Journal Articles (Medical School)

Permanent URI for this collectionhttp://hdl.handle.net/20.500.12280/257

Browse

Now showing 1 - 20 of 146

Antimicrobial resistance profiles and detection of mecA, blaCTX-M-1, and blaSHV genes in bacteria among diabetic foot ulcer patients from selected referral hospitals in Uganda
(Springer Nature Link, 2025-11-04) Namatovu, Alice; Vahwere, Mumbere Beinfait; Ntulume, Ibrahim; Ssebuufu, Robinson; Nalubega, Rebecca; Pius, Theophilus; Sikakulya, K Franck; Agaba, Gidio; Seremba, Emmanuel; Kyamanywa, Patrick; Nasinyama, George William
Effective management of Diabetic foot ulcers (DFU) requires timely treatment of infections with appropriate antibiotics based on culture and susceptibility results. However, challenges in diagnostic testing persist and consequently, data on prevalent bacteria, their antimicrobial resistance profiles and genes remains scanty. This study profiled the prevalent bacteria in Diabetic foot infection (DFI), their antimicrobial susceptibility patterns, and associated resistance genes. A multi-center cross sectional study was conducted from November 2021-January 2022, involving 117 patients with DFU, attending selected referral hospitals (Kiruddu, Jinja, Kampala International Teaching Hospital, Kitagata, Mbarara, Fort Portal and Hoima). Wound swabs were aseptically collected and placed in Stuart transport medium, then pre-enriched prior to inoculation onto Blood, MacConkey and Chocolate Agar to isolate aerobic microorganisms. Bacteria identification was based on colony morphology, Gram stain, conventional biochemical tests and Antibiotic susceptibility testing using Kirby-Bauer disk diffusion method were performed. Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) were identified phenotypically. mecA gene in selected MRSA, and blaCTX-M-1 and blaSHV-1 in ESBL-PE were detected using Uniplex PCR and electrophoresed using 1.5% agarose gel. Data was analyzed using MS Excel version 15 and Stata version 15 (Stata Corp®). Microbiologically confirmed infection was observed in 89.7% (105/117) of DFU cases, yielding 144 bacterial isolates. Poly-microbial infections were detected in 23.8% of patients. Gram-positive bacteria accounted for 55.6% (80/144) of isolates. Staphylococcus aureus (36.1% (52/144)) and Proteus spp (13.9% (20/144)) were the most prevalent Gram-positive and Gram-negative bacteria, respectively. Notably, 98.6% (142/144) of the isolates were multidrug resistant organisms (MDR). Staphylococcus aureus sensitivity was highest for Gentamycin and Ciprofloxacin (48% each) and lowest for Cefoxitin (2%). Proteus spp sensitivity was highest for Imipenem (87%) and lowest for Tetracycline, Ampicillin and Amoxiclav (0%). mecA gene was identified in 56% (5/9) of MRSA. Among the selected MDR Gram negative isolates, 60% had blaCTX-M-1, 20% had blaSHV and both blaCTX-M-1 and blaSHV in one Klebsiella pneumoniae. The high prevalence of MDR bacteria in DFI underscores the need for culture and sensitivity testing guided treatment. Detection of resistance genes calls for sustained surveillance efforts, stringent infection prevention and control, and alternative therapy exploration.
Prevalence of vitamin D deficiency and its association with adverse obstetric outcomes among pregnant women in Uganda: a cross- sectional study
(PubMed Central, 2025-01-09) Reverzani, Cristina; Zaake, Daniel; Nansubuga, Faridah; Ssempewo, Herman; Manirakiza, Leonard; Kayiira, Anthony; Tumwine, Gilbert
The study was conducted on 351 pregnant women aged ≥18 years who consented to participate in the study, who had a single intrauterine pregnancy and a gestational age greater than 26 weeks, and who delivered at St. Francis Hospital, Nsambya. We excluded pregnant women admitted to the hospital longer than 1 week before delivery; pregnant women with self-reported pre-existing kidney diseases, liver diseases, or gut or malabsorption disorders and pregnant women with severe pregnancy-unrelated comorbidities requiring intensive care unit admission before delivery. Maternal venous blood was collected at admission, and serum 25-hydroxy-vitamin D (25(OH)D) was measured by an electrochemiluminescence binding assay. Maternal sociodemographic characteristics and obstetric-medical factors, and adverse maternal and foetal outcomes were captured by using a data collection form. The data were analysed by logistic regression analysis at the univariate, bivariate and multivariate levels. The prevalence of vitamin D deficiency, defined as a serum 25(OH)D concentration less than 20 ng/mL, was 40.2%. This was seen more among the Muslims (OR 2.4, 95% CI 1.33 to 4.43, p value 0.004), members of the Banyankore tribe (OR 2.1, 95% CI 1.02 to 4.36, p value 0.043) and primigravidae (OR 0.6 for women with parity of 1–4 compared with primigravidity, 95% CI 0.36 to 0.94, p value 0.028). Among adverse maternal outcomes, vitamin D deficiency was associated with hypertensive disorders in pregnancy (OR 2.4, 95% CI 1.16 to 4.10, p value <0.001), in particular gestational hypertension (OR 2.2, 95% CI 1.21 to 4.94, p value 0.014), and pre-eclampsia/eclampsia/haemolysis, elevated liver enzymes and low platelets syndrome (OR 2.9, 95% CI 1.45 to 6.08, p value 0.003), with increased preterm birth (OR of 4.0, 95% CI 1.78 to 10.84, p value<0.001) and with delivery of babies with low birth weight (OR 4.2, 95% CI 2.63 to 13.62, p value 0.001). The study found a high prevalence (40.2%) of vitamin D deficiency among pregnant women delivering at St. Francis Hospital, Nsambya. Additionally, vitamin D deficiency was linked with adverse maternal and foetal outcomes such as hypertensive disorders in pregnancy, preterm birth and low birth weight.
