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Recent Submissions

Short-Term Success Rate and Risk Factors for Failure of the Urethral Plication Procedure in the Management of Post-Obstetric Fistula Closure Stress Urinary Incontinence Among Ugandan Women: A Prospective Cohort Study
(International Journal of Women's Health, 2026) Musa Kayondo; Onesmus Byamukama; Brenda Ainomugisha; Rogers Kajabwangu; Paul Kato Kalyebara; Leevan Tibaijuka; Henry Mark Lugobe; Verena Alice Geissbuhler; Christopher Tarnay
Objective: To determine the six-month success rate and risk factors for failure of the urethral plication procedure in the management of post-obstetric fistula closure Stress Urinary Incontinence (SUI). Methods: This was a prospective cohort study of 70 women with moderate or severe SUI who underwent surgery for post-obstetric fistula closure SUI using the urethral plication procedure, managed at eight fistula repair sites in Uganda. Participants underwent clinical evaluation, methylene blue dye testing, post-void residual assessment, and single-channel cystometry to confirm stress urinary incontinence and exclude residual fistula, overflow incontinence, and urge incontinence. Urethral plication was the primary continence procedure; however, in some participants, concomitant reconstructive procedures, including urethral elongation and urethral reconstruction were performed based on intraoperative anatomical findings. The participants were followed up for a period of six months. Assessment for statistically significant changes in the grade of SUI at baseline and at six months post-surgery among the failures was done using Bowker’s test of symmetry and the Stuart–Maxwell test for marginal homogeneity. Descriptive analyses and multivariable log binomial regression were performed to determine risk factors for failure. Results: A total of 70 women were enrolled with a mean age of 34 (SD ±12.1) years. Concomitant reconstructive procedures were performed in 26/70 (37%) of participants. The success rate at six months post-surgery was 61% (43/70) dropping from 70% (49/70) at time of discharge. Of the 27 participants who remained incontinent, 15 (56%) demonstrated improvement in the grade of incontinence (Bowker’s test; χ2 = 20.0, df = 3, p = 0.0002, and Stuart–Maxwell test; χ2 = 17.9, df = 2, p = 0.0001). Severe vaginal scarring was the only independent risk factor (RR=3.77; 95% CI: 1.59–8.96; P=0.001). Conclusion: The short-term success rate of the urethral plication procedure is moderately high, and in carefully selected women, it appears to be a safe and effective option for managing post-obstetric fistula closure stress urinary incontinence. Although the procedure is more likely to fail in women with severe vaginal scarring, the severity of the incontinence improves in those that fail
Taenia solium development and host interactions in neurocysticercosis: a narrative mini review on mechanistic pathways to epileptogenesis
(Acta Epileptologica, 2026) Franck Katembo Sikakulya; Hervé Monka Lekuya; Larry Kasereka Kamabu; Mathieu Katembo Manzekele; Eric Ochen; Fatuma Djuma Sonia; Jeannot Munihire Baanitse; Furaha Nzanzu Blaise Pascal; Rishi A. Shah; Shitu Hauwa Balarabe; Olivier Kambere Kavulikirwa; David Kitya; Malcolm K. Jones
Neurocysticercosis (NCC), a central nervous system infection caused by the larval stage of Taenia solium, remains a leading cause of acquired epilepsy in endemic regions. Mounting evidence indicates that seizure development in NCC is not solely driven by host inflammatory responses but reflects complex, dynamic interactions between parasite development, host neuroimmune processes, and neuronal network remodeling. This narrative mini-review integrates experimental and clinical data to demonstrate that T. solium larvae actively shape the cerebral microenvironment through stage-specific immune modulation, blood–brain barrier disruption, and the release of neuroactive excretory–secretory products. During cyst degeneration, parasite antigens and excitatory amino acids drive microglial and astrocytic activation, amplify glutamatergic signaling, and destabilize inhibitory neurotransmission, collectively reducing seizure thresholds. These acute events are followed by chronic structural alterations, including perilesional gliosis, synaptic reorganization, and persistent network hyperexcitability, particularly around parenchymal and calcified lesions that serve as enduring epileptogenic foci. Integrating parasite developmental biology with neuroimmune and neuroexcitatory mechanisms, this review reconceptualizes NCC epileptogenesis as an active, multilevel dialogue between parasite, host, and neuron, rather than a passive, inflammation-driven consequence of infection. This integrated mechanistic framework highlights opportunities for biomarker discovery and therapeutic strategies that look beyond mere parasite eradication to address sustained neural dysfunction. It further underscores the critical need for One Health-oriented interventions to disrupt the T. solium transmission cycle and alleviate the long-term burden of NCC-associated epilepsy.
