Makerere University

Whilst wetlands are vital ecosystems supporting natural cycles and biodiversity, intensive agricultural practices and land use have led to widespread degradation, particularly in tropical Africa. In Uganda’s ‘cattle corridor’, an agro-pastoral landscape stretching across 84 000 km ² , natural wetlands have been largely destroyed, and their degradation exacerbated by climate change. The Rufuuha wetland, located in southwestern Uganda, provides a study model to examine biodiversity across different habitat sectors: (i) intact, (ii) degraded, and (iii) restored areas. We studied the amphibian and reptile communities in Rufuuha wetland, which had been heavily degraded due to local community activities, such as agriculture and cattle grazing, before restoration efforts began in 2015. We found significant differences in species richness and diversity between the three areas. While species richness was similar across the areas, diversity and evenness were highest in the intact sector, followed by the restored and degraded areas. There was no support for the Intermediate Disturbance Hypothesis, whereas evenness clearly detected changes in the community structure of herpetofauna along the habitat gradient that species richness did not. Amphibians were well-represented in the survey, showing clear patterns related to habitat quality, while reptile sampling was less comprehensive. Our study demonstrates that restoration efforts can positively impact biodiversity in Afrotropical wetlands. However, it is not yet clear whether the same biodiversity levels as in the intact areas can be reached also in the restored areas. Further studies, particularly on reptiles, are needed to better understand the full ecological impacts of habitat restoration in this region.

Vertical transmission of HIV continues to be a key contributor to pediatric HIV infections globally. Routine HIV testing at each antenatal care (ANC) visit can reduce the likelihood of such infections. However, a sub-optimal number of women are re-tested for HIV on their subsequent ANC visits. This study determined the proportion of pregnant women who were retested during ANC and the associated factors in selected health facilities in Mayuge district, Uganda. This was a cross-sectional study that utilized quantitative data collection techniques among 344 randomly selected women recorded as HIV-negative at their first ANC visit in 2022 from records at selected health facilities in Mayuge district. A semi-structured questionnaire designed in Kobo Collect software was utilized to collect the data. The data were collected through in-person interviews or by phone. Descriptive data were reported for the sample, and multivariable modified Poisson regression models were fitted to estimate prevalence ratios for factors associated with HIV re-testing. Out of 344 women attending ANC, 18.6% (64/344) had been retested for HIV. The factors associated with HIV retesting included attending ANC in the second trimester (APR = 0.62; 95%CI:0.40–0.98), attending at least four ANC visits (APR = 2.24; 95% CI:1.22–4.09), having a planned pregnancy (APR = 1.96; 95%CI: 1.14–3.37), being satisfied with the quality of health services provided (APR = 1.79; 95%CI: 1.05–3.04), and having easily accessible HIV testing resources at the ANC clinic (APR = 2.04; 95%CI: 1.08–3.85). HIV retesting during ANC in Mayuge district was low and mostly influenced by ANC-related factors at the individual and systems levels. These factors ought to be addressed to improve the uptake of maternal HIV retesting.

Background Female sex workers (FSWs) have the highest HIV prevalence in Uganda. Pre-exposure prophylaxis (PrEP) has been recommended as a key component of the HIV combination prevention strategy. Although patient initiation of PrEP has improved, continuation rates remain low. This study evaluated PrEP continuation among FSWs and explored potential determinants of PrEP adherence within a public referral hospital in urban Uganda. Methods We conducted an explanatory sequential mixed method study at Kiruddu National referral hospital in Uganda. Secondary data on socio demographic characteristics and follow up outcomes of at least one year was collected for all FSWs who were initiated PrEP between May 2020 and April 2021 and data analyzed on July 15,2023. We used Kaplan–Meier survival analysis to evaluate continuation on PrEP from time of initiation and follow-up period. The capability, opportunity, and motivation to change behaviour model was used to explore perspectives and practices of FSWs (n = 24) and health care providers (n = 8) on continuation on PrEP among FSWs, using semi structured interviews. The qualitative data was deductively coded and analyzed thematically, categorizing the themes related to PrEP continuation as facilitators and barriers. Results Of the 292 FSWs initiated on PrEP, median age was 26 years (interquartile range, 21–29), 101 (34.6) % were active on PrEP, 137 (46.9%) were lost to follow-up, 45 (15.4%) were no longer eligible to continue PrEP, eight (2.7%) were transferred out and one (0.3%) had died. Median survival time on PrEP was 15 months (Interquartile range IQR, 3–21). The continuation rates on PrEP at six (6) and 12 months were 61.1% and 53.1%, respectively. Facilitators of PrEP continuation included awareness of risk associated with sex work, integration of PrEP with other HIV prevention services, presence of PrEP Peer support and use of Drop-in centers. The barriers included low community awareness about PrEP, high mobility of sex workers, substance abuse, and the unfavorable daytime clinic schedules. However, the quantitative findings from the multivariable Cox Proportional Hazards Model did not align with the reported findings for the qualitative evaluation. Conclusion Continuation on PrEP remains low among FSWs. Interventions for PrEP continuation should address barriers such as low community awareness of PrEP, substance abuse and restrictive health facility policies for scale of the PrEP program among FSWs in Uganda. Integration of PrEP with other services and scale up of community PrEP delivery structures may improve its continuation.

