School of Medicine (KABSOM)

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Open Access
Temporal Changes in Plasmodium Falciparum Genetic Diversity and Multiplicity of Infection Across Three Areas of Varying Malaria Transmission Intensities in Uganda.
(Kabale University, 2025) Mwesigwa, Alex; Kiwuwa, Steven M.; Musinguzi, Benson; Kawalya, Hakiim; Katumba, James Davis; Baguma, Andrew; Mutuku, Irene M.; Adebayo, Ismail Abiola; Nsobya, Samuel L.; Byakika‐Kibwika, Pauline; Kalyango, Joan N.; Karamagi, Charles; Nankabirwa, Joaniter I.
Background: Malaria is a significant public health challenge in Uganda, with Plasmodium falciparum (P. falciparum) responsible for most malaria infections. The high genetic diversity and multiplicity of infection (MOI) associated with P. falciparum complicate treatment and prevention efforts. This study investigated temporal changes in P. falciparum genetic diversity and MOI across three sites with varying malaria transmission intensities. Understanding these changes is essential for informing effective malaria control strategies for the different malaria transmission settings. Methods: A total of 220 P. falciparum-positive dried blood spot (DBS) filter paper samples from participants in a study conducted during 2011–2012 and 2015–2016 were analyzed. Genotyping utilized seven polymorphic markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34–313, and C3M69–383. Genetic diversity metrics, including the number of alleles and expected heterozygosity, were calculated using GENALEX and ARLEQUIN software. MOI was assessed by counting distinct genotypes. Multi-locus linkage disequilibrium (LD) and genetic differentiation were evaluated using the standardized index of association ( IAS) and Wright’s fixation index (FST), respectively. Statistical comparisons were made using the Kruskal–Wallis test, and temporal trends were analyzed using the Jonckheere–Terpstra test, with statistical significance set at p < 0.05. Results of the 220 samples, 180 were successfully amplified. The majority of participants were males (50.6%) and children aged 5–11 years (46.7%). Genetic diversity remained high, with mean expected heterozygosity (He) showing a slight decrease over time (range: 0.73–0.82). Polyclonal infections exceeded 50% at all sites, and mean MOI ranged from 1.7 to 2.2, with a significant reduction in Tororo (from 2.2 to 2.0, p = 0.03). Linkage disequilibrium showed a slight increase, with Kanungu exhibiting the lowest IAS in 2011–2012 (0.0085) and Jinja the highest (0.0239) in 2015–2016. Overall genetic differentiation remained low, with slight increases in pairwise FST values over time, notably between Jinja and Tororo (from 0.0145 to 0.0353). Conclusions: This study highlights the genetic diversity and MOI of P. falciparum in Uganda’s malaria transmission settings, noting a slight decrease in both genetic diversity and MOI over time. Continued surveillance and targeted control strategies are essential for monitoring the impact of malaria control efforts in Uganda.
Open Access
Distribution of Candida Species Isolated from People Living with Human Immunodeficiency Virus With Oropharyngeal and Oral Candidiasis in Africa in the Era Of Universal Test and Treat Policy: A Systematic Review and Meta-Analysis.
(Kabale University, 2024) Musinguzi, Benson; Obuku, Ekwaro A.; Mwesigwa, Alex; Migisha, Richard; Kinengyere, Alison Annet; Ndagire, Regina; Baguma, Andrew; Okek, Erick Jacob; Olum, Ronald; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
Background The introduction of antiretroviral therapy (ART) and the implementation of the human immunodeficiency virus (HIV) universal test and treat (UTT) policy have led to a decline in the incidence of opportunistic infections. However, oropharyngeal and oral candidiasis remain prevalent and continue to pose challenges among people living with human immunodefciency virus (PLHIV) in Africa, indicating the need for a better understanding of the distribution of Candida species responsible for these infections. This systematic review and meta-analysis aimed to determine the distribution of Candida species isolated from PLHIV with oropharyngeal and oral candidiasis in Africa in the era of UTT policy. Methods The review followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted to identify eligible studies to be included in the meta-analysis and analyzed using a random effects model in STATA version 17. The risk of bias was assessed using the Joanna Briggs Institute quality assessment tool. Results Fourteen studies with 4281 participants were included in the review. Overall, 2095 Candida isolates were reported, 78.7% (1650/2095) of which were C. albicans, 19.6% (410/2095), non-albicans Candida (NAC), and 1.7% (35/2095) could not be identified to the Candida specific species level. The most prevalent NAC species were C. glabrate (26.3%), followed by C. tropicalis (24.9%), C. krusei (15.6%), C. parapsilosis (11%), and C. dubliniensis (6.3%). The pooled prevalence of oropharyngeal and oral candidiasis was 48% (95% CI 34–62%). The prevalence of oropharyngeal candidiasis was higher in the pre-UTT era, at 56% (95% CI 40–72%, p<0.001), than in the post-UTT era, at 34% (95% CI 10–67%, p<0.001). The risk of bias assessment revealed that 71.4% (10/14) of the included studies had a low risk of bias and that 28.6% (4/14) had a moderate risk of bias. Conclusions While C. albicans remains, the predominant species causing oropharyngeal and oral candidiasis among PLHIV in Africa, NAC species also contribute significantly to the infection burden. Despite ART and UTT policies, oropharyngeal candidiasis remains prevalent, emphasizing the need for targeted interventions.
