Central Uganda Research Articles

Malnutrition and unsuccessful tuberculosis treatment among people with multi-drug resistant tuberculosis in Uganda: A retrospective analysis

RationaleMulti-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. ObjectiveWe determined the factors associated with unsuccessful TB treatment among persons with MDR-TB at a large TB Unit in Central Uganda. MethodsWe 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 resultsWe 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). ConclusionUnsuccessful 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.

Association between foreign agricultural investments and adoption of soil and water conservation practices in Uganda

ObjectivesRecently, some developing countries are promoting foreign agricultural investments in Agriculture to exploit currently under-exploited land. Yet, the benefits to recipient countries remains less understood and inconclusive. The study sought to understand the association between proximity to a foreign agricultural investments (FAI) and adoption of soil and water conservation farming methods by smallholder farmers in Uganda.MethodologyWe used cross-sectional data collected from a total of 1,181 smallholder respondents, sampled through a multi-stage random sampling process resulting in three independent samples from South-western, Central and Northern Uganda. Using logistic regression analysis and pooled data, we study the association between proximity to a FAI and other factors that influence the adoption of soil and water conservation farming practices by smallholder farmers in Uganda.ResultsDescriptive results show that at the aggregate level proximity to a FAI, the education level of the farmer and ownership of information and communication assets (radio and mobile phone) are significantly different between adopter and non-adopters of soil and water conservation farming methods in the research area. The econometric findings of the study suggest that proximity to a foreign agricultural investments (FAI) has weak but significant spillovers on soil and water conservation farming practices of smallholder farmers it their vicinity with possible site specific variations that warrant more in-depth investigation. The effect of proximity to FAI on the adoption of soil and water conservation farming practices is complemented by the education level of the farmer and access to means of communication (radio, and in particular mobile phone set) indicating the importance of information and also broader socio-economic conditions.RecommendationWe recommend policies that enhance increased exposure of smallholder farmers to FAI especially those that help promote rural digital penetration through increased band width, FM radios and affordable data packages.

Long-term retention and positive deviant practices in Uganda’s community client-led antiretroviral distribution groups (CCLADs): a mixed-methods study

BackgroundHIV testing and starting antiretroviral therapy (ART) are pivotal in treating people living with HIV (PLHIV) but sustaining PLHIV on treatment remains challenging. We assessed retention and attrition in community...

Enhancing HIV treatment and support: a qualitative inquiry into client and healthcare provider perspectives on differential service delivery models in Uganda

BackgroundHIV/AIDS continues to be a significant contributor to illness and death, particularly in sub-Saharan Africa. In this study, we conducted a qualitative assessment to understand Client and Healthcare Provider Perspectives on Differential Service Delivery Models in Uganda. The purpose was to establish strengths and weaknesses within the services delivery models, inform policy and decision-making, and to facilitate context specific solutions.MethodsBetween February and April 2023, a qualitative cross-sectional study was utilised to gather insights from a targeted selection of individuals, including People Living with HIV (PLHIV), healthcare workers, HIV focal persons, community retail pharmacists, and various stakeholders. The data collection process included eleven in-depth interviews, nine key informant interviews, and eight focus group discussions carried out across eight districts in Central Uganda. The collected data was analyzed through inductive thematic analysis with the aid of Excel.ResultsThe various Differentiated Service Delivery Models (DSDMs), notably Community-Client-Led Drug Distribution (CCLAD), Community Drug Distribution Point (CDDP), Community Retail Pharmacy Drug Distribution Point (CRPDDP), and the facility-based Facility Based Individual Model (FBIM), were reported to have several positive impacts. These included improved treatment adherence, efficient management of antiretroviral (ARV) supplies, reduced exposure to infectious diseases, enhanced healthcare worker hospitality, minimized travel time for ART refills, stigma reduction, and decreased waiting times. Concern was raised about the lack of improvement in HIV status disclosure, opportunistic infection treatment, adherence to seasonal appointments, and sustainability due to the overreliance of the DSDMs on donor funding, suggesting potential discontinuation without funding. Doubts about health workers’ commitment surfaced. Notably, the CCLAD model displayed self-sustainability, with clients financially supporting group members to collect medicines.ConclusionCommunity-based DSDMs, such as CCLAD and CDDP, improve ART refill convenience, social support, and client experiences. These models reduce travel and waiting times, lowering infection risks. Addressing challenges and enhancing facility-based models is vital. In order to maintain funding after donor funding ends, sustainability measures like cross-subsidization can be used. If well implemented, the DSDMs have the potential to produce better or comparable ART outcomes compared to the FBIM model.