Depression and loss to follow-up among patients treated for premalignant cervical lesions at a tertiary hospital in Uganda: a cross-sectional study
(BMC Women's Health, 2026) Samuel Maling; Frank Ssedyabane; Hope Mudondo; Rogers Kajabwangu; Nathan Kakongi; Eleanor Turyakira; Alexcer Namuli; Wilfred Arubaku; Martin Galiwango; Randall C Thomas; Deusdedit Tusubira
Background Cervical cancer prevention relies on timely treatment and follow-up of premalignant cervical lesions, yet loss to follow-up (LTFU) remains common in many low-resource settings. Depression may be associated with poor engagement in care, but evidence among women treated for premalignant lesions in Uganda is limited. We assessed the prevalence of depression and its association with LTFU among women treated for premalignant cervical lesions at Mbarara Regional Referral Hospital in Uganda. Methods This was a retrospective cross-sectional study at the Cervical Cancer Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. Women treated for premalignant cervical lesions between January 2017 and December 2022 with complete records and active telephone contacts were enrolled (n = 112). Follow-up status was defined by clinic attendance on the scheduled review date or within three months thereafter. Depressive symptoms were assessed during telephone interviews (May–June 2023) using the Patient Health Questionnaire-9 (PHQ-9), categorized as moderate/severe (≥ 10) versus no/mild (< 10). sociodemographic and treatment-related data were collected using a separate structured questionnaire/clinical record abstraction. Logistic regression was used to assess the association between depression and LTFU, adjusting for district of residence, marital status, education level, and employment status. Results Of 112 participants, 75.0% (84/112) were LTFU. The mean age was 36.4 years (SD = 8.8). Moderate to severe depressive symptoms were present in 17.9% (20/112). Mean PHQ-9 scores were higher among participants who were LTFU than those retained in care (6.2 ± 5.2 vs. 0.7 ± 3.1; p < 0.001). Depression was associated with increased odds of LTFU (AOR = 9.697; 95% CI: 1.087–86.536; p = 0.042). Conclusion Women treated for premalignant cervical lesions at Mbarara Regional Referral Hospital had high LTFU, and depressive symptoms were strongly associated with disengagement from follow-up care.
Harmful alcohol use in rural Uganda: a pilot study from the Kigezi sub-region
(BMC Public Health, 2026) Nazarius Mbona Tumwesigye; Vincent Mubangizi; Wilber Karugahe; Agnes Napyo; Sam Maling; Aggrey Mukose; Catherine Gitige; Mary Mbuo; Cissie Namanda; Merlin Willcox
Introduction Currently, Uganda has the highest per capita alcohol consumption in Africa, and the negative effects of harmful use of alcohol are quite prevalent. Some rural areas face a complex set of underlying factors that may be responsible for this trend, including unemployment and easy access to cheap alcohol. Kigezi sub-region is one of the areas most affected by the harmful use of alcohol. This paper characterizes harmful use of alcohol in form of patterns of use, timing for drinking, types of drinks; and identifies factors associated with it in the sub-region’s tourist area around Lake Bunyonyi. Methods This was a cross-sectional study. A two-stage stratified sample survey was carried out and yielded 339 participants from 34 villages. It had standard questions on alcohol use and included the WHO’s Alcohol Use Disorders Identification Test (AUDIT) score. Harmful alcohol use was assessed using two measures. First, we calculated the proportion of participants with AUDIT scores between 8 and 40, indicating medium- to very high-risk alcohol use (MHA). Second, we used a proxy measure for alcohol use disorder (AUD), defined as the proportion of participants who, in the past 12 months, reported experiencing at least monthly any of the following: loss of control over drinking, alcohol-related failure to meet obligations, or the need for a morning drink after heavy alcohol consumption. The inclusion criteria for participants were adults aged ≥ 18 years, who consented to the study, while the exclusion criterion was withdrawal of consent during the interview process. The factors associated with harmful use of alcohol were determined using multilevel mixed effects generalised linear models that account for the clustering at the village level. Results The prevalence of AUD was 17.7% and of MHA was 28%. The prevalence of MHA was significantly lower among women (APR = 0.47, 0.28–0.76) and higher among those whose relatives or friends condoned alcohol consumption (APR = 1.77, 95% CI: 1.12–2.81), and it increased with improved income level (p < 0.001). Other factors included being more educated, a reduced frequency of engagement with religious activities, and earning a living through skilled trades. Key reasons for stopping alcohol include religious commitment, family background, and observed negative experiences. Most drinkers drink local brew/unrecorded alcohol and prefer to drink at the weekend. Although a few drinkers start drinking before 8am, the number grows to 50% and 60% by 4pm and 5pm respectively. Conclusion Harmful use of alcohol prevalence is higher than what is found in the WHO’s recent nationwide study and other epidemiological studies. The drinking culture leans towards drinking at weekends and daytime drinking and consumption of local brew. The factors associated with harmful use of alcohol include family and friends’ influence, higher income level, and reduced religiosity.
