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BackgroundAlthough pregnancy and child birth-related complications remain a global public health concern, little is known about their prevalence and associated factors. Our study assessed pregnancy-related complications and associated factors among women attending antenatal care at a specialized maternal and child health national referral hospital in Uganda.MethodologyA cross-sectional study was conducted among 285 pregnant women. Data were collected using the KoboCollect mobile application, and analysed using STATA 14. A modified poisson regression model was used for inferential statistics.FindingsOut of the 285 women, 27.4% (78/285) had pregnancy-related complications. The most reported complications were anaemia, 10.9% (31/285); eclampsia, 8.1% (23/285); and still births, 4.9% (14/285). Having a higher gravidity of 4-6 (APR= 0.32, 95% CI: 0.17-0.57) and of more than 7 (APR= 0.32, 95% CI: 0.14-0.73) was negatively associated with pregnancy-related complications. Factors positively associated with pregnancy-related complications included; late first ANC (APR=1.85, 95% CI: 1.17-2.92), parity of ≥ 3 (APR= 3.69, 95% CI: 1.50-9.08) and induced abortion prior to current pregnancy (APR= 1.64, 95% CI: (1.08-2.47).ConclusionThe prevalence of pregnancy-related complications was very high. Anaemia, eclampsia and still births were the most prevalent. A late first ANC, gravidity higher than 4, parity higher than 3, and history of an induced abortion prior to the current pregnancy were associated with having pregnancy-related complications. Interventions aimed at reducing maternal morbidity and mortality should aim at promoting early ANC attendance, and increasing access to safe abortion and family planning services.

With shortages of face masks being reported worldwide, it is critical to consider alternatives to commercially manufactured face masks. This study aimed to test and compare the efficacy of various makes of locally made or homemade cloth face masks obtained from face-mask vendors in Kampala, Uganda, during the COVID-19 pandemic. The testing was performed to assess the bacterial filtration efficiency (BFE), breathability, distance-dependent fitness, and reusability of the locally made or homemade cloth face masks, while considering the most commonly used non-published face-mask decontamination approaches in Uganda. During laboratory experimentation, modified protocols from various face-mask testing organizations were adopted. Ten different face-mask types were experimented upon; each face-mask type was tested four times for every single test, except for the decontamination protocols involving washing where KN95 and surgical face masks were not included. Among the locally made or homemade cloth face masks, the double-layered cloth face masks (described as F) had better BFE and distance-dependent fitness characteristics, they could be reused, and had good breathability, than the other locally made or homemade cloth face masks. Despite these good qualities, the certainty of these face masks protecting wearers against COVID-19 remains subject to viral filtration efficiency testing.

BackgroundThe COVID-19 continued to pose several public health, social, economic challenges and the drivers for the occurrence of different COVID-19 waves remains undocumented in Uganda. We conducted a cross-sectional population-based survey among recovered COVID-19 cases to establish the drivers of SAR-CoV-2 infections. We performed a retrospective study and interviewed 1120 recovered COVID-19 cases from 10 selected districts in Uganda. We further conducted 38 Key Informant Interviews of members of the COVID-19 District Taskforce and 19 in-depth interviews among COVID-19 survivors from March to June, 2021. Results Out of the 1120 recovered COVID-19 cases interviewed, 62% were aged 39 years and below and 51.5% females with 90.9% under home based care management. Cases were more prevalent in business (25.9%), students (17.2%), farmers (17.1%) and health workers (12.4%) and 79.9% developed COVID-19 symptoms mainly cough, flu, and fever. Being asymptomatic was found to be associated with not seeking healthcare (APR 2, P ConclusionsOur study identified several drivers under the broad categories of demographic, patient, health facilities and services, social and economic factors that attributed to emergence and sustenance of COVID-19 second wave from March to June, 2021. Specifically, being female, young, asymptomatic, under Home Based Care Management, social gatherings, school going, not vaccinated were among the major drivers of the second wave. We strongly recommend that the Ministry of Health together with National Taskforce for COVID-19 Response to reconsider some aspects of Home-Based Care Management to only established institutions and organizations with potential and facilities to monitor cases in addition to training and monitoring all those involved in supporting the Home Based Care Management.

