Edgar Mugema Mulogo

• MPH, MSc., PhD
• Professor (Associate) at Mbarara University of Science and Technology

Pediatric severe malaria is a significant contributor of morbidity and mortality in Uganda. Most information is derived from tertiary referral centers and urban centers. Little is known about routine care or post-discharge outcomes in rural areas. We conducted a longitudinal cohort study of pediatric severe malaria at St. Paul’s Level IV Health Cen...

Background In Africa, the first Plasmodium falciparum artemisinin partial resistance mutation, was Kelch13 (K13) 561H - detected and validated at appreciable frequency in Rwanda in 2014. Surveillance to better define the extent of the emergence in Rwanda and neighboring countries is critical. Methods We used novel liquid blood drop preservation co...

Postpartum sepsis following caesarean sections among women in Uganda remains a risk. However, erratic supplies of standard dressing material make the risk a reality. Alternative wound dressing materials, therefore, remain a viable option. This study examined the outcome of a honey and olive oil‐based dressing material on caesarean section wound hea...

Background In Uganda, village health workers (VHWs) manage childhood illness under the integrated community case management (iCCM) strategy. Care is provided for malaria, pneumonia, and diarrhoea in a community setting. Currently, there is limited evidence on the cost-effectiveness of iCCM in comparison to health facility-based management for child...

In Africa, the first Plasmodium falciparum Kelch13 (K13) artemisinin partial resistance mutation 561H was first detected and validated in Rwanda. Surveillance to better define the extent of the emergence in Rwanda and neighboring countries as other mutations arise in East Africa is critical. We employ a novel scheme of liquid blood drop preservatio...

Traditional medicinal knowledge and healing practices of indigenous spiritual healers play important roles in health care, and contribute towards achieving Universal Health Care. Traditional spiritual healers (TSHs) are grouped into three categories. One category of Baganda TSHs, Balubaale, engage ancestral spirits during health management. Balubaa...

Introduction Globally, the progress to attain the open defecation free (ODF) environment has remained very slow. This study examined context specific factors influencing household open defecation free status in Uganda Methods A cross-sectional study was conducted in Kabale district in southwestern Uganda and 492 participants were randomly selected...

Traditional medicinal knowledge and healing practices of indigenous health care spiritualists play an important role in health care, and contribute towards achieving Universal Health Care. The traditional healthcare spiritualists (THSs) were grouped into three categories. One category of Baganda THSs, Balubaale, engage ancestral spirits during heal...

The increasing global sensitivity to spirituality in medicine and sociology has elevated the relevance of beliefs in ancestral spirits as an integral element in Africa’s multi-ethnic society and biocultural diversity for health management. However, ancestral spirituality in healthcare in the local context, remains sparse and elusive since most lite...

Background Surgical management of Hirschsprung disease (HD) in low- and middle-income countries is typically a staged procedure, necessitating multiple hospitalizations and clinic visits increasing family financial burden. Currently, there is limited information on the costs borne by caretakers of children with Hirschsprung disease seeking surgical...

In Uganda, children with febrile illness are often treated with antibiotics even though most have self-limiting, likely viral, infections. C-reactive protein (CRP) measurement can help identify those who are more likely to have a bacterial infection and therefore need antibiotic treatment. Implementation of a CRP rapid diagnostic test (RDT) at the...

Background Pre-referral treatment aims to stabilize the child’s condition before transferring them to a higher level of healthcare. This study explored pre-referral treatment for diarrhea, malaria and pneumonia in children U5. The study aims to assess pre-referral treatment practices among community health workers (CHWs) for children aged 2 to 59 m...

Background Coronavirus disease (COVID-19) vaccine hesitancy is a global challenge. In low- and middle-income countries (LMICs), the problem has persisted despite vaccine availability and decreasing infections. In Uganda, there is still limited information on the extent and predictors of vaccine hesitancy. This study sought to assess the prevalence...

Background Resistance to antibiotics is rising and threatens future antibiotic effectiveness. ‘Antibiotic targeting’ ensures patients who may benefit from antibiotics receive them, while being safely withheld from those who may not. Point-of-care tests may assist with antibiotic targeting by allowing primary care clinicians to establish if symptoma...

