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Andrew Marvin Kanyike,1,2,&ast; Ashley Winfred Nakawuki,3 Gabriel Madut Akech,1 Raymond Bernard Kihumuro,4 Timothy Mwanje Kintu,5 Racheal Nalunkuma,2 Rachael Mukisa Nakandi,2 Joshua Mugabi,1 Nicholas Twijukye,1 Denis Bwayo,1 Richard Katuramu1,&ast; 1Department of Internal Medicine, Faculty of Health Sciences, Busitema University, Mbale, Uganda; 2Department of Internal Medicine, Mengo Hospital, Kampala, Uganda; 3Department of Nursing, Faculty of Health Sciences, Busitema University, Mbale, Uganda; 4Way Forward Youth Africa Limited, Kampala, Uganda; 5Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda&ast;These authors contributed equally to this workCorrespondence: Andrew Marvin Kanyike, Department of Internal Medicine, Mengo Hospital, Kampala, Uganda, Email andrewmarvinkanyike@gmail.comIntroduction: Despite advancements in Antiretroviral Therapy (ART), people living with HIV (PLHIV) face increasing risks of HTN, leading to significant morbidity and premature mortality, undermining the hard-earned gains of fighting HIV. The prevalence of hypertension among HIV patients and associated risk factors has not been extensively studied in the rural parts of Uganda.Objective: We assessed the prevalence, awareness, and factors associated with hypertension among PLHIV at two health facilities in Eastern Uganda.Methods: A cross-sectional study was conducted at Mbale Regional Referral Hospital and Bugobero Health Center IV HIV clinics from May to July 2023. We recruited patients with HIV above the age of 18 years and willing to consent. Participants were interviewed using a structured questionnaire adapted from the WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) and the AIDS Clinical Trials Group. Anthropometric measurements and blood pressure were taken. Bivariate and multivariable logistic regression were performed. A P value < 0.2 in the bivariate analysis was transferred to the multivariable logistic regression model. A P value < 0.05 was statistically significant.Results: The study surveyed 400 PLHIV with a mean age of 46.5 (SD: 12.4) years; most were female (n=261, 65.3%). Hypertension prevalence was at 37.5%, with 20.5% in stage 2 and 68% ((n=102) of hypertensive participants were unaware. Hypertension was associated with age ≥ 50 years (aOR: 2.11, 95% CI: 1.33– 3.37, p = 0.002), a suppressed viral load (aOR: 3.71, 95% CI: 1.02– 5.13, p = 0.046) and BMI ≥ 25 Kg/m2 (aOR: 1.64, 95% CI: 1.01– 2.66, p = 0.044).Conclusion: Hypertension is a significant burden among PLHIV in Eastern Uganda, influenced by HIV and lifestyle-related risk factors. Improved screening and diagnosis are needed with close monitoring for patients with viral load suppression due to the possible negative effects of ART on blood pressure.Plain Language Summary: This study explored the prevalence, awareness, and risk factors linked to high blood pressure among people living with HIV (PLHIV) at two health facilities in Eastern Uganda. We found that 37.5% of the participants had high blood pressure, yet the majority (68%) were unaware of their condition. We identified older age ≥ 50 years, a higher body mass index (BMI) ≥ 25 kg/m2, and having a suppressed viral load as significant risk factors for high blood pressure among PLHIV. These results reveal the urgent need for improved health strategies that integrate the management of HIV and hypertension and preventive care to enhance the overall health outcomes for PLHIV in rural areas.Keywords: human immunodeficiency syndrome, antiretroviral therapy, hypertension, body mass index

Tonny Kyagambiddwa,1,&ast; Timothy Mwanje Kintu,1,&ast; Emmanuel Miiro,1,&ast; Franchesca Nabalamba,1 Gloria Suubi Asiimwe,1 Anne Marion Namutebi,2 Fardous C Abeya,3 Boniface A Lumori,3 Isaac Ijuka,4 Rose K Muhindo,1,3 Andrew Mutekanga,1,3 Richard Musinguzi,5 Francis Natuhwera,6 Joseph Ngonzi,1,7 Edwin Nuwagira3,8 1Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Kabale Regional Referral Hospital, Kabale, Uganda; 3Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 4Mayanja Memorial Hospital, Mbarara, Uganda; 5Masaka Regional Referral Hospital, Masaka, Uganda; 6Fort Portal Regional Referral Hospital, Fort Portal, Uganda; 7Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda; 8Tuberculosis Treatment Unit, Mbarara Regional Referral Hospital, Mbarara, Uganda&ast;These authors contributed equally to this workCorrespondence: Tonny Kyagambiddwa; Edwin Nuwagira, Mbarara University of Science and Technology, Tel +256782980116 ; +256779096887, Email tonnykyagambiddwa97@gmail.com; enuwagira@must.ac.ugBackground: There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda.Methods: We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation < 94%, lung infiltrates > 50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance.Results: Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32– 6.82; p = 0.009) and altered mental state (GCS < 15) (HR: 6.89, 95% CI: 1.48– 32.08, p = 0.014) were significant predictors of 30-day mortality.Conclusion: There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.Keywords: COVID-19, Uganda, mortality, young and middle-aged adults

