Uganda Cancer Institute

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.

PurposeThis study aimed to determine the prevalence, morphological classification, and factors associated with anemia among neonates at Soroti Regional Referral Hospital neonatal unit.Patients and MethodsWe conducted a hospital-based cross-sectional study among 239 neonates between June and August 2025. Data on sociodemographic characteristics of neonates and mothers were collected using structured questionnaires and a review of medical records. Venous blood was collected from mothers during labor and cord blood was collected within 30 minutes of delivery or in situation where cord blood was not collected, then venous blood was collected from neonates. Hemoglobin estimation was done using a Nihon Kohden automated analyser. Neonates with umbilical cord hemoglobin <13 g/dL and mothers with venous blood haemoglobin <11 g/dL were classified as anemic. For anemic neonates, Giemsa-stained blood smears were examined to determine morphological type of anemia and screen for malaria parasites. Bivariate and multivariate logistic regression analysis were employed to identify factors associated with neonatal anemia, with a p-value ≤0.05 considered statistically significant.ResultsThe median age for neonates in days was 1 day and ranged from 0 to 27 days. The prevalence of neonatal anemia was 11.7% (95% CI: 7.6–15.8). Normocytic normochromic anemia was the most frequent morphological type (78.6%), followed by normocytic hypochromic (10.7%) and microcytic hypochromic anemia (10.7%). Multivariate analysis identified four factors independently associated with neonatal anemia: maternal history of anemia (AOR: 5.39 [95% CI: 1.15–25.32], p=0.033), lack of iron-folate supplementation during pregnancy (AOR: 6.62 [95% CI: 2.23–19.7], p=0.001), infrequent consumption of fruits and vegetables (AOR: 6.52 [95% CI: 1.23–34.48], p=0.027), and the presence of maternal anemia at delivery (AOR: 5.48 [2.11–14.21], p<0.001).ConclusionThis study confirms that neonatal anemia is a persistent health issue in eastern Uganda. The identified risk factors are primarily rooted in maternal health and nutrition. Our findings underscore the imperative for integrative antenatal strategies that combine nutritional education, promotion of iron-folate supplementation, and proactive management of maternal anemia to effectively reduce the burden of neonatal anemia.

Although radiotherapy is an essential part of comprehensive cancer care, access is heavily limited in most sub-Saharan African (SSA) countries. Patients' barriers to care can be grouped as availability, accessibility, accommodation, affordability, and acceptability. We aimed to assess cancer patient- and caregiver-reported barriers in nine SSAn countries (Republic of the Congo, Ethiopia, Gabon, Kenya, Mali, Nigeria, Tanzania, Uganda, and Zimbabwe). We conducted a telephone-based survey among 553 randomly selected patients with breast, cervical, colorectal, and prostate cancer, Kaposi sarcoma and non-Hodgkin lymphoma diagnosed between 2018 and 2019 registered in population-based registries of the African Cancer Registry Network. We inquired about receipt of radiotherapy and barriers irrespective of recalling a recommendation. Among all categories, 21.6% (Use of alternative medicine) to 39.6% (Cost of treatment) of patients reported severe barriers. Most common was problematic Cost of treatment (69.0% overall). A high share of patients from Congo, Kenya, Nigeria, and Tanzania reported barriers. Higher education and wealth were associated with reduced problems in all categories except increased problems with Fear and Use of alternative medicine. Receipt of radiotherapy was associated with fewer problems with Availability of transport (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.13-0.88) and Trust in healthcare workers (OR: 0.44; 95% CI, 0.24-0.8), and increased Fear (OR: 2.33; 95% CI, 1.33-4.05). Seeing that one-third of the patients reported severe problems in all dimensions, shortage of radiotherapy units is not the only problematic aspect of access to radiotherapy. Improvements in affordability, patient-healthcare worker communication, and psychosocial support are needed.

The increasing global use of unvalidated herbal products poses substantial health risks, highlighting the importance of rigorous toxicity evaluations. In the Elgon sub-region, Rhoicissus tridentata extracts are traditionally used to treat prostate cancer, but the absence of standardized dosages restricts their potential use and limits evidence for informing chemotherapeutic applications. This study aimed to investigate the subacute toxicity of R. tridentata extracts in Wistar albino rats. We used 84 Wistar albino rats to assess clinical toxicity symptoms, hematological and biochemical parameters, and histopathological changes using advanced equipment like hematology machines and COBAS INTEGRA Chemistry Plus 600. A total of 84 Wistar albino rats were used to assess clinical symptoms, hematological, biochemical parameters and majar organ histopathological changes. Histological biomarkers were analyzed using Coulter Counter Hamatology analyzer while biochemical indices were analyzed using COBAS INTEGRA Chemistry Plus 600, but eosinophils increased significantly (p ≤ 0.0001), confirming mild toxicity. To guarantee the safe use of R. tridentata in therapy, determining the maximum dose that produces no adverse effects (NOAEL) is essential to inform dosing in sub-chronic and sub-acute toxicity. Regulatory agencies evaluating herbal products containing R. tridentata should exercise caution and require standardized dosing protocols and comprehensive toxicity assessments to safeguard public health.

