a capsaicinoid gel derived from C. annuum in Wistar rats. Methods An acute dermal toxicity test was conducted in female Wistar rats using OECD guideline 402. Rats received a single dermal application of 5% capsaicinoid gel at 200, 1000, or 2000 mg/kg and were observed for clinical signs over 14 days. Analgesic activity was evaluated using a formalin-induced paw-licking model. Male rats received topical treatments of capsaicinoid gel (100, 200, or 400 mg/kg) or 1% diclofenac gel (positive control), followed by formalin injection. Pain behaviour was scored in early (0-10 minutes) and late (15-60 minutes) phases. Hematological and biochemical parameters were assessed after 21 days. Results: No mortality was observed. Transient dermal and autonomic effects (e.g., erythema, tremors) were noted at higher doses but resolved spontaneously. The gel significantly reduced formalin-induced pain behaviours in both test phases, particularly at higher doses. Hematological and biochemical parameters showed mild, dose-related changes but remained within physiological ranges. Conclusion: The 5% capsaicinoid gel exhibited promising analgesic effects and an acceptable safety profile in rats. These findings support its potential as a topical analgesic, warranting further formulation optimization and chronic toxicity evaluation.
Impact of non-communicable diseases on maternal and perinatal outcomes in a low resource setting
(Maternal Health, Neonatology and Perinatology, 2025) Tibaijuka, Leevan; Boatin, Adeline A.; Tornes, Yarine Fajardo; Owaraganise Asiphas; Kayondo, Musa; Kanyesigye, Hamson; Atukunda,Esther C.; Bebell, Lisa M.; Bajunirwe, Francis; Geertruyden, Jean-Pierre Van; Jacquemyn,Yves; Ngonzi,Joseph
Background: Non-communicable diseases (NCDs) are increasingly prevalent among women of reproductive age and may pose significant risks to maternal and perinatal health. Despite their growing burden, data on their impact in low-resource settings remains limited. This study aimed to investigate the impact of pre-pregnancy NCDs on severe maternal and adverse perinatal outcomes among pregnant women admitted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: We prospectively enrolled pregnant women admitted to the maternity ward of MRRH from July 2022 to October 2023. We consecutively included all women with one or more NCDs and next two admissions without NCDs. Baseline sociodemographic and clinical documentation of pre-pregnancy NCDs including chronic hypertension, pre-gestational diabetes, cardiac disease, chronic kidney disease, sickle cell disease, asthma, and epilepsy. Participants were followed from admission through delivery, puerperium, and post-discharge with phone calls at 2, 4, and 6 weeks, and severe maternal and adverse perinatal outcomes were documented. We compared outcomes between women with and without NCDs and performed multivariable logistic regression analyses to determine the association between NCDs and these outcomes, adjusting for potential confounders, including maternal age, gravidity, employment status, HIV serostatus and delivery mode. Results: We enrolled a cohort of 300 pregnant women (100 with NCDs and 200 without NCDs) with a mean age of 27.8 ± 5.9 years. Severe maternal outcomes occurred in 80/300 participants (26.7%), with a significantly higher incidence among those with NCDs (36.0%, n = 36/100) compared to those without (22.0%, n = 44/200), including maternal death (4.0%, n = 4 vs. 0.5%, n = 1), acute heart failure (7.0%, n = 7 vs. 0%), ICU admission (9.0%, n = 9 vs. 2.0%, n = 4), pulmonary embolism (4.0%, n = 4 vs. 0%) and sepsis (7.0%, n = 7 vs. 1.0%, n = 2). At least one adverse perinatal outcome occurred in most participants (52.7%, n = 158/300). Women with NCDs also experienced significantly higher rates of adverse perinatal outcomes (69.0%, n = 69/100) than those without NCDs (44.5%, n = 89/200), including miscarriage (11.0%, n = 11 vs. 1.0%, n = 2), neonatal death (11.5%, n = 9 vs. 4.5%, n = 8), and NICU admission (48.7%, n = 38 vs. 20.3%, n = 36). In multivariable analysis, having one or more pre-pregnancy NCD (adjusted odds ratio [aOR]: 2.02, 95% CI [1.10, 3.68]) and attending fewer than four antenatal care (ANC) visits (aOR: 2.25, 95% CI [1.26, 4.04]) were significantly associated with increased risk of both severe maternal and adverse perinatal outcomes (NCDs: aOR: 2.39, 95% CI [1.34, 4.26];< 4 ANC visits: aOR: 1.95, 95% CI [1.12, 3.38]). Conclusions Pre-pregnancy NCDs and inadequate antenatal care are linked to severe maternal and adverse perinatal outcomes. Strengthening early identification, integrating NCD management into routine maternal care, and ensuring adequate antenatal visit coverage are critical to mitigating these risks. These findings underscore the need for targeted, multidisciplinary interventions to improve outcomes in resource-limited settings.