In Uganda, spirituality is closely associated with traditional healthcare, however though prevalent, is considered controversial, mystical, less-documented and is often misunderstood. There is a paucity of literature on the description of health, illness, disease, management approaches among spiritual traditional healthcare practitioners. This arti...

In rural Uganda where birth dose vaccination for Hepatitis B is not routine, we implemented a pilot program for preventing mother to child transmission which effectively identified women with high-risk HBV and started antiviral treatment during pregnancy. Further work is required to enhance antiviral adherence through delivery to ensure effective p...

Background: Malaria epidemics result from extreme precipitation and flooding, which are increasing with global climate change. Local adaptation and mitigation strategies will be essential to preventing excess morbidity and mortality. Methods: We investigated the spatial risk of malaria infection at multiple timepoints after severe flooding in ru...

Background: Surgical management of Hirschsprung disease (HD) in low- and middle-income countries is typically a staged procedure, necessitating multiple hospitalizations and clinic visits increasing family financial burden. Currently there is limited information on the costs borne by caretakers of children with Hirschsprung disease seeking surgical...

Background Village Health Workers (VHWs) in Uganda provide treatment for the childhood illness of malaria, pneumonia, and diarrhoea through the integrated community case management (iCCM) strategy. Under the strategy children under five years receive treatment for these illnesses within 24 h of onset of illness. This study examined promptness in se...

Background Malaria risk is not uniform across relatively small geographic areas, such as within a village. This heterogeneity in risk is associated with factors including demographic characteristics, individual behaviours, home construction, and environmental conditions, the importance of which varies by setting, making prediction difficult. This s...

Background: In integrated community case management (iCCM) care, community health workers (CHWs) provide home-based management of fever, diarrhea and fast breathing for children aged <5 y. The iCCM protocol recommends that children with danger signs for severe illness are referred by CHWs to health facilities within their catchment area. This stud...

Background: The new WHO Labour Care Guide, also regarded as the “next-generation partograph” basing on recent evidence has been recorded as a core component of the 2018 consolidated set of guidelines on intrapartum care for positive child birth experience. The Ugandan Ministry of Health is in the process of adopting the new WHO Labour Care Guide (L...

Background In rural Uganda a significant number of persons afflicted with pre-diabetes are unaware of the condition. This is likely to lead to diabetic complications resulting in catastrophic health expendirure.The burden of prediabetes in rural Isingiro has not previously been determined. This study examined the prevalence of prediabetes and the a...

This article details the study protocol for a double-blind, randomized placebo-controlled trial to determine the effectiveness of permethrin-treated baby wraps to prevent Plasmodium falciparum malaria infection in children 6–24 months of age. Participating mother-infant dyads will be randomized to receive either a permethrin-treated or a sham-treat...

Background: Current supply shortages constrain yellow fever vaccination activities, particularly outbreak response. Although fractional doses of all WHO-prequalified yellow fever vaccines have been shown to be safe and immunogenic in a randomised controlled trial in adults, they have not been evaluated in a randomised controlled trial in young chi...

Background The World Health Organization has promoted “test and treat” guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be tr...

Barriers continue to limit access to viral load (VL) monitoring across sub-Saharan Africa adversely impacting control of the HIV epidemic. The objective of this study was to determine whether the systems and processes required to realize the potential of rapid molecular technology are available at a prototypical lower-level (i.e., level III) health...

Background Pre-referral treatment is critical for management of childhood illnesses. Under iCCM strategy, community health workers (CHWs) give pre-referral treatment to children under five years of age with danger signs. The study examined the magnitude and predictors of pre-referral treatment in a rural setting. Methods A retrospective study prem...

Background Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV) and reduces HIV transmission. While availability and efficacy of ART have improved in sub-Saharan Africa (SSA), access remains a challenge. Travel burden, measured as travel time, distance, and cost, has been posited as a potential barrier to ART. For exam...

The World Health Organization recommends all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment. Despite recommendations, many fevers presenting at private drug shops are treated presumptively as malaria without diagnostic testing. The purpose of this qualitative study was t...

Background The control of malaria, pneumonia, and diarrhoea is important for the reduction in morbidity and mortality among children under 5 years. Uganda has adopted the Integrated Community Case Management strategy using Community Health Workers (CHWs) to address this challenge. The extent and trend of these three conditions managed by the CHWs a...