Translation and cultural adaptation of the FertiQoL questionnaire into Luganda: a comprehensive report
(African Journals Online (AJOL), 2025-06-23) Makumbi, Douglas; Kayiira, Anthony; Tumwine, Gilbert; Byaruhanga, N Romano; Zaake, Daniel
The FertiQoL questionnaire is globally recognized to assess quality of life (QoL) among infertile individuals. To make this tool accessible to Luganda-speaking populations in Uganda, it was necessary to translate the questionnaire into Luganda, ensuring cultural relevance and linguistic accuracy. The translation process followed a rigorous forward-backward translation methodology. Two separate translations were performed by native Luganda speakers. The unified version was translated back into English to find discrepancies. Experts validated the translated questionnaire, showing high agreement on most items, confirming its cultural and linguistic suitability. The translated questionnaire was pilot tested on 20 infertile patients at St. Francis Nsambya Hospital to assess the clarity and comprehensibility. The pilot study indicated that most items were understood, with no significant difficulties reported. However, four items required minor modifications. The Luganda FertiQoL questionnaire effectively measures the quality of life in individuals experiencing infertility in Uganda. Le questionnaire FertiQoL est mondialement reconnu pour évaluer la qualité de vie (QdV) des personnes infertiles. Afin de rendre cet outil accessible aux populations lugandaphones en Ouganda, il a été nécessaire de le traduire en luganda, garantissant ainsi sa pertinence culturelle et sa précision linguistique. Le processus de traduction a suivi une méthodologie rigoureuse de traduction aller-retour. Deux traductions distinctes ont été réalisées par des locuteurs natifs du luganda. La version unifiée a été retraduite en anglais afin d'identifier les divergences. Des experts ont validé le questionnaire traduit, montrant une forte concordance sur la plupart des items, confirmant ainsi sa pertinence culturelle et linguistique. Le questionnaire traduit a été testé auprès de 20 patients infertiles à l'hôpital St. Francis Nsambya afin d'évaluer sa clarté et sa compréhensibilité. L'étude pilote a montré que la plupart des items étaient compris, sans difficulté majeure signalée. Cependant, quatre items ont nécessité des modifications mineures. Le questionnaire FertiQoL en luganda mesure efficacement la qualité de vie des personnes souffrant d'infertilité en Ouganda.
Congenital bilateral perisylvian syndrome: a rare case
(Science Direct, Elsevier Ltd., 2025-02) Namata, Tushabe Tracy; Tumusiime, Crescent Max; Nabaweesi, Josephine; Sebunya, Robert
Bridging the gaps in the setup of a functional epilepsy monitoring unit in Uganda to support epilepsy surgery
(Neurosurgical Focus, 2025) Wegoye, Emmanuel; Bieber, David; Khisa, Shadrack; Moskalyk, Khrystyna; Mutonyi, Brenda; Nantongo, Betty; Idro, Richard; Vicenteno, Mariana; Padilla, Erik; Abdelmageed, Sunny; Garcia, M Roxanna; Sebunya, Robert; Okechi, Humphrey; Widjaja, Elysa; Lam, Sandi
As many as 80 million people in the world have epilepsy. Those living in the developing world are disproportionately affected. Approximately 770,000 people in Uganda are affected by epilepsy. Drug-resistant epilepsy affects approximately 30%–40% of patients with epilepsy, and one-third of these patients may be eligible for surgical management. This article describes the formation of an epilepsy monitoring unit in Uganda as the first step toward establishing a surgical epilepsy program for pediatric patients. A hybrid remote and in-person collaborative model was developed between teams in Mbale and Kampala in Uganda and Chicago in the US. The authors describe a process that spanned 2 years (2021–2023) for developing readiness for referrals for pediatric epilepsy surgery candidates in Uganda.
