Journal Articles (Health)

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Predictors of survival among older adults with HIV in Uganda’s AIDS support organization centers of excellence (1987 2023): a retrospective longitudinal study
(Springer Nature Link, 2025-02-26) Atuhairwe, Christine; Atuhaire, Leonard; Wandera, Ojambo Stephen; Amongin, Dinah; Ochieng, Titus; Misinde, Cyprian
The growing number of older adults living with HIV, facilitated by wider access to antiretroviral therapy (ART), presents unique challenges. This study aims to identify predictors of survival among older persons living with HIV receiving ART in Uganda’s AIDS Support Organization Centers of Excellence (1987–2023). Understanding these predictors can inform effective clinical interventions to improve outcomes for this population. This study conducted a retrospective analysis of medical records from 11 TASO centers of excellence in Uganda (1987–2023). Using Cox proportional hazards regression, we identified factors associated with survival among older adults living with HIV. TASO centers of excellence in Entebbe, Gulu, Jinja, Masaka, Masindi, Mbale, Mbarara, Mulago, Rukungiri, Soroti, and Tororo. Cox proportional hazards regression analysis identified factors influencing survival among older persons living with HIV (OPLHIV). Of the 30,758 OPLHIV medical records analyzed (1987–2023), 72.5% were active on ART, 5.9% had died, 15.2% were lost to follow-up, and 5.6% transferred to other facilities. Survival was significantly associated with: gender (female, HR = 1.19, p < 0.001), marital status (married, HR = 0.99, p < 0.001; separated/divorced, HR = 0.85, p < 0.001), WHO clinical stage (II, HR = 1.66, p < 0.001), viral load (> 200 copies/ml, HR = 1.49, p < 0.001), and ART adherence (fair, HR = 0.94, p = 0.157). Key predictors of survival among Older Adults Living with HIV (OPLHIV) include: female gender, age 50–59, weight 51–70 kg, married status, viral load > 200 copies/ml, WHO HIV clinical stage II, paid employment, and ART adherence. To improve survival outcomes, consistent clinical screenings of WHO clinical stages, viral load, and ART adherence are essential. These measures can guide healthcare providers in making informed treatment decisions to enhance survival and quality of life for OPLHIV in Uganda. Strengthen routine monitoring of viral load, ART adherence, and WHO clinical staging. Provide targeted support to married and separated/divorced adults to improve their survival chances. Address gender disparities in care to enhance outcomes for females. Focus on maintaining ART adherence and viral suppression to reduce mortality risks.
Exploring the correlates of health-related quality of life in older persons on HIV antiretroviral therapy attending the Aids Support Organisation in Uganda
(African Journals Online, 2025-09-24) Atuhairwe, Christine; Misinde, Cyprian; Atuhaire, Leonard
Despite advancements in Anti-retroviral Therapy (ART), older persons living with HIV (OPLWHIV) continue to face significant challenges, including poor health outcomes and lower quality of life. This study aimed to explore the correlates of health-related quality of life (HRQoL) for older persons on HIV ART attending the Aids Support Organization (TASO) in Uganda. Methods: We conducted a cross-sectional survey among OPLHIV enrolled in care at 11 stand-alone TASO centres between February to August 2024. Data was analyzed using STATA 15, employing an Ordinal Logistic Regression model to identify HRQoL correlates for individuals over 50 years old living with HIV. Results: Ordinal Logistic Regression results revealed that various demographic, social, and clinical indicators significantly correlated with different HRQoL domains. General health perception was associated with multiple sexual partners (p=0.038), advanced HIV disease (p=0.011), and a viral load >200 copies/ml (p=0.003). Physical functioning correlated with tertiary education (p=0.049), being separated (p=0.004), 11-15 years on ART (p=0.027), and WHO clinical stage II (p=0.050). Factors for role functioning included age 60+ (p=0.002), secondary education (p=0.021), unemployment (p=0.001), WHO clinical stage II (p=0.002), and TB history (p=0.037). Social functioning linked to secondary education (p=0.004), being widowed (p<0.001), viral load >200 copies/ml (p=0.008), and WHO clinical stage II (p=0.011). Pain was associated with age 60+ (p=0.014), tertiary education (p=0.004), and unemployment (p=0.005). Energy correlated with secondary education (p=0.062), being separated (p=0.021), viral load >200 copies/ml (p=0.003), and WHO clinical stage II (p=0.028). Health distress was tied to secondary education (p<0.001), tertiary education (p<0.001), unemployment (p=0.033), and WHO stage II (p<0.001). Finally, mental health was associated with secondary education (p=0.017), being widowed (p=0.043), multiple sexual partners (p=0.015), and WHO stage II (p=0.001). Overall HRQoL specifically correlated with age 60+ (p<0.001), secondary education (p<0.001), and WHO stage II (p=0.008). Conclusion: Significant correlates across multiple HRQoL domains consistently included age (60+ years), educational attainment (secondary and tertiary), unemployment, separated or widowed marital status, specific HIV markers (advanced HIV disease, viral load >200 copies/ml, ART duration), and WHO clinical stage II. Having multiple sexual partners and a history of TB also factored into certain domains. Given these findings, TASO Uganda, with its extensive regional presence, is exceptionally well-positioned to implement multifaceted interventions. These should prioritize comprehensive support for older adults, promote health education and social support, enhance comprehensive HIV care, and provide integrated geriatric HIV health services to improve the HRQoL of OPLWHIV in Uganda.
