Socioeconomic determinants of malaria prevalence among under five children in Uganda: Evidence from 2018-19 Uganda Malaria Indicator Survey

Background & objectives: Malaria remains a significant public health problem in sub-Saharan Africa, affecting mainly children and pregnant women. In Uganda, little is known about the underlying socioeconomic correlates of malaria prevalence in children under five years of age. This study investigated the link between malaria infection among children under five and the socio-economic factors in Uganda. Methods: We estimated the prevalence of malaria among under-five children using secondary data from the 2019 Uganda Malaria Indicator Survey. Malaria infection status was ascertained using rapid diagnostic tests (RDTs). Multivariable logistic regression was employed to explore the socioeconomic correlates of malaria prevalence. Svyset command in STATA 16.0 was used to control for survey design. Results: Overall, 6503 children were enrolled in the study. Of these, 1516 children tested positive for malaria, leading to an observed malaria prevalence of 23.3%. Older children (OR 1.01, 95%CI 1.01–1.01), and those from rural areas (OR 1.8, 95%CI 1.09–2.84) had higher odds of malaria infection. Children belonging to the highest wealth quintile had lower odds of malaria (OR 0.2, 95%CI 0.08–0.44). Indoor residual spray (OR 0.2, 95%CI 0.10–0.51) and use of treated bed nets (OR 0.8, 95%CI 0.69–0.99) were associated with reduced odds of malaria in children Interpretation & conclusion: Despite the significant increase in malaria preventive interventions in the last two decades, malaria remains highly prevalent in Ugandan under-five children. Indoor residual spraying and treated bed nets need to be promoted countrywide to reach malaria control targets. It is also imperative that appropriate education on proper and consistent use of mosquito bed-nets should be emphasized alongside embracing living habits that reduce the chances of mosquito bites like staying indoors.

A comparative analysis of two national tuberculosis reporting systems and their impact on tuberculosis case notification in Uganda

Background: Before 2018, the use of parallel tuberculosis (TB) reporting systems was resource intensive with duplication of efforts and hence the need to select one that contributed to better TB case notification at the National TB and Leprosy Program (NLTP) in Uganda. We sought to analyse the difference in reporting rates between the two systems in order to improve NTLP TB case notification rates, logistics management, and planning for better health service delivery initiatives. Methods: We conducted a comparative study to assess TB case notification between the web-based DHIS2 and the district TB supervisor-led health management information system between January 2016 to December 2017. We used Poisson regression analysis to assess the statistical differences in reporting rates between the two reporting systems. Results: The association between TB case notification and the type of reporting system was statistically significant (Prob > chi2 = 0.0000). The Incident Rate Ratio (IRR) for the web-enabled DHIS2 system versus the district TB supervisor-led health management information system was 1.106625. Conclusion: The web-based integrated DHIS2 system was more effective in reporting missing TB cases. It presents an opportunity for better planning and allocation of resources for improved service delivery in a low-income setting.

Challenges and Opportunities of the Ugandan Traditional Herbal Medicine Sector

The use of herbal medicine products worldwide and in Uganda is on the rise and there is much-renewed interest in their use because of the belief that they are safe. However, this belief is not backed up by credible scientific research for many products in Uganda. Almost all herbal products produced locally in Uganda have no scientific proof for their claimed safety and efficacy for the treatment of the various conditions they are claimed to treat example; covid-19, HIV, hypertension, erectile dysfunction, and others. There is an urgent need to quickly improve and enforced research on the local products in order to realise the economic benefits which could be lying hidden in them and put a ban on adulterated products from being sold to the public. This review was conducted in order to determine the challenges and opportunities in the Traditional Herbal Medicine sector in Uganda. It was found out that enormous challenges face the Traditional Medicine sector in Uganda including; lack of research on products available for use, claims of one product treating multiple conditions, adulteration of products with established Pharmaceutical drugs and no stringent regulations on registration of products. However, a lot of opportunities were also noted available for exploitation to develop the sector further. Collaboration with local Universities to speed up research using the Reverse Pharmacology approach [1] on the available products, strictly enforcing regulation on product registration and exploiting the reverse Pharmacology approach to study the local products, aggressive and intentional investment in basic research infrastructures and speeding up Clinical Trials on products found to be safe and effective could allow the realisation of the benefits which could be hidden in the local Traditional Medicine products.