Introduction: In resource limited settings, the highest burden of adverse maternal-fetal outcomes at referral hospitals is registered from emergency obstetric referrals from lower health facilities. Implementation of referral protocols has not been optimally successful possibly attributed to lack of understanding of profile of obstetric referrals...

Background In rural Uganda many people are either pre-diabetic or diabetic, however they do not know that these conditions afflict them. The burden of pre-diabetes in rural Isingiro had not previously been determined. The study examined the prevalence of pre-diabetes and associated factors. Methods A cross-sectional survey that enrolled 370 partici...

Background: Emergency obstetric referrals develop adverse maternal-fetal outcomes partly due to delays in offering appropriate care at referral hospitals especially in resource limited settings. Referral hospitals do not get prior communication of incoming referrals leading to inadequate preparedness and delays of care. Phone based innovations may...

Background Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June–August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda. Methods We...

Objective: Integrated community case management (iCCM) of childhood illness in Uganda involves protocol-based care of malaria, pneumonia and diarrhoea for children under 5 years old. This study assessed volunteer village health workers' (VHW) ability to provide correct iCCM care according to the national protocol and change in their performance ov...

Globally, billions of people still lack access to safe water, including basic drinking water services, particularly in sub-Saharan Africa. We analyzed water quality for improved water sources and associated factors in Kibuku district, Eastern Uganda. The mixed-methods study employed included; water quality analysis, a questionnaire survey, and key...

Introduction Achieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in...

Background Progress against malaria has stalled and may even be slipping backwards in high-burden countries. This is due to a range of factors including insecticide resistance and mosquito feeding behaviours that limit contact with widely-employed interventions including long-lasting insecticidal nets and indoor-residual spraying. Thus, further inn...

Globally, respiratory illness is one of the most common reasons that children seek care. It is often treated inappropriately with antibiotics, which can drive the development of antibiotic resistance.

Background Malaria, pneumonia and diarrhoea continue to be the leading causes of death in children under the age of five years (U5) in Uganda. To combat these febrile illnesses, integrated community case management (iCCM) delivery models utilizing community health workers (CHWs) or drug sellers have been implemented. The purpose of this study is to...

Introduction Achieving the Open defecation free (ODF) status remains a major challenge in Uganda, yet it contributes significantly to child health improvement. Literature on social, cultural and behavioral aspects that influence the ODF status in rural Uganda is limited. The study therefore, explored perceived factors influencing the ODF status in...

Background Malaria epidemics are a well-described phenomenon after extreme precipitation and flooding, which account for nearly half of global disasters over the past two decades. Yet few studies have examined mitigation measures to prevent post-flood malaria epidemics. Methods We conducted an evaluation of a malaria chemoprevention program implem...

Abstract Background Long-lasting insecticidal nets (LLINs) remain a cornerstone of malaria control, but strategies to sustain universal coverage and high rates of use are not well-defined. A more complete understanding of context-specific factors, including transmission intensity and access to health facilities, may inform sub-district distribution...

Background Measles outbreaks are prevalent throughout sub-Saharan Africa despite the preventive measures like vaccination that target under five-year-old children and health systems strengthening efforts like prioritizing the supply chain for supplies. Measles immunization coverage for Kasese district and Bugoye HC III in 2018 was 72 and 69%, respe...

Background CRISPR-based diagnostics are a new class of highly sensitive and specific assays with multiple applications in infectious disease diagnosis. SHERLOCK, or Specific High-Sensitivity Enzymatic Reporter UnLOCKing, is one such CRISPR-based diagnostic that combines recombinase polymerase pre-amplification, CRISPR-RNA base-pairing, and LwCas13a...

Background Malaria, pneumonia, and diarrhea continue to be the leading causes of death in children under the age of five in Uganda. To combat the above-mentioned febrile illnesses, integrated community case management (iCCM) delivery models utilizing CHWs or drug sellers have been implemented. The purpose of this study is to compare the cost-effect...

Background Long-lasting insecticide-treated nets (LLINs) remain a cornerstone of malaria control, but optimal distribution strategies to sustain universal coverage are not well-defined Methods We conducted a cross-sectional survey of 2,190 households in the highlands of western Uganda to examine LLIN source and use among children age with elevatio...

