Research Articles

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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.
Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study
(Elsevier, 2025-10-22) 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.
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.
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.
Barriers and facilitators to integrating tuberculosis treatment into community pharmacies for people with TB/HIV in Kampala, Uganda: A qualitative study
(PLOS, 2025-11-21) Izudi, Jonathan; Cattamanchi, Adithya; Sekaggya-Wiltshire, Christine; Kiwanuka, Noah; Sammann, Amanda; King, Rachel
Community pharmacies (private retail drug shops or pharmacies) have proven successful for delivering anti-retroviral therapy to people living with human immunodeficiency virus (HIV). Leveraging this model for tuberculosis (TB) treatment integration could improve access to both TB and HIV treatment among people with TB/HIV. We identified the barriers and facilitators to integrating TB treatment into community pharmacies for people with TB/HIV in Kampala, Uganda, using a qualitative study across six public health facilities. Participants included people with TB/HIV; healthcare providers (HCPs) from the six facilities and their affiliated community pharmacies; and experts from the Ministry of Health. Data were collected through interviews guided by the Consolidated Framework for Implementation Research (CFIR). We performed framework analysis and mapped the emergent sub-themes to the relevant CFIR domains. We enrolled 47 participants: six TB focal persons, six HIV focal persons, nine pharmacy HCPs, three Ministry of Health staff, and 23 people with TB/HIV. Major facilitators included the convenience of accessing both TB and HIV treatment at a single location; enhanced privacy and reduced stigma; improved accessibility through extended hours, shorter wait times, and proximity; readiness of community pharmacy HCPs to deliver TB treatment; willingness of people with TB/HIV to engage in self-managed care; and training of pharmacy HCPs in TB care. Key barriers included unclear eligibility criteria for enrolling people with TB/HIV, absence of TB counseling services at pharmacies, inadequate infrastructure for TB drug storage, limited confidence among pharmacy HCPs in delivering TB care, and unclear logistics and operational procedures for implementation. Therefore, context-specific interventions that are developed in collaboration with key stakeholders, address barriers like eligibility criteria refinement, enhanced pharmacy HCP training, and financial incentives, and leverage facilitators like policy support and stakeholder readiness, are needed for the successful integration of TB treatment into community pharmacies for people with TB/HIV in Uganda.
Determinants of underweight and overweight/ obesity among people with tuberculosis in Kampala, Uganda: A cross-sectional study
(PLOS, 2026-02-13) Kyazze, Simon; Appeli, Saidi; Baluku, Joseph Baruch; Izudi, Jonathan
Background Malnutrition significantly contributes to mortality among people with tuberculosis (TB). However, evidence on factors associated with the specific forms of malnutrition, specifically underweight and overweight/obesity, beyond clinical determinants, remains limited in many settings. We investigated the prevalence and determinants of underweight and overweight/obesity among people with pulmonary TB across five health facilities in Kampala, Uganda. Methods This analytic cross-sectional study involved people with pulmonary TB, either clinically diagnosed or bacteriologically confirmed, aged ≥18 years sampled across five health facilities in Kampala, Uganda. Nutritional status was assessed using body mass index (BMI, kg/m²) and categorized as underweight (<18.5), normal weight (18.5–24.9), and overweight/obese (≥25.0). To identify factors independently associated with nutritional status, normal weight was considered as the reference category in a multinomial logistic regression analysis, adjusting for multiple covariates and clustering at the health facility level. The measure of association was the adjusted relative risk ratios (aRRR) and the corresponding 95% confidence intervals (CI). Results Of the 818 participants studied, 417 (51.0%) had normal weight, 302 (36.9%) were underweight, and 99 (12.1%) were overweight or obese. Adjusted analysis showed that being underweight was associated with household food insecurity (aRRR 2.04, 95% CI: 1.48–2.80) while being overweight or obese was associated with self-employment (aRRR 2.26, 95% CI: 1.35–3.79) and being newly diagnosed with TB (aRRR 2.10, 95% CI: 1.30–3.41). Conclusion This study, conducted among people with pulmonary TB in an urban setting in Uganda, showed that underweight and overweight/obesity are prevalent. Furthermore, the study showed that food insecurity is associated with being underweight, while being overweight or obese is associated with being self-employed or newly diagnosed with TB. Therefore, TB control programs need to regularly assess the nutritional status of people with TB to mitigate the effect of being underweight or overweight on treatment outcomes.