Open Access
“I Desire to Have an HIV‐Free Baby”: Pregnant and Breastfeeding Mothers’ Perceptions of Viral Load Testing and Suppression in HIV Care in Southwestern Uganda.
(Kabale University, 2024) Kabami, Jane; Akatukwasa, Cecilia; Kabageni, Stella; Nangendo, Joanita; Byamukama, Ambrose; Atwiine, Fredrick; Mftumukiza, Valence; Tamu, Munezero John Bosco; Arinaitwe, Elizabeth; Mutabazi, Andrew; Ssebutinde, Peter; Musoke, Phillipa; Kamya, Moses R.; Katahoire, Anne R.
Introduction Viral suppression is a critical component for preventing mother-to-child transmission of HIV(MTCT). Mothers’ perceptions of viral load suppression is crucial in the attainment of successful outcomes in preventing mother-to-child transmission of HIV. We therefore aimed to explore the experiences and perceptions of women on viral suppression. Methods This was a qualitative sub-study embedded in a cluster-randomized trial (NCT04122144) designed to improve viral load outcomes among pregnant and breastfeeding mothers living with HIV in four level III/IV health facilities in Southwestern Uganda. Thirty-two in-depth interviews were conducted with pregnant and breastfeeding women with HIV from 1st March 2020 to 30th September 2020 to explore their understanding and interpretation of viral suppression. Interviews were audio-recorded, transcribed, and coded in Dedoose software for analysis. Results A total of 32 Women living with HIV were enrolled in this qualitative study. WLHIV explained viral suppression in the context of attaining good health and having HIV-free babies. Adherence to ART was presented as a key avenue to viral suppression. The level of engagement with providers was presented as a key attribute of attaining viral suppression. The participants narrated their experiences with viral load testing within the routine services. However, they revealed experiencing some proximate barriers to suppression, including anticipated stigma, challenges with nondisclosure of HIV status, pregnancy distress, and distance to the health facility. Conclusion The understanding and interpretation of viral suppression among pregnant and breastfeeding mothers living with HIV provides a basis for adopting behaviors leading to the prevention of vertical transmission of HIV. Health care workers can support women by providing clear and culturally appropriate education about viral suppression, adherence strategies and creating a supportive and non-judgmental environment.
Open Access
Plasmodium Falciparum Genetic Diversity and Multiplicity of Infection Among Asymptomatic and Symptomatic Malaria-Infected Individuals in Uganda.
(Kabale University, 2024) Mwesigwa, Alex; Ocan, Moses; Cummings, Bryan; Musinguzi, Benson; Kiyaga, Shahid; Kiwuwa, Steven M.; Okoboi, Stephen; Castelnuovo, Barbara; Bikaitwoha, Everd Maniple; Kalyango, Joan N.; Karamagi, Charles; Nankabirwa, Joaniter I.; Nsobya, Samuel L.; Byakika‐Kibwika, Pauline
Plasmodium falciparum (P. falciparum) remains a significant public health challenge globally, especially in sub-Saharan Africa (SSA), where it accounts for 99% of all malaria infections. The outcomes of P. falciparum infection vary, ranging from asymptomatic to severe, and are associated with factors such as host immunity, parasite genetic diversity, and multiplicity of infection (MOI). Using seven neutral microsatellite markers, the current study investigated P. falciparum genetic diversity and MOI in both asymptomatic and symptomatic malaria individuals in Uganda. Methods This cross-sectional study analyzed 225 P. falciparum isolates from both asymptomatic and symptomatic malaria patients, ranging in age from 6 months to≥18 years. P. falciparum genetic diversity, MOI, and multilocus linkage disequilibrium (LD) were assessed through genotyping of seven neutral microsatellite markers: Polyα, TA1, TA109, PfPK2, 2490, C2M34–313, and C3M69–383. Genetic data analysis was performed using appropriate genetic analysis software. Results P. falciparum infections exhibited high genetic diversity in both asymptomatic and symptomatic individuals. The mean expected heterozygosity (He) ranged from 0.79 in symptomatic uncomplicated malaria cases to 0.81 in asymptomatic individuals. There was no significant difference (p=0.33) in MOI between individuals with asymptomatic and symptomatic infections, with the mean MOI ranging from 1.92 in symptomatic complicated cases to 2.10 in asymptomatic individuals. Polyclonal infections were prevalent, varying from 58.5% in symptomatic complicated malaria to 63% in symptomatic uncomplicated malaria cases. A significant linkage disequilibrium (LD) was observed between asymptomatic and symptomatic uncomplicated/complicated infections (p<0.01). Genetic differentiation was low, with FST values ranging from 0.0034 to 0.0105 among P. falciparum parasite populations in asymptomatic and symptomatic uncomplicated/complicated infections. Conclusion There is a high level of P. falciparum genetic diversity and MOI among both symptomatic and asymp‑ automatic individuals in Uganda. Asymptomatic carriers harbor a diverse range of parasites, which poses challenges for malaria control and necessitates targeted interventions to develop effective strategies.