Background: Neglected tropical diseases (NTDs), including soil-transmitted helminths (STHs) and schistosomiasis, continue to impose a heavy burden, especially in sub-Saharan Africa and Uganda, despite being preventable. Integration of NTD management into primary healthcare has been inadequate. While researchers have explored community perspectives, there is a notable gap in understanding the viewpoints of healthcare workers (HCW), which is crucial for effective NTD control strategies. This study explores HCW' perspectives in Eastern Uganda, highlighting challenges in schistosomiasis and STH prevention and management., Methods: In this qualitative descriptive study, we conducted semistructured interviews with 10 key informants who were HCW in Eastern Uganda with experience in managing STHs and schistosomiasis. Participants were selected purposively and interviewed through Zoom guided by a comprehensive interview guide. The data were transcribed, coded and analyzed thematically., Results: We identified five key themes regarding the impact and management of NTDs: (i) the burden of NTDs, where schistosomiasis and STHs were notably prevalent among children and communities adjacent to water bodies; (ii) transmission of NTDs, emphasizing water bodies and poor sanitation as primary routes of disease spread; (iii) clinical manifestations of NTDs, detailing the symptomatic presentations that complicate diagnosis and management; (iv) challenges in managing and diagnosing NTDs, highlighting the shortages of essential medications and diagnostic tools, along with the under-prioritization of NTDs within healthcare systems; and (v) fatalities and complications arising from NTDs, reporting on the severe outcomes and under-reporting of deaths associated with NTDs due to misdiagnosis, delayed treatment and traditional healing preferences., Conclusion: The interviewed Ugandan HCW demonstrated sufficient knowledge of schistosomiasis and STHs, but faced challenges due to inadequate diagnostic tools and medication shortages. The study underscores the need for NTD prioritization with direct funding and government involvement, alongside strategies that integrate continuous medical training, effective community outreach and an enhanced healthcare system response to reduce the burden of NTDs., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Neglected tropical diseases (NTDs) affect millions of people in Africa, with Uganda bearing a significant burden. The World Health Organization (WHO) set a goal to reduce NTDs and improve access to diagnosis and management by 2030. However, NTDs have not been well integrated into primary healthcare in many countries, including Uganda, due to limited knowledge and resources among health workers. The study aimed to assess the readiness and capacity of primary healthcare centres to diagnose and manage soil-transmitted helminths (STHs) and schistosomiasis., Methods: A cross-sectional quantitative study was conducted among 204 health workers in 20 health facilities in four districts bordering Lake Kyoga. In this study we evaluated health workers' knowledge of symptoms, diagnosis and management of STHs and schistosomiasis as well as the availability of resources and training., Results: Our findings indicate that health workers have strong knowledge about STHs (86.76%), with lower knowledge levels regarding Schistosoma haematobium (59.72%) and Schistosoma mansoni (71.43%). Regarding resources and training, 95% of health facilities had laboratory services, but the majority lacked diagnostic equipment. Furthermore, only 17% of health workers reported prior training on schistosomiasis and related topics and only 25% had training on surveillance and reporting., Conclusions: While health workers in eastern Uganda demonstrated a good knowledge base for some NTDs, there were knowledge gaps and challenges in training on surveillance and reporting mechanisms. Continuously building the capacity of health workers along with investing in diagnostic infrastructure is essential for improved NTD control and ultimately reducing associated morbidity and mortality in the region., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: With the global rise in the elderly population, ensuring geriatric-friendly healthcare services is paramount. This study aimed to assess the current readiness of health facilities in Kampala City, Uganda, to provide geriatric-friendly care services., Methods: We conducted a cross-sectional study in 35 health facilities (HF) including Private for-profit (PFP), Private not-for-profit, and public (government-run) facilities at different levels i.e., Health Centre III, Health Centre IV, and Hospitals, within Kampala City, Uganda. Data was collected using a self-administered health facility assessment tool. Facilities scoring 80-100 were classified as fully ready to offer geriatric-friendly care, 51-79 indicated moderate readiness, and 0-50 indicated low readiness., Results: The overall readiness index (RI) across all facilities was low, 44.09 (SD ± 14.18). The National Referral Hospital (NRH), PFPs, and HFs in Kampala Central had the highest RI of 55.34. 47.63 and 51.09 respectively. The low readiness of HF to provide geriatric-friendly care was due to the low scores in leadership and governance (13.49), financing (19.29), human resource (42.66), and Health Management Information System (47.99) WHO building blocks. HCIVs had a higher readiness index than the other HF levels (Coefficient: 17.40, 95% CI: 4.16 to 30.64, p = 0.012). HFs in Kawempe had a significantly lower RI than those in Makindye and Kampala Central (Coefficient: -13.80, 95% CI: -24.48 to -3.11, p = 0.013)., Conclusion: The findings of our study indicate that public and private health facilities in Kampala City are not ready enough to provide geriatric-friendly care services., (© 2024. The Author(s).)