ABSTRACT Several systematic reviews have been published on psychosocial care interventions (PCIs) in cancer care. However, there are limited systematic reviews and meta-analyses (SRMA) on the effectiveness of PCIs in cancer care for adults patients in low- and-middle income countries (LMICs). This study aimed at synthesizing the available evidence on the effectiveness of PCI in improving the quality of life (QoL) of adult cancer patients in LMICs. We registered the protocol with PROSPERO (ID: CRD4202342156) before conducting this SRMA. Studies published between 2002 and 2023 were searched from MEDLINE, Web of Science, EmBASE and APA PsycINFO. We followed the standard guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results of the pooled studies were analysed using MedCalc version 10.10 statistical software. Twenty-six intervention studies were included in this SRMA. The Eastern Mediterranean WHO region had the highest number of studies and Africa region had the least. Most studies utilised Cognitive Behavioural therapy-related interventions (38%, n = 10 studies), while Family systems therapy 4% (n = 1) was the least utilised. From the subgroup analyses of the means and standard deviations of domains of QoL in the pooled primary studies, the respective standardized mean differences indicated that the PCIs had a significant positive effect on the physical (0.972: p = 0.002), social (0.884: p = 0.005) and psychological (0.590: p = 0.03) domains of QoL of adult cancer patients. However, some PCIs did not improve the QoL of study participants. Generally, PCIs effectively improved most domains of the QoL of adult cancer patients. However, more research is needed for PCIs that had a negative effect on some domains of the QoL of cancer patients. Lastly, there is need for LMICs to prioritise resources to strengthen the integration of psychosocial care interventions in cancer care to meet the different QoL sub-domains of patients with cancer.

ABSTRACTObjective To identify modifiable intensive care unit factors associated with outcomes among patients receiving invasive mechanical ventilation in a low-income setting.Methods This prospective, multicenter, registry-embedded observational study has two components: a prospective registry-based cohort assessing patient- and care-process-related factors and a cross-sectional intensive care unit survey evaluating organizational structure. Functional intensive care units in Uganda will be included. Patients aged ≥ 15 years old requiring invasive mechanical ventilation will be enrolled. Patients extubated within 48 hours, transferred after > 24 hours, and imminent early death will be excluded. Primary outcomes will include 28-day intensive care unit mortality, intensive care unit length of stay, and mechanical ventilation duration. Tracheostomy-related outcomes will be explored in a pre-planned sub-study. Factors potentially associated with outcomes will be categorized into non-modifiable and potentially modifiable factors. Non-modifiable factors will include patient-related factors like age, comorbidities, and illness severity; potentially modifiable factors include processes of care (e.g., sedation levels) and intensive care unit organizational structure (e.g., staffing patterns). Multilevel multivariable logistic regression models will assess association outcomes. Survival analysis (Kaplan-Meier curves) will explore mortality trends. Confounders will be identified using directed acyclic graphs.Results (anticipated findings) This study will generate high-quality data on modifiable intensive care unit factors associated with ventilated patient outcomes in low-resource settings.Conclusion This is Uganda’s first registry-embedded, multicenter intensive care unit study to systematically potentially modifiable factors associated with ventilated patient outcomes. This study will provide evidence-based insights to optimize critical care management in low- and middle-income countries by leveraging real-time intensive care unit registry data.

Abstract Background: Chronic gastritis is marked by persistent stomach mucosal inflammation due to a variety of etiologies but more commonly driven by Helicobacter pylori (H. pylori) infection, affecting over half the global population and increasing gastric cancer risk. This study investigated H. pylori prevalence, its demographic and histopathological associations among chronic gastritis patients in Uganda. Methods: A cross-sectional laboratory study analyzed 150 formalin-fixed paraffin-embedded tissue blocks from chronic gastritis patients using H&amp;E and modified Giemsa stains. Data was analyzed with STATA version 17, determining prevalence through proportions, assessing associations using Chi-square tests and Fisher exact test, and conducting multivariate analysis with logistic regression. Significance was set at p≤0.05 with 95% confidence intervals. Results: The study included 150 patients (male-to-female ratio 1.5:1; mean age 48 years, SD=17, range 12–89). H. pylori prevalence was 29.3%. Significant associations were observed with age (p=0.033), chronic inflammation (p=0.009), neutrophil activity (p&lt;0.001), and intestinal metaplasia (p=0.045), but not sex (p=0.796). Multivariate analysis confirmed associations with severe chronic inflammation, neutrophil activity, and intestinal metaplasia, highlighting H. pylori’s role in disease severity. Conclusion: H. pylori infection, with a 29.3% prevalence, significantly contributes to chronic gastritis in Uganda. Its associations with age, chronic inflammation, neutrophil activity, and intestinal metaplasia emphasize the need for targeted eradication programs, particularly for adults, to prevent progression to severe gastric pathology, regardless of sex.