Perceived quality of life and associated lifestyle practices among older people living with HIV in Uganda. a cross‑sectional study
(Springer, 2025-09-03) Atuhairwe, Christine; Misinde, Cyprian; Ochieng, Titus; Atuhaire, Leonard
Perceived quality of life (QoL) is a critical element for older persons living with HIV-positive diagnosis. The intersection of aging, chronic illness, and the complexities of managing HIV significantly influences their quality of life. This study investigated the relationship between perceived QoL and lifestyle factors among older adults living with HIV in Uganda. This cross-sectional survey was conducted with older adults (above 50 years) living with HIV attending The AIDS Support Organization centres across the major regions in Uganda. Data were cleaned and analyzed using STATA 15, with modified Poisson regression assessing factors associated with perceived quality of life. A total of 440 participants were interviewed. While 52% reported poor perceived quality of life before initiating antiretroviral therapy (ART), this decreased to 35% after ART initiation. This suggests a substantial improvement in the health of older adults living with HIV. Before ART initia tion, poor quality of life was significantly associated with being aged 60 years or older (adjusted risk ratio [aRR] 1.17, 95% CI 0.94-1.46), adhering to the Seventh-day Adventist (SDA) faith (aRR 1.89, 95% CI 1.12-3.21), being a casual labourer (aRR 0.62, 95% CI 0.41-0.94), being married (aRR 0.65, 95% CI 0.42-1.01), having one sexual partner (aRR 1.50, 95% CI 1.16-1.93), alcohol consumption (aRR 0.71, 95% CI 0.15-0.85), infrequent fruit consumption (aRR 1.75, 95% CI 0.99 3.09), consuming white meat 1-3 times per week (aRR 1.61, 95% CI 1.23-2.10), engaging in sports 4-7 days per week (aRR 0.25, 95% CI 0.08-0.75), walking 4-7 days per week (aRR 0.79, 95% CI 0.62-1.00), and having diabetes (aRR 1.57, 95% CI 1.13-2.19). After ART initiation, poor quality of life remained significantly associated with being 60 years or older (aRR 1.34, 95% CI 0.98-1.83) and being a salaried employee (aRR 0.38, 95% CI 0.21-0.81). Additionally, frequent white meat consumption (4-7 days per week) (aRR 2.01, 95% CI 1.18-3.42) and moderate sports engagement (1-3 days per week) (aRR 1.94, 95% CI 1.47-2.55) were significantly associated with poorer quality of life after ART initiation. No significant asso ciations were observed with other variables. Perceived quality of life in older persons living with HIV was poorer among those aged over 60 years. The risk of poor QoL was lower among those who eat white meat and participate in sports weekly. Increasing physical activity through regular exercise routines in older adults can help reduce the risk of age-related diseases, improve energy levels, reduce stress, enhance appetite and sleep quality, boost cardiovascular and pulmonary endurance, and enhance overall quality of life.