IntroductionWater should comply with standard/regulatory physio-chemical and biological parameters to ensure that it is safe for domestic use. We therefore sought to assess the physico-chemical and biological quality of groundwater sources in Kadama subcounty, Kibuku district, Eastern Uganda. MethodsA cross-sectional quantitative study was conducted. We collected water samples from twenty-three functional water sources. We assessed the turbidity, pH and presence of Escherichia coli (E. coli) using the turbidity meter, pH meter and membrane filtration technique, respectively. Furthermore, physical sanitary inspection of the water sources was done using a standard pretested observational checklist to assess existing risk factors.ResultsThe majority, 69.5% of the water sources included in the study were boreholes, with about 43.5% of them from Nandere parish. Majority of the water sources 86.9% (20/23) had clogged/blocked drainage channels, about a third of water sources 60.9% (14/23) did not have fences/protection around them and majority of the water sources, 82.6% (19/23) had stagnated apron. Some water sources 8.7% (2/23) had open defecation around them. The water samples had a mean pH of 6.87 (SD 0.920) with 4.4% acidic, 86.9% normal/acceptable pH level and 8.6% in alkaline state. About two-thirds (65.3%) of these water sources had turbidity levels less than 5 NTUs. In addition, boreholes had a better turbidity score of 81.2% (13/16) compared to the water wells 71.4% (5/7). About half, 43.5% of the water sources were above the WHO recommended range of zero coliforms. ConclusionsSome ground water sources had sanitary risk factors and significant levels of E. coli which makes them unfit for human consumption, though they can be used for other domestic purposes including washing clothes. This calls for urgent need to keep surrounding water sources clean and continuously disinfect drinking water from groundwater sources before human consumption.

Background Although the community health workers’ (CHWs) / volunteer health teams’ (VHTs) work is widely appreciated, some households do resist their interventions, and figures of authority sometimes question their manner and ability. Despite critical shortage of health workers’ world-over, little has been done to explore whether community health workers satisfy the people they serve. To fill this VHT training and support gap, Omni Med Uganda, a local Non-Governmental Organization in Uganda, has been implementing an enhanced hybrid VHT program since 2008. This study aimed at assessing community satisfaction with the CHW activities involved the enhanced CHW program. Materials and methods A cross-sectional study was employed. Qualitative data was collected from 217 participants using semi-structured questionnaires. Descriptive statistics such as frequencies, proportions, and means were performed for socio-demographic characteristics, Community satisfaction, and CHW activities. Prevalence Ratios (PR) were used to determine association between Community satisfaction and enhanced CHW activities. Results Majority of the respondents 81.1% (176/217) reported that the performance of the CHWs was satisfactory to maintain their health and that of their families. CHW activities such as confirming sick persons (APR:1.26 :95%CI (1.01–1.44), mobilization for cook stove building, (APR: 1.18: 95%CI (1.04–1.34), and monthly visits at participant’s homes (APR: 1.17: 95%CI (1.01–1.35) were positively associated with community satisfaction. Conclusion Enhancement of CHW activities should be considered during CHW programs. However, CHW performance should also be considered because community satisfaction does not imply high performance by CHWs and adherence to health interventions by the community.