Cryptococcus neoformans is a fungal pathogen that can cause lethal disease in immunocompromised patients. Immunocompetent host immune responses, such as formation of pulmonary granulomas, control the infection and prevent disseminated disease. Little is known about the immunological conditions establishing the latent infection granuloma in the lungs. To investigate this, we performed an analysis of pulmonary immune cell populations, cytokine changes, and granuloma formation during infection with a latent disease-causing clinical isolate in C3HeB/FeJ mice over 360 days. We found that latently infected mice progress through three phases of granuloma formation where different immune profiles dominate: an early phase characterized by eosinophilia, high IL-4/IL-13, and C. neoformans proliferation in the lungs; an intermediate phase characterized by multinucleated giant cell formation, high IL-1α/IFNγ, granuloma expansion, and increased blood antigen levels; and a late phase characterized by a significant expansion of T cells, granuloma condensation, and decreases in lung fungal burden and blood antigen levels. These findings highlight a complex series of immune changes that occur during the establishment of granulomas that control C. neoformans in the lungs and lay the foundation for studies to identify critical beneficial immune responses to Cryptococcus infections. IMPORTANCE Cryptococcus neoformans is a fungal pathogen that disseminates from the lungs to the brain to cause fatal disease. Latent C. neoformans infection in the lungs is controlled by organized collections of immune cells called granulomas. The formation and structure of Cryptococcus granulomas are poorly understood due to inconsistent human pathology results and disagreement between necrotic granuloma-forming rat models and non-necrotic granuloma-forming mouse models. To overcome this, we investigated granuloma formation during latent C. neoformans infection in the C3HeB/FeJ mouse strain which forms necrotic lung granulomas in response to other pathogens. We found that latent C. neoformans granuloma formation progresses through phases that we described as early, intermediate, and late with different immune response profiles and granulomatous characteristics. Ultimately, we show that C3HeB/FeJ mice latently infected with C. neoformans form non-necrotic granulomas and could provide a novel mouse model to investigate host immune response profiles.

Background Perinatal depression remains a substantial public health challenge, often overlooked or incorrectly diagnosed in numerous low-income nations. Objective The goal of this study was to establish statistical baselines for the prevalence of perinatal depression in Kampala and understand its relationship with key demographic variables. Methods We employed an Android-based implementation of the Edinburgh Postnatal Depression Scale (EPDS) to survey 12,913 women recruited from 7 government health facilities located in Kampala, Uganda. We used the standard EPDS cutoff, which classifies women with total scores above 13 as possibly depressed and those below 13 as not depressed. The χ ² test of independence was used to determine the most influential categorical variables. We further analyzed the most influential categorical variable using odds ratios. For continuous variables such as age and the weeks of gestation, we performed a simple correlation analysis. Results We found that 21.5% (2783/12,913, 95% CI 20.8%‐22.3%) were possibly depressed. Respondents’ relationship category was found to be the most influential variable ( χ ² 1 =806.9, P<.001; Cramer’s V=0.25 ), indicating a small effect size. Among quantitative variables, we found a weak negative correlation between respondents’ age and the total EPDS score ( r =−0.11, P <.001). Similarly, a weak negative correlation was also observed between the total EPDS score and the number of previous children of the respondent ( r =−0.07, P <.001). Moreover, a weak positive correlation was noted between weeks of gestation and the total EPDS score (r =0.02, P =.05) Conclusions This study shows that demographic factors such as spousal employment category, age, and relationship status have an influence on the respondents’ EPDS scores. These variables may serve as proxies for latent factors such as financial stability and emotional support.