Introduction The control of malaria, pneumonia, and diarrhea is important for the reduction in morbidity and mortality among children under five years. Uganda has adopted the Integrated Community Case Management strategy using Community Health Workers to address this challenge. The extent and trend of these three conditions managed by the Community...

Background In some areas of Uganda, village health workers (VHW) deliver Integrated Community Case Management (iCCM) care, providing initial assessment of children under 5 years of age as well as protocol-based treatment of malaria, pneumonia, and diarrhoea for eligible patients. Little is known about community perspectives on or satisfaction with...

We enrolled 250 febrile children in western Uganda to compare the results of malaria rapid diagnostic tests when using capillary versus venous blood. Participants were tested with four different RDT types. PCR testing was performed as the reference standard. Sensitivity and specificity were broadly similar across RDT types and sampling method. Agre...

Background Stocks of yellow fever vaccine are insufficient to cover exceptional demands for outbreak response. Fractional dosing has shown efficacy, but evidence is limited to the 17DD substrain vaccine. We assessed the immunogenicity and safety of one-fifth fractional dose compared with standard dose of four WHO-prequalified yellow fever vaccines...

Background The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of u...

Village health workers (VHWs) in Bugoye subcounty, Uganda, provide integrated community case management (iCCM) care to children younger than 5 years for malaria, pneumonia, and diarrhea. We assessed the longevity of VHWs' skills in performing and reading malaria rapid diagnostic tests (RDTs) 4 years after initial training, comparing VHWs who had co...

Background: In Integrated Community Case Management (iCCM), village health workers (VHW) assess and treat malaria, pneumonia and diarrhea using a clinical algorithm. Study objectives included: 1) Compare VHWs' performance on case scenario exercises to record review data; 2) assess impact of formal education on performance in the case scenario exer...

Background: The spatial distribution and burden of dengue in sub-Saharan Africa remains highly uncertain, despite high levels of ecological suitability. The goal of this study was to describe the epidemiology of dengue among a cohort of febrile children presenting to outpatient facilities located in areas of western Uganda with differing levels of...

Background Yellow fever vaccine stocks have been insufficient to cover exceptional demands for outbreak response. Fractional dosing evidence is limited to the 17DD substrain vaccine. We assessed the immunogenicity and safety of one-fifth fractional dose compared to standard dose of each of the four WHO-prequalified yellow fever vaccines produced fr...

Abstract Background In East Africa, fishing communities are considered most-at-risk populations for the acquisition of HIV. We estimated HIV prevalence and assessed progress towards the UNAIDS 90–90-90 targets along the HIV treatment cascade in 12 fishing communities surrounding Lakes Edward and George, Uganda. Methods We conducted a cross-sectiona...

Objective: Teenage pregnancy is a growing health challenge among adolescents in Uganda with its magnitude varying across the different regions of Uganda. This study evaluated the magnitude and factors associated with prior teenage pregnancy among women aged 18 -67 years in a rural community of Kasese district, Uganda Results: Fifty-two percent (...

Objective: Teenage pregnancy is a growing health challenge among adolescents in Uganda with its magnitude varying across the different regions of Uganda. This study evaluated the magnitude and factors associated with prior teenage pregnancy among women aged 18-67 years in a rural community of Kasese district, Uganda. Results: Fifty-two percent (52%...

Objectives Emergency medicine in low‐ and middle‐income countries (LMICs) is hindered by lack of research into patient outcomes. Chief complaints are fundamental to emergency care but have only recently been uniquely codified for an LMIC setting in Uganda. It is not known whether chief complaints independently predict emergency unit patient outcome...

Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression. We designed an intervention, Mobile Antiretroviral Therapy and HIV care (MAP-HC) in rural southwestern Uganda aimed to reduce travel distance and hypothesized that MAP-HC would improve ART adherence and rates of viral load suppression. The study was conduct...

CRISPR-based diagnostics are a new class of highly sensitive and specific assays with multiple applications in infectious disease diagnosis. SHERLOCK, or Specific High-Sensitivity Enzymatic Reporter UnLOCKing, is one such CRISPR-based diagnostic that combines recombinase polymerase pre-amplification, CRISPR-RNA base-pairing, and LwCas13a activity f...