Sex differences in alcohol use and perceptions of cognitive health in rural Uganda
(BMC geriatrics, 2026) Emmanuel Maleka; Julius Kyomya; Joyce Namwase; Humphrey Beja; Samantha Mary; Godfrey Zari Rukundo; Edith K. Wakida; Celestino Obua
Background Dementia is a significant public health issue affecting over 50 million people worldwide. Alcohol consumption has been identified as a modifiable risk factor for dementia and its progression. This study aimed to explore the sociocultural factors influencing sex differences in alcohol consumption and community perceptions of its potential cognitive effects, including dementia risk in rural Uganda, where alcohol use is prevalent. Methods We employed a qualitative study design in the Ibanda and Lira districts, guided by the Gender Analysis Framework (GAF). We conducted in-depth interviews with 20 older adults (aged 60 years or older) who consume alcohol and 10 key informant interviews with community leaders. We used a deductive thematic analysis approach to generate themes and sub-themes using GAF. Results Four main themes are presented in this study: Access to resources, Practices and participation, Beliefs and perceptions, and Institutions, Laws and Policies. We found that men had greater access to alcohol due to their economic independence and social norms, often drinking in social settings. This was facilitated by peer relationships and the acceptance of drinking as a social norm for men. Women’s access to alcohol is limited by household responsibilities and cultural expectations, with consumption mainly at home and in smaller quantities. Community norms discourage alcohol consumption by women and are associated with shame and family disruption. Most participants believed that alcohol could cause memory problems, although some felt that other factors, such as age, could contribute to cognitive decline. Weak enforcement of alcohol regulations and religious influences were noted, with women reported to be more receptive to religious guidance on quitting alcohol consumption. Conclusions Gender disparities exist in alcohol access, consumption patterns, and social norms in rural Uganda. Participants commonly associated alcohol use with forgetfulness and short-term memory problems, perceptions that are consistent with early cognitive effects of alcohol but not with later stages of dementia. There is a need for gender-specific interventions to address alcohol consumption and to raise awareness about its potential impact on cognitive health in this population.
High Prevalence of Unhealthy Alcohol Use Among Persons with HIV, Viral Non-suppression and Any Alcohol Use in Mbarara, Uganda: A Brief Report
(AIDS and Behavior, 2026) Rebecca J. Fisk-Hoffman; Allen Kekibiina; Winnie R. Muyindike; Huimin Cheng; Patrick Agumenaitwe; Ve Truong; Olivia Allison; Natalia Gnatienko; Judith I. Tsui; Judith A. Hahn; Nneka Emenyonu; Leah Forman; Wuji Shan; Lunze Karsten; Jeffrey H. Samet
Unhealthy alcohol use is associated with HIV viral non-suppression. It is unclear how common unhealthy alcohol use is among non-suppressed persons with HIV (PWH) who drink alcohol. We conducted chart reviews to recruit PWH in Uganda with recent viral non-suppression for a study on the efficacy of gabapentin for promoting viral suppression among those with unhealthy alcohol use. Of the 288 PWH screened, 87% self-reported unhealthy alcohol use on the Alcohol Use Disorders Identification Test-Consumption and 73% tested positive for urine ethyl glucuronide. These data suggest that alcohol interventions are needed among Ugandan PWH with viral non-suppression and who drink.
Prevalence and Factors Associated with Type 2 Diabetes Self-Management Among Patients Attending Mbale Regional Referral Hospital: A Cross-Sectional Study in Eastern Uganda
(Diabetes, Metabolic Syndrome and Obesity, 2026) Rogers Makonje; Ronald Ouma Omolo; Steward Mudenda; Nathan Mugenyi
Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that requires sustained self-management to achieve optimal glycemic control and prevent long-term complications. Effective self-management involves adherence to medication, healthy diet, physical activity, blood glucose monitoring, and regular clinic attendance. However, evidence suggests that self-management practices remain suboptimal in many low- and middle-income countries, including Uganda, and data from regional referral hospitals are limited. This study aimed to determine the prevalence of self-management practices and identify factors associated with effective self-management among patients with T2DM receiving care at Mbale Regional Referral Hospital, Eastern Uganda. Methods: A hospital-based cross-sectional study was conducted between among 385 adults with T2DM attending the diabetes clinic. Participants were selected using systematic random sampling from the clinic registry. Data were collected using a structured interviewer-administered questionnaire, including the Diabetes Self-Management Questionnaire (DSMQ). DSMQ total scores were transformed to a 0–100 scale, with a cut-off of ≥70% defining good self-management. Descriptive statistics summarized participants’ characteristics, and bivariate and multivariable logistic regression analyses were performed using STATA version 17.0 to identify factors independently associated with good self-management. Results: Only 34.6% (133/385) of participants demonstrated good self-management. Factors independently associated with good self-management included higher education level (AOR = 2.4, 95% CI: 1.52–4.81, p=0.001), employment (AOR = 5.3, 95% CI: 3.53–9.18, p=0.02), higher monthly income (AOR = 3.2, 95% CI: 1.52–5.98, p=0.001), shorter diabetes duration (1–5 years vs >10 years; AOR = 2.7, 95% CI: 1.35–8.25, p=0.005), awareness of diabetes complications (AOR = 3.1, 95% CI: 1.70–5.76, p=0.041), and family support (AOR = 2.1, 95% CI: 1.60–7.74, p=0.006). General diabetes knowledge was not significantly associated with self-management. Conclusion: The prevalence of good self-management among T2DM patients at Mbale Regional Referral Hospital is low. Socio-economic factors, awareness of diabetes complications, shorter disease duration, and family support significantly influence self-management behaviors. Interventions targeting these factors are essential to improve diabetes outcomes in this setting.