Factors associated with the uptake of cataract surgery among adults identified with operable cataract in South Western Uganda
(Journal of Ophthalmology of Eastern, Central and Southern Africa (JOECSA), 2025) Kanji R; Onyango J; Twinamasiko A; Arunga S
Objective: To determine the factors associated with the uptake of cataract surgery among adults identified with operable cataract in South Western Uganda. Methods: In a hospital-based cross-sectional study, patients presenting with operable cataract at two large tertiary level eye hospitals in south-western Uganda were prospectively consecutively enrolled between, October 2020 to January 2021. Operable cataract was defined, as a best-corrected visual acuity equal or less than 6/60 where the principal cause is cataract. The outcome of interest was undergoing a cataract surgery within 3 months of diagnosis. In a multivariable logistic regression model, we tested for social demographic and other baseline features associated with uptake of a cataract operation. Results: During the study period, a total of 400 patients with operable cataract were enrolled out of a total outpatient attendance of 1692 in the two hospitals (23.6%). The median age was 71 (IQR 65-80, full-range 30-102) and 222 (55.5%) were female. Most were married 242 (60.5%), the majority with no formal education 184 (46%). The most common occupation was being a peasant 256 (64%). The majority of the patients were household heads 285 (71.2%) and a large proportion required an escort to the hospital 384 (87%). Bilateral operable cataract was present in 146 (36.5%). Within the study period, the uptake of cataract surgery was 64% 95% CI (59- 68). In a multivariable logistic regression model, <50 years (OR 3.0, 95% CI (1.26 – 7.23) P-value = 0.021), female gender (OR 1.5, 95% CI (1.04 – 2.34) P-value=0.032) and bilaterally affected eyes (OR 2.95, 95% CI (1.8 – 4.8) P-value 0.001) were associated with uptake of cataract surgery. Conclusion: This study showed that younger patients compared to older ones, females compared to males and bilaterally affected patients compared to unilateral were more likely to uptake cataract surgery. This provides useful background information for planning improvements in the uptake of cataract services.
Exploring potential opportunities and strategies of using the Labour Care Guide to improve labour monitoring and health outcomes among health care providers in Uganda: a qualitative study
(BMC Pregnancy and Childbirth, 2025) Mugyenyi R. Godfrey; Esther C. Atukunda; Wilson Tumuhimbise; Yarine F. Farjardo; Josaphat Byamugisha
Background: Labour monitoring tracks cervical dilation, contractions, and foetal heart rate to ensure safe childbirth. Prolonged labour is identified when progress exceeds expected timelines, shown on the partograph or Labour Care Guide (LCG). The LCG helps health care providers detect abnormal labour patterns early. This study explored how the LCG could enhance labour monitoring in Uganda, identifying strategies to improve maternal and foetal outcomes through timely assessments and interventions. Methods: Between June and September 2023, qualitative interviews were held with Health Care Providers and Ministry of Health officials familiar with the Labour Care Guide. Conducted privately and digitally recorded, the interviews were transcribed and coded. Through iterative analysis, researchers identified multilevel factors influencing sustained engagement in labour monitoring and the uptake and implementation of the LCG. Results: The median age of the interviewed HCPs was 36 years(IQR,27-54). All participants demonstrated great enthusiasm, describing the LCG as a simple, easy-to-use and comprehensive tool that could quickly aid detection of prolonged labour for timely management, if modified appropriately. HCPs identified LCG’s potential to facilitate sustained use through perceived ability to correctly define active labour at 5 cm of cervical dilatation, with major labour parameters recorded on one-A4-paper for easy comparison and reference. LCG facilitated HCP-patient labour companion interaction for social support and would undergo customization to address user needs, enhance accountability and reduce over-documentation since the same single-page format could capture all the necessary details needed to make a one-stop quick and effective clinical decision. HCPs underscored the role and sustained benefits of off-site training, team building, guidelines accessibility, real-time feedback, peer mentorships and championships. LCG pitfalls included small fonts, observation ordering, missing record of social-demographic and key outcome data, plus fields/parameters deemed redundant/inappropriate. Conclusion: Our data demonstrates a responsive, enthusiastic and supportive environment that has potential to facilitate LCG customization, uptake and scale up. The high LCG expectations are important considerations in developing sustainable and acceptable implementation strategies that meet user needs. More work is needed to refine and evaluate the tool’s effectiveness in improving labour monitoring in Uganda.
