Uganda Management Institute

Contamination of drinking water by potentially toxic elements (PTEs) remains a critical public-health concern in Uganda. This systematic review compiled and harmonized quantitative concentrations (mg/L) for key PTEs, lead (Pb), cadmium (Cd), arsenic (As), chromium (Cr), mercury (Hg), copper (Cu), zinc (Zn), nickel (Ni), cobalt (Co), manganese (Mn), and iron (Fe), across various potable and informal water sources used for drinking, including municipal tap water, boreholes, protected and unprotected springs, wells, rainwater, packaged drinking water, rivers, lakes, and wetlands. A comprehensive search of different databases and key institutional repositories yielded 715 records; after screening and eligibility assessment, 161 studies met the inclusion criteria, and were retained for final synthesis. Reported PTE concentrations frequently exceeded WHO and UNBS drinking water guidelines, with Pb up to 8.2 mg/L, Cd up to 1.4 mg/L, As up to 25.2 mg/L, Cr up to 148 mg/L, Fe up to 67.3 mg/L, and Mn up to 3.75 mg/L, particularly in high-risk zones such as Rwakaiha Wetland, Kasese mining affected catchments, and Kampala’s urban springs and drainage corridors. These hotspots are largely influenced by mining activities, industrial discharges, agricultural runoff, and corrosion of aging water distribution infrastructure, while natural geological conditions contribute to elevated background Fe and Mn in several regions. The review highlights associated health implications, including neurological damage, renal impairment, and cancer risks from chronic exposure, and identifies gaps in regulatory enforcement and routine monitoring. It concludes with practical recommendations, including stricter effluent control, expansion of low-cost adsorption and filtration options at household and community level, and targeted upgrades to water-treatment and distribution systems to promote safe-water access and support Uganda’s progress toward Sustainable Development Goal 6.

BackgroundLow Vitamin D levels are prevalent among people living with HIV (PLWH) on antiretroviral therapy (ART) and are associated with dyslipidemia and cardiovascular risk. This study examined the association between atherogenic indices and low vitamin D levels among PLWH in Southwestern Uganda.MethodsWe conducted a cross-sectional study among 218 randomly selected PLWH who had been on ART for ≥6 months at Mbarara City Health Centre IV, Southwestern Uganda from August 13, 2024 to August 23, 2024. Low serum Vitamin D level was defined as serum 25-hydroxyvitamin D concentration <30 ng/mL.ResultsAtherogenic combined index (ACI), high-sensitivity C-reactive protein (hs-CRP)/HDL-C ratio, and total cholesterol to high density lipoprotein cholesterol - body mass index (TC/HDL-C-BMI) index were independently associated with low vitamin D. Compared to the first tertile, ACI second and third tertiles had higher likelihood of low vitamin D (aPR = 2.23, 95% confidence interval (CI): 1.28-3.89, P = 0.005; aPR = 2.53, 95% CI: 1.05-6.05, P = 0.023). The high-sensitivity C-reactive protein to high-density lipoprotein cholesterol (hs-CRP/HDL-C) ratio third tertile was also significant (aPR = 1.44, 95% CI: 1.05-1.96, P = 0.024). TC/HDL-C-BMI index third tertile showed nearly twice the prevalence (aPR = 1.95, 95% CI: 1.10-3.45, P = 0.023).ConclusionACI, hs-CRP/HDL-C ratio, and TC/HDL-C-BMI index are potential predictors for Low serum Vitamin D levels among PLWH.

