Estimating regional and national cancer incidence in Uganda: a retrospective population-based study, 2013-2017.

BACKGROUND: Cancer is becoming a major health problem in Uganda. Cancer control requires accurate estimates of the cancer burden for planning and monitoring of the cancer control strategies. However, cancer estimates and trends for Uganda are mainly based on one population-based cancer registry (PBCR), located in Kampala, the capital city, due to a lack of PBCRs in other regions. This study aimed at estimating cancer incidence among the geographical regions and providing national estimates of cancer incidence in Uganda. METHODS: A retrospective study, using a catchment population approach, was conducted from June 2019 to February 2020. The study registered all newly diagnosed cancer cases, in the period of 2013 to 2017, among three geographical regions: Central, Western and Eastern regions. Utilizing regions as strata, stratified random sampling was used to select the study populations. Cases were coded according to the International Classification of Diseases for Oncology (ICD-0-03). Data was analysed using CanReg5 and Microsoft Excel. RESULTS: 11598 cases (5157 males and 6441 females) were recorded. The overall national age-standardized incidence rates (ASIR) were 82.9 and 87.4 per 100,000 people in males and females respectively. The regional ASIRs were: 125.4 per 100,000 in males and 134.6 per 100,000 in females in central region; 58.2 per 100,000 in males and 56.5 per 100,000 in females in Western region; and 46.5 per 100,000 in males and 53.7 per 100,000 in females in Eastern region. Overall, the most common cancers in males over the study period were cancers of the prostate, oesophagus, Kaposi's sarcoma, stomach and liver. In females, the most frequent cancers were: cervix, breast, oesophagus, Kaposi's sarcoma and stomach. CONCLUSION: The overall cancer incidence rates from this study are different from the documented national estimates for Uganda. This emphasises the need to enhance the current methodologies for describing the country's cancer burden. Studies like this one are critical in enhancing the cancer surveillance system by estimating regional and national cancer incidence and allowing for the planning and monitoring of evidence-based cancer control strategies at all levels.

Strategies for isoniazid preventive therapy in HIV-positive patients who consume alcohol.

WHO guidance to defer isoniazid preventive therapy (IPT) among those with regular alcohol use because of hepatotoxicity concerns may exclude many people living with HIV (PLWH) at high TB risk in these settings.To evaluate hepatotoxicity during TB preventive therapy (TPT) in PLWH who report alcohol use in Uganda over 10 years.We developed a Markov model of latent TB infection, isoniazid preventive therapy (IPT - a type of TPT), and TB disease using data from the Alcohol Drinkers' Exposure to Preventive Therapy for TB (ADEPTT) study. We modeled several treatment scenarios, including no IPT, IPT with liver enzyme monitoring (AST/ALT) during treatment, and IPT with pre-screening using the tuberculin skin test (TST).The no IPT scenario had 230 TB deaths/100,000 population over 10 years, which is more than that seen in any IPT scenario. IPT, even with no monitoring, was preferred over no IPT when population TB disease incidence was >50 in 100,000.For PLWH who report alcohol use in high TB burden settings, IPT should be offered, ideally with regular AST/ALT monitoring. However, even if regular monitoring is not possible, IPT is still preferable to no IPT in almost every modeled scenario..

Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid effectiveness-implementation trial.

BACKGROUND: Rural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research. METHODS: This cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment. DISCUSSION: The Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health. TRIAL REGISTRATION: ClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023).

SARS-CoV-2 seropositivity in African women living with HIV and their infants.