‘Empowerment’ as a proximal implementation outcome for task shifting with informal cadres: findings from a qualitative study with traditional healers in rural Uganda
(Implementation Science Communications, 2025) Misha Hooda; Madison Stead; Gabriel Nuwagaba; Sylvia Natukunda; Constance Birungi; William Bugeza; Maureen Tushabe; Srija Gogineni; Denis Nansera; Winnie Muyindike; Juliet Mwanga‑Amumpaire; Radhika Sundararajan
Background: Task shifting and task sharing (TSS) are widely used implementation strategies to expand HIV service delivery in low-resource settings. Informal lay health workers, such as traditional healers (THs), have been proposed as critical partners in bridging service delivery gaps. However, the mechanisms that support their successful integration into formal health systems remain underexplored. This qualitative sub-study aimed characterizes a novel proximal implementation outcome – empowerment – based on lived experiences of THs participating in a TSS intervention in rural Uganda. Methods: Between July and August 2023, we conducted 22 in-depth interviews with THs in rural Uganda who completed a three-day training to become lay HIV supporters. The curriculum included HIV transmission, ART adherence, stigma reduction, and HIV self-testing. Interviews were conducted in the local language, transcribed, translated into English, and analyzed using a thematic approach. Our analysis was guided by Lee and Koh’s empowerment framework, which links role transformation to domains of empowerment. Results: THs reported experiencing empowerment across four domains: meaningfulness, competence, self-determination, and impact. Participants described strong alignment between their traditional caregiving roles and new responsibilities in HIV support. They reported increased HIV-related knowledge, confidence in client care, autonomy in decision-making, and a sense of contributing meaningfully to improved health outcomes. Notably, we identified a fifth domain – external validation – defined as recognition and legitimacy conferred by representatives of the bio medical health system. This domain was central to participants’ perceived integration, motivation, and potential sustainability of their involvement in these types of programs. Conclusions: We propose empowerment as a novel proximal implementation outcome that reflects the internal and external transformations necessary for successful implementation with informal providers. Our findings support expanding Lee and Koh’s empowerment framework to include external validation, particularly for cadres operating outside the formal system. Positioning empowerment as a proximal outcome offers a valuable lens for evaluating early success of broad implementation strategies that involve role transformation, such as training trainers, or engaging community champions.
Diagnostic accuracy of the TrueNat™ MTB plus assay for detecting pulmonary tuberculosis in adults
(PLoS One, 2025) Sarapia P. Mallya; Peter M. Mbelele; Riziki M. Kisonga; Daphine D. Mtunga; Haroun H. Banzi; Stephen S. Mpiima; Muzafaru Twinomujuni; Joel Bazira; Kennedy Kassaza
Tuberculosis (TB), caused by Mycobacterium tuberculosis remains a global threat, affecting 10.8 million people and causes 1.3 million deaths annually. Over 2.5 million cases go undiagnosed partly due to current diagnostic limitations. In particular, smear microscopy is less sensitive, culture is slow and prone to contamination, and the rapid Xpert® MTB/RIF Ultra (Ultra) needs advanced infrastructure. This study assessed the diagnostic accuracy of TrueNat™ MTB Plus assay (TrueNat), a portable, WHO-endorsed point-of-care tool, compared to Ultra, smear microscopy, and Löwenstein–Jensen (LJ) culture. This cross-sectional study enrolled 260 consenting adult participants (≥18 years) with presumptive TB in northern Tanzania. Participants’ sputum samples were tested for M. tuberculosis using smear microscopy, LJ culture, Ultra and TrueNat. TrueNat performance was assessed using sensitivity, specificity, predictive values and area under the curve (AUC) against the standard-of-care and a composite reference standard. Age and body-mass-index were summarised using median and interquatile range (IQR). Categorical variables were reported as proportions. Multivariate logistic regression identified TB predictors (p<0.05). Data analysis and visualization were conducted using R. Among 260 participants, 165 (63.5%) were male, with a median age of 46.0 years (IQR: 35.5–57.3); 15 (5.8%) were HIVpositive, and 52 (20%) had undernutrition. TB was detected in 109 (41.9%) participants by at least one test. TrueNat showed sensitivity/specificity of 34.4%/94.7% vs. smear microscopy, 98.9%/95.3% vs. culture, and 86.2%/95.2% vs. Ultra. The AUC values were 0.75, 0.92, 0.96, and 0.91 compared to smear microscopy, LJ culture, Ultra, and a composite reference method, respectively. Participants reporting weight loss were 2.84 times more likely (95% CI: 1.68–4.84, p<0.001) to test positive for TB by TrueNat. The TrueNat compared favorably to both Ultra and culture in terms of diagnostic accuracy, offering the added benefits of faster results and greater suitability for resource-limited settings. These findings suggest that TrueNat is a promising test for rapid TB detection in low-resource settings, warranting further studies to evaluate its implementation and impact on patient management.