Prevalence and factors associated with drug-resistant epilepsy among children attending the pediatric neurology clinic at an urban tertiary hospital in Uganda
(East African Journal of Neurological Sciences, 2025-10-12) Kyosiimire, Florence; Namata, T Tracy; Nyangabyaki, Catherine; Sebunya, Robert
Epilepsy is among the most prevalent and serious neurological diseases. Anti-seizure medications are still the mainstay of management in most epilepsies. Globally, 10-40% of patients are estimated to have drug resistant epilepsy (DRE). However, there is limited data regarding DRE among children in low resource settings. Objective: This study aimed at determining the prevalence and factors associated with DRE among children with epilepsy in a large pediatric neurology clinic in Uganda. Methods: A cross-sectional study was performed between April and June 2023. Children aged 1 to 17 years with epilepsy, who had been on antiseizure medication (ASM) for at least 12 months, were recruited. Results: The prevalence of DRE was 12.2% (34/278); (95% CI: 8.6 – 16.7%). Factors associated with DRE included; multiple seizure episodes [APR=6.5, 95% CI: 3.3-17.4, P<0.0001], multiple seizure types [APR=4.4, 95% CI: 3.0-9.4, P<0.0001], diagnosis of an epilepsy syndrome [APR=3.6, 95% CI: 2.5-8.3, P=0.026], prior history of status epilepticus [APR=3.6, 95% CI: 2.7-6.1, P=0.001], focal seizure type [APR=2.3, 95% CI: 1.3-4.2, P=0.002], and symptomatic epilepsy [APR=2.1, 95% CI: 1.4-3.8, P=0.041]. Conclusion: The 12.2% prevalence of DRE estimated in this study is still high. Lower-level clinicians should be on higher alert for children with high risk factors for DRE like; multiple frequent seizures types, likely developmental and epileptic encephalopathies (DEE) and symptomatic epilepsy for timely referral to tertiary epilepsy specialized care. The study further underscores the need to make epilepsy syndromes part of routine epilepsy care.
Management of cerebral palsy in low- and middle-income countries
(Science Direct, Elsevier, 2025-10-09) Kija, Edward; Namata, Tushabe Tracy; Sebunya, Robert
Cerebral Palsy (CP) is the most common cause of childhood disability globally with a higher prevalence in low and middle-income countries (LMIC). Hypoxic-ischemic encephalopathy (HIE) caused by preventable perinatal insults is still the leading cause of CP in LMIC. Spastic quadriplegic CP is the most common subtype in LMIC accounting for 70-80 % of cases. Lack of awareness compounded by stigma delays initiation of intervention leading to a poorer outcome and reduced quality of. The comprehensive management of children with CP requires an interdisciplinary team of experts. Such expertise is often lacking in LMIC. When available, its distribution is largely skewed towards urban areas. Although there is a higher burden of comorbidities, screening and diagnosis of the related conditions are inadequate, leading to poor management. Surgical interventions such as intrathecal baclofen, selective dorsal rhizotomy for spasticity and gastrostomy tube insertion for children with severe gastroesophageal reflux disease is often limited by costs and shortage number of trained personnel. Evidence-based local guidelines are essential for managing children with CP, guiding government investments to improve the quality of life for entire families. Concerted efforts in healthcare system reforms, policymakers, community engagement and awareness to enhance early diagnosis and appropriate referral, management through locally generated evidence-based interventions are required in LMIC to improve care among of children with CP and their families.
Neurodevelopmental delay and associated factors among preterm infants aged 6 to 24 months adjusted gestation age in two urban hospitals in Uganda
(PLOS, Global Public Health, 2025-05-29) Nalwoga, Joyce; Nakibuuka, Victoria; Manirakiza, Leonard; Namata, Tushabe Tracy; Sebunya, Robert
Neurodevelopmental delay has been reported among preterm infants who survive beyond the neonatal period. However, there is paucity of data regarding neurodevelopmental outcomes in preterm infants in Africa, including Uganda. This study aimed to determine the prevalence and factors associated with neurodevelopment delay (NDD) in preterm infants aged 6–24 months of adjusted gestation age. A cross-sectional study was conducted among 206 preterm infants, aged between 6 and 24 months of adjusted gestation age in the preterm follow up clinics at St. Francis Hospital Nsambya and Mulago Specialized Women and Neonatal Hospital in Kampala-Uganda from 25th January 2021–25th January 2022. The prevalence of NDD was 13.6% (28/206), with social delay comprising 12.1% (25/206), fine motor delay 11.7% (24/206), language delay 10.7% (22/206) and gross motor delay 7.8% (16/206). Significant factors associated with NDD included microcephaly [aPR = 6.2, CI: 2.6-33.5, P < 0.001], severe acute malnutrition (SAM) [aPR = 4.6, CI: 1.87-12.56, P = 0.021], incomplete immunization [aPR = 2.8, CI: 1.23-4.76, P = 0.013], neonatal sepsis [aPR = 3.8, CI: 1.1-9.3, P = 0.026], neonatal hypoglycemia [aPR = 6.2, CI: 1.8 16.4, P = 0.002], lack of caretaker social support [aPR = 8.3, CI: 2.43-37.9, P = 0.002] and large family size (≥5 children) [aPR = 6.8, CI: 2.24-22.7, P = 0.002]. NDD affects 13.6% of preterm infants, with the social and fine motor delays being most prevalent. Modifiable factors like malnutrition, lack of caretaker social support and incomplete immunization should be screened and addressed to reduce NDD among preterm infants in Uganda.
