Makerere University

Background: The antimicrobial resistance catastrophe is a growing global health threat and predicted to be worse in developing countries. Phages for Global Health (PGH) is training scientists in these regions to isolate relevant therapeutic phages for pathogenic bacteria within their locality, and thus contributing to making phage technology universally available. Materials and Methods: During the inaugural PGH workshop in East Africa, samples from Ugandan municipal sewage facilities were collected and two novel Escherichia coli lytic phages were isolated and characterized. Results: The phages, UP19 (capsid diameter ∼100 nm, contractile tail ∼120/20 nm) and UP30 (capsid diameter ∼70 nm, noncontractile tail of ∼170/20 nm), lysed ∼82% and ∼36% of the 11 clinical isolates examined, respectively. The genomes of UP19 (171.402 kb, 282 CDS) and UP30 (49.834 kb, 75 CDS) closely match the genera Dhakavirus and Tunavirus, respectively. Conclusion: The phages isolated have therapeutic potential for further development against E. coli infections.

The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) was established to build a cross-country platform for joint-learning around quality improvement implementation approaches to reduce mortality. This paper describes and explores the structure of the QCN in four countries and at global level. Using Social Network Analysis (SNA), this cross-sectional study maps the QCN networks at global level and in four countries (Bangladesh, Ethiopia, Malawi and Uganda) and assesses the interactions among actors involved. A pre-tested closed-ended structured questionnaire was completed by 303 key actors in early 2022 following purposeful and snowballing sampling. Data were entered into an online survey tool, and exported into Microsoft Excel for data management and analysis. This study received ethical approval as part of a broader evaluation. The SNA identified 566 actors across the four countries and at global level. Bangladesh, Malawi and Uganda had multiple-hub networks signifying multiple clusters of actors reflecting facility or district networks, whereas the network in Ethiopia and at global level had more centralized networks. There were some common features across the country networks, such as low overall density of the network, engagement of actors at all levels of the system, membership of related committees identified as the primary role of actors, and interactions spanning all types (learning, action and information sharing). The most connected actors were facility level actors in all countries except Ethiopia, which had mostly national level actors. The results reveal the uniqueness and complexity of each network assessed in the evaluation. They also affirm the broader qualitative evaluation assessing the nature of these networks, including composition and leadership. Gaps in communication between members of the network and limited interactions of actors between countries and with global level actors signal opportunities to strengthen QCN.

Background There has been a lot of debate on genetically modified (GM) crops both globally and locally in Uganda. Whereas some of the debates have been informed by scientific research, many are not. The level of acceptance and attitudes of people towards GM crops is a function of their knowledge. However, there is a paucity of studies on the knowledge and attitudes of Ugandans on GM crops. This study aimed to assess the level of knowledge of GM crops in Uganda. Methods We carried out a mixed methods study in September 2021 in Bushenyi, Jinja and Wakiso districts. We conducted 18 focus group discussions (FGDs), 13 key informant interviews (KIIs) and 698 quantitative interviews. The quantitative interviews were conducted using structured questionnaires. The FGD and KI interviews were audio recorded and transcribed verbatim. The qualitative data were analyzed using framework analysis and the quantitative data were analyzed using modified Poisson regression to identify factors associated with the level of knowledge of GM crops in STATA 15. Results Out of the 698 respondents interviewed, only 273 (39.1%) had ever heard of GM crops. About 204 (74.7%) of the 273 respondents reported having a moderate–high understanding of GM crops and 62.3% (170) of the respondents further reported that GM crops are harmful to their health and environment, despite some of their intrinsic benefits, such as high productivity, improved income and resilience to pests and diseases. In addition, Out of the 698 respondents interviewed, only 37.7% were wary of the possibility of the emergence of super pests due to the development of resistance to some GM crops. Conclusions Most of the community members do not have adequate knowledge about GM crops, hence, there is need for sensitization and legislation on GM crops before their release to the public.