Background Anaemia is a major cause of morbidity among children under five years in Uganda. However, its magnitude among refugee populations is marginally documented. In this study, the prevalence and contributors to anaemia among children 6 to 59 months in Kyangwali refugee settlement in Western Uganda was determined. Methods This was a cross-sectional study that was carried out among 415 mother- child dyads at Kwangwali refugee settlement. Anaemia was determined by measuring haemoglobin concentration using the HaemoCue method, while nutritional status was examined using standard World Health Organisation (WHO) nutritional indices. Data abstraction forms, pretested questionnaires and face to face interviews were used to collect patient data. Associations between the independent variables and anaemia were examined using modified Poisson regression with robust standard errors. In all statistical tests, a P- value of < 0.05 was considered as significant. Results The proportion of children with anaemia was 49.2% (95% CI: 44.4–53.9). Anaemia was 1.4 times (95% CI = 1.13–1.82; p = 0.003) more prevalent among wasted children than the normal children. The prevalence of anaemia was also higher among underweight children than those with normal weight (aPR = 1.37, 95% CI = 1.11–1.70; p = 0.004). Additionally, the prevalence of anaemia was higher among children of birth order of 6 or above (aPR = 2.00, 95% CI = 1.22–3.29; p = 0.006), while anaemia prevalence was lower among children whose mothers’ had attained secondary level of education (aPR = 0.19, CI = 0.04–0.98; p = 0.048) and those who fed on fish (aPR = 0.75, 95% CI = 0.57–0.99; p = 0.039) and meals prepared with oils and fats (aPR = 0.70, 95% CI = 0.51–0.97; p = 0.029). There was no significant relationship between anaemia occurrence and the household dietary diversity score. Conclusions About half of the study children were found to be anaemic. The most significant contributors to anaemia in the study population were malnutrition, maternal education, feeding practices and birth order. The study findings suggest need of screening of children for anaemia at all nutritional clinics, promotion of education, addressing barriers to sustainable food supply and accessibility of nutrient-dense foods, treating anaemia in children alongside other micronutrient deficiencies and addressing the nutritional needs of multiparous mothers in refugee communities.

Antiretroviral therapy (ART) use and HIV suppression among people living with HIV (PLHIV) are critical for HIV control and prevention. Extreme restrictions on movement early during the COVID-19 pandemic in Uganda may have impeded the ability to initiate and sustain access to and use of ART. From our stepped-wedge cluster-randomized trial of an integrated PrEP and ART intervention for HIV-serodifferent couples at 12 ART clinics in Uganda, we identified participants who enrolled and had a 6-month post-ART initiation viral load measured before the beginning of the first COVID-19 lockdown (Period 1), participants whose enrollment and 6-month viral load measurement straddled pre-COVID and COVID lockdown times (Period 2), and participants whose enrollment and 6-month viral load were quantified entirely during COVID-19 (Period 3). ART and viral load data were abstracted from standard-of-care HIV clinic records. We used adjusted generalized estimating equation models to compare viral suppression between the different periods. We enrolled 1,381 PLHIV, including 896 (64.9%) in Period 1, 260 (18.8%) in Period 2, and 225 (16.3%) in Period 3. Almost all (1371, 99.3%) initiated ART within 90 days of enrollment and 59.2% had baseline CD4 > 350 cells/mm³. Among those enrolled, 88.8% of participants in Period 1 were virally suppressed (< 1000 copies/mL) within six months of ART initiation, 80.5% in Period 2, and 88.2% in Period 3. All pairwise comparisons demonstrated statistically similar levels of viral suppression. Despite COVID-19 lockdown measures, PLHIV in serodifferent partnerships successfully initiated ART and attained and maintained viral suppression.

Background The experiences of adult cancer patients in low-income countries regarding health care and infrastructure are largely undocumented. This study aimed to describe the experiences of adult men and women receiving treatment at a specialized cancer facility in Uganda. Method Thirty-two adult patients with cancer (≥18 years) with varying cancer diagnoses participated in 5 focus group discussions and a key informant interview at Uganda's specialized oncology facility. The interactions were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results The participants had both advanced and early stage cancers of varying ages (19–79 years). Four themes emerged: the Organization of care, Personal challenges, Mental suffering, and Satisfaction with care. The Organization of Care theme included categories describing rough sleep, poor food supply, inadequate facilities, and drug shortages. Personal challenges include high treatment costs and delays in accessing care. Mental suffering comprises of 4 categories: stigma, isolation, abandonment, and emotional distress. Satisfaction with care included improve health outcomes and professionalism. Conclusion Participants predominantly reported negative experiences, whereas those with early stage disease primarily emphasized positive experiences. It is imperative for nurses to heighten their awareness of cancer and its treatment, cultivate empathy, and engage positively with both patients and their families. Further research on healthcare professionals' experiences regarding cancer care is needed to gain a comprehensive understanding of cancer care in Uganda.