BACKGROUND: SARS-CoV-2 seropositivity data in women living with HIV (WLHIV), their infants and associated factors in this subpopulation remain limited. We retrospectively measured SARS-CoV-2 seropositivity from 07/2020-11/2021 among WLHIV and their children in the PROMOTE observational cohort in Uganda, Malawi, and Zimbabwe prior to widespread SARS-CoV-2 vaccination in those countries. METHODS: Plasma stored during 3 waves of the COVID-19 pandemic in East/Southern Africa were tested for SARS-CoV-2 specific IgG antibodies (Ab) using serological assays that detect adaptive immune responses to SARS-CoV-2 spike protein. (EUROIMMUN, Mountain Lakes, New Jersey and Roche Diagnostics, Indianapolis, IN). Modified-Poisson regression models were used to calculate prevalence rate ratios (PRR) and 95% confidence intervals (CI) to identify sociodemographic and clinical risk factors. RESULTS: PROMOTE samples from 918 mothers and 1237 children were analysed. Overall, maternal SARS-CoV-2 seropositivity was 60.1% (95% CI: 56.9 -63.3) and 41.5% (95%CI: 38.8 - 44.2) for children. Non-breastfeeding mothers had a 31% higher risk of SARS-CoV-2 seropositivity compared to breastfeeding mothers (aPRR=1.31, 95%CI: 1.08-1.59). WLHIV with undetectable viral load had a 10% increased risk of SARS-CoV-2 seropositivity (aPRR=1.10, 95%CI: 0.89-1.37). Moreover, those who were normotensive had 12% increased risk SARS-CoV-2 seropositivity (aPRR= 1.12, 95% CI: 0.68-1.85) compared to women with hypertension. Children between 2 and 5 years had a 19% reduced risk of SARS-CoV-2 seropositivity (aPRR=0.81, 95%CI: 0.64-1.02) when compared to younger children. Mother/infant SARS-CoV-2 serostatuses were discordant in 346/802 (43.1%) families tested: mothers+/children- in 72.3%; mothers-/children+ in 26.3%; child+/sibling+ concordance was 34.6%. CONCLUSIONS: These SARS-CoV-2 seropositivity data indicate that by late 2021, about 60% of mothers and about 40% of children in a cohort of HIV-affected families in eastern/southern Africa had been infected with SARS-CoV-2. More mothers than their infants tested SARS-CoV-2+, likely due to a greater external exposure for mothers linked to daily routines/employment, and school closures. Breastfeeding was protective for mothers, likely because of higher likelihood of staying home with young children, and thus less exposure. Discordant results between children within the same families underscores the need to further understand transmission dynamics within households.

How feasible or useful are timeliness metrics as a tool to optimise One Health outbreak responses?

INTRODUCTION: As timeliness metrics gain traction to assess and optimise outbreak detection and response performance, implementation and scale-up require insight into the perspectives of stakeholders adopting these tools. This study sought to characterise the feasibility and utility of tracking One Health outbreak milestones across relevant human, animal, plant, and environmental sectors to systematically quantify timeliness metrics in Uganda, a country prone to outbreaks of WHO priority diseases. METHODS: A database of outbreak events occurring in Uganda between 2018 and 2022 was compiled. Outbreak reports meeting our inclusion criteria were reviewed to quantify the frequency of milestone reporting. Key informant interviews were conducted with expert stakeholders to explore the feasibility and utility of tracking metrics using a framework analysis. Quantitative and qualitative data were collected and analysed concurrently. RESULTS: Of the 282 public health emergencies occurring between 2018 and 2022, 129 events met our inclusion criteria, and complete data were available for 82 outbreaks. For our qualitative portion, 10 informants were interviewed from 7 institutions, representing the human, animal and environmental sectors. Informants agreed most One Health milestones are feasible to track, which was supported by the frequency of milestone reporting; however, there was a demonstrated need for increased reporting of after-action reviews, as well as outbreak start and end dates. Predictive alerts signalling potential outbreaks and preventive responses to alerts are seen as challenging to routinely capture, reflecting the lack of public health action for these domains. CONCLUSION: Despite consensus among stakeholders that timeliness metrics are a beneficial tool to assess outbreak performance, not all One Health metrics are being tracked consistently, thereby missing opportunities to optimise epidemic intelligence, preparedness and prevention. The feasibility of tracking these metrics depends on the integration of reporting channels, enhanced documentation of milestones and development of guidance for early adopters, recognising country-specific on-the-ground realities and challenges to national scaling efforts.

Psychological distress among family caregivers of persons with Alzheimer's disease and related dementias in Uganda.