Depression symptom severity and behavioral impairment in school-going adolescents in Uganda
(Springer Nature Link, 2025-01-25) Anguzu, Ronald; Abbo, Catherine; Dickson-Gomez, Julia; Bobholz, Max; Kiconco, Arthur; Shour, R. Abdul; Kabanda, Richard; Kalani, Kenneth; Cassidy, D. Laura
During adolescence, a critical developmental phase, cognitive, psychological, and social states interact with the environment to influence behaviors like decision-making and social interactions. Depressive symptoms are more prevalent in adolescents than in other age groups which may affect socio-emotional and behavioral develop ment including academic achievement. Here, we determined the association between depression symptom severity and behavioral impairment among adolescents enrolled in secondary schools of Eastern and Central Uganda. This cross-sectional study was conducted among 1,669 adolescents enrolled in secondary schools in Eastern and Central Uganda. Our outcome variable was behavioral impairment defined as self-reported behav ior that interferes with an individuals’ ability to do schoolwork (school performance) or get along with others (peer interaction) (yes/no). The key independent variable was depression symptom severity assessed using the Child and Adolescent Symptom Inventory-5 (CASI-5), a behavior rating scale for symptoms of DSM-5 emotional and behav ioral disorders. Modified Poisson regression models tested the independent association between depressive symp tom severity and behavioral impairment. Prevalence Rate Ratios (PRR) and 95% confidence intervals (95%CI) were reported. Participants’ mean age was 15.3 years (SD = 1.8), 58.5% were female, 86.8% witnessed domestic violence, 47.4% had behavioral impairment, and 2.8% had mild depression symptoms. School-going adolescents with mild depression symptoms had two times higher risk of behavioral impairment when compared to those with no or slight depression symptoms, after controlling for potential confounders. Other factors independently associated with higher risk for behavioral impairment were female sex (Adj. PRR 1.27, 95%CI 1.12, 1.43) compared to males, taking alcohol (Adj. PRR 1.42, 95%CI 1.25, 1.61) compared to not taking alcohol, boarding school enrollees (Adj. PRR 1.62, 95%CI 1.33, 1.98), and day school enrollees (Adj. PRR 1.46, 95%CI 1.21, 1.76) compared to mixed (day and boarding) school enroll ees respectively, advanced level enrolment (Adj. PRR 1.25, 95%CI 1.05, 1.48) compared to ordinary level enrolment, and attending urban schools (Adj. PRR 1.27, 95%CI 1.11, 1.45) compared to rural secondary school attendance. Behavioral impairments are widespread among Ugandan secondary students. Mild depression symp toms adversely affect adolescents’ academic and social lives, potentially leading to long-term consequences. Where feasible, early detection of depressive symptoms and treatment may mitigate their negative effects on student school performance ability and peer/social interaction. Future research should examine school-level factors influencing academic performance by depression status. Policymakers in education and gender sectors should prioritize mental health programs in secondary schools.
Conceptualization of the Africa CDC public health risk communication and community engagement community of practice for Africa (PH-RCCE-CoPA) in 2020: successes and challenges in implementation
(Sage Journals, 2025-06-13) Djoudalbaye, Benjamin; Kabanda, Richard; Mavuto, Thomas; Njai, Modou; Mhiraf, Addis; Gweh, G. Nekerwon
The Africa Centres for Disease Control and Prevention established and launched the Public Health Risk Communication and Community Engagement Community of Practice in Africa (PH-RCCE-CoPA) initiative during the COVID-19 pandemic in May 2020 in collaboration with the World Health Organization Regional Office for Africa and developed terms of reference. This initiative aimed to strengthen capacity of Member States and institutionalize Risk Communication and Community Engagement (RCCE) for public health emergencies in Africa through the exchange of knowledge and best practices, as well as respond to rumours and misconceptions. Establishing the PH-RCCE-CoPA and subsequent training of RCCE focal points in Member States facilitated a coordinated approach to RCCE which helped to reduce rumours and misconceptions and increase COVID-19 vaccine confidence and uptake.
Community health system capacities and capabilities within an evolving community health policy framework: mixed methods study of stakeholders in central Uganda
(BMJ Journals, 2025-01-11) Kabanda, Richard; Ocaatre, Miria Ronald; Atwine, Diana; Kim, Bounggui; Waiswa, Erisa Simon; Kavuma, Denzel Prichard; Lee, Yeni; Mutoni, Loretah; Kim, Solyi; Park, Yein; Okuga, Monica; Tweheyo, Raymond
Empowering communities through identifying and unlocking community capacities and capabilities is vital for improving community health systems. This study assessed the community health system’s status quo and readiness for implementing a government-led, partner-supported community health worker project. A mixed methods cross-sectional study. Two districts and one city in central Uganda. 21 key informants (KIIs) with district leaders, 4 focus group discussions (FGDs) with community health workers (CHWs) termed as village health teams in the Ugandan setting and a survey of 487 CHWs and 419 pregnant women who had childbirth 12 months before. KIIs and FGDs explored community health system resources using the WHO health systems building blocks and the UNICEF health system strengthening maturation model. However, the surveys explored the work-related attributes and services delivered by the CHWs and to the community, respectively. A framework analysis was used for qualitative data in NVivo 14. While descriptive and stratified analyses were conducted for quantitative data in Stata I/C 15.0: proportions for the varied geographical entities were compared using the t-test with p values <0.05 considered significant, one-way ANOVA was used to compare means. Overall, all sites had relatively strong governance of community health only challenged by multiple implementing partners that were weakly coordinated. There was an exclusive paper-based information management system that linked to the national DHIS-2 software. Community reporting rates varied between 20% and 80%. Community health financing was weak, similarly to commodities availability. The mean age of the community health workforce was high at 50.9 (SD 11.9); the majority reported adequate skills in service delivery except for community first aid, Kangaroo mother care and noncommunicable diseases. Households’ most received CHW services included home visits, treatment for sick under-five children and child immunisation. The existing CHW system has governance and reporting strengths but could be enhanced through revitalization, enhanced coordination of stakeholders, providing appropriate training, work tools, supervision and engaging the community for accountability of results.