Classifying a distinct form of diabetes in lean individuals with a history of undernutrition: an international consensus statement
(The Lancet Group, 2025-10) Wadivkar, Pradnyashree; Jebasingh, Felix; Thomas, Nihal; Yajnik, S Chittaranjan; Vaag, Arthur Allan; Kibirige, Davis; Bahendeka, Silver; Bajaj, Mandeep; Boyne, S Michael; Bavuma, Charlotte; Abodo, Jacko; Wild, Sarah; Kolthur-Seetharam, Ullas; Mukhopadhyay, Satinath; Somasundaram, P Noel; Schwarz, Peter; Christensen, L Dirk; Pathan, Faruque; Jones, G Angus; Mathur, Sandeep; Kehlenbrink, Sylvia; Hawkins, Meredith; on behalf of the Vellore Declaration Signatories
Since 1955, a form of diabetes in lean, young (BMI < 18·5 kg/m2, age < 30 years) individuals with a history suggestive of undernutrition from before birth and throughout childhood has been described in the literature. In 1985, WHO formally classified it as malnutrition-related diabetes, but subsequently removed the classification in 1999 over a disagreement as to whether undernutrition was a sufficient risk factor to cause this type of diabetes. Emerging evidence now strongly supports the distinct classification of this unique diabetes phenotype, which is characterised by substantial impairment of pancreatic insulin secretion, with normal hepatic and peripheral insulin sensitivity, an absence of ketoacidosis, and no islet cell autoantibodies. In this consensus statement, we synthesise this evidence to produce a set of common features of the disease, proposed pathogenetic mechanisms, and suggested management and prevention strategies. During a consensus meeting in Vellore, India, in January, 2025, type 5 diabetes was proposed as the nomenclature for this distinct form of diabetes, subsequently formalised at the International Diabetes Federation (IDF) World Diabetes Congress in April, 2025. We call upon the international diabetes community to recognise this distinct form of the disease, and to support the IDF's Type 5 Diabetes Working Group and its goals to promote more research into its phenotype, pathophysiology, and treatment, which will benefit millions of patients worldwide, particularly in low-income and middle-income countries.
Prevalence and correlates of diagnosed and undiagnosed diabetes mellitus among adults in rural Uganda during the COVID-19 pandemic: an evaluation of a community-based screening programme
(Oxford Academic, 2025-05-02) Sseguya, Wenceslaus; Bahendeka, Silver; Mody, Nimesh; MacLennan, Sara; Guntupalli, M Aravinda
One in two people with diabetes in sub-Saharan Africa remains undiagnosed, which has contributed to the region's high rates of diabetes-related morbidity and mortality. While the COVID-19 pandemic likely exacerbated diabetes prevalence, limited data from the region, including Uganda, hampers our understanding of this impact. To address this gap, we analysed the diabetes prevalence and correlates among adults from three rural districts of Uganda using data from a community-based screening programme conducted by community health workers (CHWs) during the pandemic. We used anonymised data of 2587 records to analyse the prevalence and correlates of diagnosed and undiagnosed diabetes. Prevalence was presented as proportions with 95% CIs. Correlates of diabetes and undiagnosed diabetes prevalence were analysed using logistic regression and presented as ORs. The overall prevalence of diabetes was 11.3% (95% CI 10.2 to 12.5%), with a 7.2% (95% CI 6.2 to 8.1%) prevalence for diagnosed diabetes. A high proportion (36.4%) of diabetes cases were undiagnosed. Older age, high body mass index and pre-existing hypertension were associated with high diabetes prevalence. There was a high proportion of undiagnosed diabetes among rural adults during the pandemic. Engaging CHWs in routine diabetes screening and awareness programmes can reduce the burden of undiagnosed diabetes.
Impact of the COVID-19 pandemic on quality of life of adults with diabetes in rural Uganda: a cross-sectional survey
(Oxford Academic, 2025-10-07) Sseguya, Wenceslaus; Bahendeka, Silver; MacLennan, Sara; Guntupalli, Meera Aravinda
The coronavirus disease 2019 (COVID-19) pandemic was associated with unprecedented healthcare, economic and social disruptions that impacted persons with diabetes mellitus (PWDM). We aimed to establish how the quality of life (QoL) of persons with diabetes in rural Uganda was impacted by the COVID-19 pandemic, using the pre-pandemic, pandemic and post-pandemic self-reported QoL scores. We surveyed 410 PWDM ≥30 y of age from three rural districts in south-western Uganda. Median QoL scores were computed and variations across the three time periods were analysed using the Friedman analysis of variance and McNemar tests as appropriate. Logistic regression was used to identify factors associated with QoL. A p-value <0.05 indicated statistical significance. The overall median QoL scores were 67.2 (pre-pandemic), 62.4 (pandemic) and 68.8 (post-pandemic) (p<0.001). There was a 75% increase in the proportion of participants with unsatisfactory QoL during the pandemic (p<0.001). Having diabetes complications (p<0.001), chronic comorbidity (p=0.012), no formal education (p<0.003) and travelling for healthcare using non-motorised transport (<0.001) were all independently associated with post-pandemic unsatisfactory QoL. The COVID-19 pandemic caused significant deterioration in QoL among rural PWDM, raising the need for policies to prioritise the consideration of their evolving needs while designing measures for future similar widespread emergencies.
