School of Public Health (Public-Health)

Permanent URI for this community

http://10.29.1.53:4000/handle/10570/4

Browse

A Machine Learning Model for Prediction of Antibiotic Resistance with Escherichia Coli Infections Using Demographic, Clinical and Microbiological Data.

(Makerere University., 2026-01-13) Kahuma, Clare Allelua.

IntroductionIn, low- and middle-income countries like Uganda, there is growing reliance on empirical prescription of broad-spectrum antibiotics which, while targeting a wide range of pathogens, contributes to the development of resistance to common pathogens such as E. coli. This challenge is compounded by the poor selection of antibiotic panels in many laboratories, which often fail to reflect local resistance patterns and patient-specific factors, leading to inefficient use of scarce resources and delayed appropriate treatment. Objectives of the study The objectives of this study were to; 1) identify risk factors for drug resistant E. coli infections using machine learning techniques; 2) evaluate the performance of different machine learning models in predicting the likelihood of drug resistance among patients with E. coli infections using demographic, clinical and microbiological data; and 3) develop a web-based interface to support proper antibiotic prescription and targeted antimicrobial decision-making. MethodologyA retrospective analysis was conducted on 1,552 records of patients diagnosed with E. coli infections in 10 tertiary healthcare facilities in Uganda. These records were analyzed using machine learning models including Lightgbm, xgboost, random forest, gradient boosting, and decision trees. Feature selection was guided by a weighted importance score and frequency count framework. The best performing model was deployed in a streamlit-based web interface.Results Key predictors of resistance included antibiotic type, patient age, hospital site, specimen type, prior antibiotic use, and hospitalization history. XGboost emerged as the top-performing models for prediction of drug resistance, with an accuracy of 82.32%, a precision of 82.36%, recall of 85.37%, F1 score of 83.84%, and ROC AUC of 90.17%. The web-based interface was implemented using python streamlit technology, intergrated with the best performing model to enable real-time resistance prediction.ConclusionThis study demonstrates the potential of machine learning to transform antimicrobial resistance surveillance and clinical decision-making in resource-limited settings.
A machine learning-based clinical decision support system mobile application for pain management in children with Sickle cell disease

(Makerere University, 2025) Atugonza, Gamukama

Introduction: Sickle Cell Disease is a genetic blood disorder characterized by recurrent, severe pain episodes that severely impact the quality of life in children. Despite medical advancements, effective home-based pain management remains a major challenge, particularly in resource-limited settings with inadequate access to specialized care. This study developed a patient-centered Clinical Decision Support System mobile application, powered by Machine Learning and Natural Language Processing, to support caregivers in managing SCD-related pain in children. Objective: To design, develop, and evaluate a Machine Learning-based CDSS mobile application that assists caregivers in making timely, informed decisions for managing SCD pain in children. Methods: A user-centered, mixed-methods approach was used in four iterative phases: (1) contextual analysis through interviews and observations; (2) definition of functional and non-functional requirements; (3) design and development of a mobile CDSS integrating SVM for pain severity classification and NLP for interpreting free-text symptom input; (4) evaluation through real-world testing with 5 caregivers and 2 healthcare professionals. Results: The CDSS achieved 100% task completion during user testing, with an average input time of 2.5 to 5 minutes. NLP accuracy reached 90%, and caregivers reported high satisfaction, especially with Luganda support and clear recommendations (e.g., half-tablets, spoons). Healthcare professionals confirmed clinical alignment with national SCD guidelines. Conclusion: Therefore, based on the results the CDSS mobile app significantly enhances caregiver confidence, supports safe home-based decisions, and bridges the gap between household care and clinical guidance. Its culturally appropriate design and ML/NLP integration make it suitable for use in low-resource settings. Recommendation: Scale-up should include multilingual expansion, integration with national health systems, and live escalation features. The CDSS also holds promise for adaptation to other children chronic conditions requiring home-based decision support.
A machine learning-based risk prediction model for type 2 diabetes mellitus among young adults in Uganda

(Makerere University, 2025) Nassali, Joanita

ABSTRACT Background: Type 2 Diabetes Mellitus (T2DM) is a growing global health concern, and its prevalence is rising among young adults in Uganda. Machine learning algorithms have demonstrated potential in predicting T2DM risk, but their application among young adults in Uganda remains limited. Objectives: This study aimed to develop and evaluate Type 2 Diabetes Risk Prediction Models for young adults using machine learning, compare the performance of the models in relation to previous research on diabetes risk prediction, utilizing the online Diabetes Databases and to determine type 2 Diabetes risk predictors among Young Adults attending outpatient clinics from Mulago National Referral Hospital. Methodology: This retrospective study extracted data from the medical records of young adults from outpatient Registers from Mulago National Referral Hospital. Supervised Machine learning techniques, including Naïve Bayes (NB), Random forests (RF), logistic regression (LR), support vector machines (SVM), and decision trees (DT), were applied to build the risk prediction model. performance metrics, such as accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC-ROC), were used to evaluate the model's predictive capabilities. The models were then compared with previous research on diabetes risk prediction. SHAP values were used to provide interpretability to the Logistic Regression model by quantifying the contribution of each feature to the predictions. Results: Out of the 5 supervised machine learning-based classification predictive models studied, logistic Regression and Random Forest emerged as the most effective models, offering both high performance and interpretability. The Logistic Regression model in this study also outperformed other models, with higher AUC-ROC values than those reported by Chang et al. (0.86), Tigga and Gard et al. (0.92), and Zhu et al. (0.85). Although Random Forest performed better when comparing the study data and the online data. Key predictors of type 2 diabetes include age, Body Mass Index (BMI), and systolic and diastolic blood pressure. Higher BMI and elevated systolic blood pressure were also associated with an increased risk of developing type 2 diabetes. Also, Hypertension, Family Relationship, Family history, and cardiovascular disease exhibit very strong positive correlations with Diabetes Status. Conclusion: This study shows that machine learning, especially Logistic Regression, is highly effective in predicting Type 2 Diabetes in young adults in Uganda. It is recommended to integrate such predictive models into routine screenings and focus public health efforts on managing BMI and blood pressure for diabetes prevention.
A Spatio-temporal analysis to assess the influence of climate change on respiratory diseases in Kampala city, Uganda

(Makerere University, 2025-12-16) Agweng, Fiona.

