Browsing by Author "Bajunirwe, Francis"

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    A qualitative study of knowledge, experiences, and healthcare needs of people living with lymphedema in Kamwenge District, rural Uganda
    (Springer Nature, 2025-10-27) Mwesigye, Vicent; Tebulwa, Joanita Berytah; Musinguzi, Benson; Agaba, Bosco Bekita; Muyambi, Raul; Asiimwe, Gerevasio Kalemire; Zamarano, Henry; Birungi, Caroline; Bagenda, Charles Nkubi; Bajunirwe, Francis; Bazira, Joel; Itabangi, Herbert; Byarugaba, Frederick; Mulogo, Edgar Mugema
    Background Lymphedema is a long-term, disabling condition caused by dysfunction of the lymphatic system, yet it continues to receive little attention in low-resource settings. In rural areas such as Kamwenge District, Uganda, those affected endure ongoing physical symptoms including swelling, pain, and reduced mobility alongside significant emotional and social challenges. Stigma, cultural misunderstandings, and poor access to timely diagnosis and effective care further hinder their well-being. While global neglected tropical disease (NTD) programs have made progress, many vulnerable communities remain overlooked. This qualitative study explored the lived experiences of lymphedema patients and caregivers in Kamwenge, focusing on local beliefs, knowledge gaps, and healthcare barriers to inform context-specific and stigma-sensitive interventions. Methods A community-based qualitative study design was employed. Data were collected through five focus group discussions (FGDs) involving lymphedema patients and caregivers, and seven key informant interviews (KIIs) with local health officials, community leaders, and religious figures. Participants were purposively sampled from Rukunyu Hospital and surrounding communities to capture diverse perspectives. Data were transcribed, translated, and analysed using Braun and Clarke’s thematic analysis approach. Results Seven key themes emerged: (1) patients’ daily struggles with pain, dependence, and economic hardship; (2) stigma leading to social exclusion; (3) gaps in knowledge and culturally influenced misconceptions about causes and treatment; (4) gender-specific vulnerabilities such as abandonment and psychological distress; (5) weak healthcare infrastructure and limited access; (6) reliance on informal coping strategies including herbal remedies, faith, and peer support; and (7) institutional deficiencies alongside community-driven recommendations for improved care and prevention. Despite some health education efforts, misinformation and stigma remain widespread, and affected individuals are often excluded from social support programs. Conclusion Lymphedema in Kamwenge District is a complex issue intersecting health, social stigma, and systemic weaknesses. Urgent, community-focused interventions are critical to closing knowledge gaps, enhancing healthcare services, reducing stigma, and integrating lymphedema management into national health policies.
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    Addressing stigma, mental well-being, and alcohol use among people with tuberculosis in Sub-Saharan Africa: A Call for an integrated care model
    (American Society of Tropical Medicine and Hygiene (ASTMH), 2025-07-29) Izudi, Jonathan; Bajunirwe, Francis; Cattamanchi, Adithya; West, Nora
    Tuberculosis (TB) remains a major public health challenge in sub-Saharan Africa (SSA), with stigma, mental health issues, and alcohol use significantly affecting treatment outcomes. Stigma delays TB diagnosis, reduces treatment adherence, and disrupts care continuity. Mental health conditions, such as depression and anxiety, further undermine adherence, whereas alcohol use accelerates TB disease progression and leads to poor treatment outcomes. Current TB care models in SSA lack integrated support for psychosocial and behavioral health needs. This article advocates for a comprehensive care model that integrates mental health screening, counseling, psychosocial support, alcohol use disorder screening, and harm reduction strategies into TB programs. Effective implementation requires collaboration among TB care providers, mental health specialists, and alcohol use counselors supported by research, provider training, and community engagement. By addressing stigma, mental health, and alcohol use, this model can enhance treatment adherence and outcomes, advancing the WHO’s End TB Strategy in SSA.
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    Appropriateness, barriers, and facilitators of multi-month dispensing of tuberculosis drugs in rural eastern Uganda: A qualitative study to inform a non-inferiority randomized trial
    (PLOS, 2025-09-05) Izudi, Jonathan; Bajunirwe, Francis; Adithya, Cattamanchi; West, Nora
    Multi-month dispensing of tuberculosis (TB) drugs is an innovative strategy that may reduce frequent clinic visits and travel costs among people with TB (PWTB) in rural areas. To inform a planned trial, we explored the appropriateness, barriers, and facilitators to multi-month dispensing among PWTB and healthcare providers in rural eastern Uganda. We used qualitative methods situated within the Consolidated Framework for Implementation Research to explore two refill schedules for multi-month dispensing of TB drugs—a four- or five-visit refill schedule. In December 2024, we collected data through interviews with PWTB, their treatment supporters, and healthcare providers at the regional, district, and health facility levels. Data were analyzed using thematic analysis. All participants (n = 39; 22 healthcare providers, 12 PWTB, and five treatment supporters) expressed willingness to adopt multi-month dispensing, with a four-visit schedule as the preferred option. Healthcare providers preferred the five-visit schedule for individuals with complex health conditions: severe illness, clinical instability, or bacteriologically confirmed pulmonary TB. Multi-month dispensing was perceived to benefit healthcare providers by reducing workload, improving patient flow, and enhancing patient management. Perceived benefits to PWTB included reduced clinic visits and travel costs, time savings, improved treatment adherence, reduced wait times and TB-related stigma, and increased satisfaction with care. Facilitators included integration with existing treatment models, person-centeredness, community and family support, reliable drug supply, clear operational guidelines, healthcare provider training and readiness, enhanced monitoring and evaluation, clinic accessibility, readiness to utilize multi-month dispensing, and leadership support. Barriers included undefined eligibility criteria, uncertain effects of multi-month dispensing, differing refill schedules for PWTB and HIV, treatment non-adherence due to forgetfulness and medication sharing, and patient disengagement due to insufficient follow-up. Multi-month dispensing is perceived to benefit PWTB and healthcare providers. Further studies to measure the impact on treatment outcomes should leverage facilitators and address barriers to adoption and effectiveness.
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    Detection of filarial IgG and IgM antibodies among individuals with lymphedema in the Kamwenge District, Western Uganda
    (Springer Nature, 2025-07-08) Mwesigye, Vicent; Tebulwa, Joanita Berytah; Musinguzi, Benson; Agaba, Bosco Bekita; Bagenda, Charlse Nkubi; Bajunirwe, Francis; Bazira, Joel; Mulogo, Edgar; Herbert, Itabangi; Byarugaba, Frederick
    Filarial infections trigger a complex immune response characterized by the production of different antibodies, particularly immunoglobulin G (IgG) and immunoglobulin M (IgM). These immunoglobulins play a key role in diagnosing the disease, with IgM typically indicating recent infection and IgG reflecting past or ongoing exposure. Assessing their presence provides valuable insight into an individual's immune response and infection history. This study examined the levels of IgG and IgM in people living with lymphedema in the Kamwenge district, Western Uganda, to better understand their immunological status in relation to filarial infection. This cross-sectional study, conducted in the Kamwenge district, aimed to assess the presence of anti-filarial antibodies among lymphedema patients. A total of 154 participants, predominantly female (71.4%), with a mean age of 54.7 years, were selected through simple random sampling. Serological testing using the Abbexa Filariasis IgG/IgM Rapid Test revealed that 10.4% tested positive for IgG, and 1.9% for IgM antibodies. We enrolled a total of 154 participants, the majority of whom were female 110 (71.4%) while 44 (28.6%) were male. The participants had a mean age of 54.7 years, with a standard deviation of 15.6 years. Overall, 10.4% (n=16) tested positive for filarial antibodies. Specifically, 10.4% (n=16) were positive for filarial IgG, while 1.9% (n=3) tested positive for IgM antibodies. The serological findings demonstrated a low prevalence of recent filarial infections, with a higher occurrence of past or chronic exposure among participants. This suggests that while active transmission may be limited, lymphatic filariasis remains an ongoing public health concern in the Kamwenge district. These results emphasize the need for continued surveillance, early detection, and targeted interventions to effectively manage and mitigate the burden of filarial-related lymphedema in the region.