Mental health in low-income countries: a call to improve mental health in Uganda
(PLOS, 2025-04-30) Omona, Kizito; Bashabire, Barungi Mponye Nice; Bulamu, Ritah; Mugabe, Bernadine; Balamaga, Ssanyu Samuel; Akurut, Enyipu Betty
The World Health Organization defines mental health as a state of mental wellbeing that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community [1]. It is an integral component of our general health that underpins our individual and collective abilities to make decisions, build relationships and shape the world we live in –and yet it remains a low priority in many low-income countries. Uganda, like many sub-Saharan African countries, faces significant challenges in addressing mental health concerns. The burden of mental illness is exacerbated by poverty, conflict, and a lack of awareness. Supporting and managing the wellbeing of people is faced with numerous challenges, especially for those who already face a variety of hurdles or difficulties. For example, Mugisha, Bantu & Nakalema [2] explored the mental health impact on parents raising children with Autism Spectrum Disorder (ASD) in Uganda. They highlighted stigma, economic hardship, and lack of mental health support services as key factors exacerbating mental health struggles. The results revealed very high levels of stress and stigma among parents and experiences of financial difficulties, marital conflicts, and psychological strain resulting from societal discrimination were common. Parents reported experiencing feelings of shame, embarrassment, and hopelessness, exacerbated by societal misconceptions and the lack of support systems. The prevalence of anxiety symptoms among parents (45.9%) surpassed previous estimates, indicating a significant mental health burden within this population. Another study examined the intersection of mental health and HIV/AIDS in Uganda and emphasized again, how financial stress, social stigma, and lack of resources all hinder mental well-being within this community [3]. This echoes findings in many other similar studies [4,5]. In this Opinion, we aim to provide an overview of the state of mental health in Uganda, assess existing policies and challenges, and offer possible solutions.
Management practices of primary postpartum hemorrhage among traditional birth attendants: a qualitative survey, Iganga, Uganda
(National Institutes of Health, 2025-12) Namasambi, Sharon; Omona, Kizito
Postpartum hemorrhage is a significant barrier to the achievement of Sustainable development goal 3.1, given that it is associated with more than a quarter of all maternal mortality cases. Traditional birth attendants (TBAs), who are outlawed in many countries, including Uganda inclusive, attend to about 33% of all births globally. The objective of this study was to explore the management practices of primary postpartum hemorrhage among traditional birth attendants in Iganga district. The study used a case phenomenological qualitative exploratory design, targeting traditional birth attendants. Snow balling was used to select participants and engage them in-depth interviews. Data collected was analyzed thematically, with the induction approach. It was found that TBAs carried out PPH assessment using three methods; quantification of blood lost using household cups, vital assessment and visual assessment. Visual assessment was the most dominant. Postpartum hemorrhage resuscitation practices mainly rotated around the use of warm water. They did not carry resuscitation. The treatment interventions used were: use of herbal medicine and referral of severe cases to hospital. TBAs in Iganga district visually assess postpartum hemorrhage but they do not conduct resuscitation procedures. They use herbal uterotonics in the treatment of postpartum hemorrhage alongside with referral to hospital.
Uncovering the determinants of poor welfare among doctors in the Central Region of Uganda, East Africa
(Springer Nature Link, 2026-10-07) Akiyo, Fidel; Katumba, Edrine Dickens; Opolot, Emmanuel; Ssentongo, Mugerwa Saadick; Omona, Kizito
Welfare is the general health, happiness, and safety of a person or group. Anything that threatens or undermines this living state is a direct cause of poor welfare. Poor welfare, which results from multiple contributing factors, is a common issue experienced by many doctors in low-income countries. Remuneration remains a strong contributing factor to the improvement of doctor’s welfare. This study aimed to uncover the determinants of poor welfare among doctors in the Central Region of Uganda, East Africa. This study presents data collected through a self-administered questionnaire within the Uganda Medical Association Central branch jurisdiction. Analytical cross-sectional design with mixed method approach was used. Results Using WHO-5 well-being index, on average, the total raw score was 9(36%), which is well below score 13. Thus, out of the 111 doctors, 72% of the doctors had score below 13 (below 50%), hence poor mental wellbeing. Using Patient Health Questionnaire (PHQ-9), 20% of doctors had mild depression (score 5–9), 29% had moderate depression (score 10–14) and 49.5% had severe depression, all of which point to poor welfare. Net monthly income (p = 0.000), levels of burnout (p = 0.001) and depression (p = 0.000) were found to be determinants of poor welfare. After controlling for confounders, respondents who earned 2–3 million Ugandan shillings were 2.7 times more likely to have poor welfare [aPR = 2.71 at 95% CI(1.03–2.09)] compared with their colleagues who earned more than 5 million Uganda Shillings. Respondents with high level of burnout were 3.9 times more likely to have poor welfare [aPR = 3.92 at 95% CI(1.18–6.76)]. Poor welfare among doctors is a multifaceted problem driven by a combination of financial, environmental and institutional factors. The key determinants include inadequate compensation, extreme workload pressures, poor working conditions and significant psychological stress, which often lead to burnout.