Background Lab-based surveillance (LBS) of antimicrobial resistance (AMR) is not systematically implemented in Uganda. We aimed to identify the gaps in establishing regular LBS of AMR in Uganda. Methods This was a retrospective records review. It was done at Mulago Hospital (MH) Microbiology Lab (MHL). It analyzed lab records on bacteria and their antimicrobial susceptibility profiles (ASPs) over 6 months. Since MH is the national referral hospital, we hypothesized that (1) MHL is the best resourced and that any limitations seen here are amplified in labs at regional referral hospitals (RRHs) and health centers (HCs); (2) data from MHL on LBS mirrors that from labs at RRHs and HCs; (3) the state of records from MHL show lab performance and the presence or absence of standard operating procedures (SOPs), as would be the case at RRHs and HCs. Results The lab got 1760 samples over the six months. The most common sample was urine (659, 37.4%). From the 1760 samples, data on 478 bacterial isolates were available. Urine gave the most isolates (159, 33.3%). Most of the isolates were gram-negative (267, 55.9%). Escherichia coli (100, 37%) was the most common gram-negative (of the Enterobacteriaceae). Pseudomonas aeruginosa (17, 6%) was the most common gram-negative (of the non-Enterobacteriaceae). The gram-negative bacteria were highly resistant to β-lactams. These were highly sensitive to carbapenems. The Staphylococcus aureus were highly resistant to β-lactams. The gram-positive bacteria were highly sensitive to vancomycin. ASPs for all bacterial categories were incomplete. Conclusions The findings from MHL suggest that there is a need to improve antimicrobial susceptibility testing capacity. They also suggest that the situation at RRHs and HCs around the country could be worse. So, there is a need to extend the political will, which already exists, into operational and implementation action.

BackgroundThe Corona Virus Disease of 2019 (COVID-19) has gravely affected several aspects of national and global society, including education. Given the risk it poses, the Government of Uganda (GOU) adopted and recommended face mask use as one of the preventive measures to limit its transmission in communities. However, there is limited data on the levels of face mask usage and associated factors among students in schools in Uganda. This study aimed at assessing the face mask usage and associated factors among students in schools in rural Eastern Uganda amidst the COVID-19 pandemic.MethodsA cross sectional quantitative descriptive study was conducted among 423 students in schools in rural Eastern Uganda. Multi-stage sampling method was employed in the selection of study participants. The data was collected by trained data collectors using structured questionnaires pre-installed on ODK enabled smart phones. The data entered was cleaned using Excel 2016 and exported to Stata14.0 statistical software (Statacorp, College station, Texas, USA) for analysis. Bivariate and multivariable logistic regression analyses were employed using 95% CI (confidence interval). Variables with p-value < 0.20 and those with literature backup evidence were included in the multivariable model. Variables with p-value < 0.05 were considered to be statistically significant. This study revealed that less than three quarters (62.3%) wore face masks correctly.ResultsAlmost all, 98.9% of the participants mentioned that they wore face masks due to fear of missing classes and 49.0% disagreed that they were vulnerable to COVID-19. Students in boarding schools (AOR = 1.61, 95%CI: 1.05-2.47), those who believed that they were vulnerable to COVID-19 (AOR = 1.70, 95%CI: 1.11-2.10), and those who disagreed that masks are uncomfortable (AOR = 1.62, 95%CI: 1.06-2.46) were more likely to wear facemasks correctly.ConclusionThis study revealed that more than a third of the students did not wear face masks correctly. Correct wearing of face masks was associated with being in a boarding school, belief that they were susceptible to COVID-19, and disagreeing that masks were uncomfortable. This therefore highlights the need for sensitization programmes in academic institutions in order to improve students’ perceptions toward COVID-19 and face masks, and consequently increase correct face mask usage in schools.

Face-masking could reduce the risk of COVID-19 transmission. We assessed knowledge, attitudes, perceptions, and practices toward COVID-19 and face-mask use among 644 high-risk individuals in Kampala, Uganda. In data analysis, descriptive, bivariate, and multivariate logistic regression analyses with a 95% CI were considered. Adjusted odds ratios were used to determine the magnitude of associations. P-values < 0.05 were considered statistically significant. The majority, 99.7% and 87.3% of the participants, respectively, had heard about COVID-19 and believed that face-masks were protective against COVID-19, whereas 67.9% reported having received information on face-mask use. Food-market vendors and those with no formal education were 0.5 and 0.3 times less likely to have received information about face-mask use than hospital workers and those who had completed secondary school, respectively. Those who had received information on face-mask use were 2.9 and 1.8 times more likely to own face-masks and to perceive them as protective, respectively. Food-market vendors were 3.9 times more likely to reuse their face-masks than hospital workers. Our findings suggest that Ugandan high-risk groups have good knowledge, optimistic attitudes and perceptions, and relatively appropriate practices toward COVID-19.

