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Characterization of Extended Spectrum Beta-lactamase Uropathogens Isolated from Refugees with Urinary Tract Infections in Nakivale Refugee Settlement Camp, Southwestern Uganda
(International STD Research & Reviews, 2024-11-11) Ayan Ahmed Hussein; Kennedy Kassaza; James Mwesigye; Nalumaga Pauline Petra; Bashir Mwambi; Taseera Kabanda; Joel Bazira
The World Health Organization estimates one in four individuals has had at least one urinary tract infection (UTI) episode requiring treatment with an antimicrobial agent. At Nakivale refugee camp, the overwhelming number of refugees often associated with poor living conditions predispose the refugees to urinary tract infections. This study determined the prevalence of UTIs, the antimicrobial susceptibility pattern of the isolated bacterial pathogens, the prevalence of Extended-Spectrum Beta-Lactamase (ESBL) bacteria, and the molecular characterization of genes encoding ESBLs among refugees in the Nakivale refugee settlement. This was a cross-sectional study that involved 216 outpatients who visited Nakivale Health Centre III between July and September 2020. The urine samples were received and examined at the microbiology laboratory of Mbarara University of Science and Technology. The urine samples were cultured and identified. Antibiotic susceptibility was carried out following CLSI recommended guidelines while the presence of genes encoding ESBL was detected using conventional PCR amplification. The prevalence of UTI was 24.1% (52/216). Staphylococcus aureus was the most prevalent causative agent, accounting for 22/52 (42.31%) of total isolates, followed by Escherichia coli 21/52(40.38%). Multidrug-resistant isolates accounted for 71.15% (37/52). A total of twenty-one isolates (70.0%) were extended spectrum beta-lactamase producing bacteria. The most prevalent genes were TEM beta-lactamase (blaTEM) and CTX-M beta-lactamase (blaCTX-M). The prevalence of UTI among refugees in the Nakivale settlement was high which calls for continuous epidemiological surveys to determine the prevalence of multi-drug resistance uropathogens including ESBL-producing organisms across refugee camps in Uganda.
Primary Healthcare Services and Health-Related Quality of Life of Older Persons with Non- Communicable Diseases: A Narrative Literature Review
(International Journal of Global Health, 2024-08-30) Atim Fiona; Frank Kiyinji; Faustino Orach-Meza; Rose Clarke Nanyonga
In response to the rising burden of non-communicable disease (NDC), the World Health Organization (WHO) developed tools to enable early detection and management of NCDs in Primary Healthcare centers (PHC). Globally, the prevalence of NCDs remains alarmingly high with 41 million deaths annually. Of these, 17 million people die before the age of 70, and 86% of these premature deaths occur in low-and middle-income countries. This narrative review aimed to assess the effect of PHC services on health-related quality of life (HRQoL) of older persons with NCDs, to critically analyze the potential of the existing literature in informing improvements in PHC services. We searched various databases (PubMed, Springer, Scopus, and ScienceDirect) for relevant literature. Peer-reviewed articles on the influence of PHC services on HRQoL among older persons with NCDs written and published in English between January 2013 and May 2024 were considered. The review indicates that effective PHC services are linked to good HRQoL. However, PHC services are sub-optimal and poor in low- and middle-income countries, hence more health interventions are essential to improve PHC services to enhance HRQoL of older persons
Health-Related Quality of Life Perception Among Older Persons with Non-Communicable Diseases in Primary Healthcare Facilities: A Qualitative Inquiry
(International Journal of Global Health, 2024-09-11) Atim Fiona; Ndagire Regina; Chloe Nampima; Frank Kiyinji; Catherine Lwanira; Rose Clarke Nanyonga; Faustino Orach-Meza
Background: The understanding of older persons with non-communicable diseases (NCDs) regarding health well-being is paramount and can translate to increased self-efficiency, independence, and enhanced well-being. However, little is known about older persons' understanding of the concept of health-related quality of life (HRQoL) in Uganda. The study explored perceptions and unveiled understanding of older persons with NCDs on HRQoL in central Uganda. Methods: This exploratory qualitative study design involved 23 participants recruited from selected Primary healthcare facilities in Central Uganda. Thematic analysis using an inductive approach generated themes that informed the study's qualitative findings. Results: The study highlighted the physical domain as a key component of HRQoL, encompassing holistic well-being, lifestyle modification, and financial stability. To promote well-being and support a healthy aging journey, it is essential to adopt a person-centered approach that aligns with the perceptions of older adults on HRQoL
Malnutrition and unsuccessful tuberculosis treatment among people with multi-drug resistant tuberculosis in Uganda: A retrospective analysis
(Elsevier, 2024-12) Samuel Engoru; Francis Bajunirwe; Jonathan Izudi
Rationale: Multi-drug-resistant tuberculosis (MDR-TB) poses a significant public health challenge to the control and successful eradication of TB globally. Suboptimal treatment outcomes are common among persons with MDR-TB necessitating a need to understand the contextual factors. Objective: We determined the factors associated with unsuccessful TB treatment among persons with MDR-TB at a large TB Unit in Central Uganda. Methods: We retrospectively reviewed medical records for all persons with MDR-TB at Mubende Regional Referral Hospital MDR-TB Clinic in Central Uganda. The patients were treated with either second-line, modified second-line, or individualized anti-TB regimens and completed treatment between January 2012 and October 2023. The primary outcome was unsuccessful TB treatment defined as death, treatment failure, or loss to follow- up and measured as a binary outcome. We used a multivariable binary logistic regression analysis to determine the factors independently associated with unsuccessful TB treatment at a 5 % statistical significance level. We reported the adjusted odds ratio (aOR) and the 95 % confidence interval (CI). Measurements and results: We analyzed data from 98 persons with MDR-TB who were aged 15–78 years (mean 36.4 ± 15.4 years). Of these, 40 (40.8 %) were cured, 25 (25.5 %) completed TB treatment, 1 (1.0 %) had treatment failure, 13 (13.3 %) died, and 19 (19.4 %) were lost to follow-up. Overall, 33 (33.7 %) participants had unsuccessful TB treatment which was associated with older age for a 1-year increase in age (aOR 1.05, 95 % CI 1.01–1.09), malnutrition—mid-upper arm circumference of <12.5 cm (aOR 2.99, 95 % CI 1.16–7.98), and previous TB treatment (aOR 0.28, 95 % CI 0.10–0.77). Conclusion: Unsuccessful TB treatment is high among persons with MDR-TB at this TB Unit. It is more likely as age advances and when persons with MDR-TB have malnutrition, but less likely when they have been previously treated for TB. Therefore, interventions to improve treatment outcomes may be beneficial for persons with MDR- TB who are older, malnourished, and those newly diagnosed with the disease. For example, routine nutritional assessment and counseling, including nutritional support for malnourished persons with MDR-TB may be needed to optimize their TB treatment success.
Malnutrition is a risk factor for tuberculosis disease among household contacts: A case-control study in Uganda
(Elsevier, 2024-08) Jonathan Izudi; Samuel Engoru; Francis Bajunirwe
Objective: Household contacts (HHCs) of persons with tuberculosis (TB) including rifampicin-resistant or multi- drug-resistant TB (RR/MDR-TB) are at risk for TB infection. We investigated whether index patient-level clinical and socio-demographic factors of persons with MDR-TB are associated with TB disease among their HHCs in Uganda. Methods: We designed an unmatched case-control study. Cases were HHCs of persons with MDR-TB that had TB disease while controls were a random sample of HHCs of persons with MDR-TB that had no TB disease. The case- to-control ratio was 1:3. We identified the factors that significantly differed between the cases and controls in a multivariable binary logistic regression analysis and reported the odds ratio (OR) and 95% confidence interval (CI). Results: We found similar demographic and clinical characteristics among the 11 cases and 33 controls. In a multivariable analysis, malnutrition was significantly associated with being a case than a control (adjusted OR 5.01; 95% CI 1.18-24.83). Conclusion: Therefore, TB Control Programs should focus on identifying malnutrition among persons with MDR- TB and providing nutritional counseling and support to improve recovery, and potentially reduce household TB transmission and optimize treatment success. Additionally, rapid screening for TB and preventive therapy should be prioritized to reduce transmission
Africa should research the long-term sequelae of mpox.