Non-uptake of COVID-19 vaccines and reasons for non-uptake among healthcare workers in Uganda: a cross-sectional study
(BioMed Central Ltd - Springer Nature, 2024-05-25) Kyakuwa, Nasimu; Abaasa, Andrew; Mpooya, Simon; Kalutte, Hamza; Atuhairwe, Christine; Perez, Laurent; Kikaire, Bernard
Background Vaccines play a crucial role in eradicating and containing disease outbreaks. Therefore, understanding the reasons behind vaccine refusal and associated factors is essential for improving vaccine acceptance rates. Our objective was to examine the determinants of COVID-19 vaccine non-uptake and explore the reasons for non-uptake among healthcare workers (HCWs) in Uganda. Methods Between July and August 2021, we conducted a cross-sectional study among healthcare workers in primary healthcare facilities (private and government) in Entebbe Municipality, Uganda. Participants were recruited using convenience sampling, and consenting individuals received credentials to access an electronic database and complete a structured questionnaire. There were no established HCWs contact registers in the municipality, and the study was conducted during a national lock down, therefore, the HCWs who were on duty at the time of the study were approached. The survey questions were based on the ‘3Cs’ model of vaccine hesitancy and focused on confidence, convenience, and complacency factors. Non-uptake of vaccines was defined as not having received any of the available vaccines in the country. We employed counts, percentages, and simple logit models to summarize the reasons for non-uptake of COVID-19 vaccines and to identify associated factors. Results The study recruited 360 HCWs, 61.7% of whom were female, with an average age of 31 years (SD = 7.9). Among them, 124 (34.4%) healthcare workers did not receive any COVID-19 vaccine. Non-uptake of COVID-19 vaccines was independently associated with several factors, including age [35 + years adjusted odds ratio (aOR) = 0.30, 95% CI: 0.13–0.66 compared with 18–24 years], facility ownership [government, aOR = 0.22 (0.10–0.49) compared with private not-for-profit], previous testing for coronavirus [yes, aOR = 0.35 (0.19–0.65)], and previous involvement in COVID-19 vaccine activities [yes, aOR = 0.17 (0.10–0.29)]. The primary reasons cited for non-uptake of COVID-19 vaccines were related to a lack of confidence in the vaccines, such as concerns about side effects (79.8%) and the need for more time to understand the vaccines (89.5%), as well as the importance of weighing benefits and risks (84.7%) before being vaccinated. A smaller proportion, approximately 23%, cited reasons related to complacency and lack of convenience in accessing vaccination services. Conclusion The high proportion of non-uptake of COVID-19 vaccines among this population primarily stems from a lack of confidence and trust in the vaccines, coupled with insufficient time allowed for users to make informed decisions. This underscores the urgent need for ongoing monitoring and trend analysis of vaccine non-uptake to guide the development and implementation of strategies aimed at building and sustaining vaccine confidence. Adequate time should be allowed to explain benefits of vaccination to the population to allay fears that might exist before actual vaccination is rolled out.
High uptake of COVID-19 vaccines among healthcare workers in urban Uganda
(PLOS, 2024-04-16) Kyakuwa, Nasimu; Kimbugwe, Geofrey; Nakanjako, Flavia; Kalute, Hamza; Mpooya, Simon; Atuhairwe, Christine; Perez, Laurent; Kikaire, Bernard
Objectives The aim of the study was to describe the facilitators, barriers to and level of uptake of COVID-19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. Materials and methods We conducted a cross-sectional study among HCWs in private and public health facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using a structured questionnaire that was shared, via an online link, to consented participants. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID-19 vaccines. Results The study enrolled 360 participants, with 61.7% (n = 222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID-19 vaccine, with higher uptake among females 64% (n = 151). Age above 40 years (OR 2.16), working in a government healthcare facility (OR 3.12), participating in COVID-19 vaccine related activities (OR 4.62), and having tested for SARS-COV-2 (OR 3.05) increased the odds of having been vaccinated. Working in small roadside clinics reduced the odds of being vaccinated by almost 70%, while HCWs in government health services were 3.1 times more likely to have been vaccinated. History of having cared for a COVID-19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Conclusion Vaccine uptake among HCWs was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022
COVID-19 vaccine uptake and associated factors among individuals living in a peri-urban area in Uganda: a cross-sectional study
(PubMed Central - Public Library of Science, 2024-11-04) Nanteza, Bridget Mary; Nanyonjo, Gertrude; Kyakuwa, Nasimu; Nakanjako, Flavia; Kalute, Hamza; Atuhairwe, Christine; Watera, Christine; Ssemwanga, Deogratius
Introduction: The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. Methods: This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The 'chi-square test' and 'modified Poisson regression' were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics. Results: Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1st and 2nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013). Conclusion: Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.
