Ugandan Population Research Articles

A History of the Ndrukpa (Lendu): The Invisible Ethnic Minority Community in Uganda

This paper documents the history of the Ndrukpa (Lendu) people; an invisible ethnic minority community in the West Nile region of Uganda. Ndrukpa is an indigenous ethnic community and the first inhabitants of the West Nile and parts of the Acholi subregion. The Ndrukpa – often known as the Lendu - belong to the Sudanic ethnic groups of Uganda and are one of the country's marginalised groups. Ndrukpa population in Uganda is approximately 18,000, and the global population stands at 1,411,000 people, with the majority living in the Democratic Republic of the Congo (DRC). The central thesis of this paper is that contemporary social exclusion of ethnic minority communities such as the Ndrukpa is a historical manipulation and a colonial legacy often tracing their roots to the colonial divide and rule structure. These structures continue to be evoked and used by contemporary ethnic and political stakeholders to their advantage. Social exclusion is often aggravated as in the case of the Ndrukpa people, when their history remains undocumented. Documenting the history of a socially excluded ethnic minority community can be used as a tool and strategy to end social exclusion

Insights into large carnivore populations in Uganda: A participatory survey of lions, leopards, and hyenas using spatial capture-recapture

Monitoring wildlife populations at scale is fraught with logistical and resource constraints. Despite this, estimating wildlife population state variables and vital rates remains crucial for science, and to assess conservation investment and effort. The veracity and transparency of results also helps prevent politicization of wildlife populations. In Uganda, robust estimates of carnivore population size are rare in the literature. To overcome a near two-decade long data gap we initiated a survey of African lions, leopards, and spotted hyenas with the Uganda Wildlife Authority across six important protected areas. Surveys were conducted within a spatial capture-recapture framework, the industry gold-standard for monitoring carnivore populations. For lions, we used unstructured spatial sampling protocols (in the form of vehicle-based searches), while for leopards, and spotted hyenas we deployed camera traps. Our protocols were designed to obtain unambiguous individual identification photographs. This large-scale effort involved data collection by >100 local conservation stakeholders (including lodge guides, trophy hunters, university students, and government rangers). Locally extinct in three areas, we show lion numbers are precariously low in two of three sites where they still occur (Queen Elizabeth abundance=39.72, Posterior standard deviation (PSD)=7.96; Kidepo Valley abundance=22.23, PSD=11.67). Murchison Falls was identified as Uganda’s lion stronghold with an estimate of ∼240 individuals (PSD=34) and average park-wide densities of 7.43 individuals/100 km2 (PSD=1.05). Leopard densities were highest in Lake Mburo and Murchison Falls. In Murchison they reach some of the highest densities in Africa (14.06 individuals/100 km2, PSD=2.65). Spotted hyena densities were high compared to lions (range=6.15–45.31 individuals/100 km2), except in Lake Mburo where densities were markedly lower (park abundance=23 individuals in 370 km2, PSD=5.26). Our work has critical policy implications, and forms the foundation of the new Strategic Action Plan for Large Carnivore Conservation in Uganda (2023–2033). It also illustrates how cutting-edge, transparent and collaborative science, implemented by multiple wildlife conservation stakeholders can help gauge the conservation status of their wildlife resources.

A cross-sectional geospatial analysis of access to cesarean delivery in Uganda by facility functionality

Introduction: There is minimal data on spatial access to surgical maternal care in Uganda. We aimed to determine geospatial access to facilities performing cesarean delivery in Uganda at differing facility functional levels. Methods: We defined three levels of facility functionality: level 1 – functional by designation, i.e., health system level; level 2 – performed at least one cesarean delivery in the past year; and level 3 – performed at least 20 cesarean deliveries in the past year. We mapped facilities in ArcGIS Pro using GPS coordinates, calculated Manhattan distances, and using transportation network data, identified the area indicating 30-minute, 1-hour, and 2-hour geographic walking and driving access to facilities. The population estimate raster was overlain with drive time analysis areas to calculate the total population catchment within each travel time. Results: Of 6937 total facilities, 339 (4.9%) met level 1 functionality, 287 (4.1%) met level 2 functionality, and 241 (3.5%) met level 3 functionality. The percentages of women within 30-minute, 1-hour, and 2-hour walking times from level 1 facilities were 9.7%, 19.8%, and 34.8%, respectively. These percentages decreased to 9.2%, 19%, and 33% for level 2 functionality and 8.1%, 17.4%, and 30.5% for level 3 functionality, respectively. Access varied regionally, with the poorest access in the Northern region (20% within 2 hours walking) compared to the Central region (55.2% within 2 hours walking). Conclusion: We demonstrate a substantial proportion of the Ugandan population does not have timely access to cesarean delivery, with substantial subnational variation. This inequity in access to surgical obstetric care is vital information that can assist policymakers in achieving universal maternal health access.