(The Lancent Global Health., 2024-10) Allan Komakech; Brian Ngongheh Ajong; ∙ Danny Kalala; Nora Efire; Cris Kacita; Emmanuel Hasivirwe Vakaniaki; Jonathan Izudi; Laurens Liesenborghs; Nicaise Ndembii
In July, 2022, WHO declared mpox—a viral zoonotic illness—a public health emergency of international concern, due to the rising number of cases and its spread to many countries outside Africa.1 By May, 2023, reported cases of mpox had reduced in regions outside Africa, leading to the lifting of the emergency declaration. In August, 2023, the WHO Director-called upon state parties to develop national mpox plans that incorporated lessons learned, to strengthen laboratory-based surveillance, to enhance community protection through risk communication, and to comprehensively support research for prevention and control.2 However, mpox remains a critical public health problem in Africa, where it was first identified among humans in 1970, in the Democratic Republic of the Congo (DR Congo).3
Adverse events associated with AstraZeneca COVID-19 vaccine among adults in Greater Kampala, Uganda: a cross-sectional study
(African Health Sciences, 2024-07-11) Allan Komakech; Jonathan Izudi; John Kamulegeya; reda L. Aceng; James Acaye; Edirisa Juniour Nsubuga; Petranilla Nakamya; Daniel Kadobera; Lilian Bulage; Benon Kwesiga; Alex R Ario
Background: Uganda started AstraZeneca COVID-19 vaccination in March 2021 but information about adverse events is lim- ited. We assessed adverse events following AstraZeneca vaccination among adults in Greater Kampala, Uganda. Methods: In this cross-sectional study, we systematically sampled persons who had received ≥1 dose of the AstraZeneca vac- cine and collected data between March and April 2021 through telephone interviews. We defined adverse events as any untoward medical occurrence after vaccination and serious adverse events as any event leading to hospitalization, persistent disability >28 days, death, or congenital anomaly. Results: Of 374 participants aged 20-85 years, the prevalence of adverse events was 76.5%. Common adverse events included injection site redness and hadache; no serious adverse event was reported. Participants aged 20–29 years (Adjusted odds ratio (AOR) 4.58; 95% confidence interval (CI): 1.92–10.95), 30-39 years (AOR 3.69; 95% CI: 1.81–7.51) and 40-49 years (AOR 2.78; 95% CI 1.26–4.90) were more likely to develop adverse events compared to those aged ≥50 years. Conclusion: Adverse events are prevalent, largely among those aged <50 years; serious adverse events are rare. Persons aged <50 years should be targeted for surveillance of adverse events alongside appropriate health education and counselling. Keywords: Adverse events; assessment; COVID-19; Greater Kampala; Uganda
Caring for people with non-communicable diseases: the views and experiences of health and social care professionals in Uganda
(Policy Press, 2024-06-10) Lorna Montgomery; Charlene M. McShane; Olinda Santin; Florence Nakaggwa; Peninah Agaba; Judith Apio; Angela Namwanje Kawooya; Alimah Komuhangi; Christopher Jenkins; Mandi MacDonald; Florence Githinji; Cyprian Misinde; Rose Clarke Nanyonga
Resource-limited health systems in sub-Saharan Africa struggle to provide population-wide high-quality primary healthcare, with particular concerns relating to professional workforce issues and the role of family caregivers. This qualitative study design explores the perceptions of (n = 19) health and social care professionals of the challenges they face in caring for individuals living with non-communicable diseases in Uganda. Identified challenges resulted from staffing and resource limitations, with wider issues relating to poverty and the burden placed on carers. As non-communicable diseases continue to rise, these empirical findings can inform developments in policy and service delivery in low and middle-income country contexts. Keywords: health and social care professionals; family carers; chronic disease; Uganda
Predictors of under-weight among children younger than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan:a community-based cross sectional study