Objectives The COVID-19 pandemic affected provision and use of maternal health services. This study describes changes in obstetric complications, referrals, stillbirths and maternal deaths during the first year of the pandemic and elucidates pathways to these changes. Design Prospective observational mixed-methods study, combining monthly routine data (March 2019–February 2021) and qualitative data from prospective semi-structured interviews. Data were analysed separately, triangulated during synthesis and presented along three country-specific pandemic periods: first wave, slow period and second wave. Setting Six referral maternities in four sub-Saharan African countries: Guinea, Nigeria, Tanzania and Uganda. Participants 22 skilled health personnel (SHP) working in the maternity wards of various cadres and seniority levels. Results Percentages of obstetric complications were constant in four of the six hospitals. The percentage of obstetric referrals received was stable in Guinea and increased at various times in other hospitals. SHP reported unpredictability in the number of referrals due to changing referral networks. All six hospitals registered a slight increase in stillbirths during the study period, the highest increase (by 30%–40%) was observed in Uganda. Four hospitals registered increases in facility maternal mortality ratio; the highest increase was in Guinea (by 158%), which had a relatively mild COVID-19 epidemic. These increases were not due to mortality among women with COVID-19. The main pathways leading to these trends were delayed care utilisation and disruptions in accessing care, including sub-optimal referral linkages and health service closures. Conclusions Maternal and perinatal survival was negatively affected in referral hospitals in sub-Saharan Africa during COVID-19. Routine data systems in referral hospitals must be fully used as they hold potential in informing adaptations of maternal care services. If combined with information on women’s and care providers’ needs, this can contribute to ensuring continuation of essential care provision during emergency.

Chest Ultrasound Scan (CUS) has been utilized in place of CXR in the diagnosis of adult pneumonia with similar or higher sensitivity and specificity to CXR. However, there is a paucity of data on the use of CUS for the diagnosis of childhood TB. This study aimed to determine the diagnostic accuracy of CUS for childhood TB. This cross-sectional study was conducted at the Mulago National Referral Hospital in Uganda. Eighty children up to 14 years of age with presumptive TB were enrolled. They all had CUS and CXR performed and interpreted independently by radiologists. The radiologist who performed the CXR was blinded to the CUS findings, and vice versa. Radiologists noted whether TB was likely or unlikely. A two-by-two table was developed to compare the absolute number of children as either TB likely or TB unlikely on CXR or CUS. This was used to calculate the sensitivity and specificity of CUS when screening for TB in children, with a correction to accommodate the use of CXR as a reference test. The sensitivity of CUS was 64% (95% CI 48.5%-77.3%), while its specificity was 42.7% (95% CI 25.5%-60.8%). Both the CUS and CXR found 29 children with a likelihood of TB, and 27 children unlikely to have TB. CUS met the sensitivity target set by the WHO TPP for Triage, and it had a sensitivity and specificity comparable to that of CXR.

Background The cattle industry contributes to Uganda's agricultural output. It faces challenges that include theft and parentage ascertainment. These challenges can benefit from recent molecular genomics and bioinformatics technologies. Objectives We employed genomic analyses to establish potential ownership of a group of nine cattle that were being claimed by two farmers in Uganda. We investigated the genetic relationship of Ugandan cattle with regional indigenous breeds as well as exotic breeds that are currently present in Uganda. In addition, we investigated regions that are likely to be under selection in the Ugandan cattle. Methods Hair samples were collected from seven and two animals from farmers A and B, respectively. They were genotyped for 53,218 Single Nucleotide Polymorphism markers. To establish genetic relationships between the sampled animals, we performed genomic analyses including, principal component analysis (PCA), hierarchical clustering analysis and identity by state/descent. We also performed admixture and runs of homozygosity analyses to assess the ancestry composition and identify regions potentially under selection in Ugandan cattle, respectively. Results The seven animals from Farmer A were genetically close to each other but showed minimal relationship with the disputed animals. The two animals from Farmer B were genetically distant from each other but showed greater similarity to four of the disputed animals. Four of the disputed animals showed great dissimilarity from the animals of both farmers. Comparison of these with the reference breeds revealed minimal European exotic genetic introgression into these animals, but rather high similarity to the Sheko. Results also revealed high homozygosity in the major histocompatibility complex regions. Conclusions Our results demonstrate the use of currently available genomic tools to empirically establish the ownership of cattle; these could be scaled up as a resourceful and viable tool that could be employed to support conflict resolution where reliable livestock identification is unavailable.