Globally, the majority of new HIV infections are recorded in Eastern and Southern Africa, with the youth being disproportionately affected. HIV prevention is the cornerstone of controlling the spread of HIV and ending this epidemic by 2030. However, barriers to the utilization of HIV prevention services remained underexplored especially among the youth in rural settings in sub-Saharan Africa. This qualitative study, conducted between February and April 2022 in rural southwestern Uganda, explored these barriers and identified recommendations to improve the utilization of HIV prevention services among youth. We conducted six focus group discussions (with youth [15-24 years] both in and out of school), nine in-depth interviews (with teachers, health workers, and members of the village health team), and four key informant interviews (with district officials) to collect data. Thematic analysis revealed barriers at the individual level (e.g., misconceptions, fear of testing, low perceived HIV risk, confidentiality concerns), community level (e.g., stigma, lack of counseling, peer influence), and health system level (e.g., lack of youth-friendly services). Recommendations included formation of youth peer support groups, ongoing awareness campaigns, and socio-economic empowerment initiatives, particularly targeting adolescent girls and young women. National scaling of these initiatives is essential to overcoming identified barriers and reducing HIV transmission among this vulnerable population. Additionally, economic empowerment especially among adolescent girls and young women in rural areas has enormous potential to address the spread of HIV in this sub-population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ssali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Patient-centered care (PCC) is a key domain of healthcare quality. Its importance is driven by evidence-based medicine, the predominance of chronic conditions requiring self-care, and the recognition of the priority of patient goals, values, priorities, and preferences in determining care plans. This article emphasizes the urgent need for Africa to develop PCC and a workforce committed to its implementation, as well as highlights an initiative by African medical students to champion PCC continent-wide. Embracing this transformative approach presents Africa with an unprecedented opportunity to improve care for each person. Through a comprehensive exploration of unique strategies and considerations in African health professions education, this viewpoint seeks to spark dialogue and inspire action towards a future where patient-centered care is the foundation of healthcare delivery in Africa., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Mental health problems such as depression, anxiety and alcohol use disorders are among the leading causes of disability worldwide. Among university students, alcohol use and poor mental health are associated with risky sexual behavior. Given the syndemic occurrence of these disorders most especially in young adults, we describe the relationship between them so as to guide and intensify current interventions on reducing their burden in this population., Methods: This was a cross-sectional study based on an online survey among healthcare professional university students that captured sociodemographic characteristics, risky sexual behavior, alcohol use disorder, generalized anxiety disorder, and depression. Structural equation modelling was used to describe the relationship between these variables using RStudio., Results: We enrolled a total of 351 participants of which 11% (37/351) had Alcohol Use Disorder, 33% (117/351) had depressive symptoms and 32% (111/351) had symptoms of anxiety. A model describing the relationship between these variables was found to fit well both descriptively and statistically [χ 2  = 44.437, df = 21, p-value = 0.01, CFI = 0.989, TFI = 0.980, RMSEA = 0.056]. All observed variables were found to fit significantly and positively onto their respective latent factors (AUD, anxiety, depression and risky sexual behavior). AUD was found to be significantly associated with risky sexual behavior (β = 0.381, P < 0.001), depression (β = 0.152, P = 0.004), and anxiety (β = 0.137, P = 0.001)., Conclusion: AUD, depression and anxiety are a significant burden in this health professional student population and there's need to consider screening for anxiety and depression in students reporting with AUD so as to ensure appropriate interventions. A lot of attention and efforts should be focused on the effect of AUD on risky sexual behavior and continued health education is still required even among health professional students., (© 2023. The Author(s).)