BACKGROUND: Alzheimer's disease and related dementias (ADRD) present growing global health challenges, especially in aging populations, such as Uganda. In Uganda, familial caregiving, predominantly undertaken by female relatives, is the primary form of support provided to patients with ADRD. Cultural stigma around dementia and limited access to support services amplify caregivers' challenges. This study examined psychological distress, depression, and quality of life (QoL) among family caregivers of patients with ADRD in Wakiso District, Uganda. METHODS: This cross-sectional study involved 90 caregivers from three sub-counties in Wakiso, selected through purposive sampling to capture diverse experiences. Participants included caregivers aged 18 years and older who were knowledgeable and had cared for a person with ADRD for not less than six months, with those providing more than 70% of physical care being prioritised. Data were collected using the Kessler Psychological Distress Scale, the Caregiver Dementia Quality of Life Measurement Scale, and the Center for Epidemiologic Studies Depression Scale, with an 80% response rate achieved through local collaboration. The statistical analyses focused on psychological distress, QoL, and depression. RESULTS: The study included 82.2% females and 17.8% males, with a median age of 52 years for females and 35 years, respectively. Females were more likely to be single or widowed, whereas males were more likely to be married. The study revealed a high prevalence of psychological distress and depression among caregivers (64.4%) regardless of sex. The analysis indicated that having children was a significant predictor of better QoL (OR 3.04, 95% CI 1.79-5.66, p = 0.034) and a lower risk of depression (OR 0.10, 95% CI 0.01-0.86, p = 0.036). No other sociodemographic factors were significantly associated with health outcomes across the models. CONCLUSION: Our findings revealed a heavy burden of psychological distress and depression among Ugandan caregivers of patients with ADRD, highlighting the need for structured support systems, including mental health services and gender-responsive interventions in low-resource settings.

Community Involvement in Onchocerciasis Post-elimination Surveillance in Bududa District, Eastern Uganda: A cross-sectional study.

BACKGROUND: Globally, there are an estimated 20.9 million cases of onchocerciasis, with Africa bearing the greatest burden. The World Health Organization (WHO) has targeted the disease for elimination by 2030. As of August 2023, there were 15 foci in 37/48 (76%) districts and one city in Uganda that had reached the elimination phase. However, there is a paucity of data on community involvement in post-elimination surveillance (PES) activities. The communities in the post-elimination phase are expected to maintain surveillance, provide health education, refer cases for treatment, and participate in surveillance. However, it is not clear whether this is being done. In this study, we assessed the feasibility of community involvement in post-elimination surveillance activities in Bududa District, Eastern Uganda, to draw key generalisable lessons for similar settings. METHODS: This was a cross-sectional study employing rigorous mixed methods of data collection. We used a semi-structured questionnaire to collect quantitative data on randomly sampled study participants in two sub-countries in the district. Community involvement in post-elimination surveillance (PES) was our dependent variable, measured using Yes or No questions, and our independent variables were measured on different scales. Computations of proportions and associations were done using Stata 15 software. Conversely, qualitative data were collected via focus group discussions (FGDs) for community participants and key informant interviews (KIIs) for local leaders. For the qualitative component, we had 2 FGDs, each consisting of 8 gender-balanced participants per group and 8 KIIs. Qualitative data analyses were done using a robust thematic framework approach, ensuring the reliability and validity of our findings. RESULTS: A total of 422 participants with a mean age of 51.4 years (SD = 15.8) participated in the study. Community involvement in post-elimination surveillance was low (14%). Factors associated with involvements were district support [Adjusted odd ratio AOR 14, 95 CI = (2.5, 81.7)], seeing black flies in the environment in a week preceding the survey [AOR 8, 95% CI = (1.5, 42.5)], in one month [AOR 3.8, 95% CI = (1.1, 13.2)], and being a community volunteer in the Ivermectin treatment program [AOR 4.3, 95% CI = (1.03, 17.9)]. Lack of funding, poor motivation, poor program sustainability planning, and a lack of drugs at health facilities were key challenges affecting community involvement in post-elimination surveillance. CONCLUSION: Community involvement in onchocerciasis post-elimination surveillance activities in Bududa District in Eastern Uganda was low but could be improved by increased district support, funding, community motivation and sensitisation.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

The distribution of esophageal cancer patients enrolled in care at the Uganda Cancer Institute by sub-regions, districts and ethnicity.

Background: There is limited published data regarding the distribution of esophageal cancer patients by sub-regions, districts and ethnicity in Uganda. Objectives: To study the distribution by sub-regions, districts, ethnicity and sub-regions post-care outcomes of esophageal cancer patients in care over ten years at the Uganda Cancer Institute. Methods: Patients' charts with confirmed diagnoses of esophageal cancer for 2009-2019 were identified. Case information, which included demographics, clinical presentation, distribution by sub-regions, districts, ethnicity and sub-regions post-care outcomes, were retrospectively abstracted. Results: Central 671(34.15%), Southwestern 308(15.67%), Elgon 176(8.95%) and East central 163(8.29%) sub-regions had most patients. Mostly from administrative districts of Wakiso 167(8.50%), Mbarara 51(2.59%), Tororo 53(2.70%), Busia 33(1.68). Baganda, Banyakole, Bagisu and Basoga ethnic groups predominate. Patients from neighbouring countries were mainly from Rwanda 56(2.85%), South Sudan 24(1.22%), then Kenya 21(1.07%), and Rwandese, Dinka and Luo by ethnicity, respectively. Central and Southwestern sub-regions had the most post-care outcomes of the patients regarding living, death, and loss to follow-up. Conclusion: Patients are commonly from the administrative districts of Central, Southwestern, Elgon and East Central sub-regions and neighbouring countries of Rwanda, South Sudan and Kenya. Baganda, Banyakole, Bagisu and Basoga are the main ethnic groups. Central and Southwestern sub-regions are with most post-care outcomes.