Determinants of Late HIV Diagnosis and Advanced HIV Disease Among People Living with HIV in Tanzania
(Dovepress - Taylor & Francis, 2024-08-26) Bendera, Anderson; Baryomuntebe, Mugisha Deogratias; Uchechukwu, Nwanna Kevin; Nanyingi, Miisa; Kinengyere, Bemanya Patience; Mujeeb, Salaam; Sulle, Jachi Esther
Background: About half of people infected with Human Immunodeficiency Virus (HIV) often present late for care, resulting in higher healthcare costs, undesired treatment outcomes, and ongoing HIV transmission. This study aimed to assess the prevalence and determinants of late HIV diagnosis and advanced HIV disease (AHD) in Tanzania. Methods: Data were obtained from the 2016-17 Tanzania HIV impact survey. We included 677 newly diagnosed people living with HIV. Late HIV diagnosis and AHD were defined as having a CD4 cell count below 350 cells/µL or 200 cells/µL at diagnosis, respectively. Bivariate and multivariable logistic regression models were fitted to identify the determinants of late HIV diagnosis or AHD. Results: The mean age of the participants was 37.8 years (SD, 12.4). About two-thirds were women (62.6%). The prevalence of late HIV diagnosis was 42.4%, whereas the prevalence of AHD was 17.7%. Factors associated with late HIV diagnosis included age 31-40 years (adjusted odds ratio [aOR] = 1.72, 95% confidence interval [CI]: 1.14-2.60), age ≥41 years (aOR = 1.79, 95% CI: 1.16-2.76), male sex (aOR = 1.88, 95% CI: 1.29-2.73), and active syphilis infection (aOR=2.63, 95% CI: 1.20-5.76). Factors associated with AHD were age 31-40 years (aOR = 2.12, 95% CI: 1.18-3.81), age ≥41 years (aOR = 2.42, 95% CI: 1.32-4.41), male sex (aOR = 1.77, 95% CI: 1.09-2.87), formal education (aOR = 0.49, 95% CI: 0.30-0.81) and active syphilis infection (aOR = 2.49, 95% CI: 1.07-5.77). Conclusion: Late HIV diagnosis and AHD are prevalent among newly diagnosed people living with HIV in Tanzania. Specific subgroups are more likely to present late for HIV care, including middle-aged and older adults, men, illiterate individuals, and those with active syphilis and HIV co-infection. Therefore, we recommend expanding HIV testing services and implementing targeted interventions to improve early access and enrollment in HIV care.
Experiences of mothers receiving male midwives’ assistance during childbirth in Kween District, Uganda
(African Journal Online - Womens's Health and Action Research Centre (WHARC), 2024) Soyekwo, S. Wilfred; Tumuhaise, Criscent; Ndibazza, Juliet
This study explored the perceptions and experiences of mothers who were cared for by male midwives (MMWs) during delivery in Kween District. The study utilized a qualitative phenomenological approach to document responses of participants. Data was collected from three health facilities that had male midwives delivering mothers at the time of the study, and targeted postnatal mothers 18-49 years who had been delivered by a MMW in the last 6 months. Thirty-three mothers participated in the study: 15 in individual in-depth interviews and 18 in three focused group discussions. Collected data were transcribed in word, coded in excel and exported to Atlas.t 7 for analysis. Thematic and content analysis were utilized to derive insights from the data collected. The results showed that perceptions varied significantly across participants. Respondents attached certain beliefs and perceptions that the delivery process is an intimate matter that should only be handled by fellow women. Fear and discomfort when touched by a MMW and discomfort by mothers’ partners, came out as strong viewpoints. However, there were strong experiences that MMWs demonstrated supportive, caring, respectful, sympathetic and passionate provision of care. These findings agree with several other studies reviewed during the study. Comprehensive sensitization focused on promoting the utilization of skilled birth attendants regardless of gender is necessary in reducing maternal mortality.