Outpatient therapeutic care (OTC) programs are essential for managing severe acute malnutrition (SAM) among children under 5 years. However, default rates in northern Uganda remain high- reaching up to 21.9%. This study explored the experiences of health workers delivering OTC services on outpatient therapeutic care treatment default at Gulu regional referral hospital (GRRH). This was a qualitative descriptive study that employed phenomenology. Semi structured interviews were conducted with nine purposively selected health workers. All interviews were transcribed verbatim and analyzed thematically. Six core themes emerged from the data analysis: organization of the OTC program, causes of treatment default, consequences of default, management and prevention strategies, programmatic challenges, and recommendations for program improvement. Many health workers described multiple drivers of default, including structural and systemic barriers (e.g., long distances, transport costs, RUTF stockouts, staff absenteeism, and seasonal farming), caregiver-level challenges (e.g., Domestic violence, long distances, transport costs, family separation, poverty, seasonal farming, inadequate social support, and cultural beliefs), health literacy gaps (e.g., misinformation, misconceptions and negligence), and child-level clinical complications (comorbidities e.g., HIV, TB, cerebral palsy). Outpatient therapeutic care treatment default is driven by a complex intersection of health system and structural limitations, caregiver socio-economic challenges, and child-related factors. Addressing these requires strengthening defaulter tracing via systematic tracking and community follow up, decentralizing OTC services to lower level facilities with dedicated staff, and ensuring consistent RUTF supply, staffing, and clinic schedules.

BackgroundDolutegravir (DTG)-based antiretroviral therapy (ART) has been associated with weight gain and obesity which are also linked to hepatocellular dysfunction. Despite these associations, the link between obesity indices and hepatocellular damage among people living with human immunodeficiency virus (PLWH) on DTG-based ART remains poorly understood. This study examined the association between obesity indices and elevated serum transaminases, markers of liver damage, among PLWH on DTG-based ART in Southwestern Uganda.MethodsWe conducted a cross-sectional study among 212 PLWH aged 18years and above who had been on DTG-based ART for ≥1 year at Municipal Health Centre IV, Southwestern Uganda. Data was collected using a semi-structured questionnaire. Anthropometric measurements were taken, and a blood sample collected from each participant for laboratory measurement of serum alanine and aspartate transaminase activity.ResultsElevated serum transaminase activity was found in 12.7% (27/212, 95% confidence interval (CI): 8.9%-18.0%) of participants. Participants with elevated transaminases had significantly higher median waist-to-hip ratio (0.88 vs 0.83, P < 0.001) and waist circumference (WC) to body mass index (BMI) ratio (3.56 vs 3.42, P = 0.026) compared to those with normal activity. In multivariate analysis, only WC/BMI ratio remained significantly associated (aOR = 3.68; 95% CI: 1.11-12.16; P = 0.033) with elevated serum transaminase activity. At an optimal cut-off of 3.45; sensitivity = 78%, specificity = 52%), WC/BMI had significantly predictive power, (area under the curve= 0.651; 95% CI: 0.580-0.722) for elevated serum transaminase activity.ConclusionWC/BMI ratio is a potential predictor of elevated transaminases among PLWH on DTG-based ART in South western Uganda.

Abstract Introduction Dyspepsia affects 6.9% of people globally and significantly impairs quality of life, yet it often remains undiagnosed. Undiagnosed dyspepsia (UD) affects up to one-third of patients and is prevalent among students due to stress, irregular eating, and self-medication. In Uganda, limited access to endoscopy results in many cases being undiagnosed, yet recent data among health professional students remains scarce. Objective To determine the prevalence of UD, associated factors, and its relationship with QoL among undergraduate health professional students at Makerere University. Methods This was a cross-sectional study involving 378 undergraduate health professional students from Makerere University between March and April 2025. Participants were pursuing Medicine and Surgery, Nursing, Pharmacy, and Dental Surgery, aged ≥ 18 years, and were selected by stratified simple random sampling. Data on socio-demographics, lifestyle, and dyspeptic symptoms were collected using a structured questionnaire based on various tools. Data was analyzed using STATA 17 in the survey window. Prevalence of UD was estimated with 95% confidence intervals. Modified Poisson regression was used to determine associated factors, while mixed-effects linear regression was used to analyze the relationship between dyspepsia and quality of life. Results The prevalence of undiagnosed dyspepsia (UD) was 13.5% (95% CI: 10.2–17.4). Drinking tea, either some days (aPR = 0.424; 95% CI: 0.197–0.913) or daily (aPR = 0.345; 95% CI: 0.167–0.713), and engaging in high physical activity (aPR = 0.374; 95% CI: 0.151–0.927) were associated with a protective effect. Predisposing factors were eating two meals daily (aPR = 2.637; 95% CI: 1.213–5.733), alcohol use (aPR = 1.775; 95% CI: 1.062–2.966), moderate fatigue (aPR = 1.842; 95% CI: 1.126–3.011), underweight Body Mass index (aPR = 2.202; 95% CI: 1.038–4.675), and longer sleep duration (aPR = 1.925; 95% CI: 1.156–3.204). No significant association was found with quality of life (p = 0.217). Conclusion The prevalence of UD among undergraduate health professional students was moderately high, though not significantly associated with quality of life. Targeted health education that promotes regular physical activity, addresses fatigue, and discourages excessive alcohol and coffee consumption may help reduce the burden of UD in this population.