BACKGROUND: Drug-resistant TB (DR-TB) remains a significant public health burden and a threat to the progress made in TB control and prevention in sub-Saharan Africa. OBJECTIVE: To determine the risk-predictors of poor treatment outcomes in patients with DR-TB in Uganda. METHODS: We retrospectively reviewed medical records of adult Ugandans who had been treated for DR-TB at Mbarara Regional Referral Hospital (MRRH) in Uganda. RESULTS: Of the 385 files reviewed, 332 (86.2%) met the study inclusion criteria. Of these, 226 (68.1%) were men and 193 (58.1%) were HIV-positive. A total of 73 participants (22.7%) had unfavorable treatment outcomes (treatment failure, loss to follow-up or death). History of cigarette smoking (OR 5.10, 95% CI 2.4-11.4; P < 0.001), age >60 years (OR 6.32, 95% CI 2.2-18.6; P < 0.001), anemia (OR 2.38, 95% CI 1.1-5.3; P = 0.02) and thrombocytopenia (OR 3.60, 95% CI 1.6-8.1; P <  0.001) were independent predictors of unfavorable treatment outcomes. CONCLUSION: There is a high prevalence of unfavorable treatment outcomes among patients with DR-TB. Further research is required to design a prognostic model for DR-TB patients in a resource-limited setting.

Background: As the burden of dementia continues to rise in sub-Saharan Africa, it is crucial to develop an evidence base for potentially modifiable risk factors such as Traumatic Brain Injury (TBI). Cognitive impairment may result from TBI and since it is an established prodromal form of dementia, we investigated the burden of cognitive impairment and associated factors in persons with a history of TBI in southwestern Uganda., Methods: This was a community-based quantitative study with a cross-sectional design among 189 persons with a history of TBI in southwestern Uganda. Data were collected by the research team in March and June 2022 and entered into Kobo Toolbox before being transferred to RStudio version 4.1.0 for cleaning and analysis. Data were analyzed at a 5% level of significance., Results: Most study participants had some form of cognitive impairment (56.1%), with 43.1% of the participants having mild cognitive impairment (MCI). Cognitive impairment was associated with older age (p-value<0.001); loss of consciousness following the TBI (p-value = 0.019) and a history of tobacco use (p-value = 0.003). As a measure of severity of the TBI, loss of consciousness (aOR = 4.09; CI = 1.57-11.76; p<0.01) and older age (aOR = 1.04; CI = 1.01-1.07; p<0.01) were identified as risk factors for cognitive impairment., Conclusion: There is a high burden of cognitive impairment among individuals with a history of TBI in southwestern Uganda, and most associated risk factors are potentially modifiable. Long-term follow-up of TBI patients would enable early identification of some risks. Patients with TBI could benefit from behavioural modifications such as restriction of alcohol intake and tobacco use to slow down the progression into dementia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kintu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: University-based mental health services for medical students remain a challenge, particularly in low-income countries, due to poor service availability. Prior studies have explored the availability of mental health services in high-income countries but little is known about mental health services in countries in sub-Saharan Africa, such as Uganda. Medical students are at a higher risk of developing mental health challenges during their course of study as compared with other students. Thus, there is a need for well-structured mental health services for this group of students. The aim of this study was to explore perspectives on mental health services for medical students at a public University in Uganda., Methods: This was a qualitative study where key informant interviews were conducted among purposively selected university administrators (n = 4), student leaders (n = 4), and mental health employees of the university (n = 3), three groups responsible for the mental well-being of medical students at a public university in Uganda. Interviews were audio-recorded, transcribed, and thematically analyzed to identify relevant themes., Results: The working experience of university administrators and mental health providers was between eight months to 20 years, while student leaders had studied at the university for over four years. We identified five broad themes: (1) Burden of medical school: A curriculum of trauma, (2) Negative coping mechanisms and the problem of blame, (3) The promise of services: Mixed Messages, (4) A broken mental health system for students, and (5) Barriers to mental health services., Conclusion: Distinguishing between psychological distress that is anticipated because of the subject matter in learning medicine and identifying those students that are suffering from untreated psychiatric disorders is an important conceptual task for universities. This can be done through offering education about mental health and well-being for administrators, giving arm's length support for students, and a proactive, not reactive, approach to mental health. There is also a need to redesign the medical curriculum to change the medical education culture through pedagogical considerations of how trauma informs the learning and the mental health of students., (© 2022. The Author(s).)