Morphological Variants and Factors Associated With Neural Tube Defects at a Regional Referral Hospital
(Health Science Reports, 2026) Benard Owere; Patience D. Nalumaga; Dauglas Nkoyooyo; Innocent Ayesiga
Background: Neural Tube Defects (NTDs) remain a significant public health concern, especially in low‐resource settings. This study investigated the morphological variants of NTDs and identified factors associated with their development among neonates at Mbarara Regional Referral Hospital (MRRH). Methods: A retrospective cross‐sectional descriptive study was conducted using medical records from January 2022 to December 2024. One hundred and six records of neonates diagnosed with NTDs were included. Data were analyzed using STATA version 17. Bivariate and multivariate logistic regression analyses were performed to assess associations between risk factors and NTD types. Results: Open NTDs accounted for 70.75% of cases, with myelomeningocele being the most common. Most defects were posteriorly located (81.13%). Low birth weight (AOR = 4.09, CI: 1.00–6.67, p = 0.049) and lack of folic acid supplementation (AOR = 7.12, CI: 1.32–8.33, p = 0.022) were significantly associated with open NTDs. Conclusion: Open NTDs are the predominant morphological variant at MRRH. Key risk factors include low birth weight, inadequate folic acid supplementation, and maternal HIV status.
“Once you get TB, life changes”: post-tuberculosis experiences and care needs in East Africa
(IJTLD chronic respiratory disease, 2026) Kirsten Prabhudas-Strycker; Winnie Muyindike; Lameck Diero; Sylvia Kitur; Julia Omondi; Sarah Namwanje; Lillian Ayesiga; Bob Ssekyanzi; MaKayla Waugh; Suzanne Goodrich; Helen Byakwaga; Aggrey Semeere; Kara Wools-Kaloustian; Neelima Navuluri; Leslie A. Enane
Introduction: Recognition of tuberculosis (TB) sequelae is growing. Evidence regarding post-TB experiences and care needs may inform care models. Methods: The TB Sentinel Research Network of the International Epidemiology Databases to Evaluate AIDS is a global prospective study of people aged ≥15 with pulmonary TB. In Eldoret, Kenya, and Mbarara, Uganda, we conducted in-depth interviews with a purposive sample of individuals treated for TB and multi-disciplinary healthcare workers (HCWs) providing TB care, using a semi-structured guide. We conducted a reflexive thematic analysis. Results: In interviews with 25 HCWs and 61 individuals treated for TB, participants described trajectories of TB illness and recovery, and some persistent challenges after TB treatment across physical, economic, social, and mental health domains of wellbeing. Experiences were marked by stigma and isolation. Physical illness exacerbated economic vulnerability, which compromised physical health and presented barriers to care. There was a lack of care access and need for person-centered post-TB care. Care needs included addressing potential TB recurrence, lung health impairment, psychosocial, nutritional, and economic challenges. Conclusions: Post-TB experiences are marked by persistent symptoms, economic vulnerability, stigma, and psychosocial challenges. These experiences are generally neglected in the current care paradigm, underscoring needs for accessible, person-centered post-TB care models.
HIV-Related Toxoplasmosis Infection. A Rare Case of Simultaneous Cardiac and Cerebral Involvement
(International Medical Case Reports Journal, 2025) Yekosani Mitala; Nathan Murungi; Abraham Birungi; Samuel Tumwesigire; Simeon Eloba; Augustine Mutudhu; Moses Arineitwe; Dianah Ishimwe; Richard Dratu; Francis Nsumba Kitenda; Joel Musayi; Hope Mudondo; Raymond Atwine
Toxoplasmosis is a significant opportunistic infection among people living with HIV (PLHIV), primarily manifesting as cerebral disease. Cardiac involvement, while rare, significantly complicates clinical management. This report describes an unusual presentation of concurrent cerebral and cardiac toxoplasmosis in a 50-year-old HIV-positive male initially treated for severe malaria. Despite initial symptomatic relief, the patient rapidly deteriorated neurologically and subsequently succumbed. The autopsy revealed characteristic cerebral and myocardial lesions confirmed by histopathology. The case underscores the diagnostic complexities and the necessity for high clinical suspicion in managing PLHIV with atypical presentations, especially in malaria-endemic areas.