ABSTRACTEdible oil and chitosan were extracted from the flour of four edible winged termite species (Macrotermes subhylanus, Macrotermes bellicosus, Pseudocanthotermes spriniger, and Odontotermes lateritius), characterized for physico‐chemical properties, and the antimicrobial activity of extracted chitosan was assessed against Staphylococcus aureus, Escherichia coli, and Candida albicans. Mechanical pressing yielded the significantly highest oil quantity (37.42%–38.50%) throughout all the species, followed by microwave‐assisted oil extraction. Overall, the significantly lowest oil yield was observed in the conventional soxhlet extraction method (8.05%–18.92%). Generally, the extracted termite oils appeared as clear, golden‐to‐light yellow liquids. Oil solidification temperature ranged from 10.1°C to 12.9°C, whereas the refractive index ranged from 1.23 to 1.46. Mechanically pressed oil produced the highest iodine (111–121 g iodine/100 g oil) and saponification value (110.41–113.92 mg KOH/g). The total cholesterol content of termite oils ranged from 24.98 to 39.00 mg/100 mL, and ultrasound‐assisted oil extraction yielded the lowest total cholesterol content. M. bellicosus oil had the highest total cholesterol content. Fermentation yielded the highest demineralization percentage (93.8%–96.0%), whereas the chemical method produced the highest deproteinization percentage (42.59%–49.71%) and chitosan yield (6.05%–7.00%). M. subhyalinus and M. bellicosus produced higher chitosan yields than other termite species. Termite chitosan showed the highest antimicrobial activity against E. coli, followed by S. aureus. Chemically‐extracted chitosan exhibited higher antimicrobial activity than enzymatically extracted chitosan. From the present study, edible winged termites can be utilized as an unconventional source of chitosan for antimicrobial activity and low cholesterol edible cooking oil.

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.

Patients with hypertrophic cardiomyopathy (HCM) are commonly affected by ventricular tachyarrhythmias such as ventricular tachycardia, leading to syncope and sudden cardiac death (SCD). Complete atrioventricular (AV) block in patients with HCM is very unusual but may also lead to syncope and SCD. We report a 52-year-old male who presented with recurrent episodes of pre-syncope and effort intolerance. A 12-lead ECG demonstrated deep T-wave inversion in the precordial leads with complete AV dissociation, and a two-dimensional echocardiogram revealed HCM without resting or provoked left ventricular outflow tract obstruction. The patient initially got a temporary transvenous pacemaker, followed by a dual-chamber rate-responsive pacemaker, which was subsequently upgraded to a dual-chamber implantable cardioverter-defibrillator after further risk stratification. Although rare, there have been a few reported cases of HCM complicated by atrioventricular block. This case should alert physicians to the possibility of atrioventricular block in patients with HCM, which could influence the management outcomes.