Health-Related Quality of Life Perception Among Older Persons with Non-Communicable Diseases in Primary Healthcare Facilities: A Qualitative Inquiry.

Unveiling 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 of older persons with NCDs on HRQoL in central Uganda. 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. The key themes that emerged from the study include holistic well-being, lifestyle modification, and financial stability. The key component of HRQoL that came out clearly from the study was the physical domain. There is a need to embrace a person-centered approach based on the perceptions of older persons on HRQoL, which has the potential to improve well-being and enhance a healthy aging journey.

From organic farming to agroecology farming, what challenges do organic farmers face in Central Uganda?

Revealed as a production system that does not use synthetic fertilizers or pesticides, organic farming is recognized as ecological production and has been institutionalized in Uganda. Organic production continues to face the challenges of what is considered agroecology farming, which is viewed nowadays as an opportunity for creating new value chains and food systems for agricultural production based on protecting the environment and supplying nutritious and safe foods to society. This paper focuses on agroecology farming indicators to assess organic farming in order to highlight the challenges organic farmers face in implementing agroecology practices. The data collection was carried out in 5 districts in Central Uganda: Wakiso, Masaka, Bukomansimbi, Ssembabule, and Kyotera. A multiple-stage stratified sampling was used to select 310 organic farmers in 5 districts. Various representations and correlation analyses of agroecology indicators have been conducted using descriptive statistics and correlation tests. The findings show that 51.9% of organic farmer respondents have at least three crops produced in the local climate for a long time, and 58.71% of organic farming has medium integration (animal feed is mostly self-produced and grazed, and their manure is used for compost and fertilizer). It highlights that seeds and animal genetics are self-produced, neighbor farms exchange them, and some specifics are purchased at local markets for 51.61% organic farming. The results revealed that 61.61% of organic farms visited had half of the arable soil covered with organic residues. The correlation test revealed that there is a significant positive correlation between diversity animal genetics and crop and livestock integration (r = 0.674, p < 0.01), between harvesting and saving water systems and resilience and adaptability to climate variability (r = 0.546, p < 0.01), and between diversity crops and diversity activities and services (r = 0.523, p < 0.01). Despite the interdependence of organic farming's agroecology practices, most residues and waste are not recycled or reused as organic fertilizer, and organic farmers have limited equipment to harvest and save water for production. This is an opportunity for organic stakeholders to invest in organic residues and waste recycled equipment in order to create a new value chain for organic production by producing organic fertilizers and biopesticides.

Prevalence of alcohol use by gender and HIV status in rural Uganda.

Alcohol use is a major contributor to mortality and morbidity worldwide. Uganda has a high level of alcohol use per capita. Compared to men, women are less likely to consume alcohol globally; however, women who drink have increased risks for co-occurring conditions, including depression, intimate partner violence, and HIV. This study assessed the prevalence of alcohol use and correlates of harmful alcohol use by gender and HIV status in rural Uganda. We used cross-sectional data from a study among women and men aged 15-59 residing in rural, central Uganda and accepting home-based HIV testing (Nov 2017 to Dec 2020). We estimated the prevalence of levels of alcohol use (categorized as no alcohol use (score 0), low (score 1-3 for men; 1-2 for women), medium (score 4-5 for men; 3-5 for women), high (score 6-7), and very-high (score 8-12) use with the AUDIT-C), stratified by gender and HIV status. We assessed correlates of harmful alcohol use using multivariable logistic regression models for women and men. Among 18,460 participants, 67% (95% CI: 66-67%) reported no alcohol use, 16% (95% CI: 16-17%) reported low, 5% (95% CI: 4.8-5%) reported medium, 5% (95% CI: 4-5%) reported high, and 3% (95% CI: 2.8-3) reported very high alcohol use. Compared to women, men were more likely to report alcohol use (Chi-squared p-value<0.0001). People diagnosed with HIV (both newly diagnosed and previously aware of their status prior to home-based HIV testing) were more likely to report low, medium, high, and very high alcohol use compared to those who were HIV negative (Chi-squared p-value<0.0001). Among women, those who were newly diagnosed were more likely report alcohol use, compared to those who were HIV negative. In multivariable models, being newly diagnosed with HIV (compared to HIV negative) increased the odds of harmful alcohol use among women, but not men. While alcohol use was higher among men and people living with HIV, being newly diagnosed with HIV had a stronger relationship with harmful alcohol use among women than men. More research is needed to understand how alcohol use may increase the risks of HIV acquisition among women and to identify gender-responsive services to address harmful alcohol use and increase access to HIV testing and linkage to care for women who use harmful levels of alcohol.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BackgroundEffective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.MethodsWe installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).ResultsChlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.ConclusionThe STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

