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Introduction: In Uganda, over 43% of all pregnancies among young women (15-24 years) living with HIV are either unwanted or mistimed. Unintended pregnancies account for 21.3% of neonatal HIV infections. The objective was to determine acceptability of contraceptives and associated factors among young women living with HIV attending HIV clinics inKampala. Methods: Between February and May 2019, 450 young women attending public HIV clinics (Kisenyi HC IV, Kiswa HC III and Komamboga HC III) in Kampala were systematically enrolled in a cross sectional study and interviewed using structured questionnaires. We used modified Poisson regression to determine the factors associated with acceptability of contraceptive.Data were analyzed using STATA 13.0. Statistical significance was determined at a P values < 0.05. Results: Contraceptive acceptability was 40.7% (95% CI: 27.6%-53.6%). Older age group (20-24 years) (aPR; 2.42, 95%CI; 1.06-5.52, P = 0.035), age at sex debut ≥ 18 years (aPR;1.25,95%CI; 1.13-1.38, P

Background Routine malaria surveillance data in Africa primarily come from public health facilities reporting to national health management information systems. Although information on gender is routinely collected from patients presenting to these health facilities, stratification of malaria surveillance data by gender is rarely done. This study evaluated gender difference among patients diagnosed with parasitological confirmed malaria at public health facilities in Uganda. Methods This study utilized individual level patient data collected from January 2020 through April 2021 at 12 public health facilities in Uganda and cross-sectional surveys conducted in target areas around these facilities in April 2021. Associations between gender and the incidence of malaria and non-malarial visits captured at the health facilities from patients residing within the target areas were estimated using poisson regression models controlling for seasonality. Associations between gender and data on health-seeking behaviour from the cross-sectional surveys were estimated using poisson regression models controlling for seasonality. Results Overall, incidence of malaria diagnosed per 1000 person years was 735 among females and 449 among males (IRR = 1.72, 95% CI 1.68–1.77, p Conclusions Females disproportionately contribute to the burden of malaria diagnosed at public health facilities in Uganda, especially once they reach childbearing age. Contributing factors included more frequent visits to these facilities independent of malaria and a higher reported risk of seeking care at these facilities for febrile illnesses.

Background Environmental factors such as temperature, rainfall, and vegetation cover play a critical role in malaria transmission. However, quantifying the relationships between environmental factors and measures of disease burden relevant for public health can be complex as effects are often non-linear and subject to temporal lags between when changes in environmental factors lead to changes in the incidence of symptomatic malaria. The study aim was to investigate the associations between environmental covariates and malaria incidence in high transmission settings of Uganda.Methods This study leveraged data from seven malaria reference centres (MRCs) located in high transmission settings of Uganda over a 24-month period (January 2019 - December 2020). Estimates of monthly malaria incidence (MI) were derived from MRCs’ catchment areas. Environmental data including monthy average measures of temperature, rainfall, and normalized difference vegetation index (NDVI) were obtained from remote sensing sources. A distributed non-linear lagged model was used to investigate the quantitative relationship between environmental covariates and malaria incidence. Results Overall, the median (range) monthly temperature was 30oC (26-47), rainfall 133.0 mm (3.0-247), NDVI 0.66 (0.24-0.80) and MI was 790 per 1000 person-years (73-3973). A non-linear relationship between environmental covariates and malaria incidence was observed. An average monthly temperature of 35oC was associated with significant increases in malaria incidence compared to the median observed temperature (30oC) at month lag 2 (IRR: 2.00, 95% CI: 1.42-2.83) and the cumulative increases in MI significantly at month lags 1-4, with the highest cumulative IRR of 8.16 (95% CI: 3.41-20.26) at lag month 4. An average monthly rainfall of 200mm was associated with significant increases in malaria incidence compared to the median observed rainfall (133mm) at lag month 0 (IRR: 1.24, 95% CI: 1.01-1.52) and the cumulative IRR increases of malaria at month lags 1-4, with the highest cumulative IRR of 1.99(95% CI: 1.22-2.27) at lag month 4. An average NVDI of 0.72 was associated with significant cumulative increases in IRR of malaria as compared to the median observed NDVI (0.66) at month lag 2-4, with the highest cumulative IRR of 1.57(95% CI: 1.09-2.25) at lag month 4. The rate of increase in cumulative IRR of malaria was highest within lag months 1-2 as compared to lag months 3-4 for all the environmental covariates.Conclusions In high-malaria transmission settings, high values of environmental covariates were associated with cumulative increases in the incidence of malaria, with peak associations occurring after variable lag times. The complex associations identified are valuable for designing strategies for early warning, prevention, and control of seasonal malaria surges and epidemics.