Coverage of child disability detection, management, and rehabilitation health services in Central Uganda
(The East African Health Research Commission, 2024-06-24) Akankwasa, Edith; Kamya, Willy; Sendijja, Moses; Mudoola, Janet; Lwenge, Mathias; Onzima, Anguyo DDM Robert; Katongole, Simon-Peter
Child disability is a significant public health concern which impacts 1 in 20 children. Children with disabilities (CwDs) encounter deprivation of rights, biases in society, and a lack of access to necessary services, all of which are exacerbated by structural obstacles. This study assessed the coverage of child disability prevention, management and rehabilitation services in four districts of Central Uganda after two years of interventions to improve these services. The Lot Quality Assurance Sampling (LQAS) rapid health facility assessment method was employed to assess coverage of services based on sixteen indicators. The indicators were set based on constructs of: provision of disability-related services to CwDs; use of rehabilitation services; readiness of the health facilities (HFs) to provide basic disability management and rehabilitation services; community structures for linkage to disability management and rehabilitation services; psychosocial support provision; and upholding and protecting the rights of CwDs. A district-level decision rule was set based on 80% coverage target. Despite the interventions, the services have yet to provide the desired level of benefit to CwDs and their caregivers. Out of the sixteen indicators for healthcare service coverage for CwDs, only three attained the 80% coverage target. The findings suggest that greater focus by health service planners and project implementers is still needed, especially at the community and health facility levels to enhance the prevention, management and rehabilitation of CwDs. Psychosocial health services for caregivers of CwDs need special attention in order to achieve better service approaches.
Determinants of hospital delivery among mothers attending post-natal mother-baby clinic services from January to August 2020: a cross-sectional study of Busia, Uganda
(Taylor and Francis (Informa UK), 2025-06-11) Omona, Kizito; Ojok, Ritara, Vincent
It is estimated that hospital delivery could reduce 16%–33% of maternal deaths. Despite the importance of delivering at health institutions, in many countries, mothers still prefer to give birth at home. The aim was to ascertain the determinants of hospital delivery among mothers attending post-natal mother-baby clinic services in Busia district. We used analytical cross-sectional design, with mixed method approach. A sample of 385respondent mothers were interviewed using semi-structured questionnaires. Two Focus Group Discussions (FGD) were held with mothers. Hospital delivery was at 82.6%, with most mothers delivering from government hospitals (50.9%) and private hospitals. Place of residence of mothers was associated with Hospital Delivery (X2 (1) = 1.515, p < 0.002). Mothers who lived in urban settings were 2.7times more likely to deliver from health facilities than mothers who lived in rural settings [cPR = 2.686, 95% CI (0.394–1.194)]. Husband’s educational level was a determinant of Hospital Delivery (X2 (3) = 2.054, p < 0.006). Mothers whose husbands had primary education, secondary education and tertiary education were 2.2 times, 1.5 times and 1.3 times more odd of delivering from health facility respectively. Hospital delivery in Busia was acceptably high. Women’s decision power enormously contributes to the choice of place of delivery.
Effects of school closures in COVID-19 era: evidence from Uganda Martyrs University
(Simon Fraser University, 2021-07-28) Omona, Kizito
As of March 1st, 2020, many governments embarked on nationwide school closures due to the deadly coronavirus pandemic. As the month of March came to an end, about 185 countries across the globe had closed their schools. This affected about 90% of the world’s students and Africa was significantly hit by this closure. The speed of these closures and the rapid move to distance learning gave very little time for planning or any other alternative form of learning. In Uganda, the education of 15 million children and students was disrupted. Learners had to spend the majority of their time at home playing, helping their parents with chores, engaging in agriculture and also spare some hours a day to study. The education of learners was impacted greatly. In urban areas, some learners relied on lessons available online, televisions and radios, while in rural areas, learners had to fall back on their notebooks and printed learning materials provided by the government. The objective of this study was to ascertain the effects of school closure on different stakeholders. A qualitative phenomenological study was carried out. A sample of eight lecturers, eight students, four administrators and four community members were purposively recruited for the study. The results show that the impact of the closures on teachers resulted in: (1) leaving the teaching profession, and (2) financial distress. On the part of learners, the effect was a disruption of learning. Schooling provides essential learning and when schools closed, learners were deprived of opportunities for growth and development. The disadvantage of the disruption was disproportionate for under-privileged learners who tend to have fewer educational opportunities, apart from being in schools. Undoing the effects of learning disruption may require years in Uganda.
Assessment of the accuracy of malaria microscopy in private health facilities in Entebbe Municipality, Uganda: a cross-sectional study
(BMC Springer Nature, 2021-06-06) Mutabazi, Tobius; Arinaitwe, Emmanuel; Ndyabakira, Alex; Sendaula, Emmanuel; Kakeeto, Alex; Okimat, Paul; Orishaba, Philip; Katongole, Simon Peter; Mpimbaza, Arthur; Byakika‑Kibwika, Pauline; Karamagi, Charles; Nakayaga Kalyango, Joan; Kamya, Moses R.; Dorsey, Grant; Nankabirwa, Joaniter I.