High-risk human papillomavirus testing for cervical cancer screening in Uganda: Considering potential harms and benefits in a low-resource setting.

The World Health Organization supports both the screen-and-treat (ST) approach and the screen, triage and treat (STT) approach to cervical cancer screening using high-risk human papillomavirus (hrHPV) testing. For Uganda, the sequence of hrHPV-ST and hrHPV-STT could be similar, with visual inspection with acetic acid (VIA) after positive hrHPV tests in both. To consider potential tradeoffs (overtreatment in ST versus missed cancer cases in STT), we compared hrHPV-STT with VIA triage (STT-VIA), and STT with HPV 16/18 genotyping risk stratification, to hrHPV-ST for Uganda, in terms of overtreatment, cervical cancer incidence, and life years, for the general female population of Uganda. A microsimulation model of cervical cancer was adapted. Incremental benefit-harm ratios of STT were calculated as ratios of prevented overtreatment to reduced life years, and to increased cancer cases. Additional scenarios with 20% difference in intra- and inter-screening follow-up between ST and STT were modeled. Both STT strategies resulted in life year losses on average compared to ST. STT-VIA prevented more overtreatment but led to increased cervical cancer incidence and life year losses. STT-G-VIA resulted in better harm-benefit ratios and additional costs. With better follow-up, STT prevented overtreatment and improved outcomes. For Uganda, the STT approach appears preferrable, if the screening sequences of hrHPV-based ST and STT are similar in practice. While VIA triage alone would reduce overtreatment the most, it could also result in more cancer cases. Risk stratification via genotyping could improve STT. Potential follow-up differences and resource availability should be considered by decision-makers when planning Uganda's hrHPV-based screening strategy.

Navigating HIV research among criminalized gender minority populations in Uganda: qualitative insights and lessons learned from novice researchers

BackgroundTransgender individuals often face stigma, discrimination, and various forms of abuse, which negatively impact their mental and physical health. They face a significantly greater risk of HIV, with a higher prevalence than the general population. Despite these challenges, transgender people have limited access to healthcare due to violence, legal barriers, and societal stigma, further exacerbated in countries like Uganda, where transgender identities are criminalized. Therefore, this study explored the lived experiences of HIV researchers working with gender minority populations in criminalizing contexts.MethodsThis was an interpretative phenomenological analysis (IPA) qualitative study. Twelve (12) research team members at all levels were involved in the study. Participants had less than five years of involvement in HIV research among gender minority populations. Data were collected using field notes, reflective journals, documentation from daily team debriefing sessions, and semi-structured interviews. The analysis used NVivo software.ResultsPositive experiences, barriers, and challenges were captured. The positive experiences were ‘respecting cultural diversity’, ‘expanding networks’, ‘addressing misconceptions’ and ‘finding allies’. The barriers included ‘experiencing stigma’, ‘lengthy research processes’, ‘feeling isolated’, ‘fearing for personal safety’, ‘unexpected logistical costs’, and ‘criminalization of sexual and gender minorities’. The key themes that emerged from the lessons learned were: ‘dealing with gatekeepers’, ‘diversity and sensitivity training’, ‘leveraging networks’, ’meaningful community engagement’, ‘reflexivity’, ‘ensuring safety’, ‘equal partnership’, ‘giving feedback’ and ‘awareness of legal implications’.ConclusionsThis study highlights the importance of cultural sensitivity, community engagement, and reflexivity in research design and implementation. The findings emphasize the need for innovative strategies to navigate legal, social, and logistical barriers that researchers and participants face. Despite these challenges, the study demonstrates that meaningful collaboration with community members and building trust can significantly enhance the research process and outcomes. Future research should continue to explore these strategies while addressing ethical and safety concerns.