Background: The prevalence of mental illness among medical students is high. A gap remains on what knowledge should be given to improve the attitudes and perceptions towards mental health. Despite the vast body of literature globally, no study has been conducted in Uganda to assess the levels of knowledge, attitude, and perception among medical students in Uganda., Objective: To determine the level of knowledge, attitude, and perception and their associated factors among medical students in Uganda., Methods: A cross-sectional study was done among 259 undergraduate medical students in a public university capturing information on knowledge, attitude, and perception towards mental health. Linear regression analysis was used to determine the factors associated with knowledge, attitude, and perception., Results: About 77.72% had high knowledge, 49.29% had positive attitudes, and 46.92% had good perceptions of mental health. There was a significant positive relationship between attitude and perceptions towards mental illness. At multilevel analysis, being in year 4 increased the level of knowledge (β = 1.50 [95% confidence interval (CI) = 0.46-2.54], p = 0.005) while a positive history of mental illness worsened perceptions towards mental illness (β = -4.23 [95% CI = -7.44-1.03], p = 0.010)., Conclusion: Medical students have a high level of knowledge about mental illness but the majority had poor attitudes and perceptions of mental illness. Exposure to psychiatry knowledge about mental illness in year four increased students' knowledge while prior experience with mental illness conditions was associated with poorer perceptions. The information present in this study can be used by policymakers and future researchers to design future studies and interventions to improve knowledge, perceptions, and attitudes especially among students who have a history of mental illness. Improvements in knowledge, attitude, and perception may improve the mental health services for the future patients of these medical students., (© 2022. The Author(s).)

Background: In an effort to accommodate the growing number of HIV clients, improve retention in care and reduce health care burden, the differentiated service delivery (DSD) models were introduced in 2014. One such model, Community Client-Led ART Delivery (CCLAD) was rolled out in Uganda in 2017. The extent of utilization of this model has not been fully studied. The aim of the study was to explore the patients' and health workers' experiences on the utilization of CCLAD model at Bwizibwera Health Centre IV, south western Uganda., Methods: This was a descriptive study employing qualitative methods. The study had 68 purposively selected participants who participated in 10 focus group discussions with HIV clients enrolled in CCLAD; 10 in-depth interviews with HIV clients not enrolled in CCLAD and 6 in-depth interviews with the health workers. Key informant interviews were held with the 2 focal persons for DSD. The discussions and interviews were audio recorded, transcribed verbatim and then translated. Both deductive and inductive approaches were employed to analyse the data using in NVivo software., Results: Patients' and health workers' experiences in this study were categorized as drivers and barriers to the utilization of the CCLAD model. The main drivers for utilization of this model at different levels were: individual (reduced costs, living positively with HIV, improved patient self-management), community (peer support and contextual factors) and health system (reduced patient congestion at the health centre, caring health workers as well as CCLAD sensitization by health workers). However, significant barriers to the utilization of this community-based model were: individual (personal values and preferences, lack of commitment of CCLAD group members), community (stigma, gender bias) and health system (frequent drug stockouts, certain implementation challenges, fluctuating implementing partner priorities, shortage of trained health workers and insufficient health education by health workers)., Conclusion: Based on our findings the CCLAD model is meeting the objectives set out by Differentiated Service Delivery for HIV care and treatment. Notwithstanding the benefits, challenges remain which call on the Ministry of Health and other implementing partners to address these hindrances to facilitate the scalability, sustainability and the realisation of the full-range of benefits that the model presents., (© 2021. The Author(s).)