(BMC Public Health, 2024-05-25) Francis Eriga; Godfrey Gulom; John Bosco Alege
Background Underweight is a public health problem globally, and more severe in South Sudan with wide sub- regional differences. In Nimule border town, which represents other border towns in South Sudan, data on under- weight among children below two years is unavailable. Thus, this study set out to assess predictors of underweight among children younger than 24 months in Nimule border town, Magwi County, Eastern Equatoria State, South Sudan. Methods An analytical cross-sectional study was conducted in Nimule boarder town targeting 390 children younger than two years. Systematic sampling and simple random sampling methods were used. Data were collected through a researcher-administered questionnaire with both open and closed ended questions. Data was entered in EpiData and then exported into Statistical Package for Social Sciences research (SPSS) version 20 for analysis. Descriptive data analysis was conducted and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was conducted with the Chi- squared and Fisher’s exact tests for categorical independent variables, and the student’s t-test for numerical vari- ables. Finally, multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%. Results Out of the total 390 participants, 112 (28.7%) were under weight. The study showed primary (aOR, 0.38; 95% CI, 0.12–1.18; P = 0.095) and secondary (aOR, 0.37; 95% CI, 0.12–1.17; P = 0.091 levels of education were associated with under- weight but not tertiary level of education (aOR, 0.76; 95% CI, 0.21–2.74; p = 0.671). Household income of 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10–0.68; P = 0.006) and above 10,000 (aOR, 0.11; 95% CI, 0.04–0.28; P < 0.001) South Sudanese pounds, supplementary feeding before 6 months (aOR; 0.01; 95% CI, 0.02–0.05; P < 0.001) were associated with underweight and irregular hand washing (aOR; 2.17; 95% CI, 1.14–4.11; P = 0.018) was associated with increased odds of underweight. Conclusions This study established a high prevalence of underweight. Maternal level of education particularly primary, secondary, higher household incomes in excess of 5,000 South Sudanese pounds reduced the risk of under- weight. While irregular hand washing was a risk factor for underweight. Keywords Birth, Weight, Low, Children under 24 months, Determinants
Sudan virus disease super-spreading, Uganda, 2022
(BMC Infectious Diseases, 2024-05-23) Allan Komakech; Shannon Whitmer; Jonathan Izudi; Charles Kizito; Mackline Ninsiima; Sherry R. Ahirirwe; Zainah Kabami; Alex R. Ario; Daniel Kadobera; Benon Kwesiga; Samuel Gidudu; Richard Migisha; Issa Makumbi; Daniel Eurien; Joshua Kayiwa; Lilian Bulage; Doreen N. Gonahasa; Irene Kyamwine; Paul E. Okello; Hildah T. Nansikombi; Immaculate Atuhaire; Alice Asio; Sarah Elayeete; Edirisa J. Nsubuga; Veronica Masanja; Stella M. Migamba; Patience Mwine; Petranilla Nakamya; Rose Nampeera; Andrew Kwiringira; Rebecca Akunzirwe; Helen Nelly Naiga; Saudah K. Namubiru; Brian Agaba; Jane Frances Zalwango; Marie Gorreti Zalwango; Patrick King; Brenda Nakafeero Simbwa; Robert Zavuga; Mercy Wendy Wanyana; Thomas Kiggundu; Lawrence Oonyu; Alex Ndyabakira; Mariam Komugisha; Brian Kibwika; Innocent Ssemanda; Yasin Nuwamanya; Adams Kamukama; Dorothy Aanyu; Dominic Kizza; Sophia Mulei; Stephen Balinandi; Luke Nyakarahuka; Jimmy Baluku; Jackson Kyondo; Alex Tumusiime; Dativa Aliddeki; Ben Masiira; Esther Muwanguzi; Ivan Kimuli; Daniel Bulwadda; Herbert Isabirye; Deborah Aujo; Arthur Kasambula; Solome Okware; Emmanuel Ochien; Innocent Komakech; Charles Okot; Mary Choi3; Caitlin M. Cossaboom; Carrie Eggers; John D. Klena; Modupe O. Osinubi; Katrin S. Sadigh; Mary C. Worrell; Amy L. Boore; Trevor Shoemaker; Joel M. Montgomery; Susan N. Nabadda; Michael Mwanga; Allan N. Muruta; Julie R. Harris
Background On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak. Methods In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases. Results Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data. Conclusion Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events.