Open Access
The Factors Associated with Utilization of Sexual and Reproductive Health Services Among Batwa Adolescents in Kisoro District Uganda: A Cross-Sectional Study.
(Kabale University, 2024) Kyambade, Robert; Nwankwo, Chinenye Mercy; Tamu, Munezero J.B.; Okafor, Christiana
Background: Adolescents’ sexual and reproductive health (SRH) needs are crucial and meeting such needs presents a unique challenge among minority and marginalized populations, such as the Batwa of southwestern Uganda. Objective: The study investigated the factors influencing the utilization of SRH among Batwa minority adolescents in the Kisoro district. Methods: A cross-sectional study was adopted, incorporating both qualitative and quantitative methods. Data was collected from a random sample of 241 adolescents from a target population of 608 aged 10–18 years using validated interviewer-administered questionnaires, focus group discussions, and key informants interviews. Qualitative data were coded into themes and analyzed thematically, while quantitative data was analyzed using frequencies, Chi-square tests, and multinomial logistic regression. RESULTS: The majority of adolescents (59.3%, CI: 52.84 - 65.60), were aware of the voluntary counseling services provided, 76.8% (CI: 70.91 - 81.94) were aware of family planning services, but 53.5% (CI: 47.01 - 59.95) were not aware of SHR related issues. About 44.8% (CI: 38.24 - 51.36) had visited health facilities once in the past year, while 55.2% (CI: 48.67 - 61.57) had never utilized adolescent SRH. Furthermore, 71.8% (CI: 65.43 - 77.47) were aware of adolescent-friendly SRH services. Factors associated with SRH service utilization included education (p = 0.029), source of medical services (p < 0.001), and proximity to health facilities (p < 0.001). Findings from the multinomial logistic regression showed that SRH services utilization was associated with an increased odd of distance to health facilities (OR 3.74, 95% CI: 1.86 - 7.53). Conclusion: The study highlights high levels of SRH services awareness but low levels of utilization among Batwa adolescents. Strategic planning of reproductive health service programs in Batwa communities is strongly recommended to enhance accessibility, service ownership, and utilization.
Open Access
Cognizance and Perception of Physiotherapy Intervention in Attention-Defcit/Hyperactivity Disorder Amongst Clinical Physiotherapy Students in Tertiary Institution, Nigeria.
(Kabale University, 2024) Okonkwol, Uchenna Prosper; Nwose, Joy Chinazaekpere; Akosile, Christopher Olusanja; Chukwuemeka, Uchechukwu Martha; Mbanuzuru, Ahaoma Victor; Igwe, Emeka Sylvester; Okafor, Christiana Nkiru; Ummunah, Joseph Onuuwa
This study examines the cognizance and perception of physiotherapy intervention in ADHD amongst clinical physiotherapy students in a tertiary institution and, also, determines the relationship of the study variables on the sociology-demographic characteristics. This study is a cross-sectional survey and employed a convenient sampling technique to recruit 137 respondents. A cognizance and perception questionnaire was used as the survey instrument to obtain data. Descriptive statistics of frequency, mean, and standard deviation were used to analyse the socio-demographic characteristics. Spearman rank correlation was used to analyse the relationship amongst the variables of cognizance of attention-deficit/hyperactivity disorder (COG-ADHD), perception of attention-deficit/hyperactivity disorder (PERCEP-ADHD), cognizance of physiotherapy intervention (COG-PT_ITV), and perception of physiotherapy intervention (PERCEP-PT_ITV). The Mann-Whitney U test was used to test the infuence of sociology-demographic characteristics of age and the level of study on the cognizance and perception of ADHD. Variables having a p-value<0.05 were considered statistically signifcant. The majority of the respondents (63.5%) had high cognizance of physiotherapy intervention for ADHD, while the majority of the respondents (60.6%) had a fair perception of physiotherapy intervention for ADHD. A signifcant proportion of respondents (26.3%) had no source of information on ADHD before the study. Cognizance of ADHD signifcantly correlated with perception of ADHD, ADHD, perception of physiotherapy intervention in ADHD, and cognizance of physiotherapy intervention in ADHD. There were signifcant positive correlations between gender and cognizance of physiotherapy intervention in ADHD and between the level of study and perception of ADHD. Conclusion Respondent’s perception of physiotherapy intervention in ADHD was relatively low; in contrast, their cognizance was relatively satisfactory. Strengthening their cognizance and perception is paramount.
Open Access
Prevalence of and Risk factors associated with hypertension: a community based- cross sectional study in Ndorwa West Health Sub District, Kabale district, southwestern Uganda.