Soybean is a globally important industrial, food, and cash crop. Despite its importance in present and future economies, its production is severely hampered by bruchids (Callosobruchus chinensis), a destructive storage insect pest, causing considerable yield losses. Therefore, the identification of genomic regions and candidate genes associated with bruchid resistance in soybean is crucial as it helps breeders to develop new soybean varieties with improved resistance and quality. In this study, 6 multi-locus methods of the mrMLM model for genome-wide association study were used to dissect the genetic architecture of bruchid resistance on 4traits: percentage adult bruchid emergence (PBE), percentage weight loss (PWL), median development period (MDP), and Dobie susceptibility index (DSI) on 100 diverse soybean genotypes, genotyped with 14,469 single-nucleotide polymorphism (SNP) markers. Using the best linear unbiased predictors (BLUPs), 13 quantitative trait nucleotides (QTNs) were identified by the mrMLM model, of which rs16_14976250 was associated with more than 1 bruchid resistance traits. As a result, the identified QTNs linked with resistance traits can be employed in marker-assisted breeding for the accurate and rapid screening of soybean genotypes for resistance to bruchids. Moreover, a gene search on the Phytozome soybean reference genome identified 27 potential candidate genes located within a window of 478.45 kb upstream and downstream of the most reliable QTNs. These candidate genes exhibit molecular and biological functionalities associated with various soybean resistance mechanisms and, therefore, could be incorporated into the farmers’ preferred soybean varieties that are susceptible to bruchids.

Introduction Effective antimicrobial stewardship programs require data on antimicrobial consumption (AMC) and utilization (AMU) to guide interventions. However, such data is often scarce in low-resource settings. We describe the consumption and utilization of antibiotics at a large tertiary-level hospital in Uganda. Methods In this cross-sectional study at Kiruddu National Referral Hospital, we analyzed medicine delivery records for the period July 2021 to June 2022, accessed on 12/08/2022, to extract AMC data expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID). We used the WHO point prevalence survey (PPS) to analyze AMU data with a systematic sampling of outpatient department (OPD) for a period between June and August 2022 and selected all inpatient department (IPD) patients admitted before 8:00 AM on 27/11/2022. AMU data was analyzed as the proportion of individual antibiotic prescriptions, indications for prescriptions, and compliance with the national treatment guidelines. Both AMC and AMU data were categorized by the WHO AWaRe (access, watch, and reserve) criteria. Results In the year 2021–2022, a total of 6.05 DID of antibiotics were consumed comprising 3.61 DID (59.6%) access, 2.44 DID (40.3%) watch, and 0.003 (0.1%) reserve antibiotics. The most consumed antibiotics comprised penicillin (1.61 DID, 26.7%), cephalosporins (1.51, 25%), and imidazole (1.10 DID, 18.1%). A total of 119/211 (56%) patients in the OPD and 99/172 (57.5%) patients in the IPD were prescribed antibiotics. Of the 158 OPD antibiotic prescriptions, 73 (46.2%) were access, 72 (45.6%) were watch, 0 (0%) were reserve, and 13 (8.2%) were unclassified antibiotics. Of the 162 IPD antibiotic prescriptions, 62 (38.3%) were access, 88 (54.3%) were watch, 01 (0.6%) was reserve, and 11 (6.8%) were unclassified antibiotics. Indications for antibiotic prescriptions in the OPD comprised respiratory tract infections (53, 38.1%), urinary tract infections (34, 26.6%), gastrointestinal infections (20, 14.4%), sepsis (17, 12.2%), and medical prophylaxis (12, 8.7%). The indications for antibiotic prescriptions in the IPD comprised sepsis (28.2%), respiratory tract infections (18.3%), burn wounds (14.1%), and gastrointestinal infections (14.1%). Conclusion Prescription of watch antibiotics in both OPD and IPD hospital settings was high. Establishment of robust antimicrobial stewardship measures could help improve the rational prescription of antibiotics.

