Makerere University

Image 1.

Blended oxygen has been shown to reduce severe retinopathy of prematurity (ROP) incidence worldwide, and more recently in Uganda. Although it has been established that ROP-driven visual impairment has a substantial societal burden and that screening and treatment programs are cost-effective in low- and middle-income countries, there is limited evidence for the economic impact of prevention with appropriate oxygen management equipment (OME) in these regions. We performed a cost-utility analysis of OME implementation comparing variations ranging between most and least favorable values. Disability-adjusted life years (DALYs) were calculated with a 3% discount rate. Calculations assumed a 62.1% incidence of visual impairment in untreated severe ROP and a disability weight of 0.184 for severe visual impairment due to ROP. One set of OME costs between $677.50-$1,844.11 USD in Uganda. We found that the cost to prevent one case of ROP-driven severe visual impairment in Uganda ranges from $25.55-$543.99, with a base case (best estimate) of $168.92 per case averted. This reflects 5.18 DALYs averted over the 58-year average Ugandan lifespan and a cost of $4.97-$104.98 to avert one DALY, with a base case of $32.60 per DALY averted. In comparison, prevention of malaria via mosquito net distribution was estimated in a 2020 meta-analysis to cost $50 for every DALY averted. The high-end estimate is roughly 10% of the annual gross domestic product per capita ($1,002.30). Therefore, OME is a cost-effective means to prevent severe visual impairment among infants in Uganda. Implementation of OME in Uganda would also reflect a clear ethical and humanitarian success.

Cancer cachexia, a multifactorial syndrome of weight loss, muscle wasting, anorexia, and systemic inflammation, often goes unaddressed. Healthcare professionals at Uganda Cancer Institute (UCI) face substantial clinical workloads, limited resources and constrained access to guideline-based practice and limited multi-modal care, all of which adversely affect cancer cachexia recognition and management. To assess UCI professionals' knowledge levels, practice patterns, and attitudinal barriers regarding cancer-cachexia care. A longitudinal quasi-experimental pre-post study design using mixed methods was conducted among 50 healthcare professionals. Quantitative data were collected using an ASCO/ESMO/GLIM-adapted questionnaire and analyzed with McNemar's test, Chi-square tests, and Wilcoxon signed-rank tests (STATA-v18). In-depth interviews with 10 purposively selected participants were thematically analyzed using NVivo-v15. Participants were predominantly nurses (72%), the median age was 37 years, with 7 years of oncology experience, 64% were female. At baseline, 44% reported no prior cachexia training and assessments were largely subjective and conflated with malnutrition. Post-intervention, awareness of ASCO guidelines increased significantly to 89%, misconceptions regarding nutritional reversibility declined (p = 0.0097), and confidence in cachexia management rose by 36%. Evidence-based practices, including oral nutrition prioritization (p = 0.024), short-term corticosteroid use (p = 0.025), and anti-inflammatory therapy (p = 0.034), improved significantly. Confidence in management rose by 36% and non-assessment decreased, with modest gains in cachexia-specific assessment. Improving cachexia care in resource-limited settings requires structural integration into routine oncology practice more than individual awareness, through increased staffing, training, leadership, interdisciplinary coordination, and locally adapted guidelines.

HIV exposure in utero is associated with low birth weight (LBW), even in the absence of vertical transmission. To explore mechanism, we evaluated endothelial markers angiopoietin (Ang)-1 and Ang-2 among 294 uninfected Ugandan infants born to women with HIV (WWH). The median Ang-2/Ang-1 ratio was 0.051 [interquartile range (IQR) 0.023-0.19] among infants with LBW and 0.018 (IQR 0.010-0.037) among controls (P = 0.00011). Endothelial dysregulation may contribute to LBW among infants born to WWH.