Contraceptive acceptability and associated factors among young women (15-24) living with HIV/AIDS: a hospital-based study in Kampala, Uganda

introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics in Kampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross-sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive. Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P<0.001), having friend on contraceptives (aPR; 1.90, 95%CI; 1.10 - 3.26; P =0.021) and being married (aPR; 1.20, 95%CI; 1.09 - 1.32, P<0.001) were significantly associated with acceptability of contraceptives. Conclusion: There is a low acceptability for contraceptives. Younger age group who are not yet married need to be targeted

Reporting of sexual and gender-based violence and associated factors among survivors in Mayuge, Uganda

background: Reporting of Sexual and Gender-Based Violence (SGBV) allows survivors to access support services to minimize the impact of the violence on their lives. However, research shows that most SGBV survivors do not report. Objective: We aimed to determine the proportion of survivors of SGBV in Mayuge District, Uganda, who report SGBV, and the factors associated with reporting. Methods: Using a cross-sectional study design, we analyzed data of SGBV survivors in eight villages in Mayuge district collected in a baseline survey of a larger experimental study. Data were analyzed using Modified Poisson Regression. Results: Of the 723 participants, 65% were female. Only 31.9% had reported the SGBV experienced. Reporting was 43% lower among survivors aged 45 years and older (p-value = 0.003), and 41% lower among survivors with higher than a primary school education (p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on financial support from their partners (p-value = 0.001). Female survivors were also 63% more likely to report (p-value = 0.001), while survivors who were separated/widowed were 185% more likely to report than those who were never married (p-value = 0.006). Conclusions: Reporting of SGBV by survivors in Mayuge was found to below

A mixed-methods, cross-sectional study of perceived stigma among Ugandans with epilepsy

Background: Epilepsy is associated with stigma and negatively impacts the lives of people living with epilepsy (PLWE) and their immediate families. More understanding of the stigma and discrimination experienced by PLWE in sub-Saharan Africa is needed. Methods: In a cross-sectional, mixed methods study, forty- eight PLWE who met the study inclusion criteria were enrolled. In depth interviews and focus group discussions were conducted and were audiotaped and transcribed verbatim. Analysis was conducted using a thematic, constant comparative approach with an emphasis on dominant themes. Perceived stigma was measured using the Kilifi epilepsy stigma score. Associations between socio-demographic factors and Kilifi epilepsy stigma score were assessed. Results: The median age of the study participants was 25 years, with median age (IQR) of epilepsy onset of 12 (6-18) years. The prevalence of high-perceived stigma was 31.9% (15/48). Seizure frequency was associated with high levels of perceived stigma (p-value of 0.038). Psychological abuse, rejections at home, places of employment and schools, poor relationships and intimacy and unmet engagements in social activities were cited as the perceived stigmatizing aspects among PLWE. Conclusion: In this Ugandan sample perceived stigma remains unacceptably high and interventions to address it are urgently needed in our settings.

Trauma unit admissions at the Ugandan National Referral Hospital: a descriptive study