Background: Control of Rubella and Congenital Rubella Syndrome using vaccination has shown great success in the America's. Uganda is due to introduce the Rubella vaccine however the magnitude of transmission is not well documented. Therefore this study was done to determine IgM sero-prevalance for Rubella in order to help monitor vaccine effective...

Despite many water, sanitation, hygiene (WASH) and other environmental health challenges in sub-Saharan Africa, little is known about interactions involving scientists, journalists and the public to aid public understanding of the relationship between WASH and health. Using purposive sampling, we conducted key informant interviews and focus group d...

The aim of this study was to assess the bacteriological quality of water sources in the two rural areas of Uganda using the compartment bag test (CBT). A total of 200 water samples were collected from 69 different water sources and processed within 6 h of collection. Positive and negative controls were processed each day together with water samples...

Immunization rates in most sub-Saharan African countries fall far below stated targets. Measuring access in resource-limited settings, however, is challenging, especially with the data available at the district level, which is the primary administrative division for most immunization programs. Despite calls to improve routine data collection and us...

We explored spatial variation in the prevalence of established molecular markers of antimalarial resistance across a geographically diverse, highland region of western Uganda. We identified Plasmodium falciparum CQ resistance transporter 76T mutations in all pools, but there was no evidence of spatial differences across village-based strata defined...

Background Retention of HIV Exposed Infants (HEIs) in care ensures adequate care. Data on retention of HEIs at large referral hospitals in Uganda is limited. We investigated the retention level of HEIs and associated factors. Methods We conducted a retrospective cohort study on 352 HEIs in care (January 2014 and April 2015) at Arua Regional Referr...

Background: In 2010, Uganda Malaria Control Programme distributed cost-free mosquito bed nets to households with children under-five years and pregnant women in selected sub-counties. We assessed the factors associated with sleeping under costfree mosquito nets among children under-five years in Nyakayojo sub-county, Mbarara District, Uganda. Met...

Background In much of sub-Saharan Africa, health facilities serve as the primary source of routine vital statistics. These passive surveillance systems, however, are plagued by infrequent and unreliable reporting and do not capture events that occur outside of the formal health sector. Verbal autopsies (VA) have been utilized to estimate the burden...

Introduction Adherence to antiretroviral therapy (ART) is critical in order to achieve viral suppression, one of three UNAIDS targets set for achievement before 2020. One of the main barriers to adherence is the long distance between patient residences and healthcare facilities. We designed an intervention, Mobile Antiretroviral Therapy and HIV car...

Objective: To determine frequency of palatal fistula following primary cleft palate repair and the associated factors as a measure of cleft palate repair outcome and its challenges at a cleft centre in Uganda. Results: Between May and December 2016, 54 children with cleft palate were followed up at Comprehensive Rehabilitation services of Uganda...

Background Uganda has sought to address leading causes of childhood mortality: malaria, pneumonia and diarrhoea, through integrated community case management (iCCM). The success of this approach relies on community health worker (CHW) assessment and referral of sick children to a nearby health centre. This study aimed to determine rates of referral...

There is a paucity of information on the state of water, sanitation, and hygiene (WASH) at health care facilities in Uganda. A survey on WASH service availability was conducted at 50 health care facilities across 4 districts of rural southwestern Uganda between September and November 2015. The main water points at the majority (94%) of the health c...

Background: Malaria is a leading cause of paediatric morbidity and mortality in Uganda. More than half of febrile children in rural areas initially seek care at private clinics and drug shops. These shops are generally unregulated and the quality of clinical care is variable, with the potential for misdiagnosis and the development of drug resistanc...

Not much is known about clinical decision-making in rural, low-resource settings regarding fever, a common reason for presentation to care. In this prospective cohort study of patients presenting with febrile illness to a rural Ugandan health center, we examined demographic and clinical factors predictive of an initial disposition of inpatient admi...

Abstract Background Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale. Methods From Feb...

BACKGROUND: Refugees in sub-Saharan Africa face both the risk of HIV infection and barriers to HIV testing. We conducted a pilot study to determine the feasibility and acceptability of home-based HIV testing in Nakivale Refugee Settlement in Uganda and to compare home-based and clinic-based testing participants in Nakivale. METHODS: From February...