Background: Climate change poses serious public health risks, especially the urban areas experiencing rapid growth and environmental stress. Kampala city is vulnerable to climate variability such as rising temperatures, fluctuating humidity, and irregular precipitation, which have amplified air pollution levels, exacerbating respiratory health problems. These conditions, alongside urbanisation, have increased respiratory illnesses, including asthma, chronic obstructive pulmonary disease, and pneumonia. However, little is known about how these environmental exposures interact to influence the spatial and temporal distribution of respiratory diseases in Kampala. Objectives: The study aimed to assess the impacts of climate factors on the morbidities and spatial-temporal distribution of respiratory diseases in Kampala over the last four years (2021-2024). This study provides insights into the relationship between microclimate variability, air quality, and respiratory health patterns across Kampala City, Uganda.Methods: A retrospective ecological study design was employed, using monthly aggregated data on respiratory disease illnesses obtained from the Ministry of Health (DHIS2). Climate variables were accessed and extracted through the DHIS2 climate system, an integrated tool maintained by HISP Uganda, and air quality was obtained from Air Qo devices through KCCA. All data cleaning, transformation, and statistical analyses were conducted in R. Generalized Additive Models (GAMs) were used to examine nonlinear relationships between environmental variables and disease outcome. To capture spatial and temporal dynamics, Spatial-Temporal General Additive Models (SP-GAMs) were applied. Residual checks and model diagnostics ensured the validity of results using randomised quantile residuals and smoothing terms. Results: Between 2021-2024, a total of 89253 respiratory illnesses were recorded, comprising pneumonia (65%), asthma (23%), and COPD (12%). In the adjusted GAM models, particulate matter at 2.5(pm2.5) was identified as the most statistically significant and consistent predictor of respiratory disease across all models, showing nonlinear associations with COPD (edf = 2.59, p < 0.001), asthma (edf = 3.25, p = 0.016), and pneumonia (edf = 3.62, p = 0.006). COPD also increased with rising temperatures (edf = 1.01, p < 0.001) and significantly with increased precipitation (edf = 1.00, p < 0.001). ST-GAM results showed strong spatial clustering (edf ≈ 4, p <0.001) and temporal variation. Spatiotemporal analysis using ST-GAMs showed significant clustering of respiratory diseases across Kampala (edf ≈ 4, p < 0.001), with Central, Makindye, and Kawempe divisions, as confirmed by LISA high–high clusters (p < 0.05). Temporally, Pneumonia cases peaked between March and May and again from September to November, while asthma and COPD were more prevalent between January and February and from June to August. Conclusion: The study provides evidence that air pollution, particularly PM2.5, is a key modifiable risk factor for respiratory illness in Kampala. The interaction between environmental exposures and disease outcomes is complex and varies by disease type, location, and season. These findings call for urgent intervention in air quality monitoring, climate-sensitive public health planning, and targeted interventions for vulnerable populations in high-risk divisions. Long-term surveillance and integrated data systems are essential to strengthen Kampala’s urban health resilience in the face of ongoing environmental change.
A time series analysis of the climate-related determinants of malaria in Buikwe District, Central Uganda : a data science approach

(Makerere University, 2026) Nakuya, Niona Kasekende

Introduction: Climate change affects public health, with malaria being one of the most climate-sensitive diseases. Despite numerous control interventions, Buikwe District continues to experience high malaria morbidity, and the influence of local climatic factors on transmission remains insufficiently understood. This study aimed to analyze the temporal relationships between key environmental variables and malaria trends in Buikwe District from 2015 to 2024 and to forecast future malaria patterns using a time-series modelling approach. Methods: A retrospective longitudinal study design was used, drawing on DHIS2 malaria data and ERA5-Land climate data for temperature, precipitation, and humidity, from which heat index was derived. All monthly data were included using a census approach. Analysis in R 4.4.3 involved descriptive statistics, LOESS-based seasonal decomposition, Spearman’s correlation, Augmented Dickey-Fuller tests, Granger causality, and ARIMAX modelling for forecasting. Results: Analysis revealed strong seasonal patterns in the heat index with consistent annual cycles and a rising long-term trend between 2022 and 2024, suggesting increasing heat exposure likely linked to climate change. Temperature showed a statistically significant moderate negative correlation with malaria incidence (ρ = -0.25, p = 0.006), while precipitation and relative humidity had non-significant associations. Granger causality analysis confirmed that all three environmental variables significantly predicted malaria cases. Temperature exhibited the strongest effect, with both lagged (F = 9.81, p < 0.001) and immediate (χ² = 27.92, p < 0.001) impacts. Precipitation (F = 3.94, p = 0.009) and relative humidity (F = 3.15, p = 0.025) also demonstrated predictive power. The ARIMAX(1,0,1) model identified temperature as a significant negative predictor (-142,677.10) and humidity as a significant positive predictor (53,270.62) of malaria incidence. The model achieved good performance, with a low Mean Absolute Scaled Error (MASE = 0.613) and no significant residual autocorrelation (Ljung-Box p = 0.318). Forecasts for 2025 projected fluctuating malaria incidence following seasonal climatic patterns, highlighting periods of potential increased transmission risk driven by temperature and humidity variations. Conclusion: This study demonstrates that climatic factors—especially temperature—significantly influence malaria incidence in Buikwe District. The ARIMAX model successfully captured temporal patterns and forecasted malaria trends, highlighting the value of integrating climate data into surveillance systems. Strengthening climate-informed early warning systems, entomological monitoring, and predictive modelling, alongside collaboration between health, meteorological, and research institutions, is essential for implementing targeted interventions and building effective climate-responsive malaria control strategies.
Acceptability and satisfaction of male partners with antenatal clinic-based HIV testing for PMTCT at Old-Mulago Hospital, Uganda