(Kabale University, 2024) Munezero,Tamu John Bosco; Mfitumukiza, Valence; Okafor, Christiana Nkiru; Mandera, Immaculate; Kabami, Jane; Arineitwe, Edward Bwengye; Namuyibwa, Lydia; Izo, Herbert; Baikaitwoha, Everd M.; Okonkwo, Uchenna Prosper
Globally, one billion people have hypertension (HT), it kills 9.4 million people annually. Prevalence is higher in developed countries and is rapidly rising in developing countries, and approximately 31.5% of Ugandans have HT. This study aimed to determine the prevalence of and risk factors associated with HT among adults aged 25–65 years in the Ndorwa West HSD, Kabale District. A community-based cross-sectional survey was conducted with 381 adults aged 25–65 years in Ndorwa West HSD, using a modified WHO STEPwise approach to chronic disease risk factor surveillance. Chi-square tests with 95% Confidence Intervals (CI) and p-values less than 0.05, were used to assess the association between hypertension and associated factors. Odds Ratios (OR) with their corresponding 95% confidence intervals (95% CI) estimated the risk. The prevalence of HT and pre-HT in Ndorwa HSD was 28.3% and 45.7%, respectively. 61.8% (n = 243) were females and 36.1% (n = 142) were males with a mean age of 48.18 years and standard deviation of 11.5 years. The mean Body Mass Index (BMI) was 25.92 kg/m2 and the standard deviation was 3.69 kg/m2. Only Age (p = 0.010, OR = 1.81(1.14–2.87) and level of education (p = 0.04) were significantly associated with hypertension. age ≥ 45years increased the likelihood of developing HT by 0.81 times. Behavioral factors associated with HT included awareness of the BP status (p = 0.010, OR = 0.53(CI: 0.32–0.87),use of fats/oil for cooking (p = 0.02, OR = 1.73 (CI: 1.09–2.75)), reduced salt intake (p = 0.001, OR = 0.075(CI:0.01–0.55)), and overweight and obesity (BMI) level ( p = 0.010, OR = 1.77 (CI 1.12–2.80)). BMI ≥ 25kg/m2 increased the likelihood of developing HT by 0.77 times. The prevalence of HT and pre-HT in this rapidly transitioning rural–urban population was high. The risk of CVDs is about 16 folds higher among pre-HT compared to no HT and doubles for every 10-mmHg increase in BP. Hence, the considerable risk and burden of HT and related CVDs that require a dire need to adopt strategies to prevent and control hypertension based on the identified associated risk factors in Ndorwa HSD
Open Access
Education of Nurses in Rural Primary Health Cares to Improve Vital Care of Newborns: A Community-Based Research in Nigeria.
(Kabale University, 2024) Clementina, Nkiru Eze; Christiana, Elusoji I.; Christiana, Nkiru Okafor; Augusta, Nkechi Emeh; Amuchechukwu, Veronica Nwafor; Ihuoma, Obi A.; Odinakachukwu, Onyeabor Juliana; Ohams, Ohanme Eugene
This study was designed to ascertain the level of knowledge and the degree of practice of the components of Essential New-born care (ENC), and the effects of a training programme on the knowledge and practice of ENC among nurses in rural Primary Health Cares (PHCs) in South East Nigeria. This study was a one group pre-test and post-test intervention design. The components of ENC considered were: New-Born Initiation of Breastfeeding, Thermoregulation, New-Born Cord Care, Newborn Eye Care, Initiation of Breathing and Administration of Vitamin K. A Neonatal care Knowledge and Practice Assessment (NCKPA) Questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (96) available nurses (All female). There was significant improvement in the level of knowledge and extent of practice of the components of ENC following the training programme. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of Eye care 40(41.6%) - per-intervention, and least knowledge of cord care 70 (72.9%) and eye care 90(93.8%) - post-intervention. Increase in knowledge corresponded with increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, update courses and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rate.
Open Access
The Factors Associated with Utilization of Sexual and Reproductive Health Services Among Batwa Adolescents in Kisoro District Uganda: A Cross-Sectional Study.
(Kabale University, 2024) Kyambade, Robert; Nwankwo, Chinenye Mercy; Tamu, Munezero J.B.; Okafor, Christiana
BACKGROUND: Adolescents’ sexual and reproductive health (SRH) needs are crucial and meeting such needs presents with a unique challenge among minority and marginalized populations, such as the Batwa of southwestern Uganda. OBJECTIVE: The study investigated the factors influencing utilization SRH among Batwa minority adolescents in Kisoro district. METHODS: A cross-sectional study was adopted, incorporating both qualitative and quantitative methods. Data was collected from a random sample of 241 adolescents from a target population of 608 aged 10–18 years using validated interviewer-administered questionnaires, focus group discussions, and key Informants interviews. Qualitative data were coded into themes and analyzed thematically, while quantitative data was analyzed using frequencies, Chi-square tests, and multinomial logistic regression. RESULTS: The majority of adolescents (59.3%, CI: 52.84 - 65.60), were aware of the voluntary counseling services provided, 76.8% (CI: 70.91 - 81.94) were aware of family planning services, but 53.5% (CI: 47.01 - 59.95) were not aware of SHR related issues. About 44.8% (CI: 38.24 - 51.36) had visited health facility once in the past year, while 55.2% (CI: 48.67 - 61.57) had never utilized adolescent SRH. Furthermore, 71.8% (CI: 65.43 - 77.47) were aware of adolescent-friendly SRH services. Factors associated with SRH service utilization included education (p = 0.029), source of medical services (p< 0.001), and proximity to health facilities (p < 0.001). Findings from the multinomial logistic regression showed that SRH services utilization was associated with an increased odd of distance to health facilities (OR 3.74, 95% CI: 1.86 - 7.53). CONCLUSION: The study highlights high levels of SRH services awareness but low levels of utilization among Batwa adolescents. Strategic planning of reproductive health service programs in Batwa communities is strongly recommended to enhance accessibility, service ownership and utilization.