Herein, the influence of structural attributes, including the interactions of lipases with support systems, substrates, products/byproducts, and the media environment, on enzyme stability, selectivity and activity are discussed. Substrates/products, such as methanol, glycerol, phenolic acids and polyphenols, can inhibit lipase activity by influencing the mass flow of the reactants and products or by enzyme denaturation, which is also caused by extreme pH, high temperatures, and digestive action of most organic solvents. Immobilization techniques that involve chemical bonding between the functional groups of the support and the amino acids of the lipase maintain the enzyme’s active conformation via the formation of stable secondary structures. Functionalized metal nanoparticles and metal and covalent organic frameworks (COFs and MOFs) covalently bond to lipases, reducing the reliance of the active site conformation on hydrogen bonding and disulfide bonds. The crystallinity of COFand MOF-immobilized lipases allows them to be used in contrasting media environments and at high temperatures, which increases the reaction kinetics and improves the catalytic yield. On the other hand, inert support systems such as silica promote catalytic yields by minimizing protein leaching, which fairly maintains the amount of the preloaded lipase. The structure of substrates also plays a large role, whereas some lipases strictly prefer narrow substrates. In contrast, others, such as Candida species lipases, are liberal and allow substrates of varying bulkiness/steric hindrances.

Background The escalating prevalence of dementia in Africa, propelled by rapidly ageing population, necessitates innovative approaches to raise awareness and address associated challenges. The prevalent misconception of dementia as a result of witchcraft or wizardry is a challenge, and the media acts as a key agent in dispelling such myths. By reaching divers audiences, the media reinforces the notion that dementia is not confined to Africa alone but it is a global concern. It also aids in overcoming the shame and stigma associated with dementia, encouraging individuals to seek consultation. Method A comprehensive analysis of media initiatives used by the African Dementia Consortium (AfDC) during the World Alzheimer’s Month and subsequently was conducted. Digital Platforms (Instagram, LinkedIn, Facebook), print and traditional media (publications, journals, newspaper, radio and television stations) were examined for their effectiveness in achieving recruitment objectives, destigmatizing and promoting early diagnosis. Quality tools, such as cameras and recorders, were utilized to capture relevant information, while the outcome was evaluated based on their impact on target audience assessed by greater participation. Result Media Platforms have proven instrumental in recruitment efforts by disseminating information that reaches diverse demographic groups in Africa. Through compelling visual and textual content, the media has played a key role in destigmatizing dementia, challenging prevalent misconceptions, and fostering a more inclusive understanding of the condition. In addition, media initiatives have contributed significantly to the promotion of early diagnosis by disseminating educational content that empowers individuals to recognize early signs and seek timely medical intervention. Conclusion Both the digital and traditional media play vital roles in visually and textually representing dementia, correcting misconceptions, and fostering understanding. Allocating increased resources to media initiatives hold immense benefit for Africa, contributing to a more positive perspective on dementia and dispelling negative attitudes.

Background Data from high‐income countries (HICs) suggest a decline in age‐specific incidence rates of dementia. However, this has happened primarily in HICs, with low‐ and middle‐ income countries (LMICs) facing two main challenges: a higher burden of risk factors and, in general, a faster ageing population. Most people with dementia live in LMICs, and this is set to increase, thus requiring urgent and robust action to prevent, treat and support people with dementia and their families. Methods We, in the Lancet Commission, reviewed the most recent literature, and conducted a new metanalysis on worldwide dementia risk. We have calculated worldwide figures, although there may be variation in different ethnic and socioeconomic groups. Results Dementia studies are overwhelmingly from HICs, and there is a tendency to recruit people of European origin with higher education and socioeconomic status, with few people from ethnic minority groups. The same applies in respect of worldwide clinical trials, including multicomponent interventions to reduce risk, biomarker research and pharmacological/non‐pharmacological interventions. Although most interventions are developed in HICs, culturally adapted interventions seem to be as effective in LMICs as in their original context, as long as the interventions’ core components are not compromised in the adaptation process. Conclusion Policy interventions can improve dementia prevention, particularly in LMICs and in minority and lower level socio‐economic groups ‐ precisely the people who have the greatest burden of modifiable risk and are more likely to develop dementia. Dementia prevention efforts should be tailored to the needs of the different countries and different groups within countries. Trials and research databases should aim for sociodemographic diversity to reflect real life populations. Although evidence‐based interventions developed in HICs can be effective in LMICs, there is often a lack of healthcare infrastructure and resources to deliver them. Moreover, cultural differences can make them inappropriate or less effective. Interventions should be developed in partnership with local communities to ensure their appropriateness in respect of the culture, beliefs and practises which vary within and between countries.