Background: Injuries are a neglected epidemic globally accounting for 9% global deaths; 1.7 times that of HIV, TB and malaria combined. Trauma remains overlooked with key research and data focusing on infectious diseases, yet Uganda has one of the highest rates of traumatic injury. We described demographics of patients admitted to Mulago Hospital's Shock Trauma Unit within the Emergency Department. Methods: This was a retrospective record review Trauma Unit admission from July 2012 to December 2015. Information collected included: age, sex, time of admission, indication for admission and mechanism of trauma. Results: 834 patient records were reviewed. The predominant age group was 18-35 with majority of patients being male. 54% of patients presented during daytime with 46% admitted in the evening hours or overnight. Mechanism of injury was documented in 484 cases. The most common mechanism was Road Traffic Accident (67.4%), followed by assault (12.8%) and mob violence (5.6%). The most common indication for admission was traumatic brain injury (84.5%), followed by hemodynamic instability (20.0%) and blunt chest injury (6.1%). Conclusion: There's a significant burden of high-acuity injury particularly among males with RTAs as the leading cause of admission associated with Traumatic Brain Injury as main admission indication

Prevalence of violence towards men living with HIVAIDS in rural communities of Southwestern Uganda

Background: Violence towards HIV positive men is one of the silent barriers to utilization of HIV care services. HIV positive men are potential victims of violence from other people including women, and violence may interfere with treatment outcomes. This study determined the prevalence of violence towards HIV positive men in rural communities of southwestern Uganda. Methods: A cross-sectional study was conducted among 307 HIV positive men at selected health centers using an interviewer administered questionnaire. Data were analyzed in SPSS version 23 using chi-square and multivariate regression at 95% level of significance and a precision of 0.05. Results: Of the 307 participants, 45.3% had experienced violence. Of these, 23.8% (n=73) had experienced kicking or slapping while 12.7% (39) reported sexual violence. Factors associated with violence were; using alcohol and drugs (aOR 0.26, 95% CI 0.09-0.76, p=0.014), knowledge of support structures (OR 2.25, 95% CI 1.33-3.78, p=0.002) and owning land for farming (aOR 0.26, 95% CI 0.10-0.70, p=0.011). Conclusion: The prevalence of violence at 45.3% is quite high especially since violence against men is rarely talked about. This should not be ignored there should be strategies to support this vulnerable group

Aspergillus-specific IgM/IgG antibody serostatus of patients hospitalized with moderate-critical COVID-19 in Uganda

Invasive pulmonary aspergillosis is known to complicate the coronavirus diseases-2019 (COVID-19), especially those with critical illness. We investigated the baseline anti Aspergillus antibody serostatus of patients with moderate-critical COVID-19 hospitalized at 3 COVID-19 Treatment Units in Uganda. All 46 tested patients, mean age 30, and 11% with underlying respiratory disease had a negative serum anti-Aspergillus IgM/IgG antibody immunochromatographic test on day 3 (mean) of symptom onset (range 1-26), but follow up specimens to assess seroconversion were not available

The profile and causes of death among medical doctors and dental surgeons in Uganda: 1986 to 2016

Background: The loss of health workers through death is of great importance and interest to the public, media and the medical profession as it has very profound social and professional consequences on the delivery of health services. Objective: To describe the profile, causes and patterns of death among medical doctors and dental surgeons in Uganda between 1986 and 2016. Methods: We conducted a retrospective descriptive study of mortality among registered medical doctors and dental surgeons. Information on each case was collected using a standard questionnaire and analyzed. Cause of death was determined using pathology reports, and if unavailable, verbal autopsies. We summarized our findings across decades using means and standard deviations, proportions and line graphs as appropriate. Cuzick's test for trend was used to assess crude change in characteristics across the three decades. To estimate the change in deaths across decades adjusted for age and sex, we fit a logistic regression model, and used the margins command with a dy/dx option. All analyses were done in Stata version 14.0 (Stata Corp, College Station, TX). Results: There were 489 deaths registered between 1986 and 2016. Of these, 59 (12.1%) were female. The mean age at death was 48.8 years (Standard Deviation (SD) 15.1) among male and 40.1 years (SD 12.8) among females. We ascertained the cause of death for 468/489 (95.7%). The most common causes of death were HIV/AIDS (218/468, 46.6%), cancer (68/468, 14.5%), non-communicable diseases (62/48, 13.3%), alcohol related deaths (36, 7.7%), road traffic accidents (34, 7.3%), gunshots (11, 2.4%), among others. After adjusting for age and sex, HIV/AIDs attributable deaths decreased by 33 percentage points between the decade of 1986 to1995 and that of 2006 to 2016 ­0.33 (­0.44, ­0.21. During the same period, cancer attributable deaths increased by 13 percentage periods 0.13 (0.05,0.20). Conclusion: The main causes of death were HIV/AIDS, cancer, non-communicable diseases, alcohol-related diseases and road traffic accidents. There was a general downward trend in the HIV/AIDS related deaths and a general upward trend in cancer related deaths. Doctors should be targeted for preventive and support services especially for both communicable and non-communicable diseases