Evaluating the Operational Performance of Community-Based Tourism Enterprises and their contribution to community Conservation outcomes around Bwindi Impenetrable National Park
(Journal of Tourism and Hospitality Management, 2026-04-06) Monica Kyarikunda; Grace Kagoro-Rugunda; Tom Ogwang
Although Community Based Tourism Enterprises (CBTEs) significantly support conservation and sustainable livelihoods around Bwindi Impenetrable National Park, over 30 years they have undergone major changes in management, population, market demand and tourist numbers, whose effect on the performance of CBTEs remains unevaluated. There is a danger of overreliance of communities on CBTEs, which creates a syndrome of complacency in communities to only look at biodiversity as their only source of livelihood, hindering their innovation in terms of income generation. This may lead to communities relying on the park resource as the only source of innovation for income or survival, putting a threat to the intended conservation outcomes. This study evaluated the performance of CBTEs operating within the four sectors of Bwindi Impenetrable National Park (BINP), Buhoma, Ruhija, Rushaga, and Nkuringo, to determine the extent to which they have lived up to their mandate of supporting livelihoods and enhancing conservation outcomes. Data were collected through questionnaire surveys with CBTE registered members, CBTE employees, Managers; in-depth interviews with UWA officials, Ministry of Tourism officials, local government officials, as well as NGO representatives and Focus Group Discussions (FGDs) with CBTE participants ranging from 6 to 12 participants. Community-Based Tourism Enterprises (CBTEs) around BINP exemplify a sustainable development model that integrates livelihood improvement, social cohesion, and conservation promotion. The findings show a significant relationship between CBTE performance and conservation outcomes like providing socio-economic and environmental benefits, which strengthen local support for conservation, supporting the community's drive to protect natural resources. To enhance their impact, strategic interventions are needed to increase the number of community-owned accommodation-based enterprises, capacity building to improve service quality, strengthening collaborations between CBTEs, tour operators and NGOs for value chain connections to increase tourist flow, leveraging digital marketing to increase visibility of CBTEs for better outcomes.
Incidence and Risk Factors of Chemotherapy-Induced Hepatotoxicity: A Cross-Sectional Study
(Cancer Management and Research, 2026) Sebisaalu Joel; Sarad Pawar Naik Bukke; Bharath Kumar Mamilla Mugaiahgari; Julius Kyomya; Kato Kalinge Idrine; Nimusiima Godwin; Patrick Kitheka Muasya; Amina Abubakar Abdi; Kabera Radiana Makuza; John Martin Tumwebaza; Bayapa Reddy Narapureddy; Narayana Goruntla; Daniel Chans Mwandah; Alrazi Eisa Shogar; Safa A Abdalla; John Isiiko; Tadele Mekuriya Yadesa
Background: Cancer is a major global health concern, causing significant morbidity and mortality, with particularly a high burden observed in low- and middle-income countries (LMICs). While chemotherapy remains a cornerstone of cancer treatment, it often causes adverse effects, particularly hepatotoxicity. Chemotherapy-induced hepatotoxicity (CIH) can severely compromise treatment effectiveness, often leading to necessary dose reductions or discontinuation, thereby increasing patient morbidity and mortality. Despite its clinical significance, there is currently limited data available on the incidence, severity, and risk factors of chemotherapy induced hepatotoxicity specifically within Uganda or LMIC. Objective: This study aimed to determine the incidence, severity, and risk factors with chemotherapy-induced hepatotoxicity among adult patients with cancer at the cancer unit of Mbarara Regional Referral Hospital (MRRH). Methods: A cross-sectional study was conducted among adult cancer patients receiving chemotherapy at MRRH. Data was collected through patient interviews, chart reviews, and laboratory assessments, including liver enzyme measurements. Statistical analysis was performed using STATA version 17 software. Results: Out of 216 adult patients with cancer. A total of 63 (29.2%) developed chemotherapy-induced hepatotoxicity. Most cases were of grade 1 (n = 51, 81%) followed by grade 2 (n = 8, 12.7%), then grade 3 (n = 4, 6.3%). Risk factors of chemotherapy-induced hepatotoxicity included; living with HIV (adjusted odds ratio (AOR) = 2.5, 95% CI: 1.1–5.6, p-value = 0.033) and diabetes mellitus (AOR = 20.2, 95% CI: 1.7–228.5, p-value = 0.015). Conclusion: Chemotherapy-induced hepatotoxicity affects about one in three cancer patients at MRRH, with HIV and diabetes significantly increasing risk. Routine liver function monitoring and individualized protocols, including prophylactic hepatoprotectants for high- risk patients, are essential to prevent severe hepatotoxicity and improve cancer treatment outcomes.