Effect of alcohol consumption and tobacco smoking on psychological distress: a quasi-experimental study using the 2022 Kenya demographic health survey data
(BMJ Group, 2025-06-16) Kamau, Kennedy; Andeso, Pauline; Muga, Winstoun; Karisa, Amani; Musyoki, Davis; Kuria, Joseph Mutura; Kadengye, Damazo T; Izudi, Jonathan
Methods: We analysed the 2022 Kenya Demographic Health Survey data. The primary exposure was alcohol consumption, and tobacco smoking was the secondary exposure. The outcome was psychological distress. We employed propensity score matching to achieve comparability on observed covariates between the exposed and unexposed groups. We then performed conditional logistic regression analysis, adjusting for matched pairs to establish a cause-effect relation between the exposures of interest and the outcome. We reported the OR and 95% CI. We conducted a sensitivity analysis using Mantel-Haenszel bounds to check for the robustness of the cause-effect findings to unmeasured confounders. Results: Of the 46 609 participants included in the study, 6450 (13.8%) consumed alcohol, while 2353 (5.0%) smoked tobacco. Overall, 1091 (2.3%) participants reported psychological distress. Among alcohol consumers, 352 (32.3%) reported psychological distress, compared with 115 (10.5%) among tobacco smokers. In a 1:1 ratio, we matched 10 070 individuals based on alcohol consumption and 4270 based on tobacco smoking status. In propensity-score-matched analysis, alcohol consumption (OR 2.76, 95% CI 2.06 to 3.70) and tobacco smoking (OR 2.04, 95% CI 1.29 to 3.24) showed an effect on psychological distress. Conclusion: This study found that alcohol consumption and tobacco smoking increase psychological distress among adults aged 15-54 years in Kenya. There is, therefore, a need to screen for psychological distress among people who drink alcohol or smoke tobacco to provide them with prompt mental health interventions.
Effect of facility- versus community-based HIV testing services on the diagnosis of advanced HIV disease in Uganda: a quasi-experimental study
(Springer Nature, 2025-12-30) Izudi, Jonathan; Ssentongo, Saadick Mugerwa; Appeli, Saidi; Bajunirwe, Francis
Background Advanced HIV disease (AHD) at first diagnosis remains a significant barrier to HIV epidemic control. We evaluated whether health facility-based or community-based HIV testing services (HTS) better impact the yield of AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We designed a quasi-experimental study and applied instrumental variable analysis, a causal inference methodology, to compare the effect of facility-based HTS versus community-based HTS on the yield of AHD at diagnosis among newly diagnosed PWH. The exposure was HTS comparing community-based versus facility-based, and the outcome was AHD at diagnosis, defined as CD4 < 200 cells/µL or WHO clinical stage 3 or 4 disease at baseline. The instrumental variable was the HTS access radius that reflects the HTS geographical coverage for each health facility. The instrumental variable ensured the categorization of health facilities as offering HTS within a 5 km radius only or both within and beyond 5 km. The relevance of the instrumental variable was assessed using the F-statistic and independence from measured covariates. We used a two-stage residual inclusion approach to estimate the effect of HTS on AHD at diagnosis. Causal effect was reported as an odds ratio (OR) and 95% confidence interval (CI). Results Of 1,233 participants included in the analysis, AHD prevalence was 1.9% (24/1,233). The instrumental variable was strongly correlated with HTS (First-stage F-statistic = 28.05, p < 0.0001) and uncorrelated with AHD and all measured covariates. Facility-based HTS has no significant effect on AHD at diagnosis compared to community-based HTS (OR 1.20, 95% CI 0.49–2.90). Conclusions Persons with AHD at diagnosis are a minority. Facility- and community-based HTS do not differ in identifying AHD among newly diagnosed PWH, but moderate effects cannot be excluded. These findings support efforts to implement both strategies for HIV testing to reach and test persons with advanced HIV.
Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda
(Elsevier, 2025-11-27) Izudi, Jonathan; Appeli, Saidi; Bajunirwe, Francis
Rationale: Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective: We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods: We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results: Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion: FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.
Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda
(Elsevier, 2025-11-27) Izudi, Jonathan; Appeli, Saidi; Bajunirwe, Francis
Rationale Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.
Effect of healthcare worker vs. non-health worker delivered health education on modern contraceptive uptake among women in Malawi: a quasi-experimental study
(Springer Nature, 2025-10-29) Salamba, Thom; Izudi, Jonathan; Masegese, Tumaini; Mwila, Gabriel; Gueye, Ibrahima; Kyule, Grace; Khakayi, Sadie; Karan, Annaline; Vellemu, Ruth; Mwanga, Daniel; Gerbaba, Mulusew J.
Background Most women receive health education from healthcare workers. However, the same information can be delivered by non-health workers such as religious and traditional leaders, and peers, among others. The effectiveness of non-health worker-delivered health education on the uptake of hormonal contraceptives, however, remains uncertain. We compared the effectiveness of health worker and non-health worker-delivered health education on the uptake of modern contraceptives among women of reproductive age in two large districts in Malawi. Methods We designed a quasi-experimental study in two Malawian districts (Mangochi and Chikwawa). The intervention was health education delivered by either a health worker, such as a nurse (intervention group), while the comparator was health education delivered by a non-health worker, like a religious or traditional leader, peer, or the media, among others (comparison group). The main outcome was the uptake of modern contraceptives. To remove systematic differences between the two groups and achieve comparability on observed covariates, we used inverse probability of treatment weighting to emulate a randomized trial. After achieving covariate comparability, we performed a binary logistic regression to estimate the effect of health worker-delivered health education on contraceptive uptake, adjusting for the inverse probability of treatment weights. We reported the odds ratios (OR) and 95% confidence intervals (CI). Results We studied 414 participants aged 15–49 years (median age 29 years, interquartile range 23–36). There were 316 participants in the intervention group, and 143 (45.3%) of them used modern contraceptives. The comparison group had 98 participants, and 41 (41.8%) of them used modern contraceptives (p = 0.552). Participants in the intervention group tended to have an increased modern contraceptive uptake compared to those in the comparison group, although the difference was statistically insignificant (OR 1.45, 95% CI 0.74–2.89). Conclusions Modern contraceptive uptake did not differ between health worker and non-health worker-delivered health education approaches in the two Malawian districts. Non-health worker-delivered health education could be an additional tool for reaching several women of reproductive age with modern contraceptive information. This would contribute to increasing the contraceptive prevalence rate and reducing maternal and neonatal morbidity and mortality in these districts and similar settings.
Effect of safe water delivery plus water and sanitation hygiene behavior change communication on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya: a quasi-experimental study
(Springer Nature, 2025-10-28) Izudi, Jonathan; Muchiri, Evans; Musyoka, Dennis; Simiyu, Sheillah; Tumwebaze, Innocent K.; Mbaya, Nelson; Sidze, Estelle; Musau, Kelvin; Abajobir, Amanuel
Background Diarrheal diseases are prevalent among children under five years of age in slum areas. We evaluated the effect of safe water delivery plus water, sanitation, and hygiene (WASH)-Behavior Change Communication (WASH-BCC on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya. Methods We designed a quasi-experimental study, with the intervention as safe water delivery plus WASH-BCC. The intervention arm consisted of 2 slum villages that received safe water plus WASH-BCC, while the comparison arm comprised 2 slum villages that did not receive the intervention. The primary outcome was diarrheal disease in a child under five years of age in the past 2 weeks in both study arms, defined as the passage of ≥ 3 watery stools in the past 24 h. Data were collected at the baseline and endline from a random sample of eligible households in the villages. Propensity score weighting was used to achieve similarity in measured covariates between both arms. Binary logistic regression analysis, adjusting for propensity-score weights, was utilized to estimate the causal effect of the intervention, reported as odds ratio (OR) and 95% confidence interval (CI). Results We analyzed data from 1,876 participants in a 1:1 ratio and found 382 (20.4%) children under five years of age had diarrheal disease at the endline. Diarrheal disease prevalence declined in the intervention villages (33.3% baseline vs. 23.5% endline) but increased in the comparison villages (15.7% baseline vs. 17.5% endline). We found a 31% decline in diarrheal disease in the intervention villages relative to the comparison villages (OR 0.69, 95% CI 0.55–0.86). In a difference-in-differences analysis, the decline was 11.4%. The findings remained robust in a sensitivity analysis. Conclusion The intervention significantly reduced diarrheal disease prevalence in children under five years of age in the slum setting. Therefore, there is a need to expand the intervention to the remaining areas to reduce diarrheal disease morbidity and mortality.