Down syndrome (DS) is the leading chromosomal abnormality globally and contributes to 10% of all congenital heart diseases. Approximately half of the children with DS present with congenital heart diseases (CHD) and are prone to the early development of pulmonary hypertension, leading to increased morbidity and mortality. This study aimed to evaluate cardiac screening practices and experiences for children with DS at Mulago National Referral Hospital (MNRH), Uganda. A cross-sectional multimethod study was conducted among children below 3 years with DS and their caretakers at four pediatric wards and outpatient clinics at MNRH. A research assistant-administered questionnaire was used to document participants’ demographics, history of cardiac screening, and outcomes of echocardiography and chest radiography. Key-informant and in-depth Interviews were conducted with healthcare providers and caretakers of children with DS, respectively, to explore their knowledge, practices, and barriers related to cardiac screening. Quantitative data were analyzed in STATA 15, while qualitative data were thematically analyzed using Atlas ti. A total of 61 children were recruited over 22 months, of which 31 (50.5%) were female. The mean age was 5.9 months (SD: 2.2), however, only 47 (77.1%) had undergone echocardiography, suggesting delays in early cardiac screening. The prevalence of CHD was 97.9%. The most common defects were patent-ductus arteriosus (PDA) (59.6%) and atrioventricular septal defect (36.2%). Only 12 (19.7%) children had undergone chest radiography, most frequently showing cardiomegaly (26.7%) and heterogeneous opacities (20%). Financial constraints were the main barrier to echocardiography (71.4%), while lack of healthcare worker requests limited chest radiography (77.1%). Parents and healthcare providers emphasized the importance of cardiac screening for early detection and management of cardiac defects. They recommended subsidizing or waiving screening fees and providing counselling to caretakers prior to screening to improve access. Nearly eight in ten children with DS at MNRH underwent echocardiography, revealing CHD in 97.9%, with PDA being the most common. Although the importance of cardiac screening was recognized, financial barriers and lack of imaging requests limited access. Strengthening access to routine early cardiac screening is essential to improve quality of care for children with Down syndrome in this setting.

Large-scale food fortification remains a critical strategy for reducing micronutrient deficiencies, but its effectiveness depends on whether industries consistently fortify foods to standard. This review synthesizes global evidence on industry compliance across major food vehicles, including salt, wheat flour, maize flour, edible oil, sugar, and condiments, and applies the findings to Uganda’s programme improvement agenda. A systematic review was conducted using peer-reviewed articles, programme evaluations, policy analyses, survey reports, and Uganda-specific regulatory documents retrieved from academic databases and institutional sources. The synthesis incorporated evidence from Africa, Asia, and Latin America, including Uganda and comparator settings such as Senegal, Tanzania, Kenya, Nigeria, Malawi, Mozambique, Bangladesh, India, Indonesia, Chile, and Costa Rica. The evidence shows that compliance is shaped by regulatory clarity, market structure, premix and equipment costs, quality assurance, external monitoring, political commitment, and credible enforcement. Compliance tends to be stronger in centralized industries such as wheat flour and edible oil, but weaker in fragmented maize markets and among smaller millers. Across countries, a persistent fortification quality gap remains between foods that are legally covered or reportedly fortified and foods that are adequately fortified at production, market, and household levels. Uganda reflects this broader pattern: although the legal and policy framework is established, compliance remains uneven across food vehicles, with stronger adherence among salt, wheat flour, and edible oil producers than among maize millers. Therefore, Uganda should strengthen production-based verification, improve inter-agency coordination, adopt differentiated compliance strategies by processor scale and vehicle, and invest in practical monitoring and enforcement systems that make sustained compliance feasible.