16S-Metagenomic data profiling of the bacterial community in ready-to-eat vegetable salads sold in Kampala, Uganda
(Elsevier, 2024-03) Abubaker Kawooya; Eilu Emmanuel; Jesca Nakavuma; Sunil Kumar; Hussein Mukasa Kafeero; Ddembe Bashir Mwambi; Rasheed Omotayo Adeyemo; Ismail Abiola Adebayo; Saheed Adekunle Akinola
This article presents a dataset on bacterial community structure associated with Ready-to-eat (RTE) vegetable salads sold in Kampala City, Uganda. The Illumina Miseq sequencing of 16S rRNA gene amplicon unveiled the bacterial communities and generated a metagenomic library from RTE vegetable salads to understand the diversities and distribution. The metagenome contained a total of 23,805 sequences with 35,420 Taxonomic units (OTUs). Metagenome sequence information is obtainable at NCBI under the Bioproject assigned accession number PRJNA1064313. Taxonomic hits distribution from VSEARCH analysis at phylum level classification of NN-3 discovered predominantly Proteobacteria (65.34%) followed by Firmicutes (31.60%) and Bacteroidota (0.14%). Deinococcota (0.01%) and Planctomycetota (0.01%) were also detected. Also, VSEARCH-assisted analysis of NN-4 detected a higher prevalence of Firmicutes (65.68%) than Proteobacteria (33.25%), while Bacteroidota (0.04%) indicating the presence of contaminants of faecal sources.
Prevalence and correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda
(PLOS Global Public Health |, 2024-02) Godfrey Patrick Amodoi; Ivan Mugisha Taremwa; Joan Nakakande; Pardon Akugizibwe; Samuel Mugambe; Miisa Nanyingi
Intimate partner sexual violence (IPSV) during pregnancy is of key reproductive health con- cern as it is associated with various risks linked to severe intrapartum complications. This study assessed the prevalence and the correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda. This was an analytical cross-sectional study conducted among 284 pregnant women who were obtained by sys- tematic sampling in Napak district between November and December 2020. A structured questionnaire was used to collect the data, and this was analyzed using STATA version 15. The correlates of IPSV were determined at a multivariable level using a Poisson regression model with robust variance at the individual, relationship, and societal levels of the socio- ecological model. The study enrolled 284 pregnant women of whom, 65.5% were aged between 18 and 28 years and 62.0% were not formally educated. Also, 56% of the pregnant women had experienced IPSV during their current pregnancies, the most prevalent form (35.6%) being unwanted sexual advances. Factors of women being in their third or subse- quent pregnancies, primiparity, women who rated their communication with their partners as low, being in a relationship for less than five years, lower age of the spouse, and a lower level of education (primary) among women showed a statistical association with IPSV. This study reports a high prevalence of IPSV during pregnancy, and it was associated with indi- vidual, relationship, and societal factors. Based on this, concerted efforts through sensitiza- tion on the dangers of IPSV are required to avert the practice.
Anti-Mycobacterial Activity of Medicinal Plant Extracts Used in the Treatment of Tuberculosis by Traditional Medicine Practitioners in Uganda
(Scientific Research Publishing, 2023-02-10) Mpeirwe, Moses; Taremwa, Ivan Mugisha; Orikiriza, Patrick; Ogwang, Patrick Engeu; Ssesazi, Duncan; Bazira, Joel
Tuberculosis (TB) remains a public health challenge and one of the leading causes of death worldwide. TB is preventable and curable. However, treatment of tuberculosis has continued to be difficult as a result of rapid increase of multi drug and extensively drug resistant strains of Mycobacterium tuberculosis. Medicinal plants have for centuries been traditionally used in treatment of tuberculosis and similar ailments. They possess antimicrobial properties which render them a new hope as a source of novel bioactive leads in the development of antimycobacterial agents. In this study, 2 plant species commonly used traditionally in Uganda for treatment of tuberculosis,Zanthoxylum leprieurii and Rubia cordifolia were screened for in vitro antimycobacterial activity against Mycobacterium tuberculosis strains; pan sensitive MTB H37Rv, Rifampicin resistant TMC 331 strain and two wild strains (onerifampicin resistant and another one rifampicin susceptible). Antimycobacterial activity of aqueous, ethanolic and methanolic plant extracts was determined using Resazurin Microtiter Assay (REMA). Both plant extracts exhibited significant in vitro antimycobacterial activity against all strains of My-cobacterium tuberculosis. Minimum inhibitory concentrations (MIC) of methanolic crude extracts of both plants ranged from 23.4 μg/mL to 187.5 μg/mL. Comparatively, methanol extracts of both plants possessed superior antimy-cobacterial activity against all Mycobacterium tuberculosis strains. Our findings indicated that both plants exhibited activity against susceptible and resistant strains of Mycobacterium tuberculosis. While antimycobacterial activity of Z. leprieurii confirms results from previous studies, activity of the extracts of R. cordifolia is reported for the first time in East Africa. Further studies aimed at determining the effects of combination of these plant extracts and standard anti-TB drugs should be carried out.