Nested case control study of prevalence and aetiology of dementia in a rural Ugandan population, and a situational analysis of services available for affected families: a protocol. Part of the DEPEND Uganda study (Dementia EPidemiology, unmet Need and co-Developing Solutions).

The prevalence of dementia in low- and middle-income countries is increasing, yet epidemiological data from African populations remain scarce. Crucial risk factors differ in Africa from more intensively studied global areas, including a high burden of cerebrovascular disease and HIV, but lower rates of other risk factors like physical inactivity.Understanding dementia aetiology in African settings has been limited by the expensive and invasive nature of biomarker testing. This study leverages developments in blood-based and retinal imaging biomarker technology to examine the drivers of dementia in older Ugandans.People with dementia have complex needs benefiting from multi-dimensional support. Understanding current services will allow identification of barriers and opportunities to strengthen support available to people with dementia and their families. The study is nested within the existing General Population Cohort run by the MRC/UVRI & LSHTM Research Unit. Currently, all adults aged 60+ (around 1400) are undergoing brief cognitive screening.In Part 1, cohort participants will be selected based on cognitive screening scores to undergo detailed cognitive assessment, using methods developed by the 10/66 Dementia Research Group. Part 2 is a case control study of people with and without dementia using antecedent data, questionnaires, physical assessment, retinal imaging, and Alzheimer's blood-based biomarkers. We will also compare disability, frailty, quality of life, and social engagement in people with and without dementia.Part 3 assesses current provision of formal support for people with dementia through review of publicly available literature and expert interviews. This is the first study in Africa using blood-based and retinal imaging biomarkers to examine the pathological processes underlying dementia, and it will systematically map services available for people with dementia. This paves the way for effective policy strategies for both dementia prevention and support for people with dementia and their families.

Minimal computing in refugee education in Uganda: economies of digital use and non-use, and the right constraints

ABSTRACT Using the Foundations for All (FFA) project as a frame for broader discussions of minimal computing, this paper expores education for displaced populations in Uganda and the role technology has in that education. FFA (2018–2022) was a collaboration designed to develop and implement a blended bridging programme for refugee students to participate in universities in Uganda. This paper explores the role that digital technologies had to play in this project in imagining educational futures predicated on minimalism and the judicious use and non-use of technology. When used, the emphasis on available technology was dominant, as was a pedagogical emphasis on psychosocial support and social justice. Technology seen in this approach is best imagined as facilitating opportunities for contact and care, rather than as the driver of the educational enterprise. Such an approach runs counter to many of the discourses around digital development.

The scale, forms and distribution of volunteering amongst refugee youth populations in Uganda

AbstractGeographies of volunteering have examined the relationships between people, places and forms of voluntary action, but there has been limited geographical scholarship on the scales, forms and distribution of volunteering amongst specific populations in different settings, particularly in the global South. While in the global North there are some established quantitative data sets, often produced by humanitarian and development organisations, these are largely absent in the South. Where they do exist, they often reflect Western‐centric ideas and concepts, meaning that volunteering behaviours that do not fit Western norms—such as amongst young refugees in the global South—can be excluded, or captured in ways that are partial or unrepresentative. This paper provides an important challenge to existing geographies of volunteering, expanding them through an account of volunteering amongst young refugees in Uganda, and how it articulates with social inequalities within and between the spaces and places where young refugees live. We analyse quantitative data from 3053 young refugees surveyed on their volunteering experiences in rural and urban settings in Uganda. The data provides new evidence of who these volunteers are, beyond their refugee status, why, where and how they conduct their activities, and reveals how these are connected to livelihoods and community development. Through this survey analysis, the paper argues for the need to establish grounded conceptualisations of volunteering that consider the scales, distribution, and various forms of volunteering within specific groups. In doing so, the paper offers a new framework for better understanding the relationships between volunteering and refugee lives through four interlocking factors: place, (im)mobility, income and gender. The paper concludes by discussing the implications of these findings for wider geographies of volunteering and research on refugee youth and displaced populations.

