Muni Repository (MR)
This repository contains open access publications of Muni University Library.
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Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study
(Elsevier, 2025-10-04) Ssentongo, Saadick Mugerwa; Appeli, Saidi; Izudi, Jonathan
Objectives
Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda.
Methods
We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count <200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis.
Results
Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61).
Conclusions
The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.
Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study
(Elsevier, 2025-09-12) Opolot, Godfrey; Olupot-Olupot, Peter; Okware, Samuel; Izudi, Jonathan
Rationale
People with human immunodeficiency virus (PWH) have an increased risk of multidrug-resistant TB (MDR-TB) compared to those without HIV.
Objective
To investigate the risk factors for MDR-TB among PWH in rural eastern Uganda.
Methods
We conducted a nested case–control study at Soroti Regional Referral Hospital in rural eastern Uganda. TB records from January 2017 to May 2024 were retrospectively reviewed to identify all PWH. MDR-TB was defined as resistance to at least both Isoniazid and Rifampicin following GeneXpert Mycobacterium TB and Rifampicin assay and culture-based drug-susceptible testing. Cases were PWH with MDR-TB, while controls were a random sample of PWH without MDR-TB, in a 1:3 ratio. Multivariable binary logistic regression was used to identify factors independently associated with being a case rather than a control. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported.
Results
We included 37 cases and 111 controls, and found retreatment TB was associated with being a case rather than a control (aOR 6.97; 95% CI 2.65–19.46). Male sex (aOR: 1.59; 95% CI: 0.67–3.93), clinically diagnosed pulmonary TB (aOR: 0.38; 95% CI: 0.10–1.23) or extrapulmonary TB (aOR: 0.37; 95% CI: 0.05–1.62), and recent anti-retroviral therapy initiation (aOR: 2.07; 95% CI: 0.83–5.28) were insignificantly associated with being a case.
Conclusion
This study showed that retreatment TB is associated with a higher likelihood of MDR-TB among PWH in a referral hospital in rural eastern Uganda. These findings underscore the need for intensified drug resistance surveillance and adherence support among PWH with prior TB treatment.
Adverse drug reaction reporting with the Med Safety app inUganda: a cluster-randomised, controlled trial
(Elsevier, 2025-10) Kiguba, Ronald; Ndagije, Helen B.; Mwebaza, Norah; Ssenyonga, Ronald; Giibwa, Lilian; Isabirye, Gerald; Owiny, Jonathan; Nambasa, Victoria; Ntale, Ismail; Atuhaire, Joanitah; Mwesigwa, Douglas; Mayengo, Julius; Walusimbi, David; Mugisa, Ian; Katureebe, Cordelia; Harrison, Kendal; Karamagi, Charles; Pirmohamed, Munir
Background: The massive roll-out of new and repurposed medicines in low-income and middle-income countries (LMICs) highlights the need for more efficient pharmacovigilance systems, including use of digital technologies. We assessed the effectiveness of the Med Safety app in improving suspected adverse drug reaction (ADR) reporting by health-care workers to Uganda's National Pharmacovigilance Centre.
Methods: This was a pragmatic, multicentre, open-label, cluster-randomised, controlled trial undertaken at health facilities (clusters), providing dolutegravir-based combination antiretroviral therapy in Uganda. Clusters were randomly assigned (1:1) to the intervention group or control group using a computer-generated simple randomisation sequence. In the intervention group, pharmacists with expertise in pharmacovigilance delivered 2 h of face-to-face training to health-care workers in clusters, regardless of their smartphone ownership, in Med Safety and traditional ADR reporting methods. The control group received the same training as the intervention group except for Med Safety training. The primary outcome was the cluster-level ADR reporting rate at the end of follow-up and was analysed in all sites that received the allocated intervention. The trial is registered with the Pan African Clinical Trials Registry (PACTR202009822379650) and is completed.
Findings: Between Aug 11, 2020 and Nov 1, 2022, 382 clusters were randomly assigned and 367 received the allocated intervention and were included in the primary outcome analysis (184 in the intervention group and 183 in the control group), with 2464 health-care workers (1211 in the intervention group and 1253 in the control group). The follow-up time for the included clusters was variable and was median 37·8 months (IQR 34·2–39·8). In the primary analysis, the intervention group had a higher mean overall ADR reporting rate of 10·6 (SD 17·4) reports per 100 000 person-months versus 5·9 (17·9) in the control group (incidence rate ratio 1·73 [95% CI 1·26–2·37]; p=0·001).