BackgroundVaccine hesitancy is a growing concern worldwide, particularly among caregivers of vulnerable populations such as children. We determined the prevalence and factors associated with vaccine hesitancy among caregivers of children under five years in northern Uganda.MethodsA cross-sectional analytical study was conducted in the Pece-Laroo Division, utilizing a multistage sampling technique to select caregivers of children under 5 years who provided written informed consent. Vaccine hesitancy and its underlying reasons were assessed using a two-part approach: a screening question followed by open-ended probing. A pre-tested structured questionnaire was administered to collect data, which was then analyzed using Stata version 18. A P < 0.05 was considered statistically significant.ResultsOverall, 393 of the expected 427 participants were enrolled (response rate: 92.0%). In total, 40% (n = 157) of the participants were hesitant. The main reasons for hesitancy were lack of information (41.4%, n = 65), fear of side effects (14%, n = 22), and cultural beliefs (17.3%, n = 28). Multivariate analysis revealed that caregivers with two children under 5 years were more likely to be hesitant compared to those with one child (aOR = 1.96, 95% CI 1.16–3.30, p = 0.011). Additionally, caregivers with a monthly income of 100,000–500,000 UGX were less likely to be hesitant compared to those earning less than 100,000 UGX [< $27 USD] (aOR = 0.53, 95% CI 0.32–0.88, p = 0.014).ConclusionVaccine hesitancy remains high among caregivers in Northern Uganda, with 2 in 5 of participants expressing hesitancy. To reduce hesitancy and improve timely vaccination, immunization programs should prioritize young mothers with multiple young children through digital-first outreach.

RaTexT®, an innovative rapid tick exposure test, was recently developed to provide farmers with quick, on-site results to improve their acaricide resistance management. This was achieved by exposing partially engorged adult ticks to a specially designed acaricide-impregnated matrix fitted inside a transparent polypropylene box. Each RaTexT® box contains six strips of four small, interconnected compartments, in which ticks are exposed immediately after removal from cattle in the field. In this study, we assessed whether a single strip of four interconnected compartments, instead of six strips, was sufficient to accurately detect resistance to deltamethrin and to a combination of cypermethrin, chlorpyrifos and piperonyl butoxide (PBO). We also statistically analysed the optimal number of ticks per compartment (ranging between 5 and 8). Moreover, the test reproducibility was checked by two independent observers who counted dead and live ticks in each compartment. Finally, a comparative analysis was undertaken between adult ticks exposed in RaTexT® and in the adult immersion test (AIT), and also with larvae in the resistance intensity test (RIT) and in the larval packet test (LPT). The novelty of this study lies in comparing adult ticks exposed in RaTexT and in the AIT Test, thereby overcoming limitations of previous studies, in which adults in RaTexT were compared with larvae in the LPT. The internal coefficient of variation (CV) was calculated for each dose, box and acaricidal product to assess within-box consistency. The effect of the number of ticks per compartment (n = 5-8) was examined using Monte Carlo simulations. Inter-observer reliability of reading RaTexT® was statistically measured using Cohen's kappa coefficient (κ). The comparative performance analysis of the bioassays was conducted using generalised linear models (GLMs) with laboratory and field strains of Rhipicephalus microplus ticks in Brazil. Overall agreement between individual strips and their corresponding box classification was 91.3%, indicating high consistency between replicates. The predefined threshold of ≥ 90% accuracy was met by a single strip, supporting the test's robustness even with minimal replication. The internal coefficient of variation within each RaTexT® box was high for deltamethrin (1.285 at 1× dose, 1.109 at 5× dose and 1.268 at 10× dose), but lower for cypermethrin/chlorpyriphos/PBO (0.648 at 1, 0.305 at 5× dose and 0.194 at 10× dose). Variability in the controls was relatively high (CV 1.776). Monte Carlo simulations showed that diagnostic accuracy gradually increased from 81.2% with five ticks to 86.1% with eight ticks per compartment. Furthermore, there was substantial agreement between the mortality of ticks assessed by two independent observers (κ = 0.664). Finally, the comparative test analysis revealed that the deltamethrin resistance level in RaTexT® matched that observed in the AIT. Resistance to deltamethrin was also confirmed by the LPT, with resistance ratios (RR) of 33.8 and 39.5 for two different field strains (Biotech and UFRRJ, respectively). For cypermethrin/chlorpyriphos/PBO, RaTexT® exhibited significantly lower mortality than the AIT. Resistance was also confirmed by LPT, with RR of 5.2 for Biotech strain and 7.2 for the UFRRJ strain. Overall, these findings demonstrate that RaTexT® is accurate and reproducible with a single test strip, making it a practical and cost-effective test that complements traditional laboratory bioassays.