(Makerere University, 2010-12) Drasiku, Amos

Introduction: Despite benefits of and strategies to increase male partner participation in AHCT at Old-Mulago ANC, their attendance has remained very low (15.8% tested). It is not clear whether they accept AHCT and how satisfied those who have undergone it are. Methodology: A cross-sectional study of 214 male partners of antenatal mothers at Old- Mulago ANC selected by simple random sampling was done. Quantitative data was collected using semi-structured interviewer administered questionnaires. Multivariable logistic regression analysis were performed in Stata 10SE to obtain Odds ratios of satisfaction and their 95% CI so as to identify factors which influence satisfaction with AHCT services. Qualitative data was obtained through four FGDs and analyzed by thematic content analysis method. Results: AHCT acceptance was 99.8%, most respondents (81%) were satisfied with their overall AHCT experience and 71% were satisfied with service setting. FGD participants reported that AHCT for male partners is good but some men do not want to be tested together with their wives. The FGD participants too reported satisfaction with AHCT services. Factors with statistically significant association towards overall satisfaction were cleanliness/hygiene (AOR 2.53, 95% CI 1.12-5.70) and service duration (AOR 13.05, 95% CI 2.97-57.44). Conclusion/Recommendation: Men who escort their wives to the antenatal clinic tend to accept AHCT and tend to be satisfied with the testing experience. However, service duration should be reduced by minimizing delays and commencing work early. More staffs should be allocated to the antenatal clinic especially for antenatal examinations and laboratory.
ACCEPTABILITY AND WILLINGNESS TO PAY FOR UGANDA’S PROPOSED NATIONAL HEALTH INSURANCE SCHEME AMONG INFORMAL SECTOR WORKERS IN IGANGA AND MAYUGE DISTRICTS

(Makerere University, 2019) Namuhani, Noel

Introduction: Access to health care remains a challenge especially among the informal sector in most of the low-income countries due to out of pocket (OOP) expenditures, with Uganda spending over 40.0% out of pocket on health care. To solve this, Uganda has proposed a National health insurance scheme (NHI). However, the acceptability, willingness and ability to pay for the proposed NHI scheme within the informal sector has not been explored. Objective: To assess the willingness to pay for the proposed NHI scheme and its determinants among the informal sector workers in Iganga and Mayuge districts Methodology: This was a cross sectional study. It was conducted in Iganga and Mayuge districts in June 2019. A contingent valuation method using the bidding game technique was used to elicit the willingness to pay. A total of 853/781,948 informal sector workers were randomly selected to participate in the study. Six key informant interviews with health workers and 7 FGDs with informal sector workers were also conducted. Logistic regression was done to identify the determinants for willingness to pay for the proposed NHI scheme. Results: The majority (85.2%) of the respondents would accept the proposed scheme. Most respondents (81.5%) were willing to pay for NHI, the median WTP was UGX 25,000 (USD 6.8) and 74.2% of the respondents believed that they were able to pay for health insurance. The factors that were significantly associated with WTP included; Occupation. Wealth, hearing about health insurance, use of traditional medicine and having saving group membership. Conclusion and Recommendation: The level of acceptability and willingness to pay was high. Therefore, it is viable for MOH to introduce and extend NHI to the informal sector but with affordable premiums while ensuring that the quality of services is enhanced.
Acceptability of healthy lifestyle recommendations for blood pressure reduction, and its associated factors, among hypertensive people living with HIV in a tertiary HIV clinic in Kampala, Uganda

(Makerere University, 2023-11) Nalugga, Esther Alice

Introduction: Hypertension is a significant public health problem with a prevalence ranging between 11% and 29% among people living with HIV (PLWH) in Uganda. Healthy lifestyle recommendations are essential in the prevention and management of hypertension, although determinants of their uptake may differ by regional/cultural context. I aimed to assess the acceptability of healthy lifestyle recommendations for blood pressure reduction among PLWH and hypertension at the Infectious Diseases Institute (IDI), Kampala Uganda, guided by the health belief model (HBM). Methods: A facility-based cross-sectional study was conducted among PLWH aged ≥ 18 years with hypertension receiving care at IDI. I collected data on socio-demographics, clinical history and patients’ ratings on the HBM. Healthy lifestyle recommendations assessed included dietary intake, physical activity, alcohol reduction and smoking cessation. Summary statistics were used to describe the data while logistic regression was used to determine the factors associated with acceptability of the interventions. Results: The study enrolled 427 participants with a mean age of 53 years (SD± 9.4), 57% of them females and 26% obese. Overall, 26.5% of the participants had good knowledge on healthy lifestyle recommendations, 86.9% considered healthy lifestyle recommendations acceptable while 24.4% engaged in healthy lifestyle practices. Urban residents [AOR: 0.35, 95% CI (0.14-0.90)] and participants with high self-efficacy [AOR: 162, 95% CI (37.1-704.4)] were significantly associated with acceptability. Conclusion: This study showed that acceptability of healthy lifestyle recommendations was high, however, knowledge and healthy lifestyle recommendations were low among PLWH and hypertension. Behaviour change programs, including intensive health education, targeting PLWH should be advocated for and integrated into routine HIV care to manage hypertension among PLWH in Uganda.
Acceptability of integration of cervical cancer screening into routine HIV care, associated factors and perceptions among HIV-infected women: a mixed methods study at Mbarara regional referral hospital

