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BACKGROUND: Adherence challenges with oral tenofovir-based pre-exposure prophylaxis (PrEP) are common. We developed a point-of-care assay to objectively assess tenofovir in urine and conducted a pilot trial examining the impact of counselling informed by use of this urine assay on long-term PrEP adherence. METHODS: This randomised trial enrolled women not in serodiscordant partnerships 3 months after PrEP initiation at the Kenya Medical Research Institute to compare standard-of-care adherence counselling versus counselling informed by the urine assay (urine-test counselling group) every 3 months for 12 months. In the standard of care group, urine samples were stored and tested at study end without participant feedback. Here we report the adherence primary outcome of hair concentrations of tenofovir at 12 months as a long-term metric (undetectable levels defined long-term non-adherence), as well as urine concentrations of tenofovir at each visit as a short-term adherence metric and acceptability of the assay assessed by quantitative surveys. Data were analysed by randomisation group. This completed trial was registered with ClinicalTrials.gov (NCT03935464). FINDINGS: From March 17, 2021 to Jan 18, 2022 we enrolled 49 women in the urine-test counselling group and 51 in the standard of care group; retention was 86 (86%) of 100. Nine (21%) of 42 in the urine-test counselling group had hair samples at 12 months with tenofovir concentrations below the limit of quantification compared with 15 (37%) of 41 in the standard of care group. The relative odds of long-term non-adherence in the standard of care group compared with urine-test counselling were 3·53 (95% CI 1·03-12·03; p=0·044). Pre-intervention, urine tenofovir was detectable in 65% in the urine-test counselling group and 71% in the standard of care group (p=0·68). At 12 months, 31 (72%) of 43 in the intervention group had detectable urine tenofovir compared with 19 (45%) of 42 in the standard of care group (p=0·0015). 40 (93%) of 43 participants liked the test very much and only one disliked the test. One participant in the standard of care group was withdrawn at the 6-month visit due to HIV seroconversion. INTERPRETATION: A low-cost urine tenofovir assay to inform PrEP counselling resulted in improvement in both short-term and long-term metrics of adherence. This urine tenofovir assay could help to improve long-term PrEP adherence. FUNDING: National Institute of Allergy and Infectious Diseases and National Institutes of Health.

INTRODUCTION: The incidence of pediatric Wilms tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda. METHODS: A cohort study of patients  25 cm (OR 2.67, 95% CI 1.05-6.81). CONCLUSIONS: Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.

The global surge in multi-drug resistant bacteria, including extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has led to a growing need for new antibacterial compounds. Despite being promising, the potential of fish-derived antimicrobial peptides (AMPs) in combating ESBL-producing E. coli is largely unexplored. In this study, native African catfish antimicrobial peptides (NACAPs) were extracted from the skin mucus of farmed African catfish, Clarias gariepinus, using a combination of 10% acetic acid solvent hydrolysis, 5 kDa ultrafiltration, and C18 hydrophobic interaction chromatography. Peptides were then sequenced using Orbitrap Fusion Lumos Tribrid Mass Spectrometry. The identified peptides were screened for potential antibacterial activity using Random Forest and AdaBoost machine learning algorithms. The most promising peptide was chemically synthesized and evaluated in vitro for safety on rabbit red blood cells and activity against ESBL-producing E. coli (ATCC 35218) utilizing spot-on-lawn and broth dilution methods. Eight peptides ranging from 13 to 22 amino acids with molecular weights between 968.42 and 2434.11 Da were identified. Peptide NACAP-II was non-hemolytic to rabbit erythrocytes (p > 0.05) with a zone of inhibition (ZOI) of 22.7 ± 0.9 mm and a minimum inhibitory concentration (MIC) of 91.3 ± 1.2 μg/mL. The peptide is thus a candidate antibacterial compound with enormous potential applications in the pharmaceutical industry. However, further studies are still required to establish an upscale production strategy and optimize its activity and safety in vivo.

Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.