Aetiology, outcomes, and in-hospital mortality predictors of suspected paediatric central nervous system infections in southwestern Uganda: a prospective cohort study
(The Lancet Regional Health–Africa, 2026) Phuthumani Mlotshwa; Elias Kumbakumba; Dan Nyehangane; Reza Rast; Richard Migisha; Milly Nassejje; Deborah Nanjebe; Yap Boum II; Juliet Mwanga-Amumpaire; Tobias Alfvén; Giulia Gaudenzi
Background: Central nervous system (CNS) infections remain a major cause of paediatric morbidity and mortality in sub-Saharan Africa. We aimed to describe the aetiology and outcomes of paediatric CNS infections in southwestern Uganda and identify predictors of in-hospital mortality. Methods: Children aged 0–12 years with suspected CNS infections were recruited upon admission and followed until discharge, transfer, or death between January 2019 and September 2020 at two major hospitals in southwestern Uganda. Blood and cerebrospinal fluid (CSF) underwent routine diagnostics and BioFire FilmArray ME Panel testing. We used modified Poisson regression with robust variance to identify predictors of in-hospital mortality. Findings: Among the 212 children enrolled, in-hospital mortality was 15% (95% CI: 11–20%), while 18% (95% CI:13–23%) were discharged with neurological sequelae. At admission, delayed capillary refill (adjusted risk ratio[aRR] = 5.9; 95% CI: 1.8–20), symptomatic anaemia (aRR = 2.7; 95% CI: 1.1–7.0), and elevated peripheral white blood cell count (aRR = 3.3; 95% CI: 1.8–6.1) were independently predictive of fatal outcomes. Plasmodium species were detected in 20% (n = 42) of cases, and HHV-6 in 9% (n = 19), including instances of co-infection. Among bacterial pathogens in CSF, Streptococcus pneumoniae (11/24) was the most frequently identified, followed by Haemophilus influenzae (4/24) and Neisseria meningitidis (4/24). Interpretation: Despite advances in infectious disease control, children with suspected CNS infections in south western Uganda continue to experience high mortality and neurological sequelae. Strengthened prevention, rapid diagnostics, and simple bedside markers such as delayed capillary refill, symptomatic anaemia, and elevated WBC count could enable earlier risk stratification and improved outcomes in low-resource settings.
Heat Stress and Occupational Health in a Changing Climate: A Brief Report on Brick Kiln Workers in Uganda
(African Journal of Public Health and Health Systems, 2026) Nakato Nalwoga; Okello Otieno; Musa Kato
This brief report addresses the critical occupational health challenge of heat stress among outdoor workers in Africa, exacerbated by climate change. Focusing on Uganda's brick kiln industry, it investigates the physiological impacts and health perceptions of workers within this heat-intensive informal sector. A cross-sectional study was conducted in 2024 across multiple kiln sites in Central Uganda. Data were collected through structured interviews assessing self-reported health symptoms and environmental heat exposure, complemented by direct wet-bulb globe temperature (WBGT) measurements. Findings indicate that over 87% of workers experienced heat-related illnesses, including excessive fatigue, dizziness, and muscle cramps, during the 2023-2024 working year. WBGT readings consistently exceeded internationally recommended exposure limits for heavy labour. Crucially, despite high morbidity, awareness of heatstroke as a medical emergency was low, and adaptive practices were largely informal and inadequate. The study underscores that climate change constitutes a direct occupational health hazard, disproportionately impacting vulnerable informal labour forces. It argues for the urgent integration of evidence-based heat health protection such as revised work-rest schedules and targeted health education into national occupational safety and climate adaptation policies. This report provides essential evidence for policymakers to develop interventions that safeguard this critical workforce on a warming continent
A Mediation Analysis of Sex Motives in the Locus of Control-Risky Sexual Behaviour Nexus among Students in Ugandan Universities
(THE UGANDA HIGHER EDUCATION REVIEW, 2025) Winfred Biribonwa Kyosaba; David Kani Olema; Aloysius Rukundo
This study investigates the psychological and behavioural dynamics influencing risky sexual behaviours (RSBs) among young adults in Ugandan universities during their critical transition to adulthood. A quantitative research design was employed using a self-administered questionnaire to examine the interplay between locus of control (LOC), sex motives (SMs), and risky sexual behaviours (RSBs) among 527 randomly selected students (250 males, 277 females) from four universities in Uganda. Results indicated that 78.2% of participants exhibited a strong external LOC, correlating with heightened RSB engagement (65.7%), including unprotected sex (38.3%), multiple partners (26.4%), early sexual debut (12.1%), and homosexual practices (7.8%). While sexual motives were generally moderate (e.g., intimacy, coping), peer