(Makerere University, 2021-05-07) Ninsiima, Mackline

Background: Integrating Cervical Cancer Screening (CCS) into routine HIV care has been endorsed as an effective strategy for increasing uptake of CCS, and facilitating early detection and treatment of pre-cancerous lesions among HIV-infected women in Sub Saharan Africa. In Uganda, this strategy has not been implemented yet in most HIV clinics. Assessing the acceptability of this intervention among HIV-infected women is of great relevance to inform its implementation. Objective: To assess the acceptability of integration of Cervical Cancer Screening (CCS) into routine HIV care, associated factors and perceptions among HIV-infected women enrolled in the Immune Suppression Syndrome clinic at Mbarara Regional Referral Hospital (MRRH). Methodology: A mixed methods study utilizing the explanatory sequential approach was conducted among 327 eligible HIV-infected women. Acceptability of integration of CCS into routine HIV care was measured using the Theoretical Framework of acceptability (TFA). A pre-tested questionnaire was used to collect quantitative data. Focus group discussions to explore perceptions regarding the intervention were conducted among purposively selected HIV-infected women. Descriptive analyses for all categorical dependent and independent variables were done. Modified poisson regression with robust variance analysis was utilized to determine factors associated with the acceptability of the intervention. Statistical significance was determined at p-value <0.05. The analysis was performed using STATA Version 14.0. Thematic analysis utilizing inductive coding was used to analyze qualitative data in Atlas.ti 6.0. Results: Majority of the HIV-infected women (64.5%) accepted the integration of CCS into routine HIV care. Religion, perceived risk of developing CC and ever screened for CC were statistically significantly associated with the acceptability of integration of CCS into routine HIV care. Perceived benefits of the proposed intervention were: convenience to seek for CCS, motivation to undergo CCS, improved archiving of CCS results, the confidentiality of HIV patient information, and preference to interact with ISS clinic health workers. Shame to expose their privacy to the ISS clinic health workers and increased waiting time were the only perceived challenges of the integration of CCS into routine HIV care. Conclusion: Study findings highlight the need to take advantage of this acceptability to prioritize implementation of the integration of CCS into routine HIV care, conduct intensified health education and awareness about the increased risk of developing CC among HIV-infected women. HIV-infected women should be reassured of confidentiality and reduced waiting time to increase the uptake of the integrated CCS and HIV services among HIV-infected women along the continuum of HIV care and treatment services.
Acceptability of male infant medical circumcision as an HIV prevention strategy among patients attending a Health Centre IV in Kampala District

(Makerere University, 2011) Nsereko, Mary N.

Background: Medical Male Circumcision (MMC) has been shown to reduce the risk of HIV infection by 50-60%. UNAIDS has recommended that MMC be integrated into prevention strategies in countries of high prevalence. Circumcision in infancy has the added advantages of being easier to perform and cheaper through faster healing and less complications. Objectives: The general objective was to establish the factors that influence acceptability of Male Infant Medical Circumcision (MIMC) as an HIV prevention strategy. The specific objectives were to determine knowledge of Male Medical Circumcision (MMC) and identify factors influencing acceptability of MIMC. Methods: A descriptive cross sectional design was used. Participants were selected randomly from people attending a health centre. Data from consenting adults aged 18 years and above was collected using interviewer administered questionnaires. Bivariate analysis to determine factors associated with acceptability and logistic regression was done to remove confounders. Odds ratios (ORs), 95% confidence intervals and p values are reported. Results: A total of 323 participants were interviewed. The mean age was 28.6 with a SD of 9 years. One hundred ninety three of them had 1 or more male children. At bivariate analysis, positive associations with acceptability were prior knowledge of Male Medical Circumcision (MMC) and a belief that MMC improved personal hygiene and prevented STDS/HIV. More than 80% of the respondents preferred circumcision in infancy because of a belief that it healed faster. Significant predictors of acceptability at multivariate analysis were found with being female (AOR 3.36; 95%CI 1.14-9.8), having knowledge about the preventive effect of MMC (AOR 5.61 95%CI 1.17-26.92), perceived family approval for MMC (AOR 23.59; 95%CI 6.43-86.50), and if the service were to be provided safely at affordable prices (AOR 3.27 95%CI1.17-917). Conclusion: MIMC appears to be highly acceptable in Kampala. The option for safe and affordable MIMC should be made available to all parents.
Acceptability of masking and patient separation to control nosocomial Tuberculosis in Uganda: a qualitative study

(J Public Health, 2011) Buregyeya, Esther ; Mitchell, Ellen M. H. ; Rutebemberwa, Elizeus ; Colebunders, Robert ; Criel, Bart ; Kiguli, Juliet ; Nuwaha, Fred

Objectives: This study explored the acceptability of cough etiquette, wearing masks and separation by tuberculosis (TB) suspects and TB patients in two districts in Uganda. Design: The study was conducted in Mukono and Wakiso districts in central Uganda. Eighteen in-depth interviews with patients and eight focus group discussions with health workers were conducted. Patients were asked for their opinions on cough etiquette, patient separation and wearing of masks. Results: Patients and health workers felt that physical separation was ideal, yet separation and masking were regarded as embarrassing to patients, emphasizing their potential infectiousness. Patients reported greater willingness to cover their mouth with a handkerchief than to wear a mask. Good counseling and health education were suggested to improve patients’ adoption of separation and masking. However patients expressed concerns about equity, coercive and stigmatizing approaches. Universal precautions were more acceptable than targeted ones, with the exception of separating TB patients. Lack of community awareness about airborne transmission of TB was identified as a barrier to accepting and adopting TB infection control measures. Conclusion: Scaling up effective TB infection control norms and behaviors requires a patient-centered, rights-based, and evidence-based approach. Socially acceptable measures like covering the mouth and nose with a handkerchief should be promoted. We recommend that further studies are needed to explore how community advocacy impacts on acceptability of masking. Furthermore, the efficacy of covering the mouth using a handkerchief or piece of cloth compared to wearing a mask in TB prevention needs to be evaluated.
Acceptability of modified directly observed therapy for Antiretroviral Therapy (ART) and associated factors among HIV patients in Arua Hospital