The Impact of HIV/AIDS on Vulnerable Populations in Uganda

HIV/AIDS remained a critical public health crisis in Uganda, significantly impacting vulnerable populations including women, children, adolescents, and marginalized communities such as sex workers, men who have sex with men (MSM), and people who inject drugs (PWID). Despite progress in reducing HIV prevalence and improving treatment access, these groups faced unique challenges exacerbating their susceptibility to HIV and complicating disease management. Women were burdened by gender inequalities, economic dependency, and care-giving responsibilities, leading to adverse health and economic impacts. Children and adolescents, particularly orphans, struggled with health complications, educational interruptions, and psychosocial issues. Key populations experience heightened vulnerabilities due to legal, social, and economic factors that limited their access to prevention and treatment services. Current strategies, including prevention programs, expanded access to treatment, and support services, are crucial but face challenges such as service access barriers, socio-economic issues, and cultural norms. This review utilized a comprehensive analysis of existing literature and programmatic reports to assess the impact of HIV/AIDS on these populations and evaluated the effectiveness of current interventions. Addressing the epidemic’s impact on Uganda’s vulnerable populations required targeted strategies, investment in services, and efforts to reduce stigma and discrimination, with a focus on equitable and comprehensive care. Keywords: HIV/AIDS Impact, Vulnerable Populations, Gender Inequality, Marginalized Communities, HIV Prevention and Treatment.

Incidence of Acute Kidney Injury and Associated Mortality among Individuals with Drug-Susceptible Tuberculosis in Uganda.

Although tuberculosis (TB) is associated with significant mortality and morbidity, its impact on kidney function is not well understood and is often attributed to anti-TB drugs. We aimed to assess the incidence of acute kidney injury (AKI) in the immediate post-TB diagnosis period in Uganda, a TB/HIV-endemic country in sub-Saharan Africa. We included patients enrolled in an observational cohort study of adults diagnosed with drug-susceptible TB followed longitudinally. Adults (≥ 18years) without known kidney disease were enrolled between 8/2022-7/2023 at three regional hospitals serving 12.5% of the Ugandan population. Our primary outcome was incidence of KDIGO-defined AKI within two weeks of TB diagnosis. Other outcomes included predictors of AKI and its association with 30-day survival. A total of 156 adults were included. The median (IQR) age was 39 (28-53) years, most were male (68.6%) and 49.4% had HIV. People with HIV had shorter time to TB diagnosis from symptom onset (21[7-30] days) compared to HIV-negative participants (60[23-90] days), p<0.001. The incidence of AKI was 33.3% (52/156), and was similar between people with and without HIV. Proteinuria or hematuria at enrollment was associated with higher odds of AKI (OR-2.68, 95%CI 1.09-6.70, p∼0.033). AKI was associated with significant risk of mortality (aHR-8.22, 95% CI, 1.94-34.72, p ∼0.004) independent of HIV status. The overall incidence of AKI in the immediate post-TB diagnosis period is high and associated with increased mortality risk. Our findings suggest monitoring kidney function should be routine for patients with TB, including prior to treatment initiation.

Willingness to Use Long-acting Injectable Pre-exposure Prophylaxis Among Key Populations at a Large Hiv Prevention Clinic in Kampala, Uganda: a Cross-sectional Study.