Coping strategies, challenges and potential interventions among adult patients with HIV and mental illness comorbidity in southwestern Uganda.

HIV and mental illness comorbidity presents significant healthcare challenges, especially in low- and middle-income countries where healthcare systems often address individual conditions rather than comorbidities. This results in poor coping, increased vulnerability and diminished health-related quality of life. This study investigated coping strategies, challenges and potential interventions for individuals with HIV-mental illness comorbidity in Southwestern Uganda. The study included purposively selected people with HIV and mental illnesses seeking care in health facilities across Southwestern Uganda. Data from in-depth, semi-structured interviews were transcribed verbatim and entered into ATLAS.ti-7 for analysis. Thematic analysis was employed, generating codes from the transcripts to develop themes. The data revealed three categories: coping strategies, challenges and potential interventions. Three key coping strategies emerged: conscious avoidance of emotional stressors, maintaining emotional stability through social interactions and reliance on prayer. Challenges included social isolation, financial crises, vulnerability to abuse and medication management issues. Respondents recommended scaling up mass educational programmes to increase awareness of causes, preventive measures and association between the two comorbidities, together with implementing financial aid initiatives as viable interventions. These findings highlight the importance of addressing comorbidities together for improved emotional stability and underscore the value of the proposed potential interventions for healthcare systems and policymakers.

Evaluation of the sentinel yellow fever surveillance system in Uganda, 2017-2022: strengths and weaknesses.

BACKGROUND: Uganda has a sentinel surveillance system in seven high-risk sites to monitor yellow fever (YF) patterns and detect outbreaks. We evaluated the performance of this system from 2017 to 2022. METHODS: We evaluated selected attributes, including timeliness (lags between different critical time points), external completeness (proportion of expected sentinel sites reporting ≥ 1 suspect case in the system annually), and internal completeness (proportion of reports with the minimum required data elements filled), using secondary data in the YF surveillance database from January 2017-July 2022. We conducted key informant interviews with stakeholders at health facility and national level to assess usefulness, flexibility, simplicity, and acceptability of the surveillance system. RESULTS: In total, 3,073 suspected and 15 confirmed YF cases were reported. The median time lag from sample collection to laboratory shipment was 37 days (IQR:21-54). External completeness was 76%; internal completeness was 65%. Stakeholders felt that the surveillance system was simple and acceptable, but were uncertain about flexibility. Most (71%) YF cases in previous outbreaks were detected through the sentinel surveillance system; data were used to inform interventions such as intensified YF vaccination. CONCLUSION: The YF sentinel surveillance system was useful in detecting outbreaks and informing public health action. Delays in case confirmation and incomplete data compromised its overall effectiveness and efficiency.

Awareness of cervical cancer risk factors and preventive approaches, and perceived causes of cervical cancer among secondary school girls: a cross-sectional study in Northern Uganda.

BACKGROUND: The majority of women in low- and middle-income countries have low awareness of cervical cancer. This study sought to establish awareness of cervical cancer risk factors and preventive approaches, as well as sources of information and perceived causes of cervical cancer among secondary school girls in northern Uganda. METHODS: This was a cross-sectional study conducted in rural northern Uganda. We collected data using an investigator administered pre-tested questionnaire. Analysis was done with STATA version 14.0. Multivariate analyses with logistic regressions models were used to determine magnitudes of association between independent and outcome variables. Odds ratios and accompanying 95% confidence intervals are reported. Statistical significance was considered if the two sided p-value <.05. RESULTS: Most participants (97%; n = 624) had heard of cervical cancer before this study. The most common source of information about cervical cancer was friends (31.1%; n = 194). More than half of the participants (59%; n = 380) had heard about a vaccine that prevents cervical cancer, but only a third (33%; n = 124) had ever received a dose of the vaccine. The majority of participants (89%; n = 550) reported that cervical cancer could be prevented; however only half (52%; n = 290) knew that vaccination of girls aged 9-13 years could prevent cervical cancer. The majority of participants did not recognize the risk factors for cervical cancer; for example, only 15% (n = 98), 7% (n = 45), and 1.4% (n = 9) recognized early onset of sexual intercourse, infection by the human papillomavirus (HPV), and smoking respectively. On adjusting for age, students' class, and religion, students in schools with school health programs were twice (aOR = 2.24: 95%CI; 1.24-4.06) more likely to know that cervical cancer is preventable. CONCLUSION: Secondary school girls need information on cervical cancer risk factors and approaches to prevention so that they may avoid exposures to the risk factors and promptly seek and undertake preventive approaches including HPV vaccinations.