Reliable data on antimicrobial resistance (AMR) transmission dynamics in Uganda remains scarce; hence, we studied this area. Eighty-six index patients and “others” were recruited. Index patients were those who had been admitted to the orthopedic ward of Mulago National Referral Hospital during the study period; “others” included medical and non-medical caretakers of the index patients, and index patients’ immediate admitted hospital neighbors. Others were recruited only when index patients became positive for carrying antimicrobial-resistant bacteria (ARB) during their hospital stay. A total of 149 samples, including those from the inanimate environment, were analyzed microbiologically for ARB, and ARB were analyzed for their antimicrobial susceptibility profiles and mechanisms underlying observed resistances. We describe the diagnostic accuracy of the extended-spectrum β-lactamase (ESBL) production screening method, and AMR acquisition and transmission dynamics. Index patients were mostly carriers of ESBL-producing Enterobacteriaceae (PE) on admission, whereas non-ESBL-PE carriers on admission (61%) became carriers after 48 hours of admission (9%). The majority of ESBL-PE carriers on admission (56%) were referrals or transfers from other health-care facilities. Only 1 of 46 samples from the environment isolated an ESBL-PE. Marked resistance (> 90%) to β-lactams and folate-pathway inhibitors were observed. The ESBL screening method’s sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 50%, 90%, and 100%, respectively. AMR acquisition and transmission occurs via human–human interfaces within and outside of health-care facilities compared with human–inanimate environment interfaces. However, this remains subject to further research.

BackgroundWith shortages of face-masks continuing to be reported worldwide, critical questions like whether or not there is an adequate alternative to commercially manufactured face-masks continue to linger especially in low- and middle-income settings. This study aimed at addressing this through testing and comparing various materials and forms of face-masks for filtration efficiency, breathability, microbial cleanliness, distance-dependent fitness, and re-usability of different face-masks procured from face-mask vendors in Kampala, Uganda.MethodsThis was a laboratory-based descriptive study that applied new protocols and already existing protocols with substantive modifications to ten different types of face-mask types each in quadruplicate to achieve each specified aim.ResultsSurgical face-masks had better filtration efficiency, distance-dependent fitness and breathability compared to other face-masks tested. Decontamination of these face-masks with 70% ethanol negatively affected their efficacy. Locally-made double layered face-masks had better: filtration efficiency, distance-dependent fitness and breathability compared to other locally-made cloth face-masks, and re-usability compared to all the face-mask types that had been tested.Discussion/conclusionsLocally-made double layered cloth face-masks could serve as alternative face-masks especially for populations in low- and middle-income settings like Uganda while allowing restricted use of surgical face-masks and other respirators like the KN95 to high-risk groups only.

Face-masking could reduce the risk of COVID-19 transmission. We assessed: knowledge, attitudes, perceptions, and practices towards COVID-19 and face-mask use among 644 high risk-individuals in Kampala, Uganda. In data analysis, descriptive, bivariate and multivariate logistic regression analyses, with a 95% confidence interval were considered. Adjusted-odds ratios were used to determine the magnitude of associations. P-values < 0.05 were considered statistically-significant. Majority: 99.7% and 87.3% of the participants respectively had heard and believed that face-masks were protective against COVID-19, while 67.9% reported having received information on face-mask use. Males, food market vendors, those with no formal education, and those aged 24-33, 44-53 and 54-63 years were 0.58, 0.47, 0.25, 1.9, 2.12, and 3.39 times less likely to have received information about face-mask use respectively. Majority, 67.8% owned locally-made, non-medical face-masks, while 77.0% of face-mask owners believed that they knew the right procedure of wearing them. Those who had received information on face-mask use were 2.85 and 1.83 times more likely to own face-masks and to perceive them as protective. Food market vendors were 3.92 times more likely to re-use their face-masks. Our findings suggest that Ugandan high-risk groups have good knowledge, optimistic attitudes and perceptions, and relatively appropriate practices towards COVID-19.

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI.