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ItemPrevalence and factors associated with family planning use among female adolescents aged 15-19 years in Palabek refugee settlement, Lamwo district.(Makerere University, 2025-12-19)Background: Poor access to SRH services in humanitarian settings remains a major public health concern, particularly for refugee populations facing conflict, insecurity, and poverty. Uganda hosts over 1.7 million refugees, and adolescent refugees face disproportionately high rates of unmet need for contraception, which contributes to high rates of unintended pregnancies within this vulnerable population. This study investigated the prevalence and factors associated with FP use among female adolescents aged 15–19 years in Palabek refugee settlement, Lamwo District. Methods: A cross-sectional study was conducted in May 2025. The study participants were 430 female adolescents selected through multi-stage sampling. Primary data were collected using semi-structured questionnaires and key informant interviews. Quantitative data were analyzed using STATA V.15, with bivariate and multivariate analyses employed to identify factors associated with FP use. Qualitative data from key informants were analyzed thematically. FP use was defined as current or recent use in the past 6 months of any method (modern or traditional) to prevent pregnancy.Results: FP use in the past six months was 13.5%. Implants (48.1%) and injectables (30%) were the most used methods. Reduced FP use was associated with Catholic affiliation (APR = 0.34; 95% CI: 0.14–0.81), dissatisfaction with services (APR = 0.44; 95% CI: 0.26–0.75), and living beyond 2.5 km from a hospital offering FP services (APR = 0.51; 95% CI: 0.03–0.92). Ever-married adolescents were more likely to use FP (APR = 1.89; 95% CI: 1.05–3.44). Key barriers to FP use included stigma and sociocultural norms, parental and partner influence, and limited access. Conclusion: FP use among female adolescents in Palabek was low despite high sexual activity. Being catholic, long distance to the health facility, and dissatisfaction with services were associated with reduced likelihood of family planning use. Female adolescents who had ever been married were nearly twice as likely to use family planning compared to those who had never been married. Targeted, integrated, and culturally sensitive FP interventions that are youth-friendly are needed to address belief-driven barriers, improve service quality to enhance client satisfaction, and expand access through mobile outreach and local service points.
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ItemAssesment of the Prevalence of Post-Traumatic Stress Disorder, Associated Factors, and Social Support Systems Among Adult Refugees in Kyaka Ii Refugee Settlement, Uganda.(Makerere University, 2025-12-17)Introduction, Post-Traumatic Stress Disorder (PTSD) is a major mental health concern among refugees, with prevalence rates ranging from 10% to 40% globally, depending on trauma exposure and context (Steel et al., 2009; Charlson et al., 2019). Refugees experience multiple stressors, including war, forced displacement, and socio-economic hardships, which exacerbate PTSD symptoms (Silove et al., 2017). Uganda hosts over 1.5 million refugees, with Kyaka II Refugee Settlement accommodating approximately 118,882 individuals, mainly from the Democratic Republic of Congo (DRC) and South Sudan (UNHCR, 2020). Despite Uganda’s progressive refugee policies, mental health services remain inadequate, leaving PTSD largely unaddressed (WHO, 2018). Objective,This study assessed the prevalence of PTSD among adult refugees in Kyaka II Refugee Settlement, examined associated factors, and explored the availability of social support systems in managing PTSD. Methods, A cross-sectional mixed-methods design was used. Quantitative data were collected from 384 adult refugees using the PTSD Checklist for DSM-5 (PCL-5). Associations between independent variables and PTSD were examined using Chi-square tests of independence, Fisher’s Exact Test for sparse data, and independent t-tests for continuous variables such as age. Variables with p < 0.20 were entered into a Modified Poisson regression model with robust error variance to obtain prevalence ratios (PRs). Qualitative data were collected through seven Key Informant Interviews (KIIs) and seven In-Depth Interviews (IDIs) and analyzed thematically. Results, The prevalence of PTSD was 62.0%. Bivariate analysis, including Chi-square, Fisher’s Exact Test, and Modified Poisson regression, showed no statistically significant associations between socio-demographic characteristics, trauma exposures, and PTSD diagnosis (all p > 0.05). Descriptive comparison of mean ages revealed no meaningful differences between PTSD and non-PTSD groups. Qualitative findings highlighted family, peer groups, religious institutions, and NGOs as central social support systems, while stigma, financial barriers, and disrupted families limited access to these supports.Conclusion, PTSD prevalence among adult refugees in Kyaka II is high, yet no significant quantitative predictors were identified. This underscores the importance of qualitative insights, which revealed the central role of informal and community-based social support in coping with trauma. Strengthening religious, family, and peer-based support, alongside integrated community mental health services, is critical for addressing PTSD among refugees.
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ItemRECURRENCE RATE OF MALARIA AND ASSOCIATED RISK FACTORS IN INFANTS BORN TO WOMEN WHO RECEIVED IPTp-DP OR IPTp-SP: UTILITY OF CONDITIONAL FRAILTY, PWP-GAP TIME AND FRAILTY MODELS.(Makerere University, 2025-12-15)Background: Malaria remains a leading cause of morbidity and mortality in children under five in Sub-Saharan Africa, with infants in high transmission regions experiencing high rates of recurrent malaria. Despite implementation of preventive strategies like Intermittent Preventive Treatment in Pregnancy, the burden of recurrent malaria episodes in infancy persists. Recurrent malaria not only increases the risk of severe anemia and developmental delays but also presents unique challenges for statistical modeling, as episodes are often correlated and influenced by individual-level heterogeneity. Studies have explored different dynamics of malaria in infants and how to address them but gaps still remain in contextualizing specific risk factors and how they influence malaria recurrence in this age group while making use of the most appropriate modeling techniques which account for event dependence and heterogeneity. Objective: This study aimed to investigate the recurrence rate of malaria and associated risk factors in infants born to mothers who received either IPTp-DP or IPTp-SP, and to evaluate utility of the conditional frailty, PWP-gap time, and shared frailty models in analyzing this kind of recurrent malaria data.Methods: Secondary data was used, obtained from the PROMOTE study, a prospective cohort double-blinded randomized controlled phase III trial which followed 640 infants born to women randomized to receive IPTp-DP or IPTp-SP in Busia district, Uganda. Analysis compared performance of the conditional frailty, PWP-gap time, and shared frailty models in accounting for event dependence and heterogeneity. Covariates included maternal education, age, gravidity, distance to health facility, and other socio-demographic factors. Model performance was assessed using AIC and BIC.Results: Infants whose mothers received IPTp-DP had a 6% lower hazard of recurrent malaria episodes compared to those whose mothers received IPTp-SP (HR=0.94, 95% CI: 0.82-1.07), but this difference was not statistically significant. Maternal education was protective as infants born to mothers with primary, secondary, and higher education had 21%, 42%, and 48% lower risks of malaria recurrence, respectively, compared to those whose mothers had no education. Advanced maternal age was also protective (HR=0.72, 95% CI: 0.53–0.97), while infants of multigravida mothers (≥3 pregnancies) had a 36% increased risk (HR=1.36, 95% CI: 1.02–1.80). Living 3–5 km from a health facility was associated with a 40% higher hazard of malaria recurrence (HR=1.40, 95% CI: 1.11–1.77). The conditional frailty model best fit the data with the lowest AIC=9486.1 and it accurately captured event dependence with minimal unmeasured heterogeneity.Conclusions: IPTp-DP did not significantly reduce malaria recurrence in infants compared to IPTp-SP. Socio-demographic factors like maternal education, age, and healthcare accessibility had stronger associations with malaria recurrence risk. The conditional frailty model proved most appropriate for analyzing recurrent malaria data, effectively accounting for event dependence and yielding robust estimates. These findings demonstrate the need for integrated strategies beyond malaria chemoprevention, emphasizing maternal empowerment and health system strengthening.
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ItemDeveloping a Natural Language Processing Model to Characterize Mobility Patterns of M. Tuberculosis Cases in Lubaga and Kawempe Divisions of Kampala(Makerere University, 2025)Background: Tuberculosis (TB) remains a major public health threat in Uganda, particularly in urban settings such as Lubaga and Kawempe divisions of Kampala, where community transmission is high. Over 75 percent of new TB infections are estimated to occur outside the household, yet traditional surveillance approaches fail to adequately capture these community-level dynamics. In congested areas like Lubaga and Kawempe, human movement creates complex and dynamic interactions among markets, transport hubs, education centers, and health facilities. These movements are not only vital to the local economy but also serve as potential pathways for infectious disease spread, including the transfer of TB cases over long distances. Understanding how mobility contributes to TB transmission is therefore critical for designing effective, targeted interventions. Objective: This study aimed to develop and validate a Natural Language Processing (NLP) model to characterize the mobility patterns of TB patients in Kampala using Call Detail Records (CDRs), and to identify high-risk transmission hotspots through network analysis. Methods: A retrospective cohort study design was used to analyze four years of CDR metadata from 400 bacteriologically confirmed TB patients enrolled in the Mapping Tuberculosis Transmission Study (MATTS). Preprocessing steps included geocoding, timestamp normalization, and removal of routine stop-word movements. Semantic and spatiotemporal features were extracted using TF-IDF weighting, cosine similarity, and Doc2Vec embeddings. The DBSCAN algorithm was used for mobility clustering, and a directed weighted mobility network was constructed. Centrality metrics, including degree, betweenness, and closeness, were computed to identify key convergence zones. Results: TB patients visited an average of 54 unique locations, exhibiting heterogeneous yet patterned mobility behavior. Spatial clustering revealed repeated convergence at urban markets, slums, health facilities, and transportation hubs, particularly around Kisekka Market, Bwaise, and Mulago Hospital. The mobility network showed a small number of highly central nodes linking large segments of patient trajectories. The model achieved a mean Jaccard similarity score of 0.941 for trajectory reconstruction and a silhouette score of 0.387, indicating moderate internal cluster consistency. Conclusion: Applying NLP and network analysis to mobile phone data provides novel insights into TB mobility and transmission dynamics in urban African settings. The study identifies high-risk locations that may act as transmission amplifiers and recommends that TB control programs prioritize these zones for targeted surveillance and Active Case Finding (ACF) interventions.
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ItemPrevalence and factors associated with anti-malarial drugs self- medication among first-year undergraduate students at Makerere University Kampala, Uganda(Makerere University, 2025)Malaria is a potentially life-threatening disease that requires timely and accurate diagnosis followed by prompt treatment. As such, self-medication can be risky and may lead to improper management of the illness. While self-medication for malaria using over-the-counter drugs is common in many parts of Sub-Saharan Africa, including Uganda, limited research has focused on its prevalence and associated factors among first-year undergraduate students at Makerere University in Kampala. This study set out to assess the prevalence of anti-malarial self-medication and identify the factors influencing this practice among first-year students at the university. The study aimed to assess the prevalence, associated factors and perceptions related to anti-malarial self-medication among first year undergraduate students at Makerere University. The findings are intended to inform policies and interventions aimed at regulating self- medication practices within the institution. A cross-sectional study design employing quantitative data collection methods was conducted among first year undergraduate students at Makerere University, Kampala Uganda with an estimated sample size of 608 participants. Stratified sampling was used to ensure representation across the different colleges. Data were collected using a structured questionnaire administered by trained research assistants. The questionnaire capture information on individual factors, medical related factors, healthcare system related factors, knowledge about malaria and self- medication as well as perceptions towards self-medication practices. Data analysis was performed using STATA Corp version 16. Chi square tests and Modified Poisson regression were used to identify factors associated with antimalarial self-medication. In this study, 46% (120/259) of respondents who reported experiencing a malaria episode in the past six months self-medicated with antimalarial drugs. The most common used drug was coartem (95%,114/120), followed by fansidar (21.6%, 26/120) and chloroquine (10.8%, 13/120). Several factors were significantly associated with self-medication. Married students were more likely to self-medicate compared to their single counterparts [APR: 1.59; 95% CI: (1.14–2.23)]. Students who reported waiting times longer than two hours at health facilities also had a higher likelihood of self-medication [APR: 1.47; 95% CI: (1.06–2.04)]. Conversely, the availability of anti-malarial drugs at health facilities was associated with a reduced likelihood of self-medication [APR: 0.69; 95% CI: (0.55–0.86)], as was trust in the quality of healthcare services [APR: 0.76; 95% CI: (0.60–0.96)].The majority of students reported that they were not confident in their ability to take anti-malarial medication correctly without a professional prescription or to manage potential side effects or adverse reactions that might result from self-medication.