Interpretation: Med Safety increased ADR reporting rates among health-care workers in Uganda. Integrating digital technologies into pharmacovigilance systems could strengthen drug-safety monitoring in Uganda and other LMICs.
Radiation-induced degradation in the properties of pristine anddouble-walled carbon nanotube-enhancedpoly (2,5-benzimidazole) polymers for radiation shielding in the LEO
(Elsevier, 2025-09-01) Oryema, Bosco; Square, Lynndle; Ellis, Ernst
Degradation in the properties of polymer-based materials in space environments is a critical challenge for developing lightweight radiation shielding solutions. In this paper, a comparative study of the impacts of helium ion (He+) irradiation one of the ion species in the Low Earth Orbit (LEO) environment on the structural and optical properties of pristine and 1.0 wt% double-walled carbon nanotube (DWCNT)-enhanced poly(2,5-benzimidazole) (ABPBI) polymers for LEO radiation shielding applications was conducted. The two polymer categories were separately chemically prepared in the laboratory, moulded, dried, and cut into 1 cm × 1 cm pieces, and bombarded with 0.35 MeV He+ ions at varying fluences. The Ultraviolet–Visible-Near-Infrared (UV–Vis-NIR) optical analyses of the polymers following the ion bombardment revealed that He+ irradiation considerably raises the Urbach energy and decreases the optical bandgap, indicating a rise in electronic defects and structural disorder. On the other hand, the Fourier Transform Infrared (FTIR), Atomic Force Microscopy (AFM), and X-ray Diffraction (XRD) analyses revealed higher levels of structural degradation in the pristine ABPBI samples, suggesting changes brought about by irradiation-induced oxidation and chain scission processes. In contrast, the 1.0 wt% DWCNT-ABPBI composite demonstrated improved optical and structural integrity, retention, and resistance to He+ ion-induced damage. According to the results, 1.0 wt% DWCNT reinforcement reduces radiation-induced deterioration and offers more protection from energetic ion exposure in the LEO settings. Thus, this work highlights the distinct impact of He+ ion interactions with ABPBI and the effectiveness of DWCNT inclusion in improving polymer resilience, and it contributes to the fundamental understanding of the polymer composite for radiation shielding applications.
Prevalence and factors associated with neonatal hypothermia: a cross-sectional study among healthy term neonates in a peri-urban hospital in Northern Ugand
(Springer Nature, 2025-10-08) Akao, Mary Grace; Nalwadda, Gorrette; Epuitai, Joshua; Ayebare, Elizabeth; Ndeezi, Grace; Ratib, Dricile; Tumwine, James K
Background
Neonatal hypothermia is highly prevalent even in warm tropical countries. Neonatal hypothermia increases the risk of morbidity and mortality. In Uganda, the prevalence of hypothermia is not known among healthy term neonates.
Objective
To determine the prevalence of neonatal hypothermia and the associated factors in Lira Regional Referral Hospital.
Methods
Hospital-based cross-sectional study was conducted in Northern Uganda. The interviewer-administered questionnaires and direct observations used to determine the initiation of warm-chain practices after delivery for 271 newborns. The axillary temperature of neonates was measured at intervals of 10 min, 30 min, one hour, and 2 h after birth. The multivariate binary logistic regression was done. The 95% confidence interval (CI) and p-value < 0.05 used to identify factors significantly associated with neonatal hypothermia.
Results
Neonatal hypothermia was 67.6% during the first two hours postnatal. Neonatal hypothermia was 64.5% at 10 min, 81% at 30 min, 76% at one hour and 49% at two hours postnatal. Hypothermia was significantly associated with low birth weight (Adjusted odds ratio (AOR) = 2.78; 95% CI: 1.01–7.62); male sex (AOR = 1.69; 95% CI: 1.04–3.33), not drying the newborn (AOR = 3.06, 95% CI: 1.64–5.72); no skin to skin contact within five minutes postnatal (AOR = 2.17, 95% CI: 1.15–4.10); and low maternal body temperature (AOR = 2.70, 95% CI: 1.49–4.76).
Conclusions
The prevalence of neonatal hypothermia was high in the first two hours. Neonates who were more likely to have hypothermia were male, not dried properly, low birth weight, no skin-to-skin contacts, and low maternal body temperature. Proper drying of the newborn and skin-to-skin contact can reduce the burden of neonatal hypothermia. There is a need to train the midwives on proper drying of the newborn, keeping the mother warm, and the importance of skin-to-skin contact in prevention of neonatal hypothermia among male and low birth neonates.