(Makerere University, 2010-10) Afayo, Robert

Introduction: Combination ART has led to dramatic reductions in morbidity and mortality among patients with HIV/AIDS in Uganda. Successful treatment with ART requires the patient to maintain consistent adherence to the prescribed regimen on a long term basis. However, only 68% of the Ugandan urban patients interviewed reported an adherence rate of 95% to HAART. Modified directly observed therapy for ART has been suggested as an intervention for non-adherence. This study has shed light on acceptability of modified DOT and associated factors before its adoption. Objective: To assess acceptability of modified DOT-ART and associated factors among HIV-infected patients attending Arua hospital HIV clinic in 2010 Methods: Cross–sectional design using both qualitative and quantitative methods was conducted between February and March, 2010 among HIV-infected patients attending Arua hospital. Data were collected on acceptability of a modified DOT-ART, preference of different forms of modified DOT-ART, and associated factors. The proportion of patients who were willing to accept modified DOT-ART and proportion of patients who preferred different forms modified DOT-ART were determined. Using bivariate and multivariate analysis, factors associated with acceptability of modified DOT-ART were assessed. Statistical significance was determined using 95% confidence Interval and p-value (<0.05) of Odds Ratios as the measure of effect. Qualitative data was analyzed into themes. Results: A total of 358 participants were enrolled. Of these, 55.9% (200/358) were willing to accept modified DOT. The proportion of patients on ART who accepted modified DOT was 61.5% (110/179) and those not on ART was 50.3% (90/179). The majority, (58.5%, 117/200) of participants preferred home/family-based DOT among different forms of modified DOT-ART. Male patients (OR= 0.463, 95%CI= 0.68-0.799, P= 0.006), married patients (OR= 0.354, 95%CI= 0.129-0.973, P= 0.044), patients with low social support (OR= 0.616, 95%CI= 0.384-0.990, P= 0.045), and patients not receiving co-trimoxazole prophylaxis (OR=0.324, 95%CI= 0.151-0.696, P=0.004), were less likely to accept modified DOT for ART. While patients on ART (OR= 2.431, 95%CI= 1.357-4.353, P=0.003) and those who never ever missed ARV dose (OR= 2.192, 95%CI= 1.134-4.234, P=0.020) were more likely to accept modified DOT-ART. Conclusion: The study showed that over half of the participants were willing to accept modified DOT- ART. Home/Family-based approach was the most preferred form of modified DOT-ART. Acceptability of modified DOT was higher among patients on ART compared to those not on ART. Non-acceptance of modified DOT-ART was more common particularly among the males, the married; patients with low social support, non-adherent patients and patients not taking co-trimoxazole prophylaxis. Recommendations: There is need to further explore into the acceptability and feasibility of modified DOT to other populations before MOH can consider the use of mDOT as a strategy to strengthen adherence to ART particularly to highly non-adherent patients. As MOH considers use of mDOT, education of patients on what mDOT-ART entails will be key to the success of this program.
Acceptability of SMS reminders as an HIV PREP adherence support tool and associated factors among adolescent girls and young women in Mukono District

(Makerere University, 2022-12) Muteebwa, Laban

Background: Young Women in Uganda contributed 29% of new HIV infections despite representing only 10% of the total population and are priority beneficiaries of PrEP, yet they have been found to have low adherence. SMS reminders have been found to improve adherence to PrEP in AGYW. There is paucity of literature about their acceptability among AGYW in Mukono district. Objective: To estimate the level of acceptability, the associated factors and explore the perceptions toward use of SMS reminders as a PrEP adherence support tool and among AGYW in Mukono district. Methods: This parallel convergent mixed-methods study enrolled 142 AGYW using PrEP. A structured questionnaire and In-depth interview guide were used to collect quantitative and qualitative data respectively. Quantitative data were analyzed in STATA 17.0 Continuous variables were summarized using median (IQR) and factors associated with acceptability of SMS reminders were analyzed using a modified Poisson regression. Qualitative data were analyzed by inductive thematic analysis in open code version 4.03. Results: The acceptability of SMS reminders was 90.9% (95% CI (84.9, 95.0)). Being from rural residence and not believing that SMS can breach individual’s privacy were significantly associated with acceptability of SMS reminders with adjusted prevalence ratios of 0.92 (95% CI (0.84, 0.99)) and 1.4 (95% CI (1.07, 1.84)) respectively. AGYW perceived that SMS reminders are highly acceptable to support adherence. However, they felt that the success of this intervention hinges on whether it ensures confidentiality about their PrEP use. Conclusions: SMS reminders are highly acceptable to AGYW provided they ensure confidentiality is maintained however, AGYW living in rural areas may need additional support to use this intervention.
Access to health care for febrile children in Uganda: symptom recognition, care seeking practices and provider choice

(Karolinska Institutet and Makerere University, 2009) Rutebemberwa, Elizeus Kabareebe