Open Access
Impact of Essential Newborn Care Education on Knowledge and Practice of New-Born Care Among Nurses in Rural Primary Health Centres in Ebonyi State of Nigeria.
(Kabale University, 2024) Clementina, Eze N.; Christiana, Elusoji I.; Okafor, Christiana N.; Emeh, Augusta N.; Obi, Ihuoma A.; Odira, Chika C. H.; Onyeabor, Juliana O.; Nwafor, Amuchechukwu V.; Ohanme, Eugene O.
Background: This study was designed to determine the level of knowledge and the extent of practice of the components of essential new-born care (ENC), and the effects of a training programme on the knowledge and practice of ENC among nurses in rural primary health cares (PHCs) in Ebonyi state Nigeria. Methods: This study was a one group per-test and post-test intervention design. The components of ENC considered were: New-born initiation of breastfeeding, thermoregulation, new-born cord care, newborn eye care, initiation of breathing and administration of vitamin K. A neonatal care knowledge and practice assessment (NCKPA) questionnaire tested for validity and reliability, with a Spearman’s correlation coefficient of 0.81, was used for data collection among the (48) available nurses (All female). Results: There was significant improvement in the level of knowledge and extent of practice of the components of ENC following the training programme. Despite the improvement, there were gaps in knowledge and practice of the components of ENC amongst the nurses in rural PHCs and affected were the level of knowledge of eye care 20 (41.6%) pre-intervention, and least knowledge of cord care 35 (72.9%) and eye care 45 (93.8%)-post-intervention. Conclusions: Increase in knowledge corresponded with increase in good practice of ENC. The concern with knowledge transfer and translation of knowledge into practice could be achieved by pre-service and in-service education, update courses and workshops, and this will empower the nurses, getting them familiar with current trends and practices for improved child survival rate.
Open Access
Self-Care Practices and the Associated Socio-Demographic Variables of Persons With Type 2 Diabetes Mellitus (T2dm) in Southeast, Nigeria.
(Kabale University, 2024) Okafor, Christiana Nkiru; Okonkwo, Uchenna Prosper; Ani, Kenneth Umezulike; Onuora, Ethel Ogoemeka; Nwokike, Mathew; Turyasingura, Jane Byabagambi; Munezero, Tamu JohnBosco; Mfitumukiza1, Valence; Nwankwo, Mercy Chinenye; Tumusiime, Alex
Objective: The study was aimed at assessing the self-care practices and the associated socio-demographic variables of persons with T2DM in South East, Nigeria. Methodology: A cross-sectional study involving 382 persons with T2DM proportionately selected from 4 tertiary health institutions in South Eastern, Nigeria. Data was collected using the Summary of Diabetes Self-Care Activities (SDSCA) and a researcher-developed ques- tionnaire. The questionnaire was administered to persons with T2DM who attended a diabetic outpatient clinic. Data collected was analyzed in frequency percentage. Responses on SDSCA were ranked and rated as poor, moderate, and good self-care behavior. The level of signifi- cance was placed at P < .05. Result: The majority of the participants were within the age groups of 40 to 59 (46.9%) and 60 and above (46.9%); the majority (74.6%) were married while a good proportion were traders (59.7%). Also, the majority of participants (81.2%) were on oral hypoglycemic agents. Findings further showed that a good proportion (51.3% and 89.8%) of study participants had good self-care behavior in diet and medication domains respectively. Whereas the proportion of participants with poor self-care behavior was very high in foot care (75.1%) and fairly high in both self-blood sugar testing (37.7%) and exercise (37.2%) domains. Only 7.9% practiced 3-monthly laboratory blood glucose testing while 16.5% went for eye checks every 6 months. Conclusion: Individuals with diabetes mellitus have poor self-management behavior in most domains of the self-management practice. Age, gender, marital status, educational level, and occupation significantly influenced self-management practices. Hence nurses and health educators should take diabetes self-management education very seriously to help diabetes sufferers improve their self-management behavior.
Open Access
Enrollment and Retention of Female Sex Workers in HIV Care in Health Facilities in Mbarara City.
(Kabale University, 2024) Arinaitwe, Bridget; Ariho, Philbert; Naturinda, Christine Hilda; Byoleko, Brian; Base, Anitah; Atwijukiire, Humphrey; Matavu, Hariat; Kabami, Jane; Obua, Celestine; Wakida, Edith K.; Otwine, Anne
Background: Sex work is a global driver of the HIV epidemic, and the risk of acquiring HIV is 13 times higher for female sex workers (FSWs) compared to the general population. The enrollment and retention of FSWs in HIV care is a challenge and has been a major contributing factor to increased new HIV infections. Methods: We conducted a qualitative study among 30 FSWs and 21 healthcare workers (HCWs) working in antiretroviral therapy (ART) clinics at the selected three primary health facilities in Mbarara City, Southwestern Uganda. The study participants were enrolled by both purposive and snowball sampling techniques. We obtained informed consent from all the participants, and data were collected using in-depth interviews and thematically analyzed. Results: Three themes emerged as facilitators toward enrollment and retention of FSWs into HIV care, namely, (1) good health living, (2) receptive HCWs and availability of health services, and (3) community outreach services and peer support. The barriers are summarized into four major themes: (1) stigma, community discrimination, and beliefs; (2) social obstacles; (3) adverse effects of ART; and (4) inadequate services at the health facilities. Conclusion: FSWs are challenged by unsupportive environments and communities where they live and work, which hinders their enrollment and retention in HIV care. Creating awareness of the utilization of HIV care services and extending such services to hotspot communities could enhance the response of HIV-positive FSWs to ART.