Stakeholders' perceived achievements and challenges after the safe motherhood project in Northern Uganda

The Japanese Red Cross Society (JRCS) and the Uganda Red Cross Society (URCS) implemented the Safe Motherhood project topromote mother-friendly society in northern Uganda from 2010 to 2016. The follow-up study has not been conducted and the information on achievements and challenges after the project were limited. To review the safe motherhood project in northern Uganda, the purpose of the study was to explore the stakeholders' perceived achievements and challenges after the project. Study design was qualitative content analysis using interview guides. After the approval of Institutional Review Board Clearance, the study was started (Approval Number: 2017-034). The subjects were informed about the ethical considerations (informed consent, participation on free will, confidentiality, and anonymity) in participating in the research, and they participated after signing the consent form. Six volunteers, 2 health center staff, and 2 former Uganda Red Cross staff were interviewed. Achievements were the acquisition of knowledge, attitudes changes, behavioural changes, linkage of all stakeholders, and positive influence on Safe Motherhood in community. Challenges of sociocultural barriers, attitudes toward women, accessibility and human resources, incentives and facilities, and sustainability of the project were derived from the interview. The study revealed that the project linked all stakeholders to achieve Safe Motherhood in community and all the developed registration systems were taken over. Long-term support is necessary for Safe Motherhood to take root

Determinants of developmental milestones among children 0- 23 months at Kabale Hospital, Uganda

BACKGROUND :Approximately 200 million children globally fail to fulfil their development potential due to malnutrition, poor health, and unstimulating environments. Children in Kabale, Uganda, may be at particularly high risk as the rate of malnutrition in the region is likely to impact development. The study aimed to identify possible determinants influencing developmental milestones of breastfed and non-breastfed children aged 0-23 months. MATERIALS AND METHODSThe study was conducted at the young child clinic of Kabale hospital, among 250 children aged 0-23 months and their caregivers, for two months. The study adopted a comparative cross-sectional design, and systematic random sampling was used to select the respondents for the study. The socio-demographic characteristics, nutritional status, and feeding practices were assessed using structured pretested questionnaires. Developmental milestones of the children (communication, motor, fine motor, problem-solving, and social skills) were assessed using the modified ages and stages questionnaires. The data collected was tabulated, analysed statistically, and the results interpreted. RESULTS :Developmental scores were not associated with breastfeeding and minimum meal frequency. A milestone achievement of communication skills was associated with caregiver's education, caregiver's age and length-for-age. Gross motor scores were associated with the caregiver's age, weight-for-age, and length for age. Achievement of fine motor skills was associated with caregiver's education, caregiver's age, child's age, length for age, and children who met the minimum dietary diversity score. Problem-solving scores were associated with child's age, weight for age, length for age, and children who met the minimum dietary diversity. Personal social scores were associated with lower caregiver's age and normal weight for age Conclusion: Developmental scores were not associated with breastfeeding and minimum meal frequency. Development in early childhood was mainly associated with caregiver's age, caregiver's education, child's age, weight for age, length for age, and minimum dietary diversity score. Children under the care of younger caregivers and those who attained normal nutrition status had significantly more developed motor and social skills compared to children with older caregivers and undernourished children, respectively.