Learning methods and entrepreneurial effectiveness of women-owned agri-small and medium enterprises: the mediating effect of entrepreneurial knowledge

PurposeThe purpose of this study is to establish the mediating effect of entrepreneurial knowledge in the relationship between learning methods and entrepreneurial effectiveness of women-owned agricultural small and medium enterprises (SMEs) in Uganda.Design/methodology/approachThis study is cross-sectional and correlational in nature and used a quantitative approach. A self-administered questionnaire was used to gather data from 380 women-owned agri-SMEs in Central Uganda. Statistical Package for the Social Sciences (SPSS.25) and Medgraph (Excel Version) were used to support data analysis.FindingsStudy findings revealed that learning methods and entrepreneurial knowledge are significant predictors of entrepreneurial effectiveness. In addition, entrepreneurial knowledge significantly mediates the association between learning methods and entrepreneurial effectiveness of women-owned agricultural SMEs in Uganda.Originality/valueThe study confirmed that entrepreneurial knowledge significantly mediates the relationship between learning methods and entrepreneurial effectiveness of women-owned agricultural SMEs, unlike previous studies that focused on the direct relationship between the study variables in predicting the study phenomenon.

Prediction of precancerous cervical cancer lesions among women living with HIV on antiretroviral therapy in Uganda: a comparison of supervised machine learning algorithms

BackgroundCervical cancer (CC) is among the most prevalent cancer types among women with the highest prevalence in low- and middle-income countries (LMICs). It is a curable disease if detected early. Machine learning (ML) techniques can aid in early detection and prediction thus reducing screening and treatment costs. This study focused on women living with HIV (WLHIV) in Uganda. Its aim was to identify the best predictors of CC and the supervised ML model that best predicts CC among WLHIV.MethodsSecondary data that included 3025 women from three health facilities in central Uganda was used. A multivariate binary logistic regression and recursive feature elimination with random forest (RFERF) were used to identify the best predictors. Five models; logistic regression (LR), random forest (RF), K-Nearest neighbor (KNN), support vector machine (SVM), and multi-layer perceptron (MLP) were applied to identify the out-performer. The confusion matrix and the area under the receiver operating characteristic curve (AUC/ROC) were used to evaluate the models.ResultsThe results revealed that duration on antiretroviral therapy (ART), WHO clinical stage, TPT status, Viral load status, and family planning were commonly selected by the two techniques and thus highly significant in CC prediction. The RF from the RFERF-selected features outperformed other models with the highest scores of 90% accuracy and 0.901 AUC.ConclusionEarly identification of CC and knowledge of the risk factors could help control the disease. The RF outperformed other models applied regardless of the selection technique used. Future research can be expanded to include ART-naïve women in predicting CC.

Understanding the nexus between traditional brick-making, biophysical and socio-economic environment of Goma Division, Mukono Municipality, Central Uganda

This study aimed to evaluate the environmental and socio-economic impact of traditional brick-making in Goma Division. The research methods included semi-structured questionnaires, key informant interviews, field observation, and focused group discussions. The results indicated that traditional brick-making is causing harm to the biophysical environment in the form of the degradation of wetland vegetation and deforestation (100%), landscape deformation (85%), air and water pollution, whereby DO had reduced by 19.8%, BOD, pH, TSS, TDS, EC and turbidity had increased by 3.8±0.9 ppm, 1.2±0.1, 89.4±0.1 mg/L, 18±0.9 ppm, 70±0.7 µS/cm, and 264±44 NTUs, respectively. Water pollution loads varied from point to point of sampling significantly at p&lt;0.05, with the highest loads found at the tail end or downstream of the site but lowest at a point upstream of the clay mining site. The socio-economic analysis showed that the benefits of brick-making outweigh the costs in terms of magnitude, except for the frequency of responses. All respondents indicated that brick-making had created employment, while 87% reported an improvement in their standard of living. However, the activity is associated with accidents that can result in loss of life or bodily injury. It was concluded that Mukono Municipal Environmental Officers should monitor brick-making mines and site activities to prevent the creation of open pits and caves. The environment should be treated as a borrowed asset to ensure sustainability. The study suggests that financial support and awareness should be available to clay miners and brickmakers to ensure sustainability.