Samuel Omara,1 Musa Kasujja,1 Geoffrey Okot,1 Peter Okello,1 Maxwell Okello,1 Richard Mulumba,1 Justus Kafunjo Barageine2 1Department of Obstetrics and Gynecology, Kampala International University Western Campus, Bushenyi, Uganda; 2Department of Obstetrics and Gynecology, Makerere University/Mulago Hospital, Kampala, UgandaCorrespondence: Samuel Omara, Email samuelomara06@gmail.comBackground: Post-caesarean surgical site infections (PCSSIs) significantly impact maternal morbidity, mortality, and healthcare costs in low- and middle-income countries, particularly in sub-Saharan Africa, where preventive measures are often inadequate. Despite this burden, data on PCSSIs in this context are limited. This study aimed to evaluate the incidence and factors associated with PCSSIs at Mubende Regional Referral Hospital.Methods: This prospective cohort study included 204 women who underwent caesarean sections from July to September 2023. Data was collected and participants were monitored for up to 28 days post-delivery to identify occurrences of surgical site infections (SSIs). Statistical analysis was conducted using STATA, with significance defined as a p-value of < 0.05.Results: Most participants (63.2%) were aged 18– 35 years, with over 67% having a parity of ≤ 4. Preoperative antibiotics were administered to 77.5% of participants. Most surgeries (64.2%) lasted 1– 2 hours, and the overall incidence of surgical site infections (SSIs) was 16.18%. Significant risk factors associated with more than a twofold increase in SSI risk included unstable referral status (aRR = 2.02), obstructed labor (aRR = 2.97), chorioamnionitis (aRR = 2.73), and prolonged premature rupture of membranes (PROM) (aRR = 2.05). Prolonged labor increased SSI risk by 1.37-fold (aRR = 1.37), while receipt of preoperative antibiotics was linked to a reduced SSI risk (aRR = 0.77).Conclusion: The post-caesarean SSI rate at Mubende Regional Referral Hospital is notably high, with key risk factors including unstable referral status, obstructed labor, prolonged labor, chorioamnionitis, and prolonged premature rupture of membranes (PROM). Administering preoperative antibiotics 30 minutes to 1 hour prior to surgery is linked to a reduced risk of SSI.Keywords: caesarean section, surgical site infection, Uganda

Scrub typhus is a leading cause of nonmalarial febrile illness in Southeast Asia (1). Scrub typhus is caused by miteborne Orentia tsutsugamushi infections, which until recently were thought to be [...]

PURPOSE: Intestinal obstruction caused by intestinal atresia is a surgical emergency in newborns. Outcomes for the jejunal ileal atresia (JIA), the most common subtype of atresia in low-income countries (LIC), are poor. We sought to assess the impact of utilizing the Bishop-Koop (BK) approach to JIA in improving outcomes. METHODS: A retrospective cohort study was performed on children with complex JIA (Type 2-4) treated at our national referral hospital from 1/2018 to 12/2022. BK was regularly used starting 1/1/2021, and outcomes between 1/2021 and 12/2022 were compared to those between 1/2018 and 12/2020. Statistical significance was set at p

Introduction: Africa faces immense food and health insecurity challenges, a problem partly attributed to food loss and waste during postharvest handling and distribution. In the context of research to meet the sustainable development goals, this project specifically addressed the postharvest loss of the ripe indigenous eggplant (Solanum anguivi lam) fruit called Igba Yinrin by Yoruba in South-West Nigeria, which is usually discarded in farms. The study was carried out on ripe and unripe fruits to better understand their value by comparing their effects in diabetes treatment. Methods: The study sought to assess the effects of a diet including ripe or unripe mature eggplant fruits in the sucrose-induced diabetic-like fruit fly. Bioactive compounds were identified and quantified with HPLC-UV, while the antioxidant vitamin (A, C, E), carotenoid, and mineral (Na, K, Ca, Mg, Fe, P, and Zn) content was analyzed in the fruits. Extracts were used to investigate their in vitro anti-inflammatory properties on cyclooxygenases (COX 1 and 2), 5-lipoxygenase (5-LOX), and anti-diabetes enzymes [α-amylase and α-glucosidase], while extract-supplemented diets (0.25-1% concentration) were fed to the fruit flies for 14 days. Results: Interestingly, the results showed that the ripe fruits had a significantly (p < 0.05) higher total phenol and flavonoid content, as well as a higher content of vitamins, carotenoids, and minerals, than the unripe fruits. The in vivo activities of antioxidant enzymes [superoxide dismutase (SOD), catalase (CAT), and glutathione transferase (GST)] and the total thiol level increased, while the blood glucose, reactive oxygen species (ROS), and malondialdehyde (MDA) levels decreased in Drosophila melanogaster (fruit fly). An in silico docking analysis showed strong binding affinity of the above-mentioned enzymes under investigation with the ligands hesperidin, naringin, and myricetin, which are bioactive compounds contained in the examined extracts. Conclusions: There was no significant difference in the biological effects of the ripe and unripe fruit extracts on inflammatory and anti-diabetes enzyme activities, which means that the ripe fruit, usually discarded, could serve as a sustainable alternative source of food nutrients.

A crop rotation study was conducted in the Agoro Rice scheme from mid-2015 to 2017 to determine the effect of sweetpotato–rice rotation in the lowlands on financial returns and sweetpotato root, sweetpotato vine, and rice yields compared to monocropping. Treatments included crop rotations of sweetpotato–rice–sweetpotato, rice–sweetpotato–rice, rice–rice–rice (control), and sweetpotato–sweetpotato–sweetpotato (control). The study used the sweetpotato varieties NASPOT 11 (cream-fleshed), NASPOT 10 O, and Ejumula (both orange-fleshed) and the rice varieties Wita 9, Agoro, and Komboka. The results showed that mean sweetpotato root yields in the rotation treatment were significantly higher (28 t ha−1) than the control (19.8 t ha−1), representing a 47% gain in yield. Generally, the percentage gain in yield across years due to rotation ranged from 3 to 132%, depending on the variety. The total number of vine cuttings was significantly different between treatments and seasons (P < 0.001). Mean rice paddy yields in rotation were 8–35% higher than the control. The higher yields of sweetpotato in the rotation can be attributed to the rotation crop benefitting from residual fertilizers applied in rice in the previous season, while rice in the rotation crop could have benefited from the land preparation and establishment of the sweetpotato fields. The benefit of rotation for both crops varied by variety while the revenue-to-cost ratio varied by season and crop variety. Revenue-to-cost ratios for rotation and control treatments were greater than 1, indicating net profits were positive for both. The rotation generated 0.43 times more revenue than rice monocropping. Both rotation and monocropping systems generated profits, but rotation was 43% more profitable. In other words, if monocropping generates 1 dollar, rotation generates 1.43 dollars. The study concludes that rotation of sweetpotato with rice led to (1) increased yields of both rice and sweetpotatoes, (2) more profitable utilization of land, (3) enhanced availability of sweetpotato planting material at the beginning of the upland growing season, and (4) reduced the cost of land preparation for the main rice crop. Findings from this study show that there is great potential for diversification of rice-based cropping systems in Uganda, which will contribute to building sustainable food systems.

Abstract Background Postnatal growth failure (PGF), a multifactorial condition is common in preterm infants and infants born weighing

Abstract Background Utilization of oral health services is a global public health challenge. Low- and middle-income countries are disproportionately affected. Uganda is one of the low- and middle-income countries where only 4% of the population has access to oral health services. Northern Uganda is one of the regions in the country with limited information about oral health utilization. Objective To assess factors associated with utilization of oral health services among adults aged 18–70 years in Lira district, Northern Uganda. Methods This was a quantitative cross-sectional study conducted in Lira District. Multistage sampling was used to select 576 respondents. Data was collected using a researcher-administered structured questionnaire that was adopted, modified, and pretested. Data was analyzed at three levels, including univariate, bivariate, and multivariate at 0.05 significance level. Results Of the 634 respondents, 576 responded, giving a 90.9% response rate. Results show that utilization of oral health services was 20.5% (118) among adults aged 18–70 years in 6 months. Predictors of utilization of oral services among this age group are: having not attended any formal education (AOR = 0.2, 95%CI 0.06–0.62), having poor attitudes towards oral health services (AOR = 0.55, 95%CI 0.34–0.89), having cultural influence on the utilization of the oral health services (AOR = 4.84, 95% CI 2.77–8.43), accessing the services from private not-for-profit facilities (AOR = 4.67, 95% CI 1.79–12.16), being un sure of the availability of the equipment used (AOR = 0.42, 95% CI 0.18–0.9), and availability of friendly services (AOR = 2.53, 95% CI 1.12–5.50). Conclusions and recommendations Utilization of oral health services is low in Lira district, with only 2 in 10 of the adults aged 18-70years of age utilizing oral health services in 6 months. To improve utilization, targeted health education campaigns should address cultural barriers and attitudes, while ensuring that public health facilities are better equipped and provide more user-friendly services.