Open Access
Factors Associated with Healthcare-Seeking Behavior among Health Profession Students in Selected Universities in Southwestern Uganda.
(Kabale University, 2024) Wamaani, Hannington Gamukama; Olum, Ronald; Ajuna, Noble; Atwijukire, Humphrey; Kabami, Jane; Asiimwe, John Baptist
Introduction: Health professional students (HPS) tend to seek informal health care associated with self-medication (SM). Therefore, this study investigated the factors associated with healthcare-seeking behavior (HSB) among HPS. Methods: The study employed a cross-sectional design. Four hundred (400) HPS from two universities Bishop Stuart University (BSU) and Kampa- la International University Western Campus (KIU)] in southwestern Uganda were selected using a convenience sampling method. Data was collected using a Google form containing structured questions. The link to the questionnaire was sent to prospective participants via WhatsApp platform or email between September and November 2021. Ethical clearance was obtained from the Mbarara University Research Ethics Committee. Data were entered into SPSS software and analyzed using descriptive chi-square statistics, and logistic regression. HSB was considered formal or appropriate if the participant usually sought healthcare from a health worker. Results: A total of 400 HPS were enrolled, 60.3% were males, and the mean age of the participants was 23.06 (SD =2.74) years. Fifty-seven percent (57.5%) of the participants consulted a health worker when ill in the last 12 months (had formal HSB). Most participants’ main reason for seeking health care was to treat the underlying illness (73.3%). About sixty-nine percent (68.6%) of the participants treated themselves during the most recent illness or health problem. Most of the partici- pants searched the internet for health-related information when ill at some point. (Sometimes = 35.8%, Always = 27%, Often = 16%).The academic year of HPS (P < 0.001), access to health facilities (P = 0.018), being too busy (P =0.028), and minor illnesses (P < 0.001) were significantly associated with healthcare-seeking behavior. The lower academic years 1 & 2 (OR = 0.453, P < 0.001, 95% CI = 0.296 - 0.695) and easy access to the health facility (OR = 0.447 P < 0.001, 95% CI = 0.287 - 0.696) were predictors of formal HSB, being too busy (OR = 1.620, P = 0.049, 95% CI = 1.002 - 2.621) and having a minor illness (OR = 2.465, P< 0.001, 95% CI = 1.597 - 3.803) were predictors of informal healthcare seeking behavior. Conclusion: Our study findings indicate that a larger proportion of the participants sought formal health advice upon getting ill although others resorted to self-medication. Accessibility to health facilities and lower academic years predicted formal healthcare-seeking behavior while minor illnesses and being too busy predicted informal HSB among health profession students. Health training institutions should have easily accessible student-friendly healthcare facilities to promote formal healthcare-seeking behavior.
Open Access
Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda.
(Kabale University, 2024) Atwijukiire, Humphrey; Nakidd, Gladys; Tweheyo, Otwine Anne; Kabami, Jane
Purpose: Disclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. The current study addressed this research gap and explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda. Participants and Methods: We conducted 12 in-depth interviews with the help of a translated interview guide, and they were audio recorded. Participants were purposively enrolled in the study, which employed a phenomenological qualitative design. The study was conducted at three public health facilities in Mbarara City. The data was analyzed using thematic content analysis. Approval for this research was obtained from the Mbarara University Research Ethics Committee (MUST-REC) and administrative clearance from the city clerk of Mbarara City. Results: The mean age of the participants was 38 years old, ranging from 20 to 67 years. An equal number of males (six) and females participated in this study. Most of them had at least secondary level education, and only three had primary education. Half of the participants disclosed their serostatus to partners immediately after testing HIV positive. Key emerging themes as experienced benefits of HIV serostatus disclosure included: 1) social support and care; 2) decisions regarding health, fertility, and childbearing; 3) sharing information on HIV prevention and protection measures; 4) positive living; and 5) ease of HIV serostatus disclosure. The challenges associated with serostatus disclosure were summarized as one theme: misunderstandings in the families of the discordant couples. Conclusion: Socially, psychologically, and financially HIV positive individuals have benefited from their negative partners. Healthwise, they have been supported and cared for after disclosing their positive status, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related to HIV serostatus disclosure.
Open Access
Adherence to Viral Load Testing Guidelines, Barriers, and Associated Factors Among Persons Living with HIV on ART in Southwestern Uganda: a Mixed-Methods Study.