Background The progressive nature of dementia and the complex needs means that people living with dementia require tailored approaches to address their changing care needs over time. These include physical multimorbidity, psychological, behavioural, and cognitive symptoms and possible risks arising from these and helping family caregivers. However, provision of these interventions is highly variable between and within countries, partly due to uncertainty about their efficacy and scarce resources. In the 2024 update of the Lancet Commission we aimed to summarise published evidence about the effect of non‐pharmacological interventions for people with dementia and their carers on cognition, neuropsychiatric symptoms and other person‐centred outcomes. Method We reviewed and summarised evidence according to expert consensus opinion. Result There is moderate‐quality evidence from a Cochrane review of 25 studies for effect of cognitive stimulation therapy on cognition; 1.99 (1.24‐2.74) Mini‐Mental State Examination points higher compared to control groups, and clinically relevant improvements in communication and social interaction. Multicomponent interventions for family carers reduce family carer depression, burden, or stress and are cost‐effective but remote delivery of these interventions was not better than care as usual. A meta‐analysis of 7 studies of tailored activity programmes for people with dementia found a moderate effect on improving quality of life (standardised ES Cohen’s d 0.79, 0.39–1.18; 7 studies, n = 160), decreasing neuropsychiatric symptoms (0.62; 0.40–0.83) and decreasing carer burden (0.68, 0.29–1.07) but there is little evidence on cost‐effectiveness. Exercise interventions were not effective in improving neuropsychiatric symptoms, cognition or functioning. We discuss evidence for other treatments for specific neuropsychiatric symptoms. Conclusion There is developing evidence for benefit of psychological and social interventions on key outcomes including cognition, neuropsychiatric symptoms and quality of life, with sufficient strength of evidence and cost‐effectiveness to justify these being implemented and offered routinely to people with dementia. Interventions generally should be tailored to specific symptoms and individualised to patient preferences and goals. Most interventions have been tested in majority ethnic populations in high income countries: future interventions should be co‐designed with local communities to ensure that they are appropriate for the context, culture, beliefs and practices.

Background The 2020 Lancet Commission on dementia prevention, intervention and care estimated that up to 40% of dementia cases could be prevented by tackling 12 potentially modifiable risk factors, namely less education, hearing loss, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, air pollution, smoking, obesity, traumatic brain injury, depression. As more evidence on risk factors emerges, the Lancet standing commission on dementia met to update evidence on established dementia risk factors and to consider the evidence for other risk factors. Method We used a lifecourse approach to understand how to reduce risk or prevent dementia, as many risks operate at different timepoints in the lifespan. We considered evidence for when in the lifecourse a risk factor was relevant to development of dementia as well as the size of the effect and strength of the evidence. Our interdisciplinary, international, multicultural group of experts adopted a triangulation framework, prioritising systematic reviews and meta‐analyses, performing new meta‐analyses where needed and debated and agreed on the best available evidence and its consistency. We considered whether there was evidence of disparities in impact of risk factors based on demographic characteristics, particularly ethnicity and socioeconomic status. Result Evidence for two new risk factors was considered strong enough to include this in our lifecourse model. We will present evidence for incorporation of these risk factors, including strength of evidence and potential mechanisms. We will also discuss risk factors for which evidence was not strong enough. Conclusion As more evidence about risk factors emerges we can increase our understanding of how dementia develops and how to potentially prevent it. Understanding the landscape of dementia prevention research is also helpful to appreciate where further evidence is needed and what form of evidence would be most helpful in advancing our understanding.