Abstract Background Globally, teenage pregnancy is a public health problem. Low- and middle-income countries in the Sub-Saharan region are more affected with teenage pregnancy. It is worse with teenage girls who have other vulnerabilities like living in refugee camps. However, there is little information about teenage pregnancy in refugee camps especially in resource limited areas like Northern Uganda. Objective To determine the prevalence and the factors associated with teenage pregnancy among refugees in Palabek refugee settlement, Northern Uganda. Methods This was a cross-sectional study conducted among teenage girls in Palabek refugee settlement in Northern Uganda. The study estimated a total sample size of 316 teenage girls and they were sampled using systematic random sampling. Data was collected using researcher administered questionnaire. Conditional logistics regression was employed to identify the associated factors for teenage pregnancy. Results A total of 306 teenagers participated in the study with a response rate of 98.6%. The study showed that the prevalence of teenage pregnancy among teenage girls in Palabek refugee settlement, Northern Uganda was 41.2%. The factors associated with teenage pregnancy among teenage girls in Palabek refugee settlement included: being in the 15–19 years age group (AOR = 6.3, 95%CI: 1.8–22.8), not being in school (AOR = 5, 95%CI: 2.3–10.9), not being married (AOR = 0.2, 95%CI: 0.1–0.5), delayed sexual debut (AOR = 2.4, 95%CI: 1.1–5.5), having multiple sexual partners (AOR = 0.3, 95% CI: 0.1–0.7), alcohol use (AOR = 6.7, 95%CI: 2.2–18.4), being aware of sexual reproductive health services (AOR = 0.4, 95%CI: 0.2–0.9), and having divorced families (AOR = 2.4, 95% CI: 1.2–4.9). Conclusion Study results reveal that 4 in 10 teenage girls in Palabek, Northern Uganda, are pregnant, influenced by individual, community, and health system factors. This highlights vulnerabilities in refugee camps, urging prioritization of sexual and reproductive health for adolescent girls in refugee camps.

Abstract Background In Africa, dispensing oral HIV pre-exposure prophylaxis (PrEP) within already strained public health facilities has led to prolonged waiting periods and suboptimal experiences for clients. We sought to explore the acceptability of dispensing PrEP semiannually with interim HIV self-testing (HIVST) versus quarterly PrEP dispensing with clinic-based HIV testing to optimize clinic-delivered PrEP services. Methods We conducted a qualitative study within a non-inferiority individual-level randomized controlled trial testing the effect of six-monthly PrEP dispensing with HIVST compared to the standard-of-care three-monthly PrEP dispensing on PrEP clinical outcomes in Kenya (ClinicalTrials.gov: NCT03593629). Eligible participants were ≥ 18 years, refilling PrEP for the first time, and either in an HIV serodifferent relationship (men and women) or singly enrolled (women only). A subset of participants in the intervention group completed serial in-depth interviews (IDIs) at enrollment, six months, and 12 months. We utilized stratified purposive sampling to ensure representation across participant groups. We analyzed our qualitative data thematically using a combination of inductive and deductive approaches, the latter guided by the Theoretical Framework of Acceptability (TFA). Results Between May 2018 and June 2021, we conducted 120 serial IDIs with 55 participants; 64% (35/55) were in a serodifferent relationship, 64% (35/55) were women, and the median age was 32 years (IQR 27–40). Overall, participants found this novel PrEP delivery model highly acceptable; it was well-liked, private (TFA construct: affective attitude), and less burdensome (TFA construct: burden) compared to standard PrEP delivery. Additionally, participants were confident in their ability to participate in the intervention (TFA construct: self-efficacy). Some participants, however, highlighted model disadvantages, including fewer opportunities for in-person counseling and potentially less accurate HIV testing (TFA construct: opportunity costs). Ultimately, most participants reported that the intervention allowed them to achieve their HIV prevention goals (TFA construct: perceived effectiveness) and that their confidence in at-home HIVST and PrEP continuation increased following each semiannual clinic visit. Conclusions Semiannual PrEP clinic visits supported with six-monthly drug dispensing and interim HIVST was acceptable among PrEP users who experienced the intervention in Kenya. More comprehensive pre-intervention counseling and training on HIVST may help alleviate the client concerns presented, which were often resolved over time with intervention experience.