Globally, the prevalence of prostate cancer is only the second to lung cancer. In Africa however, the commonest cancer among men is cancer of the prostate. The use of natural compounds from plants such as quercetin is being explored as a potential cure. Quercetin is a plant-based flavonoid that has anti-inflammatory, antioxidant and anticancer properties. Although quercetin has been extensively studied, its chemo preventive mode of action is not well-understood. The molecular targets and potential mechanisms underlying the action of quercetin against prostate cancer were identified and validated using network pharmacology and molecular docking methods. The biological targets of quercetin and targets associated with prostate cancer were obtained through database mining. Overlapping targets associated with quercetin and prostate cancer were identified and used to construct a compound–disease target (C-D) network and the targets were subjected to Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and protein–protein interaction analysis (PPI). A disease target- pathway network was constructed and then merged with C-D network to form a compound–disease_target–pathway (C-D-P) network. Hub targets were obtained from the C-D-P and PPI networks. The binding affinities between quercetin and the retrieved hub targets were identified. Pathway enrichment analysis showed that prostate cancer associated quercetin targets were mainly linked with pathways such as the cancer signaling pathways (HIF-1 and ErbB) and hepatitis B. Basing on the PPI and C-D-P network analysis STAT3, TP53, MAPK1, MAPK3 and KRAS were identified as the main targets and were subjected to molecular docking. The results showed quercetin’s ability to stably bind to the key targets. In conclusion, this study showed the potential molecular targets and mode of action of quercetin in prostate cancer treatment. This can potentially inform the future use of quercetin in the treatment of prostate cancer.

Drip irrigation's potential to conserve irrigation water by around 25% compared to conventional methods is widely acknowledged. Nevertheless, the influence of varied irrigation control strategies on drip irrigation's impact remains uncertain, particularly regarding crop growth parameters and water use efficiency. In this study, we examine the effects of three distinct irrigation control approaches manual, model-based, and open-loop on drip-irrigated tomato plants within an open field agricultural context. Employing a completely randomized design, we cultivated 160 tomato plants and administered irrigation water according to each strategy's water requirements. Comprehensive data on key crop growth indicators, including plant height, stem diameter , leaf chlorophyll content, clusters per plant, flower and fruit counts, yield, and water use efficiency were documented. The results emphasize the pivotal role of the model-based irrigation control strategy. Specifically, this approach yielded a substantial tomato yield increase, recording 20 t/ha, in contrast to the 16 t/ha and 14 t/ha achieved by the open-loop and manual strategies, respectively. Noteworthy, the model-based approach exhibited remarkable water savings of 10.4 kg/m 3 , surpassing the values of 7.1 kg/m 3 and 5.6 kg/m 3 obtained through the open-loop and manual strategies. These differences proved statistically significant, evidenced by a p-value of 0.05. The model-based irrigation strategy led to a 29% reduction in water consumption compared to manual control. This study establishes the model-based irrigation strategy's superiority, showcasing elevated tomato yield and improved water use efficiency. These findings furnish valuable insights into sustainable agricultural practices, particularly in the realm of drip irrigation systems.