Effectiveness of ART optimization on viral load suppression in children and adolescents with HIV in Uganda: A quasi-experimental study
(Wolters Kluwer Health, 2026-02-27) Nasuuna, Esther M; Babirye, Lillian; Kigozi, Joanita; Muganzi, Alex; Izudi, Jonathan
Uganda implemented the antiretroviral therapy (ART) optimization program in July 2019, based on an eligibility rule. ART optimization targeted individuals with prior viral load (VL) < 1000 copies/mL, while those with VL ≥ 1000 copies/mL continued with non-optimized regimens. We assessed the effectiveness of ART optimization on VL suppression among children and adolescents with HIV (CAWH) in Uganda. We also assessed the compliance of human immunodeficiency virus (HIV) clinics with the eligibility rule and its effect on ART optimization. Therefore, we designed a quasi-experimental study using data from 21 urban and rural HIV clinics. The exposure was ART optimization, defined as the initiation or transition of CAWH on dolutegravir or a protease inhibitor (boosted lopinavir). Children and adolescents with HIV on an optimized ART regimen formed the exposed group, while those on a non-optimized ART regimen comprised the nonexposed group. The primary outcome was VL suppression, defined by VL < 1000 copies/mL after ≥6 months of ART optimization. We assessed the effectiveness of ART optimization on VL suppression using 2-stage least squares instrumental variable regression due to imperfect compliance with the eligibility rule across the clinics. We also established the effectiveness of the eligibility rule on ART optimization for individuals just below and just above the cutoff. Sensitivity analysis was performed using a noncausal approach. We analyzed data from 2999 CAWH aged ≤19 years and found an overall VL suppression of 76.1% (2282/2999). We found that ART optimization showed a trend toward improved VL suppression (risk ratio [RR] 1.81, 95% CI: 0.79–4.14). However, compliance with the rule was only for 2.6% of the participants, and the rule did not improve ART optimization (RR 0.96, 95% CI: 0.88–1.05). Overall, ART optimization, guided by an eligibility rule, did not achieve the target of ≥95% VL suppression among CAWH across the 21 public HIV clinics in Uganda, partly due to low compliance with the rule, although it showed a trend toward improvement. Addressing context-specific biological, behavioral, social, and structural barriers is needed to optimize VL outcomes.
A healthy diet for a growing population: a case study of Arua, Uganda
(Springer Nature, 2023-01-27) Hermelink, Marleen I.; Pittore, Katherine H.; Álvarez Aranguiz, Adolfo; Pereira da Silva, Fatima I.; Roefs, Marlene M. I.; Kajobe, Robert; Malingumu, Richard; Hengsdijk, Huib
It is uncertain whether Sustainable Development Goal 2 (SDG2), a healthy diet for all, can be achieved in East Africa given its strong population growth, low agricultural yields, and the high perishability of nutrient-dense foods. We examine the consequences of a locally produced healthy diet on land use in a case study of the Arua district in Uganda. This type of analysis can alert policy makers to looming nutrition gaps and support the selection of alternative solution strategies. Using a linear programming (LP) model and three population growth projections, we estimate the minimum agricultural area needed in 2040 to produce a healthy diet that follows EAT-Lancet dietary diversity guidelines and supplies the average requirements of calories, proteins, Iron, and vitamin A. We also compare in scenarios to what extent i) production intensification, ii) food loss reduction, iii) by-product consumption, and iv) vitamin supplementation could reduce the required agricultural area. Results show that the necessary area to produce a healthy diet in 2040 is 160% larger than Arua’s current crop area and would greatly exceed the district’s total area. We also show that none of the changes proposed in our scenarios allows a sufficient increase in food production, suggesting that a mix of even more drastic changes across sectors will be necessary. The results underline the challenge for rural areas in East Africa like Arua to provide a healthy diet to its fast growing population, requiring integrated food system changes and policy coordination to orchestrate the increased availability of diverse and nutritious foods.
How innovation platforms govern the experiential learning process of coffee farmers in Uganda
(African Journals Online, 2024-12-16) Ochago, Robert
While researchers, development actors, and policymakers recognize that Innovation Platforms govern farmers' development knowledge when attempting to address challenges, the question of how IPs’ governance mechanisms affect their learning process remains unaddressed. Using data from a cross-sectional survey of 214 coffee IP farmers, this study employs Partial Least Squares-Structural Equation Modeling (PLS-SEM) to analyze the relationships between IP governance and farmers’ experiential learning. The relationship between challenges, reflection, experiential knowledge, active experimentation, and IP governance mechanisms (that is, IP members' commitment and trust, IP members' involvement, and Member access to IP resources) was specifically examined. Results show that when farmers try to address their challenges, IP governance mechanisms positively and negatively affect their acquisition of experiential knowledge through reflection and active experimentation using existing knowledge. Specifically, Innovation Platform members' commitment, trust, and involvement significantly and positively moderate the link between farmers’ challenges and their reflection, while the influence of members' access to IP resources is insignificant. Similarly, while access to IP resources has an insignificant and negative moderation effect on the link between farmers’ reflection and experiential knowledge, IP members' commitment, trust, and involvement have positive but insignificant effects on them. Farmers' commitment, trust, involvement, and access to IP resources did not affect the relationship between their experimentation and experiential knowledge. Finally, the IP members' commitment, trust, involvement, and access to IP resources have insignificant effects on the relationship between farmers’ active experimentation and their challenges. Coffee farmers should use their networks to encourage commitment and involvement in intellectual property to reflect and gain knowledge. Similarly, IP facilitators should build trust among their members. Agriculture extension policymakers can use IPs as units to identify practical interventions to local challenges and improve targeted rural agriculture value chains by connecting different stakeholders to farmers at the community level because reflection as a learning activity must be consciously elicited through learning actions.
Initiation of breastfeeding among mothers attending a regional referral hospital in central Uganda: a cross-sectional study
(Springer Nature, 2025-06-16) Nakayiza, Vivianne; Izudi, Jonathan; Nasuuna, Esther M; Atim, Fiona
Background: Breastfeeding initiation within the first hour of birth is beneficial in reducing the risk of maternal and neonatal mortality. However, a significant proportion of mothers delay initiating breastfeeding within an hour of birth, but the association with age has not been rigorously studied. We examined the association between maternal age and delayed initiation of breastfeeding in a large urban referral hospital in central Uganda. Methods: This analytic cross-sectional study was conducted at the Entebbe Regional Referral Hospital in Central Uganda. Data were collected using a researcher-administered questionnaire between October 1, 2019, and December 20, 2019. Delayed initiation of breastfeeding was the primary outcome, defined as putting the newborn to the breast after one hour of birth. The primary exposure was maternal age categorized as 15–24, 25–34, and 35–45 years. We performed a modified Poisson regression analysis to determine the independent association between maternal age and delayed initiation of breastfeeding, adjusting for other confounders. We stated the findings as an adjusted prevalence ratio (aPR) and 95% confidence interval (CI). Results: We studied 384 participants with a mean age of 27.5 ± 5.5 years. Of the 384 participants studied, 275 (71.6%) had delayed initiating breastfeeding, with the majority aged 15–24 years. In a multivariable analysis, delayed initiation of breastfeeding was significantly associated with maternal age groups of 15–24 years (aPR 1.28, 95% CI 1.01,1.63) and 25–34 years (aPR 1.28, 95% CI 1.01–1.60) compared to the reference group of 35–45 years. Additionally, delivery through cesarean section compared to spontaneous vaginal delivery was associated with delayed initiation of breastfeeding (aPR 1.93, 95% CI 1.49–2.49). Conclusion: Delayed initiation of breastfeeding is common and is associated with maternal age (15–24 and 25–34 years) as well as delivery through cesarean section. Routine health education and staff mentoring are needed to enhance early initiation of breastfeeding to prevent maternal and neonatal morbidity and mortality.
Innovation platforms and value chain role expansion among Ugandan coffee farmers: Evidence on peer learning, group option, and legitimacy
(EScience Press, 2026-02-25) Ochago, Robert
Innovation platforms can help Ugandan coffee smallholders expand their roles in the value chain, beyond production, when they create repeated peer learning, support group action, and build legitimacy for new roles. However, most research emphasises platform design and average outcomes and says little about the daily social costs of upgrading attempts, such as recognition, trust, moral pressure, and jealousy. This study examines how smallholders in eastern Uganda identify value chain constraints, what they learn through platform participation, and how local legitimacy shapes who persists as trader, mobiliser, or processor. Qualitative methods were used, including focus group discussions and interviews of 91 innovation platform participants from Kapchorwa, Manafwa, and Namisindwa districts. The study applied a reflective thematic analysis. The study found that the expansion of the roles beyond primary production, including marketing, buying, coordination, and service, is achieved through practical learning, peer learning, training and interactions. The dynamics of recognition by others enhance farmers' trust, enabling them to sustain these expanded roles. On the other hand, recognition also creates new obligations and moral pressure, with expectations for support, training others, and exemplary behaviour, which sometimes contribute to conflict and to withdrawal from leadership or facilitation roles. As much as collective action spaces created opportunities for bargaining and visibility, they also generated tensions over governance and the sharing of benefits. This study contributes to extension research by illustrating how platforms contribute to value chain upgrading through socially verified learning and legitimacy, and by creating social costs for the longevity of new farmer roles. The policy implications point to the need to design innovation platforms that consider governance, equitable recognition and opportunities, and support for farmer intermediaries.
Intention to disclose medical errors by healthcare providers to patients and associated factors in Ugandan health facilities: A cross-sectional study
(PLOS, 2026-02-09) Alupo, Catherine; Izudi, Jonathan; Ddamulira, Christopher
This study assessed the prevalence and factors associated with intention to disclose medical errors by healthcare providers to patients in public health facilities in Mukono District, Uganda. We conducted an analytic cross-sectional study among healthcare providers across four public health facilities in Mukono District, Uganda. The outcome, Intention to disclose medical errors to patients, was defined as self-reported likelihood of informing a patient or their caregiver about a medical error if it had occurred, including the circumstances of error occurrence and any corrective actions taken. Data were collected using a self-administered structured questionnaire capturing factors at the individual and institutional levels. Logistic regression analysis was used to identify factors independently associated with intention to disclose medical errors, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. We studied 166 healthcare providers, of whom 90 (54.2%) were aged ≥35 years and 95 (57.2%) were female. Overall, 74 (44.6%) participants reported an intention to disclose medical errors. After adjusting for potential confounders, nurses (aOR 0.09, 95% CI 0.02-0.37) and other cadres (aOR 0.09, 95% CI 0.02-0.47) had significantly lower odds of intention to disclose medical errors compared with medical doctors/physicians. In contrast, healthcare providers working in health facilities with supportive supervision had higher odds of intention to disclose medical errors than those without supportive supervision (aOR 3.32, 95% CI 1.37-8.06). Fewer than half of healthcare providers have the intention to disclose medical errors to patients, indicating a substantial gap from the ethical expectation of full transparency. Supportive supervision was associated with an increased likelihood of intention to disclose medical errors, while non-physician cadres were less likely to report intention to disclose medical errors compared to medical doctors. Interventions that strengthen supervision and empower all cadres through training and institutional support may enhance openness and accountability in healthcare practice.
Kernel morphometric characteristics and oil content among Shea tree genotypes in Uganda
(African Journals Online, 2022-09-23) Odoi, J. B; Okia, Clement Akias; Gwali, S.; Odong, T. L.; Agaba, H.; Okullo, J. B. L.
Shea tree (Vitellaria paradoxa subsp. nilotica) is an important commercial tree for domestic oil and industrial products of cosmetics, chocolate and other confectionaries traded grown worldwide. We studied seed morphometric characteristics and crude oil content of Shea nuts in Uganda. Five populations, comprising of 16 ethnovarieties, were selected from Eastern, Northern and West Nile Sub-regions of Uganda, based on their attributes as judged by the farmers. Fresh kernel weight ranged from 2 to 18.85 mg per seed. Kernel weight increased with Shea fruit weight (y = 0.1499x + 6.1887, R² = 0.306). Moyo district had the highest oil content (54.37 ± 0.32%); while Amuru district had the lowest oil content (50.5 ± 1.32%). Oil content decreased with increasing kernel size (y = -0.4541x + 57.303, R² = 0.2116) and dry matter content (y = 0.635x - 9.863, R²= 0.011); and varied between ethnovarieties and Shea tree populations, p = 0.003 and P< 0.001, respectively. Tinny seeded (45.7 - 65.49%), Round fruited (45.41 - 65.91%), Dwarf tree (45.19 - 64.19%), Elliptical fruited (45.32 - 64.19%) and Soft pulped (42.16 - 69.77%) ethnovarieties had the highest oil content. Narrow sense heritability (h2) for oil yield was 1.72; while response to selection (R) was 16.48 with genetic gain (Gs) of 2.21%, given 10% top selection intensity.
Magnitude and correlates of overweight or obesity among adults with diabetes mellitus duration of five or more years in rural Uganda: A cross-sectional study
(Elsevier, 2026-02-26) Lumori, Boniface Amanee Elias; Lodiong, Lodiong Jackson Dumo; Ucama, Ufoymungu Patrick; Izudi, Jonathan
Background Overweight and obesity are major risk factors for micro and macrovascular diseases, with diabetes mellitus exacerbating these burdens. We determined the prevalence of overweight or obesity and its associated factors among adults with diabetes mellitus with a duration of ≥5 years at Mbarara Regional Referral Hospital in Southwestern Uganda. Methods This analytic cross-sectional study was conducted over 5 months, from November 2017 to March 2018. We collected demographic and clinical data and measured body mass index (BMI). The outcome was overweight or obesity, measured as the proportion of individuals with a BMI of 25 kg/m2 or more. We used binary logistic regression to estimate associations of a priori selected variables with the outcome. Results Of 189 participants, 138 (73%) were female, the mean age was 61.5 ± 11.1 years, and the median duration of diabetes mellitus since diagnosis was 10 years (interquartile range, 7–15). Overall, 122 (64.5%) participants were overweight or obese. In the multivariable logistic regression analysis, former cigarette smoking (adjusted odds ratio (AOR) 0.2, 95% confidence interval (CI) 0.1–0.6), every 1-year increase in the duration of diabetes mellitus (AOR 1.1, 95% CI 1.0–1.1), and hypertension (AOR 2.8, 95% CI 1.2–6.5) were independently associated with overweight or obesity. Conclusion Overweight/obesity is prevalent among adults with diabetes mellitus duration of 5 years and over, in a rural Ugandan population. Former cigarette smokers have a decreased likelihood of being overweight or obese, while hypertension and every 1-year increase in the duration of diabetes mellitus are associated with a higher likelihood of being overweight or obese.

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