Long-acting injectable (LAI)-PrEP provides better protection against HIV compared to oral PrEP, which requires taking a daily pill. Our study aimed to assess knowledge about oral and LAI-PrEP and identify factors associated with willingness to use LAI-PrEP among key populations (KP) in Uganda. We conducted a cross-sectional study at the Most at Risk Populations Initiative (MARPI) clinic between November and December 2021. Participants were recruited through convenience sampling and interviewed using a structured questionnaire by trained interviewers. Participants were categorised into three groups based on their oral PrEP use: those who had not yet initiated PrEP, those who had discontinued oral PrEP, and those currently on oral PrEP. Modified Poisson regression analysis was performed to determine factors associated with the participant's willingness to use LAI-PrEP. Data was analysed using STATA 14 software. Of the 234 participants, 135 (56.7%) were female, 82.5% knew about LAI-PrEP, and 67.5% were willing to use it. The mean age was 28.7 years (standard deviation [SD] 5.8). Willingness to use LAI-PrEP was less likely among divorced, widowed, or separated individuals than those in relationships (adjusted prevalence ratio [aPR] 0.65, 95% CI: 0.43-0.98). Relative to current oral PrEP users, willingness to use LAI-PrEP was similar among those who discontinued oral PrEP (aPR 1.39, 95% CI: 0.92-2.11) and those who had not yet initiated PrEP but were at risk for HIV (aPR 1.26, 95% CI: 0.83-1.89). In this cross-sectional analysis of diverse members of key populations in Uganda, previous or non-use of oral PrEP was not associated with willingness to use LAI-PrEP relative to current users. Future studies should investigate effective methods for promoting the uptake of long-acting PrEP formulations among populations at high risk of HIV acquisition.

The feasibility, appropriateness, and usability of mobile neuro clinics in addressing the neurosurgical and neurological demand in Uganda.

Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations. Neurosurgery, neurology, and mobile health clinic providers participated in an education and interview session to assess the feasibility, appropriateness, and usability of the MNC intervention. A qualitative analysis of the interview responses using the constructs in the updated Consolidated Framework for Implementation Research was performed. Providers' opinions were weighted using average sentiment scores on a novel sentiment-weighted scale adapted from the CFIR. A stakeholder analysis was also performed to assess the power and interest of the actors described by the participants. Twenty-one healthcare providers completed the study. Participants discussed the potential benefits and concerns of MNCs as well as potential barriers and critical incidents that could jeopardize the intervention. Of the five CFIR domains evaluated, variables in the implementation process domain showed the highest average sentiment scores, followed by the implementation climate constructs, inner setting, innovation, and outer setting domains. Furthermore, many interested stakeholders were identified with diverse roles and responsibilities for implementing MNCs. These findings demonstrate that MNC innovation is feasible, appropriate, and usable. The findings of this study support the feasibility, appropriateness, and usability of MNCs in Uganda. However, integration of this innovation requires careful planning and stakeholder engagement at all levels to ensure the best possible outcomes.

Dietary risk factors for colorectal cancer in Uganda: a case-control study

IntroductionLow-income countries in East Africa have a lower incidence of colorectal cancer (CRC) than high-income countries; however, the incidence has steadily increased in the last few decades. In Uganda, the extent to which genetic and environmental factors, particularly dietary factors, contribute to the aetiology of CRC is unclear. Therefore, the objective of our study was to determine the relationship between dietary factors and CRC in Uganda.MethodsWe conducted a case-control study and recruited 128 cases and 256 controls, matched for age (± 5 years) and sex. Data regarding the frequency of consumption of the dietary factors were obtained from all the participants using an interview-based questionnaire. The potential dietary risk factors and protective factors evaluated included the type and frequency of meat consumed and the type and frequency of high-fibre foods consumed. The frequency was either 4 or more times/week, 2–3 times/week, once/week or never. Conditional logistic regression analyses were used to determine the odds ratios associated with the different risk and protective factors.ResultsThe median age (IQR) for the case participants was 55.5 (43-67.5) years, and that of the control participants was 54 (42–65) years. The male-to-female ratio was 1:1 for all the participants. Factors significantly associated with CRC cases included:- the consumption of boiled beef 2–3 times/week (aOR:3.24; 95% CI: 1.08–9.69; p < 0.035). Consumption of high-fibre foods, including:- millet for ≥ 4 times/week (aOR: 0.23; 95% CI: 0.09–0.62; p = 0.003)), spinach for ≥ 4 times/week (aOR:0.32; 95% CI: 0.11–0.97; p = 0.043), and potatoes 2–3 times/week (aOR: 0.30; 95% CI: 0.09–0.97; p = 0.044), were protective against CRC. Boiled cassava showed a tendency to reduce the likelihood of CRC when consumed ≥ 4 times/week (aOR:0.38; 95% CI: 0.12–1.18) however this did not reach statistical significance (p = 0.093).ConclusionsThe consumption of boiled beef increases the risk of CRC, while the intake of high-fibre foods may reduce the risk of CRC among Ugandans. We recommend nutritional educational programmes to increase public awareness regarding the protective role of a high-fibre diet and to limit the intake of cooked meat in our Ugandan population.