Abstract Background The World Health Organization recommends birth companionship for all women in labor. There is insufficient evidence on birth companionship in low-income settings and it is not clear if role orientation impacts effectiveness. The aim of this study was to assess the efficacy of midwife-led role orientation of birth companions of on maternal satisfaction and birth outcomes in a sub-region in Uganda. Methods A stepped wedge cluster randomized trial conducted (control n = 240), intervention n = 235) from 4 clusters. Women who had a birth companion, in spontaneously established labor and, expecting a vaginal delivery were eligible. The intervention was “midwife-provided orientation of birth companions”. The admitting midwife provided an orientation session for the birth companion on supportive labor techniques. The primary outcome was the chance of having a spontaneous vaginal delivery. Assessors were not blinded. Independent t-test and Chi-Square tests were used to assess the differences by study period. Results Mean maternal satisfaction rate was significantly higher in the intervention period compared to the control period (P > 0.001). High maternal satisfaction levels were noted among the women who were; at the regional referral hospital, younger, first-time mothers, and unmarried (P

The growing demand for clean and safe water calls for alternative water treatment methods and materials. In this work, characterization of natural zeolite samples and evaluation of their potential to remove heavy metals from water were done. Zeolite samples sourced from Mount Elgon, Uganda were characterized using X-ray Fluorescence Spectroscopy (XRF), X-Ray diffraction (XRD), Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy (SEM/EDX) and Fourier-Transform Infrared Spectroscopy (FTIR). Stock solutions of Pb(II), Zn(II) and Cr(VI) ions prepared from their salts were spiked into distilled water for the study. The ion exchange capacities of the selected ions were studied at various pH, ion exchanger dosage, initial metal ion concentration and contact time. Isothermal and kinetic models were used to evaluate the ion exchange process. Results revealed the zeolite samples composed of 39.74 wt.% SiO2, 16.69 wt.% Al3O2, 11.51 wt.% CaO and 8.54 wt.% Fe2O3 as major mineral constituents. The composition implies that samples have a Si/Al ratio ranging from 2.27 to 2.60 suitable for ion exchange of heavy metals. The major phase in the mineral is laumontite whose Ca²⁺ ions are exchanged for cations such as heavy metals during the ion exchange processes. The maximum removal efficiencies were found at pH 6 (99% and 92.1%) for Pb(II) and Zn(II), respectively, while at pH 2 (85.5%) for Cr(VI). The maximum uptake according Langmuir model were 7.59 mg/g, 7.4 mg/g and 5.50 mg/g for Pb(II), Zn(II) and Cr(VI) ions, respectively. The pseudo-second-order equation fitted well the process for all metal ions investigated. Highlights Removal efficiencies of Pb²⁺, Zn²⁺ and Cr⁶⁺ on laumontite zeolites were 99%, 92.1% and 85.5%. Respective exchange capacities for Pb²⁺, Zn²⁺, Cr⁶⁺ were 7.59, 7.40 and 5.50 mg/g. The Ion exchange processes fitted Langmuir and pseudo-second-order models.

This article looks at the importance of fisheries in Uganda on one hand, the reducing trend of fisheries revenue and catch volumes on the other hand as well as the various measures taken to revive the fisheries sector over the years. It argues that although restoring fisheries and ensuring the sustainability of fisheries resources is paramount, this should not be done while grossly violating human rights and depriving poor people of their sole source of livelihood. There is need to manage fisheries in a more holistic manner.

Cervical cancer (CC) is the most common cancer among women in Uganda, yet lifetime CC screening is as low as 5%. Training women who have screened for CC to engage in peer advocacy could increase uptake of CC screening in social networks. We conducted a randomized controlled trial of a peer-facilitated, manualized, 7-session group intervention to train women to engage in CC prevention advocacy. Forty women recently screened for CC (index participants) enrolled and were assigned to receive the intervention (n = 20) or wait-list control (n = 20). Each index was asked to recruit up to three female social network members (alters) who had not been screened for CC (n = 103 enrolled alters). All index and alter participants were assessed at baseline and month-6 follow-up. All but one (n = 39; 98%) index and 98 (95%) alter participants completed the month 6 assessment. In multivariate regression models controlling for baseline outcome measures and demographic covariates, intervention alters were more likely to have been screened for CC at month 6 [67% vs. 16%; adjusted OR (95% CI) = 12.13 (4.07, 36.16)], compared to control alters. Data also revealed significant increased engagement in CC prevention advocacy, among both index and alter participants in the intervention group at month 6, compared to the control group. The intervention was highly effective in increasing CC screening uptake among social network members, and engagement in CC prevention advocacy among not only intervention recipients, but also targets of advocacy, suggesting the potential for wide dissemination of CC knowledge. Trial Registration. NIH Clinical Trial Registry NCT04960748 ( clinicaltrials.gov ).