Hepatitis B Knowledge, Risk Perception, Behavioral Skills, and Infection Burden among Students and Staff at Victoria University, Kampala, Uganda

Background: The global efforts concertedly endorsed towards eliminating viral hepatitis as a public health challenge necessitate the provision of adequate and pertinent information related to hepatitis B virus (HBV) infectivity, which will help in tackling the lingering chronicity of HBV infection in developing countries. This study aimed to assess the burden of HBV infection and the underlying predictors of HBV infection risk among students and staff of Victoria University, Uganda. Methods: We captured data from 164 conveniently selected participants. Surface antigen for HBV (HBsAg) was detected using rapid tests. Analysis of variance (ANOVA), regression analysis, and chi- square tests were performed to ascertain the study hypotheses at a cut-off of (p&lt;0.05). Results: The respondents’ mean age was 24.25 ± 25.64 years. Relatively half (56.1%) were males. Students (85.4%) were predominant. Regarding the burden of hepatitis B virus infection, HBsAg prevalence was 4.3%, observed among unmarried, first-year students, and residents of Central Uganda. Students’ year of study (χ2 = 10.323, p =&lt;0.035) was significantly associated with HBsAg status. Furthermore, the respondents obtained mean scores of 3.45±4.10, 3.71±4.44, and 10.90±11.80 for knowledge, risk perception, and behavioral skills, respectively. Similarly, inadequate HBV-specific knowledge (F = 13.85, p&lt;0.001), low risk perception (F = 13.22, p&lt;0.001), and bad behavioral skills (F = 64.05, p&lt;0.001) all predicted the risk of HBV infection. Conclusion: The findings affirm the lingering high endemicity of HBV infection in Uganda and imply an immediate need for targeted university-based hepatitis-B-related education and relevant vaccination policies such as mass vaccination in academic institutions to prevent HBV infection effectively in Uganda.

Assessing the determinants of saving behaviour: evidence from rural farming households in Central Uganda

Savings play a significant role in any country’s economic development. Notably, because farmers tend to have seasonal income from their farming activities, they also tend to be highly vulnerable to poor saving habbit than other occupations, such as those in formal jobs. However, farmers who save part of their income for subsequent production can purchase farm inputs in time as they wait for the onset of rain. Reportedly, there has been poor saving behavior among farmers in sub-Saharan Africa. Therefore, this study aims to determine the factors responsible for farmers’ saving behavior. Descriptive and econometric (binary logistic model) analyses were employed to achieve the objectives of the study. The results indicate that the majority of farmers saved on a monthly and weekly basis. The results of the binary logistic regression model analysis showed that age, marital status, gender, experience, group membership, distance to the markets and markets, farm income, and farmers’ sub-counties of residence had a significant influence on farmers’ saving behavior. From the results, policy measures to increase the rate of savings include the employment of more extension personnel to reach as many farmers as possible. Government and extension agents should target female and less experienced farmers through adult-based education programs because they are vulnerable to poor saving behavior. Farmers should join farmer—based groups and cooperative societies, in which saving information is disseminated. The government, non-governmental organizations and financial institutions should offer financial literacy training on savings to smallholder farmers.

Understanding maternal Ethnomedical Folklore in Central Uganda: a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uterine contractions and abortion in Najjembe sub-county, Buikwe district

Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion.MethodsA cross-sectional ethnobotanical survey was conducted from May – December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software.ResultsAll respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%).ConclusionHealth surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother’s and the unborn child’s lives. Due to Uganda’s high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.