Gastric antral perforation with a fish bone, laparoscopic surgical intervention in a sub-saharan setting: a case series
(Annals of Case Reports and Medical Images, 2025-09-29) Basimbe, Francis; Musolo, Allan; Kakooza, Francis; Hakim, Din Iman; Tumusiime, Cresent; Najjuka, Geraldine
Foreign body ingestion is a common occurrence in clinical practice experienced in many parts of the world, especially among the pediatric population. However, their occurrence in an adult population is rare. Most foreign bodies in adults pass through the gastrointestinal tract without complications. Less than 1% cause perforation of the gastrointestinal tract and results in many complications including peritonitis, abscesses. Some foreign bodies have been known to result in perforations of different parts of the gastrointestinal tract. Yet many of these foreign bodies have been seen to pass throughout the gastrointestinal tract without causing obstruction or perforation. We highlight two cases of gastric antral perforations with abscess complications seen and managed in our setting with laparoscopic surgery approach with excellent outcomes in both these cases, we did Initially a diagnostic laparoscopy, this revealed a walled off abscess, an antral perforation and a sharp fish bone foreign bodies that were identified and retrieved from the anterior antral perforations. Lavage and antral perforation repair with omentopexy were done for both these patients. These are unusual cases of gastric antrum fishbone perforations with abscess formation seen in our setting and form the first set of documented cases managed laparoscopically with drainage of the abscess’s antral perforation repair and omentopexy with excellent outcomes. .
Non-autoimmune, insulin-deficient diabetes in children and young adults in Africa: evidence from the Young-Onset Diabetes in sub-Saharan Africa (YODA) cross-sectional study
(Elsevier Ltd., 2025-07-21) Katte, Claude Jean; Squires, Steven; Dehayem, Y Mesmin; Balungi, A Priscilla; Padoa, J Carolyn; Sengupta, Dhriti; Fatumo, Segun; Piloya, Thereza; Nyangabyaki-Twesigye, Catherine; Bahendeka, Silver; Majaliwa, Edna; Muze, C Kandi; Ramaiya, Kaushik; Sap, Suzanne; Motala, A Ayesha; Pirie, J Fraser; Rheeder, Paul; Van Dyk, C Jacobus; Mbanya, Claude Jean; Shields, M Beverley; Shah, S Amy; Pihoker, Catherine; Divers, Jasmin; Patel, A Kashyap; Oram, A Richard; Dabelea, Dana; Hattersley, T Andrew; McDonald, J Timothy; Crowther, J Nigel; Nyirenda, J Moffat; Sobngwi, Eugene; Jones, G Angus
Studies of type 1 diabetes in sub-Saharan Africa have suggested that the clinical phenotype might differ from phenotypes reported elsewhere. We aimed to establish whether type 1 diabetes diagnosed in children and young adults in three countries across sub-Saharan Africa is of autoimmune origin. In this observational, cross-sectional study, we identified participants without obesity from outpatient clinics in government and private hospitals in Cameroon, Uganda, and South Africa who were of self-reported Black African ethnicity with young-onset (age <30 years), insulin-treated, clinically diagnosed type 1 diabetes. We measured islet autoantibodies to GADA, IA-2A, and ZnT8A, and calculated a genetic risk score (GRS) for type 1 diabetes, which we compared with control populations without diabetes derived from the Uganda Genome Resource databank and other studies. Endogenous insulin secretion was assessed using plasma C-peptide. We compared findings with those for participants with self-reported Black (n=429) and White (n=2602) ancestry with type 1 diabetes from the SEARCH for Diabetes in Youth (SEARCH) study in the USA. Of 1072 participants identified between Aug 28, 2019, and March 31, 2022 (Cameroon and Uganda), and Oct 3, 2007, to Sept 14, 2015 (South Africa), 894 were included in our analysis (454 [50·8%] were male and 440 [49·2%] were female): 248 participants were from Cameroon, 370 from Uganda, and 276 from South Africa. Participants from sub-Saharan Africa were diagnosed with diabetes at a median age of 15 years (IQR 11–19), with a median diabetes duration of 5 years (2–10), and a BMI of 21·7 kg/m² (19·5–24·1). Only 312 (34·9%) of 894 participants were positive for islet autoantibodies; these participants had classic features of type 1 diabetes, including 225 (82·7%) of 272 with plasma C-peptide <200 pmol/L, and high type 1 diabetes GRS. Those without islet autoantibodies (582 [65·1%] of 894) had significantly lower median type 1 diabetes GRS than those with autoantibodies (9·66 [IQR 7·77–11·33] vs 11·76 [10·49–12·91]; p<0·0001), suggesting a subgroup with a non-autoimmune diabetes subtype, with clinical features and C-peptide concentrations not consistent with type 2 diabetes. Among participants diagnosed younger than 20 years, autoantibody-negative diabetes was also observed in 65 (15·1%) of 429 participants with Black ancestry in SEARCH (although less frequently than in sub-Saharan Africa [59 (55·1%) of 107]), and these participants also had a low type 1 diabetes GRS (median 10·41 [IQR 8·65–12·22] in autoantibody-negative subgroup). No such pattern was observed in White participants in SEARCH: 241 (9·3%) of 2602 were autoantibody negative and median GRS for type 1 diabetes was similar in autoantibody-negative and autoantibody-positive participants (median 13·42 [IQR 11·80–14·61] vs 13·49 [12·29–14·58]). In sub-Saharan Africa, clinically diagnosed type 1 diabetes is heterogeneous, comprising classic autoimmune type 1 diabetes and a novel, non-autoimmune, insulin-deficient diabetes subtype. There is evidence of this subtype in Black but not White individuals in the USA. Therefore, alternative causes must be considered in this group of individuals, and understanding the drivers of this subtype might offer new insights into prevention and treatment.