Implementation of UN Convention on the Rights of Persons with Disabilities in public and private schools in three districts of Uganda

The study was grounded in the recent developments of implementing the United Nations Convention on the Right of Persons with Disabilities (UNCRPD) in schools in Uganda, leading to a renewed interest in the questionings about inclusive education. Objectives: The inclusive approach was evaluated in terms of: (1) how public or private schools in Uganda understand inclusive education; (2) how schools implement inclusive education under the influence of the UN Convention; and (3) what determines the course of action and school routine of private and state schools. Methods: This exploratory qualitative research included interviews with six schools purposively selected in Mukono, Wakiso and Kampala districts of Central Uganda. The selected schools comprised three private and three state schools (i.e. representing primary and secondary schools and a vocational training institute). Results: The research demonstrated that 'inclusive education practice' that was upheld by all the schools, was ironically stained with exclusion, for example, by non-admission of students with visual and hearing impairment, inaccessible physical environment, inadequate funding and separation of students according to abilities. However, whilst all schools followed the regular curriculum, some schools developed their own ways of teaching learners with diverse learning needs. Conclusion: Some schools in Uganda have developed meaningful approaches of including students with disabilities but there are still many challenges for many. Enforcing Uganda's disability policies adapted from the CRPDs could enable learners with disabilities to enjoy their legal rights. Contribution: Since the intention of inclusion of students with disabilities stands in contrast to the reality of practice found in many schools, there seems to be a need to carry out regular assessments and measures of support for a sustainable inclusive school development

Operational analysis of the national sickle cell screening programme in the Republic of Uganda

Background: Sickle cell anaemia is a common global life-threatening haematological disorder. Most affected births occur in sub-Saharan Africa where children usually go undiagnosed and die early in life. Uganda's national sickle cell screening programme was developed in response to a 2014 sickle cell surveillance study that documented a high disease prevalence. Objective: This study describes the temporal and financial aspects of Uganda's 2014­2019 sickle cell screening programme. Methods: National sickle cell screening data from Uganda's Central Public Health Laboratories were used to calculate turn-around times (TATs) from sample collection to delivery, testing, and result reporting for blood samples collected from February 2014 to March 2019. The parameters affecting specific TATs were assessed. The exact programme expenditures were analysed to determine cost per test and per positive sickle cell disease case detected. Results: A total of 278 651 samples were analysed. The median TAT from sample collection to laboratory receipt was 8 days (interquartile range [IQR]: 6­12), receipt to testing was 3 days (IQR: 1­7), and testing to result reporting was 6 days (IQR: 3­12). Altogether, the sample continuum averaged 16 days (IQR: 11­24). Lower level healthcare facilities were associated with longer sample delivery TATs. Calendar months (January and December) and larger sample volumes impacted testing and result reporting TATs. The cost per test was $4.46 (United States dollars [USD]) and $483.74 USD per positive case detected. Conclusion: Uganda's sickle cell screening programme is efficient and cost-effective. Universal newborn screening is the best strategy for detecting sickle cell anaemia in Uganda.

The role of Escherichia coli in the etiology of piglet diarrhea in selected pig producing districts of central Uganda