(Kabale University, 2024) Lubega, Polly; Nalugya, Sylivia Juliet; Kimuli, Angella Namyalo; Twinokusiima, Majoreen; Khasalamwa, Mercy; Kyomugisa, Richard; Kabami, Jane; Owaraganise, Asiphas
Background: Uganda adapted Viral load (VL) testing for monitoring HIV treatment success and virologic failure. However, there is a paucity of data on how the VL testing guidelines are followed in practice in HIV clinics. This study determined the adherence to national guidelines on VL testing, barriers, and associated factors in persons living with HIV (PLHIV) on ART in southwestern Uganda. Methods: We conducted a cross-sectional mixed methods study from April to May 2021 at four HIV clinics in southwestern Uganda. Patient chart review using a checklist that captured age, gender, and level of a healthcare facility, dates of ART initiation, dates VL specimens were drawn, line of ART, and patient adherence to ART was done. Continuous data were summarized using mean and median and Chi-square was used for categorical data. We performed regression analysis to determine factors associated with adherence to viral load testing guidelines at a 95% level of significance. Key informant interviews with managers of the health facility, ART clinic, and laboratory were carried out, and thematic analysis was conducted to explore barriers to adherence to VL testing guidelines. Results: The participants’ mean (SD) age was 39.9(±13.1) years, 39.5% were male, 45.8% received care at a general hospital and the median duration of ART was 5 years (IQR;3–7). Of the 395 patient charts reviewed, 317 had their VL testing (80.3%) per the guidelines (defined as up to one month post-due date). Receiving care at a hospital (aOR=2.20; 95%CI 1.30–3.70; p=0.002) and increasing patient age (aOR=1.02; 95%CI 1.02–1.06; p=0.020) were the factors associated with adhering to VL testing guidelines. Long turnaround times of VL results and insufficient VL testing kits were cited by providers as barriers. Conclusion: We found suboptimal adherence to VL testing guidelines in PLHIV on ART in southwestern Uganda. Increasing patient age and getting care at a higher-level health facility were associated with guideline-based viral VL testing. The long turnaround time of VL test results and inadequate test kits hindered compliance with VL monitoring guidelines. Strategies that target young PLHIV and lower-level health facilities, increase the stock of consumables, and Shorten VL results turnaround time are needed to improve adherence to VL testing guidelines.
Open Access
Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients’ and Providers’ Perspectives in South Western Uganda.
(Kabale University, 2024) Kasande, Meble; Tusimiirwe, Happiness; Taremwa, Michael; Lamulatu, Kabiite; Amanyire, Mark; Nakidde, Gladys; Kabami, Jane
Purpose: Community Client-Led ART Delivery groups (CCLADS) were introduced as part of the differentiated service delivery models in 2017 to better serve the growing number of HIV patients and reduce unnecessary burden on the HIV care delivery system. However, there is limited evidence on the exact experiences and perceptions of patients and care providers regarding the CCLADS model of ART delivery. We, therefore, aimed to explore the experiences and perceptions of the CCLADS model from the patient and provider perspectives. Participants and Methods: A descriptive qualitative study was conducted at two ART clinics in Southwestern Uganda. We conducted in-depth interviews (IDI) to get a deeper understanding of the patient and providers’ perspectives regarding the model. Responses from participants were recorded using audio recorders and were translated and transcribed. We used a thematic approach to analyze the data. Results: A total of 20 in-depth interviews were conducted, with providers, CCLAD leaders, and Adults Living with HIV (ALHIV) to assess the experiences and perceptions of participation among People Living with HIV (PLHIV) enrolled in CCLADS and the care providers. Key themes included benefits, limitations, experiences, and perceptions of CCLADS. Benefits to ALHIV included: Longer refills, reduced transport costs, receiving drugs in time, and peer advice; to providers: time-saving, less tiresome, and reduced congestion at the facility. Barriers included: stigma, limited outreaches, and failure to comply. Patients perceived the model positively (cost-effective, improved quality care, no missed appointments), whereas others perceived it negatively (blood samples were not taken like before). Experiences also included enough time, learning some activities, and good adherence. Conclusion: Participation in the CCLADS groups provides several benefits to the patient including reduced transport, longer refills, and good adherence. Stigma remains a challenge to CCLADS participation, which requires innovative and collaborative strategies from the Ministry of Health (MOH) and implementation partners to address to sustain CCLADS participation.
Open Access
Adverse Maternal Outcomes and Associated Factors Among Mothers of Advanced Age delivering at a Tertiary Hospital, Southwestern Uganda: A Cross-Sectional Study.
(Kabale University, 2024) Masembe, Sezalio; Migisha, Richard; Turyasingura, Godwin; Aheisibwe, Hillary; Nzabandora, Emmanuel; Lule, John C.
Background Mothers of advanced age, defined as pregnant women aged≥35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. Methods. We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged≥35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, and medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We define adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery, and immediate post-partum events (obstructed labor, antepartum hemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum hemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. Results Out of 417 participants, most were aged 35–37 years (n=206; 49.4%), and had parity≥5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n=157, 95%CI: 33.1–42.4%). Common adverse maternal outcomes included caesarian delivery (23%) and obstructed labor (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labor (adjusted prevalence ratio [aPR]=1.95, 95%CI: 1.44–2.65), prolonged labor, lasting>12 h (aPR=2.86, 95%CI: 1.48–3.16), and chronic hypertension (aPR=2.01, 95%CI: 1.34–3.9). Conclusion Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labor, precipitate labor, and chronic hypertension were more likely to experience adverse outcomes. We recommend the implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.