In this study, normal ranges for hematology and serum biochemistry in children aged 1 to 5 years inUgandawere determined. By a cross-sectional study, 1168 children from Iganga, a prospective site for clinical trials in Uganda, were screened. From 1168 households, 460 children were selected for enrollment, while 600 (58%) were excluded because of either a history of fever in the previous 24 hours, presence of asexual malaria parasites in the peripheral blood or presence of fever. Accordingly, 460 children (39.4%) of median age = 3 years were enrolled in the baseline study. While the lower limits of hemoglobin, hematocrit levels, mean corpuscular volume and platelet counts for the Ugandan children were found to be less than conventional reference values of Caucasisan children, the white blood cell count reference values were higher than the international intervals. On the other hand, the upper limits of the reference intervals for serum transaminases, bilirubin, creatinine, urea, total protein and albumin in sera of the Ugandan children were higher than the corresponding values for a Caucasian pediatric population. This study showed that, if hematology test results of the Ugandan children were assessed against “imported” international reference values, up to 44.6% of the study participants would have been excluded from clinical trials or would have been reported as adverse events in such trials. The present study was not only the first report of serum biochemistry reference ranges for children aged one to five years in Uganda but also one of very few such studies in Africa.

Malaria is still a major public health problem in the world and sub-Saharan Africa is one of the most affected areas. Efforts to control malaria are highly affected by drug resistance to commonly used antimalarials. The introduction of artemisinin based combination therapy (ACT) as a first line drug seems to be a major step in treatment of uncomplicated malaria, though search for drugs to combine with artemisinins still continues. There have been reports on increased prevalence of the wild type markers Pfcrt 76K and Pfmdr1 86N in some African countries and ideas of using chloroquine (CQ) in intermittent presumptive treatment for adults (IPTa) is coming up. The common combination of artemether and lumefantrine even selects for parasites that are wild type at these positions. This study is comparing prevalence of mutation at these two positions in two East African countries with ACT as their first line drug but following somewhat different drug policies regarding CQ. In Tanzania CQ was stopped in 2001 but in Uganda CQ was retained in combination with sulfadoxine-pyrimethamine (SP) and used in home based management of fever for some time. SP is still used in IPT for pregnant women.Blood smears and dried blood spots on Whatman filter papers were collected from 100 patients with uncomplicated malaria in Mwanza, Tanzania and 100 patients from Iganga, Uganda. DNA was extracted from all samples using Tris EDTA method. PCR and RFLP were performed and sequencing done on Pfcrt amplification products.The prevalence of K76T mutations at Pfcrt in samples from Mwanza, Tanzania was 40.5% (34/84) and 100% (100/100) in samples from Iganga, Uganda. Prevalence of N86Y mutations in Pfmdr1 was 16.9% (13/77) and 77.7% (63/81) in samples from Mwanza and Iganga, respectively. The re-emergence of CQ sensitive isolates in Mwanza, Tanzania showed the haplotype CVMNK typical for wild type isolates.The prevalence of CQ resistant parasites in Mwanza, Tanzania is low compared to the existing high level of resistant parasites in Iganga, Uganda. This could be an indication that CQ may become useful in the future in Tanzania. This study shows clearly that there is a difference in mutations at these positions in these two countries implementing similar but somewhat different drug policies. In Uganda the drug resistance has reached fixation while in Tanzania the prevalence is going down.