Background: Pig production in Uganda is highly constrained by rampant piglet mortalities with diarrhea being a key feature. The present study was conducted to determine possible involvement of Escherichia coli (E. coli) as agents of diarrhea in piglets and elucidate the factors for their spread and virulence, towards development of mitigation strategies in the smallholder pig value chains in Uganda. Methodology: This was a cross-sectional study carried out from January to August 2020 on pre- and post-weaned piglets from households in Kayunga and Mityana districts of Central Uganda, selected by snowballing method to redundancy. Data about herd management and risk factors for colibacillosis were collected from selected farmers in the two districts. A total of 179 faecal samples were collected from randomly selected neonatal and pre-weaning piglets for bacteriological isolation of Escherichia coli. Virulence (enterotoxin and fimbrial) genes from the isolates were detected by multiplex polymerase chain reaction (PCR) assay. Results: From the 179 faecal samples, a total of 158 (88.3%) E. coli isolates were obtained. Virulence gene markers were detected in 18.4% (29/158) of the isolates. Among the investigated genes encoding for enterotoxin production, STb was the most prevalent (16/158, 10.13%), followed by STa (12/158, 7.59%), while gene for LT was not detected. The gene coding for F4 adhesin was the only one detected while F18 adhesin was not detected from the isolates. On multiple logistic regression analysis, only tertiary educational level (OR=0.141; 95% CI=0.30-0.666; p=0.013) and infrequent use of antibiotics (OR=0.231, 95% CI=0.062-0.859; p=0.029) among the farmers, were the two factors significantly protective of the piglets from diarrhoea. Conclusion: This study reports a high prevalence of enterotoxin gene markers among E. coli isolates in piglets and revealed the potential role of these bacteria in the aetiology of piglet diarrhoea and mortalities in Uganda. Additionally, this study identified risk factors that can be useful in formulating treatment and control strategies of infection caused by these bacteria. Further studies are needed to identify more adhesins these E. coli isolates employ for intestinal colonization, a step that will help inform vaccine development.

Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda. Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers. Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p<0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p<0.01) and highest among children 0-14 (4.8% vs 3.2% p<0.01). Conclusion: Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years

Magnitude of Prior Teenage Pregnancy among Women Aged 18–67 Years in Rural Southwestern Uganda

Objective: Teenage pregnancy is a growing health challenge among adolescents in Uganda with its magnitude varying across thedifferent regions of Uganda. This study evaluated the magnitude and factors associated with prior teenage pregnancy among women aged 18-67 years in a rural community of Kasese district, Uganda.Short ResearchArticleResults: Fifty-two percent (52%) of the 138 women interviewed, had a prior teenage pregnancy. Having experienced a teenage pregnancy was independently associated with; occupation of current household heads (adjusted odds ratio, aOR= 0.2, 95% confidence interval, CI: 0.1 –0.9), whether or not the current household could adequately meet their food needs (aOR= 0.1, 95% CI: 0.01 –0.8), and whether the current household shared toilet facilities (aOR= 4.7, 95% CI: 1.0 –21.8). Conclusion: The findings suggest that magnitude of prior teenage pregnancy among women in this rural community is much higher than the national average. Socio economic factors at household level are contributory to prior teenage pregnancy. A multi sectoral approach integrating household livelihood improvement with health interventions targeting the girl child is proposed to curb teenage pregnancy in this context.

Students' prior knowledge and skills in computer and internet use: An exploration of incoming first year undergraduate health sciences students at Gulu University, Uganda

Internet has provided infrastructure that enables access to a variety of information resources for use by medical students at Gulu University in Northern Uganda. However, little attention has been put to explore prior internet knowledge of undergraduate medical students in Uganda. Cross-sectional research design was used. Fifty-six first year undergraduate health sciences students participated in the study. Self-administered structured questionnaire was used for data collection and analysis was done using SPSS version 16. Results shows that a majority of the participants had prior knowledge of computer 48 (86.0%) and internet 44 (79.0%). 38 (68.0%) participants had access to internet and 34 (61.0%) owned computer before joining the University. Majority owned mobile phones 41 (73.0%) and used it for internet access 43 (84.0%). Use of internet was high in social media 46 (86.8) and searching general information 44 (84.6%). Participants expected easy access to teaching materials 52 (94.5%) and communication 49 (90.7%) via internet. These findings suggest need for healthcare librarians to train incoming medical students on use of ICTs; including social media platforms and mobile phones to improve their ICT literacy skills to enable them access the best academic information resources to enhance medical education.