Human Papillomavirus Vaccination Uptake and Its Predictors Among Female Adolescents in Gulu Municipality, Northern Uganda
(Dovepress, 2022-09-25) Aruho, Caroline; Mugambe, Samuel; Baluku, Joseph Baruch; Taremwa, Ivan Mugisha
Background: Human papillomavirus (HPV) is the putative case of cervical cancer. However, uptake of HPV vaccination is reportedly low in Uganda. This study explored the predictors of HPV vaccination uptake among female adolescents aged 15–18 years in Gulu Municipality, in northern Uganda. Methods: This was an analytical cross-sectional survey that was conducted among adolescents aged 15–18 years in Gulu Municipality. A structured questionnaire was used. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25. Descriptive statistics and a log binomial model were used to analyze the factors associated with HPV vaccination uptake. Results: Less than a quarter of the female adolescents (22%) aged 15–18 years in Gulu municipality, Gulu district, had been vaccinated with the human papillomavirus vaccine. HPV vaccination uptake was lower by 23% among adolescents who stayed with their mothers only (aPR = 0.769, CI = 0.595–0.995, P = 0.046), and by 14% among adolescents whose parents were unmarried (aPR0.859, CI = 0.776–0.951, P=0.003). Conclusion: This study reports a low HPV vaccination coverage among adolescents in Gulu Municipality, which is associated with parental perceptions and marital status. Efforts to increase uptake should focus on parents of adolescents.
Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda:
(Plos One, 2021-10-19) Izudi, Jonathan; Okoboi, Stephen; Lwevola, Paul; Kadengye, Damazo; Bajunirwe, Francis
Background: Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda. Methods: In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI). Results: Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13–2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32–0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04). Conclusions: Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
Factors Influencing Annual Procurement Planning of Medicines and Medical Supplies in Public Health Facilities in Kampala District
(AFRICAN JOURNALS ONLINE, 2021-09-10) Ajulong, Martha Grace; Okiria, John Charles; Owako, Martin
Background: Despite significant progress made by many countries towards meeting the millennium development goals and now sustainable development goals, there has been little improvement in access to essential medicines in developing countries. Objectives The main aim of this study is to assess the factors influencing annual procurement planning of medicines and medical supplies in the public health facilities in Kampala district. Methods: This study targeted respondents from government Health facilities in Kampala with a total population of 424 employees and applied simple random sampling to select 206 health workers. The researcher adopted mixed research approach with application of descriptive statistics, correlational and explanatory research designs that were used to maximize reliability and validity of findings. While the qualitative data was gathered through reviewing logistics tools, a physical count of the 30% purposively selected stock cards and interview of the staffs was carried out in health facilities in Kampala district, a Statistical Package for Social Science (SPSS) version 20 was used to analyze the quantitative data. Accordingly, a chi-square was used to determine the association between independent and dependent variables. Results: The findings indicated that 37.8% of the staff responded positively about the availability of annual procurement plan while the rest were from various health facilities. A significant association was observed between knowledge and availability of annual Procurement planning (X2 = 34.7; p value =.0001), as well as management support and Annual Procurement Planning (X2 = 9.87; P value = .008). Conclusion: In conclusion, the finding generated from analysis of quantitative and qualitative data revealed that a majority of the factors influencing annual procurement planning had a positive effect on medical supplies in public health facilities in Uganda although the capacity and capability of health workers, quality of logistics management information systems, and management support desires improvement.