Background Depression in adolescents constitutes a global public health concern. However, data on its prevalence and associated factors are limited in low income countries like Uganda. Methods Using a cross-sectional descriptive study design, 519 adolescent students in 4 secondary schools in Mukono district, Uganda, were randomly selected after meeting study criteria. The 4 school types were: boarding mixed (boys and girls) school; day mixed school; girls’ only boarding school; and, boys’ only boarding school. The 519 participants filled out standardized questionnaires regarding their socio-demographic characteristics and health history. They were then screened for depression using the Children Depression Inventory (CDI) and those with a cut-off of 19 were administered the Mini International Neuro-Psychiatric Interview for Children and Adolescents 2.0 (MINI-KID), to ascertain the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) diagnostic types of depression and any co morbidity. Logistic regression analyses were used to assess factors associated with significant depression symptoms (a score of 19 or more on the CDI). Results There were 301 (58 %) boys and 218 (42 %) girls with age range 14–16 years and a mean age of 16 years (SD 2.18). Of 519 participants screened with the CDI, 109 (21 %) had significant depression symptoms. Of the 109 participants with significant depression symptoms, only 74 were evaluated with the MINI-KID and of these, 8 (11 %) met criteria for major depression and 6 (8 %) met criteria for dysthymia. Therefore, among participants that were assessed with both the CDI and the MINI-KID (n = 484), the prevalence of depressive disorders was 2.9 %. In this sample, 15 (3.1 %) reported current suicidal ideation. In the logistic regression analyses, significant depression symptoms were associated with single-sex schools, loss of parents and alcohol consumption. Limitations This is a cross-sectional study therefore, causal relationships are difficult to establish. Limited resources and the lack of collateral information precluded the assessment of a number of potential factors that could be associated with adolescent depression. The MINI-KID was administered to only 74 out of 109 students who scored ≥19 on the CDI since 35 students could not be traced again due to limited resources at the time. Conclusions Significant depression symptoms are prevalent among school-going adolescents and may progress to full-blown depressive disorders. Culturally sensitive psychological interventions to prevent and treat depression among school-going adolescents are urgently needed.

In Uganda malaria causes more morbidity and mortality than any other disease and children below 5 years contribute the biggest percentage of malaria related mortality. Insecticide treated nets (ITNs) are currently one of the most cost effective option for reducing malaria-related morbidity and mortality, however the factors affecting their utilization in Uganda are still not well understood. This study examined the prevalence and factors associated with ITN utilization among children of age 0–12 years seeking health care from a Ugandan hospital using caregiver’s reports. A cross sectional design was used to collect data using a semi-structured questionnaire from 418 participants. Binary logistic regression was employed to determine predictors of ITN utilization. Results show that the prevalence of ITN utilization among children seeking health care was 34.2%. ITN utilization was higher among children of age

Etheldreda Nakimuli-Mpungu1,2, Noeline Nakasujja2, Howard Dickens Akena2, Steven Mpungu Kiwuwa3, Elly Katabira4, Elilialia Okello2, Chiadi Onyike5, Seggane Musisi21Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Departments of Psychiatry, 3Clinical Epidemiology and Biostatistics, 4Internal Medicine, Makerere College of Health Sciences, School of Medicine, Kampala, Uganda; 5Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Hospital, Baltimore, MD, USAPurpose: Patient retention in antiretroviral therapy (ART) programs in Sub-Saharan Africa is estimated at 60%. There is limited information on the effect of older age (>50 years) at ART initiation on patient retention in ART programs in Uganda. This study aimed to investigate demographic and clinical differences between older and younger human immunodeficiency virus (HIV)-positive individuals prior to ART initiation and then to assess the effect of older age at ART initiation on patient retention in an ART program.Methods: A retrospective chart review of all medical charts belonging to 773 HIV-positive individuals who initiated ART from January 2005 through July 2009 was conducted. Factors associated with older HIV-positive individuals were determined using simple and multivariate logistic regression. Survival analysis techniques were used to compare median survival times in the ART program between older and younger HIV-positive individuals. Cox regression models were used to assess the impact of older age on patient retention while adjusting for variables associated with both older age and patient retention.Results: Older HIV-positive individuals were significantly more likely to have a clinical diagnosis of HIV-related dementia (odds ratio [OR] = 7.65; P = 0.037), severe mental illness (OR = 1.28; P = 0.39), peripheral neuropathy, (OR = 3.76; P = 0.024), and HIV wasting syndrome (OR = 1.92; P = 0.023). Median survival time for older HIV-positive individuals was eight months longer than that of their younger counterparts (log-rank χ2 = 3.3, P = 0.45) Independent predictors of loss to follow-up were a clinical diagnosis of HIV-related dementia (hazards ratio [HR] = 4.63; P = 0.000), severe mental illness (HR = 1.44; P = 0.005), and HIV wasting syndrome (OR = 1.35; P = 0.008).Conclusion: There was no difference in patient retention rates between younger and older HIV-positive individuals. However, a clinical diagnosis of HIV dementia, severe mental disorder, HIV wasting syndrome, and CD4 counts less than 200 were independent predictors of low patient retention rates in this ART program.Keywords: old age, human immunodeficiency virus, acquired immune deficiency syndrome, antiretroviral therapy, neuropsychiatric syndromes, Uganda