Educational interventions through school health programs are viable strategies to improve the knowledge of secondary school girls on cervical cancer risk factors and preventive approaches.Peers/friends are key sources of information on cervical cancer to secondary school girls.Peers/friends are a sustainable strategic resource, and therefore students could be trained to provide peer training on cervical cancer risk factors and preventive approaches to fellow secondary school girls.

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

BACKGROUND: Cervical 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. METHODS: Secondary 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. RESULTS: The 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. CONCLUSION: Early 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.

Non-falciparum malaria infections in Uganda, does it matter? A review of the published literature.

BACKGROUND: Plasmodium falciparum is the dominant malaria species in the sub-Saharan Africa and the main cause of severe disease and death. Notwithstanding, severe malaria and death due to non-falciparum infections have been reported, but at much lower rates than P. falciparum infections. Following increasing use of molecular detection techniques in epidemiological studies, a higher prevalence of non-falciparum species has been reported in the region than previously thought. This article reviews the literature on the prevalence of non-falciparum malaria species in Uganda and the clinical figures of their severe diseases. It aims to elucidate the extent to which mono non-falciparum malaria infections in a highly malaria-endemic country contribute to malaria mortality and outline its policy implications on malaria case management. METHODS: The available English-language published peer-reviewed literature up to March 2024 was sought via PubMed and Google Scholar. The keywords used were severe malaria, AND P. falciparum, P. malariae, P. vivax, P. ovale spp., mixed infections AND Uganda. The review encompassed 53 articles. Articles using molecular diagnosis methods were accounted for analysis. RESULTS: The literature reported a substantial prevalence of non-falciparum infections in Uganda. Plasmodium malariae and Plasmodium ovale spp. were the second and third most prevalent reported malaria species respectively after P. falciparum as dominant species. Non-falciparum malaria infections often occur as mixed infections rather than mono-infections. Besides, molecular diagnostics revealed that 21% of initially reported mono-infections of P. falciparum were, in fact, mixed infections. No article was found on the prevalence of severe malaria or case fatality rate due to mixed or non-falciparum infections. CONCLUSION: A critical knowledge gap exists regarding the impact of mixed and non-falciparum species on severe malaria and death in Uganda. Robust evidence on prevalence, recurrent parasitaemia, and severe clinical manifestations of mixed and non-falciparum malaria infections is crucial for evidence-based and effective policymaking regarding malaria case management.

Enhancing the capacity of community health workers in prevention and control of epidemics and pandemics in Wakiso district, Uganda: evaluation of a pilot project.

BACKGROUND: Community Health Workers (CHWs) play a crucial role in outbreak response, including health education, contact tracing, and referral of cases if adequately trained. A pilot project recently trained 766 CHWs in Wakiso district Uganda on epidemic and pandemic preparedness and response including COVID-19. This evaluation was carried out to generate evidence on the outcomes of the project that can inform preparations for future outbreaks in the country. METHODS: This was a qualitative evaluation carried out one year after the project. It used three data collection methods: 30 in-depth interviews among trained CHWs; 15 focus group discussions among community members served by CHWs; and 11 key informant interviews among community health stakeholders. The data was analysed using a thematic approach in NVivo (version 12). RESULTS: Findings from the study are presented under four themes. (1) Improved knowledge and skills on managing epidemics and pandemics. CHWs distinguished between the two terminologies and correctly identified the signs and symptoms of associated diseases. CHWs reported improved communication, treatment of illnesses, and report writing skills which were of great importance including for managing COVID-19 patients. (2) Enhanced attitudes towards managing epidemics and pandemics as CHWs showed dedication to their work and more confidence when performing tasks specifically health education on prevention measures for COVID-19. (3) Improved health practices such as hand washing, vaccination uptake, and wearing of masks in the community and amongst CHWs. (4) Enhanced performance in managing epidemics and pandemics which resulted in increased work efficiency of CHWs. CHWs were able to carry out community mobilization through door-to-door household visits and talks on community radios as part of the COVID-19 response. CHWs were also able to prioritize health services for the elderly, and support the management of patients with chronic diseases such as HIV, TB and diabetes by delivering their drugs. CONCLUSIONS: These findings demonstrate that CHWs can support epidemic and pandemic response when their capacity is enhanced. There is need to invest in routine training of CHWs to contribute to outbreak preparedness and response.