The Mediating Effect of Managerial Competencies in the Relationship between Corporate Governance and Financial Performance of Companies in Uganda: A Multi-Theoretic Approach

Purpose: The dwindling financial performance of companies has attracted enormous attention globally for many years, and corporate governance remains a matter of public and academic debate. This study aimed to establish the mediating role of managerial competencies in the relationship between corporate governance and the financial performance of companies in Uganda. Materials and Methods: The study applied a positivist paradigm and a cross-sectional design. Data were obtained from a sample of 394 private companies drawn from central and western Uganda. Companies were stratified by region, sectors, and subsectors; and then selected using simple random sampling from each stratum. A structured questionnaire was distributed to board members, Chief Executive Officers, accountants, Internal Auditors, and managers who were selected purposively. Principle Component Analysis and varimax rotation were employed for data extraction and reduction. The hierarchical regression technique was employed for data analysis. Findings: The study results confirmed managerial competencies to be a partial mediator, of the relationship between corporate governance and financial performance of companies in Uganda. Implications to Theory, Practice and Policy: Building on a multi-theoretical approach, the study advocates for the revision of corporate governance and recommends private companies prioritize managerial competencies in their recruitment processes and training programs to enhance their financial performance.

Self-testing knowledge and beliefs on HIV self-testing use in central Uganda.

The government of Uganda and its implementing partners have made significant investments in HIV self-testing (HST) services to reduce clinic-related barriers to HIV testing. However, although HSTs have been around for a reasonable time, their uptake, especially among unskilled working individuals, has remained suboptimal, which threatens the efforts to achieve the 95-95-95 UNAIDS goals to end HIV by 2030. This study set out to examine whether knowledge and individual beliefs about self-testing influence the use of HIV self-tests among causal workers in Kampala. This cross-sectional study was conducted among 453 participants selected via systematic random sampling from Darling Uganda Ltd. in Wakiso district between July and September 2023. Standardized questionnaires were used, and the analysis was performed using Pearson Correlations and Linear Regression in SPSS. The findings indicate that HIV self-testing (HST) knowledge was positively related to HST use (r = .387, p≤.01), perceived susceptibility (r = .212, p≤.01), perceived benefits (r = .152, p≤.01), and perceived barriers (r = .101, p≤.05). Individual beliefs, that is, perceived susceptibility (r = .355, p≤.01), perceived benefits (r = .487, p≤.01), and perceived barriers (r = .148, p≤.01), were significantly related to HST use. Perceived benefits were the best predictor of HST use among this population (β = .442, p = .000). Therefore, (44.2%) of HST use was attributed to the benefits attached to the service. Therefore, increasing awareness regarding the benefits of HST among such populations increases the chances of HIV testing, particularly among men. This can pave the way for the 95-95-95 goal by 2030 of UNAIDS.

Prevalence of pulmonary tuberculosis among casual labourers working in selected road construction sites in central Uganda

Prevalence of pulmonary tuberculosis among casual labourers working in selected road construction sites in central Uganda

Collaborative international partnership: Enabling the development of a state-of-the-art minimally invasive surgical center in rural Uganda through telementoring.

Access to minimally invasive surgery (MIS) is limited in Sub-Saharan African countries. In 2019, the Mount Sinai Department of Surgery in New York collaborated with local Ugandans to construct the Kyabirwa Surgical Center (KSC), an independent, replicable, self-sustaining ambulatory surgical center in Uganda. We developed a focused MIS training program using a combination of in-person training and supervised telementoring. We present the results of our initial MIS telementoring experience. We worked jointly with Ugandan staff to construct the KSC in the rural province of Jinja. A solar-powered backup battery system ensured continuous power availability. Underground fiber optic cables were installed to provide stable high-speed Internet. The local Ugandan general surgeon (JOD) underwent a mini-fellowship in MIS and then trained extensively using the Fundamentals of Laparoscopic Surgery program. After a weeklong in-person session to train the Ugandan OR team, JOD performed laparoscopic cases with telementoring, which was conducted remotely by surgeons in New York via audiovisual feeds from the KSC OR. From October 2021 to February 2024, JOD performed 61 telementored laparoscopic operations at KSC including 37 appendectomies and 24 cholecystectomies. Feedback was provided regarding patient positioning, port placement, surgical technique, instrument use, and critical steps of the operation. There were no intra-operative complications. Postoperatively, field medical workers visited patients at home to collect follow-up information. Two superficial wound infections (3.3%) were reported in the short-term follow-up. Telementoring can be safely implemented to assist surgeons in previously underserved areas to provide advanced laparoscopic surgical care to the local patient population.