Aim The aim of the current study was to explore the facilitators and barriers to the utilisation of sanitation-related decision-making support tools among environmental health practitioners in Uganda. Subject and methods A cross-sectional study design, utilizing narratives from 16 key informants in both the public and private sectors was used. Data were collected with the aid of interview guides, audio-recorded, and transcribed verbatim by experienced transcribers. An interviewee transcript review was undertaken to improve the quality of transcriptions, while intercoder reliability was performed to validate the coding process. The coding process was aided by Nvivo version 12.0, following a thematic approach. Results The sources of information on sanitation-related decision-making support tools included the internet, workshops, communications from agencies such as the World Health Organisation, and the line ministries. The facilitators to utilisation of sanitation related decision-making support tools included awareness, availability of human and financial resources, and the nature of sanitation activities implemented by the practitioner organisations. Conversely, the barriers included inadequate funds, lack of awareness of sanitation-related decision-making support tools, and the nature of activities implemented by the practitioner organisations. Conclusions There is limited awareness of the sanitation-related decision-making support tools, which in combination with the limited funding and nature of activities implemented by the practitioner organisations, hinders their use. The current study, therefore, highlights the need for stakeholders to invest and undertake capacity building through workshops and other information-sharing platforms such as the internet, as a measure to increase awareness of decision-making tools.

Objectives Clinical quality registries (CQRs) have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. This narrative review describes the challenges, proposed solutions, and evidence generated by National ICU registries as facilitators for research and quality improvement. Data Sources English language articles were identified in PubMed using phrases related to ICU registries, CQRs, outcomes, and case-mix. Study Selection Original research, review articles, letters, and commentaries, were considered. Data Extraction Data from relevant literature were identified, reviewed, and integrated into a concise narrative review. Data Synthesis CQRs have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. The initial experience in European countries and in Oceania ensured that through locally generated data, ICUs could assess their performances by using risk-adjusted measures and compare their results through fair and validated benchmarking metrics with other ICUs contributing to the CQR. The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs as well as their use in quality improvement studies, clinical trials as well as international comparisons, and benchmarking for ICUs. Conclusions ICU registries have provided increased knowledge of case-mix and outcomes of ICU patients based on real-world data and contributed to improve care delivery through quality improvement initiatives and trials. Recent increases in adoption of new technologies (i.e., cloud-based structures, artificial intelligence, machine learning) will ensure a broader and better use of data for epidemiology, healthcare policies, quality improvement, and clinical trials.

The Quality of Care Network (QCN) is a global initiative that was established in 2017 under the leadership of WHO in 11 low-and- middle income countries to improve maternal, newborn, and child health. The vision was that the Quality of Care Network would be embedded within member countries and continued beyond the initial implementation period: that the Network would be sustained. This paper investigated the experience of actions taken to sustain QCN in four Network countries (Bangladesh, Ethiopia, Malawi, and Uganda) and reports on lessons learned. Multiple iterative rounds of data collection were conducted through qualitative interviews with global and national stakeholders, and non-participatory observation of health facilities and meetings. A total of 241 interviews, 42 facility and four meeting observations were carried out. We conducted a thematic analysis of all data using a framework approach that defined six critical actions that can be taken to promote sustainability. The analysis revealed that these critical actions were present with varying degrees in each of the four countries. Although vulnerabilities were observed, there was good evidence to support that actions were taken to institutionalize the innovation within the health system, to motivate micro-level actors, plan opportunities for reflection and adaptation from the outset, and to support strong government ownership. Two actions were largely absent and weakened confidence in future sustainability: managing financial uncertainties and fostering community ownership. Evidence from four countries suggested that the QCN model would not be sustained in its original format, largely because of financial vulnerability and insufficient time to embed the innovation at the sub-national level. But especially the efforts made to institutionalize the innovation in existing systems meant that some characteristics of QCN may be carried forward within broader government quality improvement initiatives.