Background Uganda has an increasing population of older persons who require special attention to reduce the burden of dementia. With the growing prevalence of dementia worldwide, two third of the people with dementia are projected to be from the de‐eloping countries by 2050. Few studies have been conducted on the prevalence of dementia and its association with central nervous system (CNS) infections among older persons in African settings, particularly in Uganda. Methods The study was conducted in March 2022 among 434 older persons aged 50 and above years who were selected by multistage sampling. Data were collected using an inter‐viewer administered questionnaire supplemented with information from participant’s medical records and a brief community screening instrument for dementia. The instrument classifies dementia into unlikely, probable or possible dementia. Data were entered in duplicate into EpiData version 3.0, then transferred to statistical package for social sciences (SPSS) version 23 for statistical analysis. Results Our study found almost one in four (23%) of the older persons in tororo district eastern part of Uganda were suffering from probable or possible dementia. Our study further found that older persons with a positive history of central nervous system infections (CNS) had nearly five times higher odds of having probable or possible dementia compared to their counterparts (cOR: 4,5: 2.76‐7.23; p< 0.001). Being in advanced age of 70+ years (aOR: 2.6; 5:4; 1.4 ‐20.5; p = 0.013), and chronic headache (aOR: 1.9; 1.1‐3.1:p = 0.019) were independent predictors of probable or possible dementia among participants in the study. Conclusion This study highlights dementia as a growing public health issue in the African settings, in Uganda with over 1243 individuals affected in 2021. The findings emphasize the urgent need for investment in research and specialized services for older adults, particularly those with dementia.

Background Our authors from around the world met to summarise the available knowledge, decide which potentially modifiable risk factors for dementia have compelling evidence and create the most comprehensive analysis to date for potentially modifiable risk factors to inform policy, give individuals the opportunity to control their risks and generate research. Method We incorporated all risk factors for which we judged there was strong enough evidence. We used the largest recent worldwide meta‐analyses for risk factor prevalence and relative risk and if not available the best data. We performed new meta‐analyses for depression and hearing loss relative risks. We used all 37,000 participants aged ≥ 45 years from HUNT, Norwegian longitudinal population‐based study, to estimate communalities (risk factors clustering) as people frequently have multiple risk factors. Four principal components explained 51% of total risk factors variance. We then calculated weighted population attributable fraction (PAF) estimates. Result We will present each potentially modifiable dementia risk factor’s prevalence, communality, relative risk, unweighted and weighted PAFs and our new lifecourse infographic. Conclusion Our results give hope suggesting many dementias can be prevented or delayed. Many risk factors are linked to deprivation, for example, where people live and exposure to air pollution, or finding affordable healthy food within walking distance and having the resources and skills to prepare it. We have more evidence that longer exposure to a risk has more effect, for example in diabetes, and that risks have more effect in otherwise vulnerable people, for example air pollution. Thus, it is important to redouble efforts to treat existing conditions in communities and people with multiple risks where approaches beyond individual treatment or behaviour change have potentially larger impact. While association is not causation, the effect on cognition of multicomponent, hearing aid and hypertensions RCTs, and naturalistic changes with reduction in air pollution, cigarette smoking, social contact, hearing and vision corrections and work cognitive stimulation, continue to suggest causal relationships with dementia. Socially disadvantaged groups in all countries are more at risk and should be prioritised for intervention. There is more evidence that risks are also modifiable for people at increased genetic risk.

Background Historically, efforts to engage under‐represented communities in health research have encountered limited success, attributable to inadequate community participation, acceptability, and ownership. Globally, an innovative strategy to foster community involvement in research is the establishment of Community Advisory Boards (CABs). These boards consist of stakeholders from the target community, providing partnership and support throughout all phases of the research, from conception to implementation and evaluation. In pursuit of effective recruitment and retention into the Recruitment and Retention of Alzheimer’s Disease Diversity Genetic Cohorts‐ Alzheimer’s disease Sequencing Project (READD – ADSP) Study, each participating site within the African Dementia Consortium (AfDC) constituted a Community Advisory Board. Method A comprehensive standard operating procedure outlining the group’s activities and delineating the composition and role of the CAB within the READD_ADSP project was developed. Eligible members received letters of invitation, and those who agreed were convened for an inaugural meeting to discuss project aims, objectives, and other pertinent details using the SOP as template. Result About 14 CAB with 120 members have been established across the nine African sites. Each board comprised a diverse mix of geriatricians, public health leaders, community and religious leaders, retiree organizations, dementia caregivers, NGO dedicated to person living with dementia, media organizations, legal experts, and communication experts. Inaugural meetings at each site demonstrated a high level of interest and motivation to collaborate with the research team for the promotion of recruitment, retention, and advocacy. Using culturally appropriate names for dementia, case identification and referral system, lack of awareness and skilled personnel were among many concerns raised at the cab meetings. There is ongoing to continue to address these concerned raised for effective recruitment at the community. Conclusion The strategic partnership with community stakeholders, facilitated through the Community Advisory Boards, proved effective in achieving recruitment and retention goals for dementia research.