Abstract Background HIV prevalence among female sex workers (FSW) is significantly higher than among women in the general population. Studies have shown that FSW engage in unprotected sex which provides higher compensation when they face emergency situations. We co-created a savings intervention – Jitegemee (rely on yourself) – with FSW to encourage them to save part of their earnings to withdraw in emergency situations in order to reduce risk. Methods We undertook a five-phase intervention development process between February 2021 and July 2023: 1) qualitative interviews with FSW to identify essential intervention features; 2) pilot trial to assess intervention feasibility; 3) literature review of studies on economic empowerment of FSW; 4) scoring of key components of Phases 1–3 on a scale of 1–5 (1 = definitely exclude, 5 = definitely include), for inclusion in the intervention package; 5) workshops with FSW and other key stakeholders to co-design the intervention. Results In phase 1, nearly all participants (99%) found the intervention acceptable to them and 95% believed it would be acceptable to other FSW. Participants suggested inclusion of financial literacy (75%), savings groups (38%) and goal-setting (24%). In the feasibility assessment, 41% saved, of whom 46% withdrew some savings. Condom use was higher among FSW who withdrew their savings compared to those who did not (χ 2 7.52; p = 0.006). In Phase 3, we identified 14 intervention components. In phase 4, all suggested intervention components scored 4.5 on average. In phase 5, we held 3 workshops with FSW to co-design the intervention, which included instructions for how to save and make withdrawals, financial literacy training, and formation of savings groups. Conclusions A savings intervention for and by FSW was highly acceptable and feasible. Involving end-users in the design process is likely to result in greater economic security among FSW and lower engagement in higher risk transactional sex.

Abstract Background Preterm birth is the leading cause of childhood mortality, and respiratory distress syndrome is the predominant cause of these deaths. Early continuous positive airway pressure is effective in high-resource settings, reducing the rate of continuous positive airway pressure failure, and the need for mechanical ventilation and surfactant. However, most deaths in preterm infants occur in low-resource settings without access to mechanical ventilation or surfactant. We hypothesize that in such settings, early continuous positive airway pressure will reduce the rate of failure and therefore preterm mortality. Methods This is a mixed methods feasibility and acceptability, single-center pilot randomized control trial of early continuous positive airway pressure among infants with birthweight 800–1500 g. There are two parallel arms: (i) application of continuous positive airway pressure; with optional oxygen when indicated; applied in the delivery room within 15 min of birth; transitioning to bubble continuous positive airway pressure after admission to the neonatal unit if Downes Score ≥ 4 (intervention), (ii) supplementary oxygen at delivery when indicated; transitioning to bubble continuous positive airways pressure after admission to the neonatal unit if Downes Score ≥ 4 (control). A two-stage consent process (verbal consent during labor, followed by full written consent within 24 h of birth) and a low-cost third-party allocation process for randomization will be piloted. We will use focus group discussions and key informant interviews to explore the acceptability of the intervention, two-stage consent process, and trial design. We will interview healthcare workers, mothers, and caregivers of preterm infants. Feasibility will be assessed by the proportion of infants randomized within 15 min of delivery; the proportion of infants in the intervention arm receiving CPAP within 15 min of delivery; and the proportion of infants with primary and secondary outcomes measured successfully. Discussion This pilot trial will enhance our understanding of methods and techniques that can enable emergency neonatal research to be carried out effectively, affordably, and acceptably in low-resource settings. This mixed-methods approach will allow a comprehensive exploration of parental and healthcare worker perceptions, experiences, and acceptance of the intervention and trial design. Trial registration The study is registered on the Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Registered 08 August 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23888 .