Changes in the prevalence of the common risk factors for non-communicable diseases in Uganda between 2014 and 2023: informed by nationally representative cross-sectional surveys
(PLOS, 2025-04-08) Kusolo, Ronald; Mutungi, N Gerald; Mbuliro, Mary; Kajjura, Richard; Wesonga, Ronald; Bahendeka, K Silver; Guwatudde, Davis
Non-communicable diseases (NCDs) remain the biggest contributor to global mortality. An important way to control NCDs is to focus on reducing the revalence of the common NCD risk factors for better NCD prevention planning. Uganda conducted its first nationally representative NCD risk factor survey in 2014, and a second in 2023. We analyzed the prevalence of the common NCD risk factors to assess changes in these between 2014 and 2023. Both surveys drew countrywide samples, and the World Health Organization’s STEPS tool was used to collect the data. We calculated weighted prevalence of the following NCD risk factors: high blood pressure, high blood glucose, overweight and obesity, current alcohol consumption, current tobacco use, inadequate consumption of fruits and vegetables, inadequate physical activity, and sedentariness. The 2014 survey enrolled 3987 participants, whereas the 2023 survey enrolled 3694. The risk factor prevalences that increased significantly were: high blood glucose from 1.5% in 2014 to 3.3% in 2023 (p< 0.001); overweight and obesity from 19.3% in 2014 to 24.1% in 2023 (p< 0.001); current alcohol consumption from 28.5% in 2014 to 31.1% in 2023 (p=0.013); and sedentariness from 26.6% in 2014 to 31.9% in 2023 (p< 0.001). The risk factor prevalences that decreased significantly were: inadequate physical activity from 5.0% in 2014 to 3.6% in 2023 (p=0.003), and current smoke tobacco use from 9.6% in 2014, to 8.3% in 2023 (p= 0.046). No significant changes were observed in the prevalence of high blood pressure from 24.6% in 2014 to 25.4% in 2023 (p= 0.418), and inadequate consumption of fruits and vegetables from 87.8% in 2014 to 86.4% in 2023 (p=0.067). There is an urgent need for various stakeholders in Uganda to implement interventions targeting reduction in the prevalence of NCD risk factors to prevent the increasing burden of NCDs and associated mortality.
Human epidermal growth factor receptor 2 expression and socio-demographic, clinical, and histopathological characteristics in gastric carcinoma at St Francis Hospital Nsambya, Uganda
(PubMed Central, 2025-09-26) Wanda, Steven; Nassali, Gorretti; Bbosa, Brian; Basimbe, Francis; Akulu, Joviah; Nsamba, Davis; Nimusiima, Praise; Muhumuza, Joshua; Othieno, Emmanuel; Okuku, Dancan Maxwel
Gastric carcinoma is a significant global health burden with diverse clinicopathological features and molecular alterations influencing prognosis and treatment. Human epidermal growth factor receptor 2 (HER2) overexpression is a critical biomarker in gastric carcinoma, guiding targeted therapeutic interventions. This study aimed to assess HER2 expression and its association with clinicopathological characteristics of gastric carcinoma. A retrospective cross-sectional study was conducted using consecutive sampling to retrieve gastric carcinoma tissue blocks that met the inclusion criteria. A total of 136 formalin-fixed, paraffin-embedded tissue blocks from patients aged 18 years and above (2013–2023) at St. Francis Hospital Nsambya were analyzed. HER2 expression was evaluated using immunohistochemistry (IHC) with a standardized test kit. Associations between HER2 expression and demographic and histopathological characteristics were analyzed. Among 136 patients, the mean age was 59.63 years, with 48.53% aged 48–67 years. Most were male (63.24%) and from the Central region (60.70%). The intestinal subtype was the most common (78.68%), with 52.21% of tumors poorly differentiated, and tumors predominantly located in the antrum (32.35%), cardia (30.15%), and body (24.26%). Regarding HER2 expression, 11.76% were positive (3+), 2.21% equivocal (2+), and 86.03% negative (0 or 1+). HER2 positivity was significantly associated with residence in the Western region (aPR = 3.67; 95% CI: 1.33–10.11; p = 0.02) and with mixed-type tumors (aPR = 3.00; 95% CI: 1.70–5.30; p < 0.001). HER2 overexpression in gastric carcinoma was low. Nevertheless, the findings underscore the importance of routine HER2 testing and access to targeted therapy. Observed associations point to potential high-risk groups warranting further investigation in larger, multicenter studies.