Background: Febrile illnesses including malaria and pneumonia are leading causes of death among children under five in Uganda. Despite government efforts to increase health care access by offering free services at government facilities, the majority of the sick children receive care after 24 hours, often with less efficacious drugs. one of the strategies suggested for increasing access is the distribution of antimalarials and antibiotics at community level. However, determinants on access to health care for febrile children are not sufficiently understood. Main aim: The aim of this study was to assess the factors associated with access to treatment for febrile children under five in order to inform the implementation of child survival interventions at community level. Methods: Four studies were conducted in Iganga-Mayuge Demographic Surveillance Site in Eastern Uganda (I-IV). Study used key informant interviews (KIIs) with eight health workers and eight traditional healers and five focus group discussions (FGDs) with mothers of children under five. Study II was a cross sectional survey of 9,176 children under five. Study III was a survey of a random sample of 1078 households with children under five. Study IV used four FGDs with fathers and mothers of children under five and eight KIIs with health workers in government and Non-Governmental Organization facilities, community medicine distributors (CMDs), and attendant in drug shops and private clinics. Content analysis was used for qualitative data. Quantitative data was analysed at univariate, bivariate and multivariate levels to determine the independent predictors of delayed care or choice of provider. Results: There is general lack of knowledge on antibiotics as first treatment for fever with pneumonia symptoms (I) and use of less efficacious drugs for malaria acquired from the open market (IV). Caretakers prefer health care providers with a variety of drugs and able to do diagnostic investigations (IV). Two thirds of the caretakers consult the private sector and 27% of them among other things because they can get treatment on credit (III). There are diverse perceptions on drug efficacy among caretakers (IV). Being of low socio-economic status (OR 1.45; 95% CI 1.06┤1.97) and presenting with pallor (OR 1.58; 95% CI 1.10-2.25) are associated with delay in care seeking >24 hours after onset. Children seeking care outside the home <24 hours had fast breathing (OR 0.75; 95% CI 0.60-0.87), had had tepid sponging (OR 0.43; 95% CI 0.27-0.68), had provider proximity (OR 0.72; 95% CI 0.60-0.87) and went to drug shops (OR 0.70; 95% CI 0.59-0.84) or CMDs (OR 0.33; 95% CI 0.15-0.74) (II). Caretakers more likely went to government facilities when children had vomiting (OR 2.07; 95% CI 1.10-3.89), or when expecting qualified (OR 10.32; 95% CI 5.84-18.26) or experienced workers (OR 1.93; 95% CI 1.07-3.48). Caretakers went to private providers when seeking treatment as "first aid" (OR 0.20; 95% CI 0.08-0.52) (III). Discussion: Caretakers should be sensitized on recognition of symptoms for pneumonia, prompt care seeking and use efficacious drugs. CMDs should be able to do some diagnostic investigations and have constant drug supply. Using drug shops and private clinics in community interventions could complement government efforts to deliver timely treatment. Keywords: fever, malaria, pneumonia, community health worker, drug shop, child
Access to improved sanitation among households in peri urban area in Bwaise II Parish, Kawempe Division: A cross sectional study

(Makerere University, 2023) Namusu, Irene

Introduction: Sustainable Development Goal (SDG) target 6.2 aims at achieving universal access to sanitation, leaving no one behind by 2030. To enhance this achievement, SDG target 1.4 aims at basic sanitation for all especially the poor and vulnerable. As such, improved sanitation has now been restricted to at least using improved sanitation facilities which are not shared by other households. This study assessed improved sanitation among households as per the Joint Monitoring Programme indicators to determine the current status of improved sanitation in Kawempe division as previous efforts to improve sanitation and research have been focused on improved technology types regardless of whether they are shared or not. Objective: To determine the proportion of households with access to improved sanitation and associated factors, environmental and policy influencing factors in Bwaise II, Kawempe division. Methods: This was a cross sectional study that utilized both quantitative and qualitative methods of data collection from household heads and key informants respectively. A household based study and key informant interviews were therefore conducted in this regard. Statistical data analysis was by logistic regression in STATA 15 software. Qualitative data were analysed thematically. Coding of data were done manually and themes identified, marched and collated together in tables. Quotes from key informants were identified, summarised and reported. Results: Access to improved sanitation was at 36.2%. Households heads in agegroup above 50 years and those with above secondary level of education were more likely to have improved sanitation (AOR : 4.21, 95% CI: 1.62-10.95) and (AOR: 5.12, 95% CI : 2.00 -13.16) respectively. Households with wife present at home during the week were less likely to have access to improved sanitation (AOR: 0.57, 95% CI 0.33 – 0.99). Ownership of a housing unit (landlord) was positively associated with access to improved sanitation (AOR: 4.04, 95% CI: 2.26 – 7.25). Collapsing soils, high water table, flooding and weak enforcement for Public Health Act (PHA) and sanitation related regulations, unfavourable land system of tenure are environmental and policy related factors respectively that limit improved sanitation in Bwaise II. Conclusion and recommendation: Access to improved sanitation was low with majority of the population using shared sanitation facilities. Access to improved sanitation was significantly higher among those who were in the above 50 years age group, those with above secondary education and those who were landlords. Factors that influenced access to improved sanitation were nature of soils, high water table, and unfavourable land tenure system. Sanitation programmes need to explore low cost and water proof technology options to promote and scale up construction of household sanitation facilities to enhance progress towards realisation of improved sanitation for all.
Access to selected sexual reproductive health services among adolescent refugees in Rhino camp refugee settlement in Arua district.