Structural and social factors affecting COVID-19 vaccine uptake among healthcare workers and older people in Uganda: A qualitative analysis.

The COVID-19 vaccine rollout programme in Uganda was launched in March 2021 for priority groups: Healthcare Workers (HCWs), older persons (≥50 years), and persons with chronic conditions. Misinformation, distrust in healthcare systems, and cultural beliefs, pose significant challenges to vaccine uptake. We describe the social and structural factors affecting the uptake of COVID-19 vaccines among HCWs and older people in Uganda. Between September and October 2021, we conducted 33 in-depth interviews with 25 HCWs aged 21-63 years from three hospitals in central Uganda and eight older people from Wakiso district. Participant selection was purposive, based on sex, occupation, education, cadre of HCWs and vaccination status. We explored participants' knowledge, beliefs, personal experiences, barriers, and facilitators to vaccine uptake as well as suggestions for future COVID-19 vaccine rollout. Interviews were audio-recorded, transcribed and translated into English, coded, and analysed by theme. Twenty-two of the 25 (88%) HCWs and 3 of the 8 (38%) older people had received at least one dose of the COVID-19 vaccine at the time of interview. The structural facilitating factors to vaccine uptake included access to correct information, fear of a risky work environment, and mandatory vaccination requirements especially for frontline HCWs. Age, chronic health conditions, and the fear of death were facilitating factors for older people. Misconceptions about COVID-19 vaccines and fear of side effects were common social barriers for both groups. Long distances to vaccination centres, vaccine stock-outs, and long queues at the vaccination centres were specific barriers for older people. The prerequisite of signing a consent form was a specific structural barrier for HCWs. Future roll out of new vaccines should have a comprehensive information dissemination strategy about the vaccines. Improved access to vaccines through community outreach, reliable vaccine supplies and addressing vaccine misinformation, may enhance COVID-19 vaccine uptake.

Regional divergent evolution of vegetation greenness and climatic drivers in the Sahel-Sudan-Guinea region: nonlinearity and explainable machine learning

IntroductionThe vegetation dynamics of the Sahel-Sudan-Guinea region in Africa, one of the largest transition zones between arid and humid zones, is of great significance for understanding regional ecosystem changes. However, a time-unvarying trend based on linear assumption challenges the overall understanding of vegetation greenness evolution and of tracking a complex ecosystem response to climate in the Sahel-Sudan-Guinea region.MethodsThis study first applied the ensemble empirical mode decomposition (EEMD) method to detect the time-varying trends in vegetation greenness based on normalized difference vegetation index (NDVI) data in the region during 2001–2020, and then identified the dominant climatic drivers of NDVI trends by employing explainable machine learning framework.ResultsThe study revealed an overall vegetation greening but a significant nonlinear spatio-temporal evolution characteristic over the region. Trend reversals, i.e., browning-to-greening and greening-to-browning, were dominant in approximately 60% of the study area. The browning-to-greening reversal was primarily observed in the southern Sahel, Congo Basin north of the Equator, and East Africa, with a breakpoint around 2008, while the greening-to-browning reversal was mainly observed in West Africa, with a breakpoint around 2011. The sustained greening primarily took place in northern Sahel, Central African Republic and South Sudan; while sustained browning clustered in central West Africa and Uganda, mainly in agricultural lands. Furthermore, the combination of Random Forest (RF) algorithm and the SHapley Additive exPlanations (SHAP) method could robustly model and reveal the relationships between the observed trends in NDVI and in climatic variables, also detected by applying EEMD. The results suggested that air temperature and precipitation were the most important climatic drivers controlling the NDVI trends across the Sahel-Sudan-Guinea region. The NDVI trends were more likely to have negative correlations with solar radiation and vapor pressure deficit in arid areas, while they could have positive correlations in humid areas. The study also found that large-scale climate changes induced by sea surface temperature (SST) anomalies had strong relationships with trend reversals in vegetation greenness at a sub-continental scale. These findings advanced the understanding of the impacts of climatic drivers on vegetation greenness evolution in the Sahel-Sudan-Guinea region.