Postgraduate surgical hernia training with a standardized hernia surgery training tool: training while serving humanity
(PubMed Central, 2025-10-28) Basimbe, Francis; Mubezi, Isaac; Kakande, Ignatius; Oppong, Chris; Akoh, Jacob; Tatumwa, Desmond Benjamin
The hernia surgery skills training course was first organized in 2016, after approval by the COSECSA (College of Surgeons of East, Central and Southern Africa) Executive at a meeting in Geneva, through representation by Prof. Laston Chikoya, then Chairman of the COSECSA Educational Committee. Uganda was selected as the hub of the training program, and Prof. Ignatius Kakande was charged with the responsibility of organizing it. He has successfully supervised the collaboration with Operation Hernia in organizing this course. The Operation Hernia UK-COSECSA Training Course is a comprehensive program in groin Hernia surgery and has had over six previous courses, providing residents with an invaluable training opportunity. It is a structured program with integrated competence assessment, delivered on a one-to-one basis. This model, designed by Operation Hernia and Surgeons for Africa, has also been used to train residents in Rwanda. It has been published and can be applied to other surgical specialties[1]. This study elaborates on a hernia surgery skills training program conducted with surgical residents and COSECSA fellow candidates. The training aimed to achieve an appropriate level of competence in mesh and tissue hernia surgery; train residents who complete the course to become trainers, thereby sustaining the program; and expand the program to surgical residents from other COSECSA countries using the Ugandan experience as a model. The rationale of this training follows the background of the high burden of hernias, where the prevalence of hernias in African countries is high[2,3]. And yet the rate of repair of hernias is low (10–100/100 000) compared to rates in high-income countries[4]. This gap highlights a critical need for enhanced surgical capacity and training in the region. Surgical trainees in African countries do not all have access to didactic structured training with competence assessment[1]. Addressing this training deficit is essential to improve surgical outcomes and meet the demand for hernia repairs across these populations.
Successful management of complicated burst abdomen with open abdomen using only simple saline dressing
(Wiley Online Library, 2025-03-25) Muganga, Dionizi; Basimbe, Francis; Nayiga, Irene; Ategeka, Amanda; Malinga, Paddy; Muwanga, Twaha
Necrosis of the rectus or lateral abdominal wall investing fascia may be associated with invasive infections or closure under extreme tension. This can lead to fascial dehiscence and evisceration of the intra-abdominal contents. Globally, abdominal wound dehiscence varies from 0.4% to 3.5% with associated mortalities reaching up to 45% in the perioperative period. Redo surgical operations and infectious complications are the major risk factors for abdominal wound dehiscence, but also presence of low albumin, glucocorticoid use, chest infections, and emergency surgeries have been also implicated. Open abdomen has been employed in incidences of trauma where a second look operation may be necessary, loss of abdominal wall, sepsis after penetrating abdominal trauma, and in cases of severe secondary peritonitis and acute pancreatitis. Patients with open abdomen are at a risk of fistula formation, sepsis, and loss of abdominal domain due to lateral fascial retraction. To reduce the mentioned complications mesh and nonmediated techniques to bridge fascia defects have been recommended with particular emphasis on biologic meshes with or without negative pressure wound therapy, component separation, or planned ventral hernia. We report a case of necrosis of the rectus and abdominal wound dehiscence and its management in a sub-Saharan setting, highlighting the challenges encountered and lessons learned. Retention sutures should be used cautiously in the management of wound dehiscence as it increases the risk of fascial necrosis in cases of intra-abdominal hypertension, as seen in our patient. In the absence of a VAC dressing, the utilization of routine saline gauze dressing promotes epithelialization over the exposed bowel and is a viable alternative to temporary abdominal closure modes of managing an open abdomen in a resource-limited setting.