Unsuppressed viral load after intensive adherence counselling in rural eastern Uganda;
(BMC Health Services Research, 2021-12-18) Ndikabona, Geoffrey; Alege, John Bosco; Kirirabwa, Nicholas Sebuliba; Kimuli, Derrick
Background:The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV ). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV ). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district. Methods: We reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January – December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established indepen-dently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical signifi-cance level using STATA version 15. Results: We reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The major-ity of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC. Conclusion: Despite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC
Assessing Providers’ Approach to Hypertension Management at a Large, Private Hospital in Kampala, Uganda
(Annals of Global Health, 2020) Green, Aliza S.; Lynch, Hayley M.; Nanyonga, Rose Clarke; Squires, Allison P.; Gadikota-Klumpers, Darinka D.; Schwartz, Jeremy I.; Heller, David J
Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains suboptimal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers’ approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings – despite the fact that the private sector provides a substantial and growing portion of health care in Uganda. Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers’ approaches to management in the outpatient setting. Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study’s findings. Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as key challenges to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers. Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.
Prevalence of Anemia and Its Associated Socio-Demographic Factors Among Pregnant Women Attending an Antenatal Care Clinic at Kisugu Health Center IV, Makindye Division, Kampala, Uganda
(Dovepress, 2020) Mahamoud, Naimo Khalif; Mwambi, Bashir; Oyet, Caesar; Segujja, Farouk; Webbo, Fred; Okiria, John Charles; Taremwa, Ivan Mugisha
Aims/Objectives: This study sought to determine the prevalence, morphological character- ization and associated socio-demographic factors of anemia among pregnant women attend- ing Kisugu Health Centre IV, Makindye Division, Kampala, in Uganda. Methods: This was a cross-sectional study that employed laboratory analysis of blood samples to determine hemoglobin concentration, and a structured questionnaire to obtain socio-demographic factors associated with anemia during pregnancy. Results: We enrolled 345 pregnant women aged 15 to 43 years. The median, interquartile range, and mean Hb levels were 8.1g/dL, 6.4 ± 2.1g/dL and 7.9g/dL, respectively. There were 89 participants whose Hb levels were indicative of anemia, giving anemia prevalence of 25.8% (95% confidence interval: 21.6–29.8). Of these, 25 (28.1%) had mild anemia, 46 (51.7%) had moderate anemia, while 18 (20.2%) had severe anemia. Thin blood film examination showed normocytic-hypochromic (75.3%), then microcytic-hypochromic (21.6%), and macrocytic- hypochromic red blood cells (3.4%). The socio-demographic factors of gestational age, parity, and mother’s occupation were significantly associated with the risk of anemia (p< 0.05). Conclusion: We report a high prevalence of anemia among pregnant women; with a majority of hypochromic-microcytic anemia. This may necessitate more anemia awareness and it requires institution of nutritional interventions to avert fetal-maternal complications
Socio-Demographics and Late Antenatal Care Seeking Behavior: A Cross Sectional Study among Pregnant Women at Kyenjojo General Hospital, Western Uganda
(Scientific Research Publishing, 2020-01-17) Komuhangi, Grace
Background: Late antenatal care attendance among pregnant women at health facilities remains a significant public health problem. Globally, approximately 830 women die every day due to pregnancy-related complications and 99% of these deaths occur in developing countries whereby 86% of pregnant women access Antenatal Care (ANC) services at least once. Objective: The general objective of the study was to determine factors associated with late antenatal care seeking behavior among pregnant women at Kyenjojo general hospital. Methods: This was a descriptive cross sectional study design that considered quantitative data collection methods among pregnant women attending ANC. The sample size was determined using Kish and Leslie (1969) formula using a proportion of 37% (0.37) of women who sought late ANC. A systematic sampling technique was used to sample pregnant women on daily basis. Results: A total of 283 women participated in the study. Spouse’s occupation was significantly associated with late ANC attendance (p = 0.026). On the other hand, education level of respondent (Fisher’s = 8.363, p = 0.028*), religion (Fisher’s = 5.77, p = 0.048*) and parity (Fisher’s 10.312, p = 0.026*) revealed statistically significant association with late ANC attendance. In multivariate logistic regression, on occupation, women with unemployed spouses were significantly associated with 25% increase in attendance of late ANC compared to those in formal employment (AOR = 0.25, CI: 0.073 - 0.855, p = 0.027*). Conclusion: The Majority of pregnant women sought ANC at 90.1% (n = 255). There’s a need for government to strengthen health promotion targeting women in rural communities.

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