(Makerere University, 2023-01-17) Kalema, Charles

Introduction: Uganda hosts 1.4 million refugees and conflict-affected people. Widely regarded as the best place in Africa to be a refuge. Adolescents in refugee camps in West Nile Region face challenges that can be mitigated with creating a comprehensive access to Sexual Reproductive Health Services (SRHs). The limited access to SRHs among adolescent refugees is associated with low availability of social services like health education in the context of sexual and reproductive health services like Family Planning Services (FP), Antenatal Care (ANC), Post-Natal and Post Abortion Care (PAC). Access to Sexual Reproductive Health Services is low among adolescents living in the refugee camp settings as compared to counterpart in the normal settings in Uganda. Objectives: The main objective was to investigate the level of access to Sexual Reproductive Health Services (SRHs) and associated factors among adolescent refugees in Rhino Camp Refugee Settlement in Arua District West Nile Region Uganda. Methods: This was a cross sectional study among 310 out of the 427 sample calculated refugee adolescents aged 14-19 years, these were selected using a systematic method with a random start in Rhino camp refugee settlement, Arua District. The (03) FGDs were used to collect qualitative data which were analyzed using t hematic analysis. Quantitative data was obtained using interviewer administered questionnaire and check list (This helped the team to verify and observe the available family planning commodities, PAC medicines etc). Data was analyzed using STATA 15. Modified Poisson regression with robust standard errors was done to assess the association between the independent and dependent variables at the bivariate and multivariate analyses. Variables with P-value of ≤ 0.2 at bivariate were considered for multivariate analysis. Variables with a P-value less than 0.05 were considered to be statistically significant. Results: A total of 310 (73% response rate) adolescents were recruited for quantitative part of the study, 24 adolescents and 14 health workers (Midwives and NGO Officials) total 38 respondents for qualitative part of the study. The mean (SD) age of adolescents at recruitment was 17.3 (±1.5) years. Of the 310 adolescents, 132 (42.6%) were male and 178 (57.4%) were female. The overall level of access to SRHs (FP, ANC and PAC) among the adolescents was 50%. This was measured by the proportion of adolescents who had the need and opportunity to reach and obtain any of the three services: The level of access is still very low SRH interventions must be put in place to increase access. At multivariate analysis, the factors that were independently associated with access to SRHS were lack of awareness of sexual reproductive health services (PR=0.33, 95% CI: 0.16, 0.93) and being single adolescents (PR=0.53, 95% CI: 0.29, 0.98). Qualitative data also revealed that long distance to health facilities, low income earning, health workers’ attitude, stock out of commodities, fear and shyness, parents’ attitude, and long waiting hours in health facilities were some of the factors that deterred access to SRHs by adolescents in refugee camps. Conclusion: The prevalence of access to SRHs among refugee adolescents in Rhino refugee settlement camp is low (50%). This was achieved by summarizing proportions for the considered three components of SRHs (YES/NO) among the adolescent refugees in Rhino camp compared to their counterparts of Ugandan, Tanzanian and Ethiopian nationalities (65%). Factors that were independently associated with access to SRHS among refugee adolescents were awareness of SRHs, level of education (primary level and secondary level), and married adolescents. There is need for effective SRH interventions in order to at least achieve the minimum sphere standards recommended in such situations including mobile clinics, awareness creation, health outreaches, availability of FP commodities, emergency transport services among others. Keywords: Sexual and reproductive health, adolescent, refugee, access to SRHs, availability, acceptability, Arua, Uganda.
Access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology Unit, Kampala – Uganda : a cross-sectional study

(Makerere University, 2025) Bwambale, Ronald

Introduction: Globally, stroke is the leading cause of disability, and rehabilitation is the primary form of therapy for stroke survivors. However, there is a dearth of information regarding access to stroke rehabilitation services following discharge from hospitalization. This study, therefore, examined access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology unit, Kampala-Uganda. Methodology: This was a concurrent mixed-methods study using cross-sectional and phenomenological study designs. Telephone interviews with an interviewer-guided questionnaire were used to collect quantitative data among 120 participants, sampled consecutively. Firth’s penalized logistic regression was used to identify associated factors. Quantitative data were analyzed using STATA version 15.0. Qualitative data were collected through in-depth, face-to-face interviews with six purposively selected participants and analyzed thematically using ATLAS.ti version 25. Results: Only 7.5% of the participants had high access to stroke rehabilitation services. Among the dimensions of access, acceptability scored highest (66.4%), followed by accessibility (24.3%), availability (20.6%), accommodation (15.9%), and affordability (3.7%). No patient characteristics showed a statistically significant association with access to stroke rehabilitation. Key themes for experiences faced while accessing stroke rehabilitation services included transport challenges, high cost of care, adequacy of rehabilitation resources at hospitals, and organization of stroke rehabilitation services. Conclusion: Access to stroke rehabilitation services remains alarmingly low in this setting, mainly hindered by the affordability of rehabilitation care.
Accessibility of essential maternal health related in-vitro point-of-care diagnostic tests at the primary health care level in Luwero district central Uganda

(Makerere University, 2021-03-02) Muniri, Abdul

Background: Poor maternal outcomes at the Primary Health Care (PHC) level of Low-Income Countries such as Uganda are partly attributed to poor maternal health services including inaccessibility of appropriate maternal diagnostics. The use of maternal health related In-Vitro Point-Of-Care Diagnostic Tests (IVPOCDTs) can bridge the gap between the delay in diagnosis and timely evidence-based maternal interventions such as treatment or referral. The clinical impact of IVPOCDTs on maternal outcomes such as safe birth depends on their accessibility. Objective: The study determined the accessibility of maternal health related IVPOCDTs in terms of their availability, utilization capacity and the technical competency of their operators at the PHC level in Luwero district so as to yield information that will inform health policies/programs that can improve accessibility of such diagnostic tests. Method: Between March and May 2020, we conducted a cross-sectional study in the 3 Health Sub Districts of Luwero district. We accessed the Luwero district inventory list of 75 HCs II and III from which we chose 65 as the study sample using probability proportionate to size stratified random sampling. We collected data on the availability and utilization capacity of IVPOCDTs and also the technical competency of their operators using a standardized, structured and WHO adapted survey tool. Data capture was by Microsoft excel and analysis was by SPSS version 23. Results: While the average number of maternal IVPOCDTs available in the HCs was 7.06 (range: 2-12; SD = 3.01), 41.7% (25/60) of the HCs reported a high availability of the diagnostics (9-12 IVPOCDTs). Almost all (83.3%) (10/12) of the IVPOCDTs had low frequency of utilization. The most frequently utilized IVPOCDT was for malaria (100%) (60/60), while the least frequently utilized was for gonorrhea (12%) (7/60). Only 10% (6/60) of the IVPOCDTs’ operators had degrees, while close to half (46.5%) (28/60) had certificates. Majority (65%) (39/60) of the same operators had a high working experience. Conclusions: There was a suboptimal accessibility of the maternal health related IVPOCDTs at the PHC level of Luwero district Central Uganda. Availability of the maternal IVPOCDTs and the technical competency of their operators were average, while the utilization capacity was low. Recommendations: There is need for policy changes to ensure adequate accessibility of the maternal health related IVPOCDTs in Luwero district to the levels recommended by the WHO guidelines for maternal assessment during pregnancy.
Accountability mechanisms in results based financing and their implementation in Lira District Northern Uganda