Widespread human exposure to ledanteviruses in Uganda: A population study.

Le Dantec virus (LDV), assigned to the species Ledantevirus ledantec, genus Ledantevirus, family Rhabdoviridae has been associated with human disease but has gone undetected since the 1970s. We describe the detection of LDV in a human case of undifferentiated fever in Uganda by metagenomic sequencing and demonstrate a serological response using ELISA and pseudotype neutralisation. By screening 997 individuals sampled in 2016, we show frequent exposure to ledanteviruses with 76% of individuals seropositive in Western Uganda, but lower seroprevalence in other areas. Serological cross-reactivity as measured by pseudotype-based neutralisation was confined to ledanteviruses, indicating population seropositivity may represent either exposure to LDV or related ledanteviruses. We also describe the discovery of a closely related ledantevirus in blood from the synanthropic rodent Mastomys erythroleucus. Ledantevirus infection is common in Uganda but is geographically heterogenous. Further surveys of patients presenting with acute fever are required to determine the contribution of these emerging viruses to febrile illness in Uganda.

On alert for Ebola: public health risk assessment of travellers from Uganda to the USA during the 2022 outbreak.

BACKGROUND: On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. METHODS: From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21 days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes. RESULTS: Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. CONCLUSION: Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.

Prevalence and Factors Associated with Impaired Maternal-Infant Bonding among Mothers Attending Young Child Clinic in Kampala, Uganda.

Impaired maternal-infant bonding can have a negative impact on the mother-infant relationship, affecting the social, emotional, and cognitive development of a child. In Uganda, there is a paucity of literature on impaired maternal-infant bonding. This quantitative, cross-sectional study aimed to determine the prevalence and factors associated with impaired maternal-infant bonding. Postnatal mothers (n = 422) attending the Young Child Clinic at Kawempe National Referral Hospital participated in the study. Maternal-infant bonding was measured using the Postpartum Bonding Questionnaire (PBQ). Participants with a score ≥ 13 on the PBQ were considered to have impaired maternal-infant bonding. The prevalence of impaired maternal-infant bonding among mothers was 45% (190/422). Logistic regression was used to determine factors associated with impaired maternal-infant bonding. Unmarried mothers (AOR = 2.05, 95% [CI = 1.03-4.09], p = 0.041), unplanned pregnancy (AOR = 5.19, 95% [CI = 3.07-8.82], p < 0.001), first-time mothers (AOR = 2.46, 95% [CI = 1.37-4.43], p = 0.003), female infant (AOR = 1.80, 95% [CI = 1.13-2.86], p = 0.013), mothers with no/low education levels (AOR = 2.29, 95% [CI = 1.05-4.50], p = 0.036), and those who delivered post term (AOR = 2.49, 95% [CI = 1.10-5.67], p = 0.028) were more likely to have impaired maternal-infant bonding. Nurses and midwives in postnatal care should include maternal-infant bonding within their client's assessment and provide supportive mother-centered care. Interventions to improve maternal-infant bonding should be created and implemented in clinical practice.

Strategies to Enhance COVID-19 Vaccine Uptake among Prioritized Groups, Uganda-Lessons Learned and Recommendations for Future Pandemics.

COVID-19 vaccination was launched in March 2021 in Uganda and initially prioritized persons >50 years of age, persons with underlying conditions, healthcare workers, teachers, and security forces. However, uptake remained low 5 months after the program launch. Makerere University's Infectious Diseases Institute supported Uganda's Ministry of Health in optimizing COVID-19 vaccination uptake models by using point-of-care, place of worship, and place of work engagement and the Social Assistance Grant for Empowerment model in 47 of 135 districts in Uganda, where we trained influencers to support mobilization for vaccination outreach under each model. During July-December, vaccination rates increased significantly in targeted regions, from 92% to 130% for healthcare workers, 40% to 90% for teachers, 25% to 33% for security personnel, 6% to 15% for persons >50 years of age, and 6% to 11% for persons with underlying conditions. Our approach could be adopted in other targeted vaccination campaigns for future pandemics.