BackgroundThe treatment outcomes for children and adolescents with rhabdomyosarcoma (RMS) in low-income countries are poor. However, there is a paucity of literature on RMS and its management outcomes in low-resource settings. We evaluated the treatment of RMS with the aim of identifying prognostic factors during management to improve outcomes.MethodsWe sourced data on children under 18 years treated for rhabdomyosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Kaplan-Meier survival analysis and Cox’s proportional hazards model were used for five-year survival analysis.ResultsOne hundred twenty-eight RMS cases were identified, with a median age of 6.0 years (IQR 3.6–10.0). The most common primary tumour site was the head and neck region, comprising non-parameingeal sites, 37 (28.9%); parameingeal sites, 32 (25.0%); and orbital tumours, 17 (13.3%). Overall, 68 (53.1%) of the primary tumour sites were unfavourable sites. Seventeen (13.3%) patients had metastatic disease at diagnosis, primarily to the lungs, 11 (64.8%). Embryonal and alveolar RMS accounted for 50.0% and 20.3% of the cases, respectively. Only 31 (24.2%) of the patients underwent surgery, and 36 (28.1%) were irradiated. The treatment completion rate was 33.6%, while 46.1% abandoned treatment. Only 25 (19.5%) patients were alive at the time of the study, 65 (50.8%) had died, and 38 (29.7%) had an unknown status. The five-year overall and event-free survival rates were 35% and 30%, respectively. Orbital primary tumour site (HR = 2.86; 95% CI 1.12–7.31; p = 0.028), metastatic disease (HR = 4.09; 95% CI 2.01–8.31; p < 0.001), elevated serum lactate dehydrogenase at diagnosis above 400 U/L (HR = 2.80; 95% CI 1.46–5.33; p = 0.002), and lack of local control (HR = 3.33; 95% CI 1.34–8.29; p = 0.010) were significant factors for poor survival.ConclusionRhabdomyosarcoma outcomes in Ugandan children are largely poor, with high treatment abandonment and mortality. Concerted, multidisciplinary efforts are needed to improve outcomes in this setting.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14735-3.

BackgroundWasting contributes to poor treatment outcomes in children with cancer, especially in low-resource settings. In these settings, there is inadequate routine, systematic assessment of the wasting status of children with cancer. Wasting is diagnosed based on visual evidence, with a subjective bias for recognition. This study determined the prevalence of wasting at diagnosis among children with cancer at the Uganda Cancer Institute (UCI) and the diagnostic accuracy of “visible wasting” in identifying children with wasting as measured by anthropometric indices, and identified predictors of 6-months negative outcomes.MethodsWe assessed the wasting status at diagnosis, diagnostic accuracy of visible wasting, and 6-month outcomes of children newly diagnosed with cancer at the UCI (both ambulatory and hospitalized) between April 2022 and March 2023. Data were analyzed using SPSS version 26. Descriptive, bivariate, multivariate, and survival analyses were performed as appropriate. Statistical significance was determined at P-value<0.05.ResultsOne hundred forty-four children with cancer, with a median age of 10.0 years (interquartile range [IQR] 4.0–14.0 years), were included. The majority, 89 (61.8%), had solid tumor, whereas 55 (38.2%) had hemato-lymphoid malignancies. Thirty-two (22.2%) of the participants had visible wasting, and 57 (39.6%) were wasted based on anthropometric measurements, 32 (56.1%) of whom showed no visible wasting. Visible wasting had a low sensitivity of 43.9% (95% CI 30.7–57.6) – ROC 0.32 (95% CI 0.23–0.42), with a false negative rate of 56.1%. Overall, visible wasting missed up to 80.6% (25/31) of children with moderate wasting and 26.9% (7/26) with severe wasting. Twenty-one (14.6%) of the patients died, 8 (38.1%) of whom were deemed to be wasted, and 15 (71.4%) had anthropometrically-defined wasting. Neutropenia occurred in 20.8% (n = 30) of the participants and sepsis in 13.9% (n = 20). In univariate analyses, wasted patients were more likely to develop neutropenia (OR 3.63; 95% CI 1.56–8.42; p = 0.003), sepsis (OR 4.50; 95% CI 1.65–12.29; p = 0.003), and die (OR 3.08; 95% CI 1.15–8.28; p = 0.026).ConclusionWasting at diagnosis is a common problem among children with cancer in this resource-limited setting and is associated with increased risks of neutropenia, sepsis, and mortality. Reliance on visible wasting as a marker for wasting misses other wasted children, some of who may be malnourished and at risk of poor outcome. For accurate categorization of wasting, all patients should undergo a standard anthropometric evaluation.