Exploring lived experiences on the usage of removable complete dentures among edentulous patients attending Makerere University Dental Hospital, Kampala, Uganda

BackgroundEdentulism remains a major disability worldwide, especially among the elderly population, although the prevalence of complete edentulism has declined over the last decades. In Uganda, the prevalence of edentulism in people aged 20 years and above is 1.8%. The therapy for edentulous patients can be realized through the use of conventional removable complete dentures, implant-supported prostheses, and computer-aided design and computer-aided manufacturing (CADCAM), however, the provision of removable complete dentures continues to be the predominant rehabilitation for edentulous patients. However, no published study has explored the lived experiences with removable complete dentures among the Ugandan population. The aim of the present study was to explore patients’ lived experiences on the usage of removable complete dentures among Ugandan edentulous patients attending Makerere University Dental Hospital.MethodsThis was a qualitative study approach using purposive sampling. Fifteen (15) respondents were selected across social demographics. Interviews were recorded and transcribed and themes were generated to draw a deeper meaning to the usage of removable complete dentures. A qualitative statistical package, Atlas Ti software was used to generate themes from the interviews followed by an interpretation of the generated data and the results were presented as text and in a table.ResultsThe reported key positive experiences due to removable complete denture rehabilitation were the improvement in speech, eating ability, regaining good facial appearance, better oral hygiene management, self-esteem and confidence to smile in public, and a feeling of completeness. However, respondents complained of pain and discomfort due to the looseness of dentures, inability to eat certain foods, and regular cleaning of dentures. The respondents did not go through proper informed consent processes before getting removable complete dentures.ConclusionThe study found that patients were satisfied with their removable complete dentures rehabilitation due to the positive experiences registered, such as the ability to eat and talk well, and restoration of self-esteem, all of which improved their quality of life. However, they experience pain and discomfort due to the looseness of dentures.

The epidemiology of behavioral risk factors for noncommunicable disease and hypertension: A cross-sectional study from Eastern Uganda.

In light of the suboptimal noncommunicable disease (NCD) risk factor surveillance efforts, the study's main objectives were to: (i) characterize the epidemiological profile of NCD risk factors; (ii) estimate the prevalence of hypertension; and (iii) identify factors associated with hypertension in a peri-urban and rural Ugandan population. A population-based cross-sectional survey of adults was conducted at the Iganga-Mayuge Health and Demographic Surveillance System site in eastern Uganda. After describing sociodemographic characteristics, the prevalence of NCD risk factors and hypertension was reported. Prevalence ratios for NCD risk factors were calculated using weighted Poisson regression to identify factors associated with hypertension. Among 3220 surveyed respondents (mean age: 35.3 years (standard error: 0.1), 49.4% males), 4.4% were current tobacco users, 7.7% were current drinkers, 98.5% had low fruit and vegetable consumption, 26.9% were overweight, and 9.3% were obese. There was a high prevalence of hypertension and prehypertension, at 17.1% and 48.8%, respectively. Among hypertensive people, most had uncontrolled hypertension, at 97.4%. When we examined associated factors, older age (adjusted prevalence ratio (APR): 3.1, 95% CI: 2.2-4.4, APR: 5.2, 95% CI: 3.7-7.3, APR: 8.9, 95% CI: 6.4-12.5 among 30-44, 45-59, and 60+-year-old people than 18-29-year-olds), alcohol drinking (APR: 1.6, 95% CI: 1.3-2.0, ref: no), always adding salt during eating (APR: 1.6, 95% CI: 1.1-2.2, ref: no), poor physical activity (APR: 1.3, 95% CI: 1.1-1.6, ref: no), overweight (APR: 1.3, 95% CI: 1.1-1.5, ref: normal weight), and obesity (APR: 2.0, 95% CI: 1.6-2.4, ref: normal weight) had higher prevalence of hypertension than their counterparts. The high prevalence of NCD risk factors highlights the immediate need to implement and scale-up population-level strategies to increase awareness about leading NCD risk factors in Uganda. These strategies should be accompanied by concomitant investment in building health systems capacity to manage and control NCDs.