Socio-demographic Determinants of Vaccine Coverage for Pneumococcus and Rotavirus among under Five Children in Busolwe Town Council, Butaleja District, Eastern Uganda: A Cross Sectional Study

Background and Aims:There is a high burden of vaccine-preventable diseases in the children under five years of age, particularly pneumonia diarrhea and which is greatly affected by low immunization coverage despite the existing efforts and policies. This study was carried out in Butaleja district and was aimed at establishing the socio-demographic determinants of vaccine coverage for pneumococcus and rotavirus among under five children (U5C) in the district. Study Design:This was a mixed methods cross-sectional study.Place and Duration of Study:Busolwe Town Council, Butaleja District, Eastern Uganda.Methodology:Structured researcher administered questionnaires were administered to 434 caregivers of U5C in different parts of Butaleja district. In-depth interviews with key informants and focused group discussions with Village Health Teams and community members were conducted. Review of Health Management Information Systems records was done. STATA 15 was used to analyze the data.Results:The study found that there is a declining trend in completion of the doses of Pneumococcal vaccine (PCV) and Rotavirus vaccine. For example, in quarter 1 of 2019, out of the 312 children who started immunization, only 2 completed Rota virus immunization and only 117 completed PCV vaccinations a trend that has been observed since 2016. The factors that showed a significant association with the the fact that they gave their child at least one dose of the vaccinewere having been sensitized on the current immunisation schedule(P-value = <0.001), misunderstanding that vaccine is harmful for child(P-value = 0.007), willingness to take children to vaccination(P-value = <0.001), and social factors such as family (P-value = <0.030). Gender also played a key determinant role where the children’s fathers lacked knowledge on significance of immunization and thus discouraged the mothers from taking the children for immunization. Inadequate funding was also highlighted from the Focus Group Discussions.Conclusion:Vaccine coverage for pneumococcus and rotavirus is still low in Butaleja district mainly due to the attitudes and perceptions of caregivers as well as the knowledge gap. There is need forextensive sensitization of all community members to enable them understand the significance of immunization. It would further be important to increase the funding of the immunization programme to intensify and ensure effectual outreaches as well as the establishment and enforcement of a policy for immunization compliance.

Role of Prevalent Weeds and Cultivated Crops in the Epidemiology of Maize Lethal Necrosis Disease in Major Maize Growing Agroecological Zones of Uganda

In Uganda, the severe Maize lethal necrosis (MLN) disease, which threatens subsistence maize production is caused by co-infection of maize plants with Maize chlorotic mottle virus (MCMV) and Sugarcane mosaic virus (SCMV). However, there is no information about natural hosts of MLN causing viruses and their role in epidemiology of MLN in Uganda. The aim of this study was to determine existence of natural alternative weed and cultivated crop hosts of MLN causing viruses. Three seasonal surveys between 2014 and 2015 were carried out in five major maize growing agroecological zones of Uganda. Weeds and cultivated crops growing in proximity to maize were observed for virus symptoms and tested for MLN causing viruses using Double Antibody Sandwich Enzyme-Linked Immunosorbent Assay and Reverse Transcriptase Polymerase Chain Reaction. Data was collected on frequency of occurrence of weeds and cultivated crop species and MLN virus disease incidence. Digitaria abyssinica, Bidens pilosa and Commelina benghalensis were the most common weed species while Phaseolus vulgaris, Manihot esculenta, Arachis hypogaea), Musa sp, Glycine max and Ipomoea batatas were most common cultivated crops. Pennisetum purpureum, Digitaria abyssinica, Cyperus rotundus, Amaranthus spinosus, Commelina benghalensis and Eleusine indica weeds species are natural hosts of Maize chlorotic mottle virus. Among the cultivated crops, Phaseolus vulgaris, Manihot esculenta and Sesamum indicum are natural hosts of MCMV. Only Sorghum (Sorghum bicolor) and sweet potato (Ipomoea batatas) tested positive for SCMV. MCMV incidence in weeds ranged from 2% to 63%% and 2% to 29% in cultivated crops. MLN causing viruses were prevalent in weeds and cultivated crops located in known hotspots for MLN in Uganda. The study has revealed that alternative hosts of MLN-causing viruses are present in major maize growing agroecological zones of Uganda and act as sources of inoculum to sustain MLN epidemics.