Introduction South Sudan, like most of rural Africa, has a high surgical disease burden and profound unmet surgical needs. This is against a background of weak surgical service delivery systems, especially in the harder-to-reach areas. Here it is further fueled by armed conflict and poverty. The surgical service delivery models applied so far have not adequately improved surgical care. Through the Intergovernmental Authority on Development Regional Initiative for Capacity Building, a surgical team was deployed to Kuajok Hospital in Warrap state. The team mentored South Sudanese health workers for 2 years while working together with other agencies operating in the locality to improve surgical services. This paper is an account of the capacity building process for surgical service improvement at this site, from 2015 to 2017. Methods A descriptive study of activities and patients seen over a 2-year period at this centre. Quantitatively, statistics were extracted and compiled from all areas of surgical care, including profiles of the various surgical conditions. Qualitatively, information was gathered through unstructured interviews. Results There was a drastic increase in surgical outpatient consultations, admissions, and operations. There was an improvement in the level of surgical care and patient care systems. New facilities like operating theaters, emergency rooms, surgical consultation rooms, and surgical wards were established. Community attitude and health-seeking behavior improved, leading to improved access to care. An indirect financial benefit was experienced due to improved patient care outcomes and reduced expenditure on referrals. Conclusion Improvement of surgical services in Africa’s hard-to-reach areas is readily attainable through partnerships and mentoring of native medical workers by personnel from fellow African countries.

Objective Fourth-generation HIV Ag/Ab Combo assay is used for HIV screening of blood for transfusion in developing countries, however, the sensitivity of the assay is questionable during the acute phase of HIV infection. Thus, the study aimed to determine the effect of combining centrifugation with HIV-1 virion lysis on the sensitivity of the fourth-generation HIV Ag/Ab combo assay. Results Of the 59 samples used, 50 were found to be HIV-1 Antibody negative and 9 were HIV Antibody positive. When the 50 HIV-1 antibody-negative samples were run on the fourth-generation HIV Ag/Ab combo assay, 8 (16%) were positive following centrifugation, 13 (26%) were positive following lysis while 25 (50%) were positive after combining centrifugation with HIV-1 virion lysis.

Purpose Shop attendants are urban dwellers who may spend significant periods in sedentary lifestyles exposing them to non-communicable diseases. This study assessed the physical activity levels and sociodemographic factors associated with meeting the WHO recommended physical activity levels among shop attendants in Mbarara municipality, Uganda. Methods We conducted a cross-sectional study among 301 shop attendants. We used the global physical activity questionnaire to assess participants' physical activity levels. Modified Poisson regression was used to assess the sociodemographic factors associated with meeting recommended physical activity levels. Results Of the 301 participants, 234 (77.7%) met the WHO physical activity recommendations, especially through work-related physical activity of moderate intensity 194 (64.5%). The median weekly duration of all moderate-intensity physical activity was 180 min (IQR=90 to 360). The median daily sedentary time was 300 min (IQR=300 to 360). Being male (adjusted prevalence ratio=1.33, 95% CI 1.17 to 1.51) was significantly associated with meeting recommended physical activity levels. Conclusion The physical activity levels among shop attendants were high and were mostly achieved through work-related activities of moderate intensity, with males being more likely to meet recommended physical activity levels. Findings suggest a need for gender-sensitive initiatives to increase physical activity levels, especially among female shop attendants.