Combined lesser curvature gastrointestinal stromal tumor excision and sleeve gastrectomy in a bleeding obese patient: a case report
(Journal of Surgery and Medical Case Reports, 2025-08-04) Basimbe, Francis; Iman, Din Hakim; Kakooza, Francis; Musolo, Allan; Raza, Ali Ghazi
Gastrointestinal Stromal Tumors (GIST) are the most frequent submucosal lesions encountered in the gastrointestinal tract. Once encountered in the stomach, they pose several challenges in resection based on their location. Some reports have observed an increased occurrence of GISTs in obese patients, however, a correlation has not been established. Some cases of fundus Gastrointestinal stromal tumor excision during sleeve gastrectomy en-mass have been reported, however, lesser curvature GIST pose a unique challenge of fashioning the sleeve. We highlight a challenging case of excising a GIST involving the lesser curvature, followed by a sleeve gastrectomy involving the greater curvature which resulted into a unique challenge of ensuring a proper anatomical low-pressure sleeve, following endoscopic calibration. Laparoscopic excision of a gastrointestinal stromal tumor and sleeve gastrectomy involving different anatomical regions of the upper stomach can be safely performed, even in our settings, despite the challenges of fashioning a low-pressure vertical sleeve.
Factors associated with successful exclusive breastfeeding among mothers in the formal sector: a mixed-method study in Kampala, Uganda
(Springer Nature Link, 2025-11-28) Edema, Jimmy; Namisi, Patrick Charles
Globally, evidence shows that exclusive breastfeeding (EBF) for the first six months of an infant’s life has health benefits for families, communities, and the nation. However, many employed women discontinue EBF before six months, while others succeed. This study aims to identify and explain the factors that enable EBF success among employed mothers in the formal sector. The study employed a sequential explanatory mixed-methods design. Quantitative phase used questionnaires administered to collect EBF data from 224 mothers with children 6–18 months. EBF was measured as self-reported by a mother who EBF her current infant/child for six months. Data was analyzed to guide the case study, where key-informant interviews were used to collect data from 10 mothers. Both phases lasted from November 2021 to February 2022. Multivariable logistic regression analysis of quantitative data established associated factors with EBF. Qualitative data was coded, grouped, and categorized to generate themes explaining EBF success. The majority (76.3%) of mothers were ≥ 25 years. Their mean age was 27.3 ± 3.65 years. Most (66%) were married. 87.4% had 3 ≥ months of maternity leave. Overall EBF prevalence at six months was 31.7%. Significant factors were: Bachelor’s degree (AOR = 3.04; 95% CI. 1.04, 8.86), Financial support (AOR = 6.62; 95% CI. 2.27, 19.31), domestic support (AOR = 5.23; 95% CI. 1.88, 14.52), psychological support (AOR = 5.45; 95% CI. 1.47, 20.20), and workmate support (AOR = 2.95; 95% CI. 1.54, 5.67). Prelacteal feeding (AOR = 0.16; 95% CI, 0.06, 0.45). More than four ANCs (AOR = 0.18: 95% CI. 0.04, 0.82). The qualitative phase generated five themes, these were: context, social support system, breastfeeding-friendly hospitals and workplace, and maternal EBF mindset. These themes fit theory-relevant concepts: social cognition and institutional factors, individual cognition, and EBF behavior. These concepts align with Social Cognitive theory. A third of the mothers had EBF. Significant factors for EBF included, bachelor’s degree, supportive environments at family, healthcare, and workplace, and a woman’s mindset. This implies mothers, practitioners, managers, and policy-makers to optimize EBF rates among employed Ugandan working women, they need to
Future fertility among pediatric cancer patients: experiences and perspectives of health workers in a low-resource setting
(Sage Publications, 2024-08-02) Kayiira, Antony; McLaughlin, Sarah; John, Neda Jennifer; Zaake, Daniel; Xiong, Serena; Balagadde, Kambugu Joyce; Gomez-Lobo, Veronica; Wabinga, Henry; Ghebre, Rahel
Although fertility preservation for patients with childhood and adolescent cancer is considered standard of care in the high-resource settings, it is rarely offered in low-resource settings. This study explores the experiences and perspectives of oncology health care professionals in Uganda to identify contextual barriers and facilitators to addressing oncofertility in low-resource settings. Using ground theory, we conducted in-depth face-to-face interviews of health care professionals managing pediatric patients at the Uganda Cancer Institute (UCI). Using a systematic, semi-structured interview guide, participants were asked open-ended questions about their understanding of fertility preservation and their perspectives on implementing this care at their institution. Although all the eligible health care providers were interviewed, interview transcripts were uploaded into NVivo version 12 and openly coded as per theoretical requirements. Codes were refined into categories and later into structured themes. Twelve health care professionals were interviewed. Most participants identified as female (n = 9). Their role in the medical team varied from nurses (n = 6), medical officers (n = 3), pediatric oncologists (n = 2), and pediatric oncology fellow (n = 1). Six themes were noted as follows: (1) importance of information, (2) importance of future fertility, (3) inadequate consideration to future fertility, (4) communication barriers, (5) inadequate knowledge, and (6) resource barriers. Although health care providers at the UCI face contextual barriers to addressing future fertility among patients with pediatric cancer, they value preserving fertility in this population. Future initiatives that aim to introduce oncofertility care in low-resource settings should prioritize educating providers and building capacity to meet the oncofertility needs in this setting.

Browse

Recent Submissions