approval emerged as notably low (M = 9.08, SD = 4.26). Mediation analysis revealed that SMs – particularly self-affirmation and partner approval – significantly mediated the LOC-RSB relationship (R² = 20%, p < 0.02), suggesting that students with external LOC often engage in RSBs to fulfil psychological needs. These findings align with the Theory of Planned Behaviour (TPB), emphasising how perceived behavioural control and intrinsic motivations shape sexual decision making. The study highlights the need for targeted interventions, including (1) empowerment programmes to cultivate internal LOC and self-efficacy, (2) peer-led education addressing normative beliefs about sex motives, and (3) youth-friendly health services to improve access to contraceptives and counselling. By integrating psychological and social determinants, universities can mitigate RSB risks and promote sexual health
Family Functioning and its Association with Alcohol Use Disorder among Adolescents in Southwestern Uganda: A Cross-Sectional Study
(Adolescence, 2026) Novatus Nyemara; Aloysius Rukundo; Richard Merkel; Elialilia S. Okello
This study investigates the association between family functioning and the severity of alcohol use disorders (AUD) among adolescents in Southwestern Uganda. Focusing on dimensions such as family cohesion, adaptability, communication, and satisfaction, the research explores how familial relationships and sociodemographic factors influence adolescent alcohol use. A cross-sectional study was conducted from September to December 2019 in Ibanda District, involving 308 adolescents aged 10 to 19 years. Participants were selected through multistage sampling, and data were collected using the Alcohol Use Disorders Identification Test (AUDIT) and the Family Adaptability and Cohesion Evaluation Scale IV (FACES IV). Ordered logistic regression was used to assess predictors of AUD severity. The findings revealed that 21.1% of participants were classified as hazardous drinkers, 9.1% as harmful drinkers, and 9.7% as dependent drinkers. Higher levels of family cohesion were associated with increased odds of more severe AUD classification (OR = 1.14, p<0.001), suggesting possible enabling or permissive dynamics in certain family contexts. In contrast, higher levels of adaptability (OR = 0.79, p<0.001) and satisfaction (OR = 0.82, p= 0.003) were protective against severe alcohol use. Additionally, lower household income, non-nuclear living arrangements, and unstable family structures were significantly associated with greater AUD severity. These findings underscore the critical role of family dynamics and socioeconomic conditions in shaping adolescent alcohol use behaviours. The study highlights the need for family-centred and context sensitive interventions that strengthen adaptability and satisfaction within the family unit, while also addressing underlying structural vulnerabilities.
Alcohol Use Disorder in Southwestern and Northern Uganda: Prevalence and associated factors
(PLOS Global Public Health, 2026) Abraham Muhwezi; Tom Murungi; Pius Musinguzi; Davis Akampumuza; Mary Samantha; Moses Ocan; Henry Ochola; Godfrey Zari Rukundo; Samuel Maling; Edith K. Wakida; Celestino Obua
Alcohol use disorder (AUD) among adults is a major public health concern globally. Alcohol use disorder affects livelihood and contributes to adverse health outcomes. We investigated the prevalence of AUD and associated factors among adults (≥ 18years) in Lira and Isingiro districts in Uganda. This was a cross-sectional study conducted among adults (≥18 years) in households, selected using multistage sampling. Data were collected using an interviewer-administered questionnaire and the Alcohol Use Disorder Identification Test (AUDIT) tool. Data were downloaded from the Kobo Toolbox interface into Microsoft Excel and then exported to STATA version 17 for cleaning and analysis. A total AUDIT score of eight or more was used to define AUD. Binary Logistic regression was used to analyze factors independently associated with AUD at a 95% confidence level. A total of 577 participants were recruited in the study, with a median age of 35 years (IQR: 26–46). Half, 50.8% (293/577) of the participants were male. Over a third, 39.9% (230/577) of the participants had AUD. Factors significantly associated with AUD were; being male (aOR = 8.01; 95% CI: 5.02–12.76), age group of 31–50 years (aOR = 2.00; 95% CI: 1.21–3.33), secondary level education (aOR = 0.63; 95% CI: 0.21–0.78), having family members who use alcohol (aOR = 4.09; 95% CI: 2.54–6.59), use of other substances (aOR = 1.79; 95% CI: 1.10–2.92), and presence of major stressors (aOR = 3.58; 95% CI: 2.22–5.78). Alcohol use disorder was highly prevalent among adults in Uganda. Being male, age, use of other substances of abuse, and alcohol use among family members were significantly associated with AUD. The Ministry of Health and other key stakeholders should prioritize AUD, strengthen the regulation of alcohol use in the country, and provide rehabilitation for individuals with AUD.