Body image, eating distress and emotional-behavioral difficulties among adolescents in Mbarara, Southwestern Uganda

BackgroundAdolescents frequently have emotional and behavioral difficulties as they struggle with the challenges of transition from childhood to adulthood. Many struggle with issues of body image and eating distress as they deal with the difficult and frequently perplexing changes that occur with puberty. Yet there is surprisingly little research on the emotional and behavioral challenges, as well as body image and eating distress among this sizable population in Uganda. This study sought to assess attitudes and behaviors related to body image and eating distress, as well as emotional and behavioral difficulties among adolescents in Mbarara, Southwestern Uganda.MethodsThis was a cross-sectional study among 788 adolescents aged 13 to 19 years in secondary schools in Mbarara city and Mbarara district in south-western Uganda. The study employed the Body Image and Eating Distress scale to assess attitudes and behaviors about dieting and body shape and the extended version of the Strengths and Difficulties Questionnaire (SDQ) to assess for perceived emotional and behavioral difficulties. Logistic regression was used to identify the association between body image and eating distress and perceived difficulties.ResultsThe prevalence of high body image and eating distress was 10.8% while that of perceived emotional and behavioral difficulties was 45.8%. Some of the adolescents (16.1%) were dissatisfied with their body shape, 24.6% exercised a lot to avoid gaining weight, 15.0% were terrified to gain even a little weight, and 12.1% could not control their eating. More males reported eating large amounts of food at one time (p = < 0.001). Having emotional and behavioral difficulties (aOR: 1.89; 95% CI: 1.18 – 3.02; p = 0.019) and coming from a two-parent household (aOR: 1.79; 95% CI: 1.10 – 2.92; p = 0.019) increased the odds of high body image and eating distress.ConclusionHigh levels of body image and eating distress are linked to behavioral and emotional problems and adolescent’s family structure. Clinicians who treat adolescents should use a holistic care strategy and be aware of the high prevalence and close association between emotional and behavioral difficulties, concerns about weight, and dieting. It is important to encourage parental involvement and support in providing information about mental health issues among adolescents.

Use of dental care services among adolescents living with HIV on antiretroviral treatment in Kampala, Uganda: a cross-sectional study

ObjectiveThe primary purpose of this study was to assess the prevalence and socio-behavioral determinants of ever-use of dental care services among adolescents aged 10–18 years, living with HIV, on Antiretroviral treatment (ART), and attending selected HIV clinics in Kampala, Uganda.MethodsA cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10 and 18 years old from 4 specific HIV clinics in Kampala. Andersen’s behavioral model guided the selection of variables, with the ever-use of dental care services as the outcome and predisposing, enabling, need-related factors and personal dental health practices as exposure variables. Data were analyzed using Fischer’s exact test for cross-tabulation and modified Poisson regression for multivariate analysis.ResultsThe prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14–18 had higher odds of using dental care services (Prevalence ratio (PR) of 3.35 than those aged 10–13 years. Fear of the spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06). Participants who were afraid of going to the dentist had higher odds of using dental care services (PR of 2.98) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with the ever-use of dental care services (PR of 4.50). Those who were satisfied with their dental condition had lower odds of using dental care services. The bad oral odor was positively associated with the ever-use of dental care services (PR of 2.80). The use of soap for toothbrushing was positively associated with the ever-use of dental care services (PR of 2.51).ConclusionThe study found a low frequency of dental care use among HIV-infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, medical-dental appointment incoordination, and satisfaction with the dental condition and bad oral odor while under personal dental health practices. The use of soap for toothbrushing was an important association with dental care. Nevertheless, these study results cannot be generalized to the entire HIV adolescent population in Uganda.

Mapping the Pharmacogenetic Landscape in a Ugandan Population: Implications for Personalized Medicine in an Underrepresented Population.

Africans are extremely underrepresented in global genomic research. African populations face high burdens of communicable and non-communicable diseases and experience widespread polypharmacy. As population-specific genetic studies are crucial to understanding unique genetic profiles and optimizing treatments to reduce medication-related complications in this diverse population, the present study aims to characterize the pharmacogenomics profile of a rural Ugandan population. We analyzed low-pass whole genome sequencing data from 1998 Ugandans to investigate 18 clinically actionable pharmacogenes in this population. We utilized PyPGx to identify star alleles (haplotype patterns) and compared allele frequencies across populations using the Pharmacogenomics Knowledgebase PharmGKB. Clinical interpretations of the identified alleles were conducted following established dosing guidelines. Over 99% of participants displayed actionable phenotypes across the 18 pharmacogenes, averaging 3.5 actionable genotypes per individual. Several variant alleles known to affect drug metabolism (i.e., CYP3A5*1, CYP2B6*9, CYP3A5*6, CYP2D6*17, CYP2D6*29, and TMPT*3C)-which are generally more prevalent in African individuals-were notably enriched in the Ugandan cohort, beyond reported frequencies in other African peoples. More than half of the cohort exhibited a predicted impaired drug response associated with CFTR, IFNL3, CYP2B6, and CYP2C19, and approximately 31% predicted altered CYP2D6 metabolism. Potentially impaired CYP2C9, SLCO1B1, TPMT, and DPYD metabolic phenotypes were also enriched in Ugandans compared with other African populations. Ugandans exhibit distinct allele profiles that could impact drug efficacy and safety. Our findings have important implications for pharmacogenomics in Uganda, particularly with respect to the treatment of prevalent communicable and non-communicable diseases, and they emphasize the potential of pharmacogenomics-guided therapies to optimize healthcare outcomes and precision medicine in Uganda.

Making home alive again after war: AcoliKaka’s Indigenous land sovereignties in Northern Uganda

AbstractAfter the war between the Ugandan government and the Lord's Resistance Army (1986‐2006), 90 per cent of the displaced rural population in Northern Uganda returned to small‐scale farming on their ancestral lands and their systems of communal land stewardship. At the time, there was much debate about transitional justice interventions to address war's violence, but in that same period over 85 per cent of Acoli chiefdoms saw affiliated clans, or kin‐based political communities (kaka), negotiate to write down their Indigenous governance constitutions for the first time. AcoliKaka’s return to their ancestral lands and small‐scale farming, and subsequent engagements withtekwaro –Indigenous knowledge –through constitution writing, served to strengthen Indigenous governance and law after their weakening in contexts of war and displacement. It is argued here that these engagements and negotiations rooted in the land, regardless of their outcomes, served to orient relationshipsawayfrom the fragmenting, unprecedented, forced Acoli‐on‐Acoli violence experienced during the war. A resurgence of AcoliKaka’s Indigenous law and governance rooted in communal land stewardship is linked to relational repair and supports calls for transitional justice processes to nurture and respect Indigenous land rights. These ethnographic arguments also lend support tokaka’s ongoing efforts towards clan unity (ribbe kaka) and to secure communal land sovereignties.

Lack of trust, insufficient knowledge and risk denial; an in-depth understanding of health workers barriers to uptake of the COVID-19 vaccine at Iganga Hospital Eastern Uganda, and Mengo Hospital Kampala Uganda

COVID 19 Vaccine hesitancy among health workers remains a major hindrance to the governments vaccine roll out plan among health workers and other target populations in Uganda. We conducted 12 focus group discussions and 20 in-depth interviews with health workers (vaccinated and unvaccinated) to understand barriers to vaccine acceptance in their own perspective and context in central and eastern Uganda. Reported barriers to vaccine acceptance included: gross lack of trust, fear of side effects, risk denial and insufficient information about the vaccine amidst negative publicity about the vaccine from the internet and social media platforms. Others were health system inhibition factors and religious beliefs against the vaccine. We recommend a health work context specific information, education and dissemination strategy to create awareness, information and more knowledge about the vaccine to health workers. We also recommend a sustained government media campaign to give more information about the vaccine and also dispel the negative publicity and misinformation about the vaccine. Dialogue with health workers at all levels of care, positive peer influence, use of religious and opinion leaders as well as government ensuring accessibly to various COVID 19 vaccines and putting vaccine posts outside hospital settings to limit exposure to COVID patients could also increase uptake of the vaccine among health workers.