Open Access
Effect of Educational Intervention Program on Self-Efficacy of Individuals with Type 2 Diabetes Mellitus in South-East, Nigeria.
(Kabale University, 2024) Okafor, Christiana Nkiru; Onyenekwe, Chinedu Charles; Okonkwo, Uchenna Prosper; Umunnah, Joseph Onuuwa; Okoro, Chukwuemeka Chukwubuikem; Mbanuzuru, Ahaoma Victor; Agunwah, Ukamaka Elizabeth; Odira, Chika Chioma; Makata, Eucharia Ngozi; Nwankwo, Chinenye Mercy
Objectives: Diabetes Mellitus is a chronic disease, which requires a level of confidence among the sufferers in its management. This study investigated the effect of an educational intervention program on self-efficacy (SE) in diabetic individuals with type 2 diabetes mellitus in South-East, Nigeria. Methods: The study was a quasi-experimental controlled study, comprising 382 individuals with type 2 DM selected, and assigned to intervention (IG) and control groups (CG). The instrument for data collection was the Stanford Chronic Disease Self-Efficacy Scale (SCDS). Pretest data were collected, and thereafter education on diabetes management was given to the IG group. The IG was followed up for 6 months. At the end of 6 months, post-test data were collected using the same instrument. Data were analyzed using Pearson Chi-square test statistics. A P-value less than .05 alpha level was considered significant. Results: There was no statistically significant difference between the two groups before intervention. However, after 6 months of intervention, a significant proportion of participants’ scores in IG moved from low to either moderate or high SE in almost all the SE domains (P < .05. Conclusions: There was an improvement in most domains of self-efficacy in the intervention group after 6 months of educational intervention.
Open Access
Factors associated with knowledge on the spread of HIV/AIDS among Secondary School Students of Groupe Scolaire De Rugando in Kigali City, Rwanda.
(Kabale University, 2024) Nwankwo, Chinenye Mercy; Uwizeye, Denyse Sibomana
Human Immunodeficiency Virus has continued to spread in most countries, including Rwanda. Youths are particularly vulnerable to HIV/AIDS because they are not sufficiently prepared to address problems related to their sexuality and also because they do not have enough real knowledge about HIV and AIDS. The study assessed factors associated with knowledge of the spread of the Human Immunodeficiency virus (HIV) among students of Groupe Scolaire de Rugando in Kigali City, Rwanda. The study adopted a descriptive cross-sectional approach among the target population of 950 students in the secondary school of Groupe Scolaire de Rugando. About 108 students were randomly selected using the systematic sampling method. Self-administered structured questionnaires were used for data collection for one month with the help of a trained research assistant. The study instrument was pilot-tested in a mission secondary school outside the study population and further validation was carried out before it was administered based on consent. The most common predisposing factors in the study to adolescents to HIV/AIDS were curiosity and the need to experiment. The study findings showed that 78% accepted that HIV is transmitted by engaging in unprotected sexual intercourse with an infected person, 65% accepted that the presence of other sex partners increases the risk of contracting HIV, 69% accepted that regular use of condoms helps to reduce the risk of contracting HIV and 55% accepted that by reducing the number of sexual partners, chances of HIV infection are reduced. Additionally, 44 (43.14%, C. I.: 33.37-53.32) of the students indicated that they had previously engaged in sex, while 58 (56.86%, C. I: 46.68-66.63) showed that they did not engage in sexual practice. The majority of the students who had engaged in sex had never used a condom (59.09%). The usage of condoms was perceived by respondents that it does not allow their partner to enjoy sex. This study recommends the need to design interventions that aim to raise awareness of the negative consequences of risky sexual behaviors; increase the availability and accessibility of condoms; fight against the entry of drugs into the country as well as their circulation and accessibility to the youth and finally, guidance and counseling services should be introduced in schools.
Open Access
Effect of Vigorous-Intensity Physical Activity on Incident Cognitive Impairment in High-Risk Hypertension.
(Kabale University, 2024) Kazibwe, Richard; Schaich, Christopher L.; Muhammad, Ahmad Imtiaz; Epiu, Isabella; Namutebi, Juliana H.; Chevli, Parag A.; Kazibwe, Joseph; Hughes, Timothy; Rikhi, Rishi R.; Shapiro, Michael D.; Yeboah, Joseph
Introduction: We investigated the effect of vigorous physical activity (VPA) on the risk of incident mild cognitive impairment (MCI) and probable dementia among individuals with high-risk hypertension. Methods: Baseline self-reported frequency of VPA was categorized into low VPA (<1 session/week), and high VPA (≥1 session/week). We used multivariate Cox regression analysis to examine the association of VPA categories with incident MCI and probable dementia events. Results: Participants in the high VPA category, compared with low VPA, experienced lower events rates (per 1000 person-years) of MCI (13.9 vs 19.7), probable dementia (6.3 vs 9.0), and MCI/probable dementia (18.5 vs 25.8). In the multivariate Cox regression model, high VPA, compared with low VPA, was associated with lower risk of MCI, probable dementia, and MCI/probable dementia (HR [95% CI]: 0.81 [0.68–0.97], 0.80 [0.63–1.03], and 0.82 [0.70–0.96]), respectively. DISCUSSION: This study provides evidence that VPA may preserve cognitive function in high-risk patients with hypertension.