(Makerere University, 2022-12) Okiror, Nathan

Introduction: Results-based financing has been proposed as an innovative reform to enhance systems performance in Uganda. Lira District is one of the districts implementing the national results-based financing (RBF) scheme under the Uganda Reproductive Maternal and Child Health services Improvement Project (URMCHIP). The diversity of relationships among various actors in RBF implementation underscores the need for mechanisms to ensure accountability among them. This was a case study which aimed at exploring the RBF accountability mechanisms, their implementation and related factors in Lira District. Methods: The study was a descriptive case study employing qualitative methods. The data collection methods included a) focus group discussions with the health workers from RBF facilities, b) key informant interviews with key actors in the RBF program at the MOH as well as in the district including district managers, health facility in charges, verifiers, members of the health facility management committees c) review of RBF documents, annual progress and audit reports. Data were analyzed thematically guided by a framework that explored the relationships and related accountability mechanisms in RBF. Results: Several accountability mechanisms existed among different actors in the RBF program. The accountability mechanisms between MOH and the districts included regulatory approaches such as contracts, while between the district and health facilities mechanisms included reporting, data verifications and financial audits. Public disclosure through display of results on notice boards and feedback through complaint boxes were the mechanisms employed between the facility and the community. Intrinsic health system arrangements such as support supervision, administrative health facility meetings were some of the enablers’ .Challenges hindering accountability mechanisms included infrequent financial support to enable regular support supervision/verification visits by EDHMT and corruption. Conclusion: Implementation of RBF accountability mechanisms in Lira was suboptimal due to the various RBF design and implementation challenges. The factors were likely to constrain RBF from reaching its full potential. More effort needed to be directed towards supporting the EDHMT and facility managers in terms of capacity building and facilitation to do their work. Additionally, efforts need to be undertaken to address the downstream challenges such as delayed disbursement of funds and corruption impeding the implementation of RBF accountability mechanisms in the district.
Adherence among Female Sex Workers taking oral HIV pre-exposure prophylaxis in Kampala, Uganda

(Makerere University, 2019-06-17) Nalukwago, Grace Kakoola

Title: Adherence among female sex workers taking oral HIV pre-exposure prophylaxis in Kampala, Uganda. Background: Globally, Sub-Saharan Africa remains most severely affected with highest HIV prevalence rates. Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations. In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%), and inadvertently form the majority of PrEP users at the Most at Risk Population Initiative (MARPI) PrEP clinic in Kampala. However, studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical in realizing the benefits of PrEP for maximum HIV prevention. To date, implementation data on adherence to PrEP among FSWs is limited in Africa. This study therefore sought to assess adherence to PrEP among FSWs. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, 2) determine factors associated with PrEP adherence as well as 3) explore factors influencing PrEP adherence among FSWs. Methods: This mixed methods cross-sectional study was conducted from August to December 2018; 126 FSWs using PrEP were interviewed using a questionnaire, and 30 women underwent in-depth interviews. Adherence was categorically defined as high adherence if a FSW takes at least six doses of PrEP in the past week and low adherence if a FSW takes less than 6 doses of PrEP in a week. Logistic regression using STATA version 14 and thematic data analysis were conducted for the quantitative and qualitative objectives respectively. viii Results: The median age of the FSWs was 24.5 years. Forty one percent of the FSWs had attended secondary level education. The median duration of sex work was 3 years. On average, the FSWs had 11 sex partners in the past week. Reported condom use among FSWs was far more consistent with clients (87.9%) compared to 59% among non-paying sexual partners. Self reported proportion with high adherence to PrEP was 71%. Factors associated with high adherence to PrEP at bivariate level were condom use with clients, color of PrEP tablet, and PrEP packaging. In multivariate analysis, not using condoms with clients (OR 0.07, 95% CI: 0.01-0.42) and using long-term contraception methods (OR 0.06, 95% CI: 0.04-0.77) were significantly negatively associated with high PrEP adherence; whereby FSWs who used long-term contraceptive methods (IUD and Implants) were 94% less likely to adhere to PrEP. FSWs adhered to PrEP because they felt at risk; because they experienced condom breaks or because they do not use condoms. Barriers of PrEP adherence include drug side effects, lack of financial resources, food insecurity, stigma, and doubts about PrEP efficacy, travel and health system factors. Conclusion: A high proportion of FSWs had high self-reported adherence to PrEP. FSWs considered PrEP as a reliable method of protection against HIV in cases of condom breaks or sex without a condom. However a number of barriers to PrEP adherence at both personal and systems level need to be addressed for successful PrEP implementation.

Browse

Browsing School of Public Health (Public-Health) by Title

Results Per Page

Sort Options