Integrating ESG Accounting in Higher Education: A Longitudinal Case Study at Mbarara University of Science and Technology, Uganda
(THE UGANDA HIGHER EDUCATION REVIEW, 2025) Charles Tushabomwe-Kazooba; Imelda Kemeza; Robinah Florah Nakakeeto; Prinari Behangana; Winfred Aliguma; Robert Stalone Buwule; Achilles Byabashaija
Despite increasing recognition of environmental, social, and governance (ESG) considerations among Uganda’s government ministries, departments, and agencies (MDAs), public universities in the country still lack a systematic and transparent framework for managing ESG-related issues. This gap weakens institutions’ capacity for sustainability engagement and undermines accountability mechanisms. The study asks: To what extent do national regulations and global standards shape ESG implementation in higher education (HE) institutions? This study employed a longitudinal case study design of Mbarara University of Science and Technology (MUST), a public university in Uganda, to examine financial reports, institutional records, and policy documents covering the 2020/2021 to 2024/2025 financial years (FYs). Five ESG-related themes and their corresponding sub-themes emerged from the analysis and were subsequently examined in greater depth. The study also included insights from 172 students and 18 faculty members, gathered through interviews and a questionnaire. Overall, the findings indicate that ESG accounting at MUST is still in its early stages, marked by weak categorisation and limited institutional integration. The study addresses a critical gap in research on ESG accounting. Aligned with the National Development Plan IV (NDP IV) and Sustainable Development Goal 4, it promotes inclusive and equitable quality education while advocating for ESG issues to be embedded in university governance, strategic planning, management, and accountability frameworks. This study concludes by advancing an ESG accounting framework that operationalises sustainability reporting within the HE sector.
Malaria attributable to one-third of anemia cases among febrile children in Eastern Uganda: A cross-sectional study
(Journal of Hematology and Allied Sciences, 2026) Benson Okongo; Enoch Muwanguzi; Daisy Asiimwe; Robert Wagubi; Elizabeth Alfred John; Clinton Olong
Objectives: The study aims to determine the Prevalence of anemia and its association with malaria infection among febrile children under 15 years at Bududa General Hospital, Eastern Uganda. Material and Methods: A hospital-based cross-sectional study was conducted among 347 febrile children between April and June 2023. Venous blood samples were collected for complete blood count and malaria microscopy. Stool samples were examined for intestinal helminths. A structured questionnaire was used to collect sociodemographic data. Multivariate logistic regression was used to identify factors associated with anemia. A P ≤ 0.05 was considered statistically significant. Results: The overall Prevalence of anemia was 225 (64.8%). The Prevalence of malaria parasitemia was 162 (46.7%), with Plasmodium falciparum as the dominant species (83.3%). Multivariate analysis revealed that malaria infection (adjusted odds ratio [aOR] = 8.24; 95% confidence interval [CI]: 3.63–18.70; P < 0.001), children aged 1–5 years (aOR = 0.24; 95% CI: 0.08–0.72; P = 0.011) and 6–10 years (aOR = 0.19; 95% CI: 0.05–0.66; P = 0.009) and a parent/guardian with secondary education (aOR = 0.40; 95% CI: 0.20–0.82; P = 0.012) were associated with anemia. The Prevalence of intestinal helminths was low (2.9%) and not associated with anemia. Conclusion: This study links a high anemia rate in febrile children to malaria, particularly affecting infants and those with less-educated caregivers, necessitating combined malaria and nutrition interventions.
Association Between Neutrophil-to-Lymphocyte Ratio and Vitamin D Deficiency in Patients With Sickle Cell Disease: A Cross-Sectional Study in Central Uganda
(Cureus, 2026) Enoch Muwanguzi; Jazira Tumusiime; Geofrey Salamu; Charles Nkubi Bagenda; Benson Okongo
Background: Vitamin D deficiency and chronic inflammation are prevalent in individuals with sickle cell disease (SCD), contributing to disease severity. Hematological ratios are simple inflammatory markers that can have various clinical outcomes. The main aim of our study was to assess the association between hematological ratios and vitamin D deficiency among patients with SCD in Central Uganda. Methods: We conducted a cross-sectional study among patients with SCD attending Mengo Hospital, Central Uganda. Data were collected using a researcher-administered questionnaire supplemented with information from participants’ medical records. Anthropometric measurements were taken, and a blood sample was drawn for laboratory measurement of hematological parameters and serum vitamin D levels. Results: Out of the 213 participants, 101 (47.4%) had serum 25-hydroxyvitamin D (25(OH)D) concentrations <20 ng/mL, indicating vitamin D deficiency, while 68 (31.9 %) had levels between 20-30 ng/mL, consistent with vitamin D insufficiency. Participants with vitamin D deficiency had a higher neutrophil-to-lymphocyte ratio (NLR) (0.27, IQR: 0.13-0.88) compared to those without vitamin D deficiency (0.22, IQR: 0.10-0.63), although the difference was not statistically significant (p=0.45). However, after adjusting for potential confounders, both the second (adjusted prevalence ratio (aPR)=1.83; 95% CI: 1.25-2.68; p=0.002) and third tertiles (aPR=1.74; 95% CI: 1.04-2.91; p=0.033) of the neutrophil-to-lymphocyte ratio were significantly associated with increased prevalence of vitamin D deficiency. Conclusions: Vitamin D deficiency is prevalent among patients with SCD in Central Uganda. High NLR is potentially associated with vitamin D deficiency among patients with SCD.