Although microscopy remains the gold standard for malaria diagnosis, little is known about its accu‑ racy in the private health facilities in Uganda. This study evaluated the accuracy of malaria microscopy, and factors associated with inaccurate smear results at private health facilities in Entebbe Municipality, Uganda. Between April and May 2018, all patients referred for a malaria smear in 16 private health facilities in Entebbe municipality were screened, and 321 patients were enrolled. A questionnaire was administered to collect demographic and clinical information, facility-based smear results were recorded from the participant’s consultation notes, and a research slide was obtained for expert microscopy during exit interview. A health facility assessment was conducted, and information on experience in performing malaria microscopy was collected from all facility personnel reading smears and the data was linked to the participant’s clinic visit. The test positivity rate of malaria parasitaemia was 15.0% by expert microscopy. The sensitivity, specifc‑ ity and negative predictive value of the facility-based microscopy were high (95.8%, 90.1 and 99.2%, respectively). However; the positive predictive value (PPV) was low with 27/73 (63%) patients diagnosed with malaria not having the disease. Majority of the inaccurate results were from 2 of the 23 laboratory personnel reading the smears. The factors associated with inaccurate smear readings included being read by a technician; (1) who had less than 5 years’ experience in reading malaria smears (adjusted Odds Ratio [aOR]=9.74, 95% confdence interval [CI] (1.06–89.5), p-value=0.04), and (2) who was examining less than 5 smears a day (aOR=38.8, 95% CI 9.65–156, p-value<0.001). The accuracy of malaria microscopy in this setting was high, although one third of the patients diag‑ nosed with malaria did not have the disease. Majority of the errors in smear readings were made by two laboratory personnel, with the main factor associated with inaccurate smear results being low experience in malaria microscopy. In-service training may be sufcient to eliminate inaccurate smear results in this setting, and these private facilities would be ideal model facilities to improve the quality of malaria microscopy in Uganda especially in the public sector where accuracy is still poor
Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study
(BMC Springer Nature, 2023-10-17) Twineamatsiko, Andrew; Mugenyi, Nathan; Kuteesa, Yvonne Nabachwa; Ejalu, David Livingstone
Health worker retention in remote and hard-to-reach areas remains a threat in most low- and middleincome countries, and this negatively impacts health service delivery. The health workforce inequity is catastrophic for countries like Uganda that still has a low health worker to patient ratio, and remote areas like Lira District that is still recovering from a long-term civil war. This study explores factors associated with retention of health workers in remote public health centers in Lira district in Northern Uganda. A descriptive cross-sectional study with quantitative methods of data collection was used among health workers namely; doctors, clinical ofcers, nurses, midwives, pharmacists and, laboratory technicians. The study utilized a structured questionnaire with closed ended questions to obtain quantitative information. Most of the respondents were females (62.90%), married (84.62%), with certifcate level (55.74%), and nurses as qualifcation (36.60%) as well as attached to Health Center 3 level (61.28%). Signifcant individual factors associated with retention included having a certifcate as highest level of education, staying with family, and working at facility for 6 or more years. The health system factors were good physical state of facility, equipment availability, availability of sundries, feeling comfortable with rotations, receiving adequate support from staf, feeling valued and respected by colleagues at workplace and access to incentives while career factors were job satisfaction, job motivation, promotion, and further training on scholarship. The study established that indeed several individual and social demographics, health system and careerrelated factors are signifcantly associated with retention of Health workers in the rural public health facilities and these are critical policy recommendations for establishing retention guidelines in a national human resources for health manual.
Antiviral use among hepatitis B infected patients in a low resource setting in Africa: a case study of West Nile, Uganda
(PubMed, 2023-06) Seremba, Emmanuel; Wandera, Claude; Ssekitoleko, Richard; Nankya-Mutyoba, Joan; Nyeko, Filbert; Amandua, Jacinto; Ejalu, David; Omale, William; Ocama, Ponsiano
Failure to access antiviral medications is a leading cause of hepatitis B (HBV)-associated morbidity and mortality in sub-Saharan Africa (SSA). Despite guideline availability, SSA is not on course to meet its elimination targets. We characterized factors associated with antiviral medication use and challenges to offering chronic care in a large Ugandan institution. We abstracted HBV care data. 2,175/2,209 (98.5%) had HBV-infection. Most participants were men [1,197 (55%)]; median (IQR) age 27 years (19-35); 388/1689 (23.0%) had cirrhosis by sonography and 141/2175 (6.5%) by the aspartate aminotransferase to platelet ratio index (APRI) score ≥2. Of the eligible, 20/141 (14.2%) with APRI score ≥2 and 24/388 (6.2%) with sonographic evidence of liver cirrhosis were not on antiviral medications. Overall, 1,106 (51%) were on medications though 65.8% had not been fully investigated. In multivariate analysis, age ≥35 years [OR (95% CI) = 1.52 (1.01-2.28), p=0.043], APRI ≥2 [OR (95% CI) =1.79 (1.48- 2.16), p<0.001], hepatitis B viral load >2,000IU/mL [OR (95% CI) = 6.22 (5.08-7.62), p<0.001] were associated with antiviral medications use. Over half of participants in care had not been fully evaluated although on treatment and many eligible patients did not access medications. There is need to bridge these gaps for SSA to realise its HBV elimination goals.

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