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Progression from uncomplicated to severe malaria among children in settings receiving different malaria control interventions in sub-Saharan Africa: a systematic review protocol
(BMJ Group, 2025-08-11) Okek, Erick Jacob; Lutwama, Julius; Kinengyere, Alison Annet; Asio, Juliet; Awor, Silvia; Le Doare, Kirsty; Musinguzi, Benson; Sande, James Obondo; Ocan, Moses; Kayondo, Jonathan
Background Different malaria control measures are deployed simultaneously in endemic settings globally, with varying impacts on malaria burden. In sub-Saharan Africa, which bears the greatest burden of malaria, evidence on the impact of implementing various control interventions on malaria immunity remains unknown. This systematic review seeks to collate evidence on the extent of progression from uncomplicated to severe malaria among populations in sub-Saharan Africa settings receiving concurrent deployment of various malaria control measures. Methods The review will use a priori criteria contained in the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. An experienced librarian (AAK) will independently search for articles from the following databases: PubMed, Web of Science, Embase, Scopus and Google Scholar. Boolean operators ‘AND’ and ‘OR’ will be used in the article search. Identified articles will be managed using EndNote. Article screening for inclusion and data extraction will be done in duplicate by two reviewers (EJO, and BM). Data extraction tools will be developed and customised in Excel. Data will be analysed using both narrative and quantitative synthesis. The level of heterogeneity between study outcomes will be measured using the I2 statistic. Subgroup analysis will be conducted to explore heterogeneity and establish the impact of different control interventions on progression from uncomplicated to severe malaria. A full systematic review and meta-analysis is expected to be ready for dissemination by the end of December 2025.
Association of high serum aspartate transaminase to high density lipoproteincholesterol ratio with probable dementia among people living with HIV on antiretroviral therapy in Southwestern Uganda
(Sage, 2025-08-11) Bagenda, Charles Nkubi; Mudondo, Hope; Ssemwanga, Elastus; Nzaramba, Daniel; Ssedyabane, Frank; Ojuko, Samuel; Musinguzi, Benson; Akiteng, Winnie; Agaba, Bosco Bekiita; Osuwat, Lawrence Obado; Maling, Samuel; Rugera, Simon Peter; Tusubira, Deusdedit
Objectives: Previous studies present conflicting evidence on the relationship between hepatocellular damage biomarkers and dementia risk. While elevated serum transaminases have been associated with mild cognitive impairment, other studies link lower transaminase levels and reduced high-density lipoprotein-cholesterol levels to increased risk of cognitive decline. This study investigated the association between serum transaminase-to-high-density lipoprotein-cholesterol ratios and probable dementia among people living with HIV on antiretroviral therapy. Methods: We conducted a secondary data analysis using a dataset from a cross-sectional study conducted among 377 people living with HIV on dolutegravir-based antiretroviral therapy in southwestern Uganda. Probable dementia was screened using the brief Community Screening Instrument for Dementia and defined as a Community Screening Instrument for Dementia cognitive score ⩽4. Serum alanine aminotransferase/high-density lipoprotein-cholesterol and aspartate aminotransferase/high-density lipoprotein-cholesterol ratios were calculated from the respective serum transaminases and high-density lipoprotein-cholesterol divided into tertiles. We used logistic regression to assess the association between the independent variables and probable dementia. Results: The median age of the study participants was 44 years (interquartile range: 30–59), with 56.2% being female. The median total cholesterol/high-density lipoprotein-cholesterol levels were significantly higher in participants with probable dementia compared to those without (3.86 versus 3.22, p = 0.03). Aspartate aminotransferase/high-density lipoprotein-cholesterol and alanine aminotransferase/high-density lipoprotein-cholesterol levels were also higher among participants with probable dementia compared to those without, although the differences did not reach statistical significance. In the fully adjusted model, compared to participants in the first tertile of aspartate aminotransferase/high-density lipoprotein-cholesterol ratio, the odds of probable dementia were higher in the second tertile (adjusted odds ratio: 1.71; 95% confidence interval: 0.62–4.74; p = 0.301) and significantly elevated in the third tertile (adjusted odds ratio: 4.48; 95% confidence interval: 1.15–17.46; p = 0.031). Conclusions: The findings suggest that an elevated aspartate aminotransferase/high-density lipoprotein-cholesterol ratio is significantly associated with probable dementia among people living with HIV on dolutegravir-based antiretroviral therapy. A high aspartate aminotransferase/high-density lipoprotein-cholesterol ratio is potentially associated with cognitive decline in this population.
How have unintended pregnancies and contraceptive use among adolescent girls and young women changed in Uganda? Evidence from the 2014 and 2019 PMA national surveys
(Public Library of Science (PLOS), 2025-04-29) Kibira, Simon P.S.; Nakafeero, Mary; Amollo, Mathew; Ssenyonga, Ronald; Ndejjo, Rawlance; Anglewicz, Phil; Kukundakwe, Melody; Luzze, Mabel; Kagongwe, Samuel; Guma, Victor; Zalwango, Vivian; Makumbi, Fredrick Edward
Unintended pregnancies among adolescent girls and young women (AGYW), and any pregnancy among adolescent girls are still a challenge, especially in Sub-Saharan Africa and Uganda. We assess prevalence of unintended pregnancy in Uganda, associated factors and contraceptive use following unintended pregnancy among adolescent girls and young women in 2014 and 2019 in Uganda. Data are from the 2014 and 2019 performance monitoring for action (PMA) surveys. There were 1,479 AGYW reporting ever/ or current pregnancy in the two surveys, 780 in 2014 and 699 in 2019. Data included socio-demographics and pregnancy intendedness. Descriptive analyses were conducted stratified by adolescent girls and young women and compared between surveys. The percent of unintended pregnancies was determined as the number of AGYW reporting unintended pregnancy divided by eligible participants. A weighted comparison of the prevalence of unintended pregnancies was made between the surveys, and statistical significance determined at a 5% type-1 error rate. All analyses were conducted with Stata version15 using svy surveyset methodology accounting for complex survey design. Relative to 2014, the 2019 survey showed a significant reduction in percent of AGYW reporting ever pregnant or given birth, 60% to 49%, p = 0.007; a decline in unintended pregnancy among adolescent girls, 52% to 42%, p = 0.049, and among young women with secondary education, 36% to 13%, p = 0.001. Conversely, the 2019 survey showed significant increase in contraception among those ever pregnant, 26% to 40%, p < 0.001; higher in young women (30% to 47%, p = 0.001) compared to adolescent girls (16% to 25%, p = 0.005). The commonest contraceptive methods were short-acting at both surveys, while the long-acting methods significantly increased among young women (20% to 35%, p = 0.003). The decline in unintended pregnancies was consistent with increased use of contraceptive methods. Although we observed a significant decline in unintended pregnancy among adolescent girls, the proportion reporting unintended pregnancy remains high.
One-year follow-up effects of the informed health choices secondary school intervention on students’ ability to think critically about health in Uganda: a cluster randomized trial
(Springer Nature, 2025-02-26) Ssenyonga, Ronald; Oxman, Andrew D.; Nakyejwe, Esther; Chesire, Faith; Mugisha, Michael; Nsangi, Allen; Oxman, Matt; Rose, Christopher James; Rosenbaum, Sarah E.; Moberg, Jenny; Kaseje, Margaret; Nyirazinyoye, Laetitia; Dahlgren, Astrid; Lewin, Simon; Sewankambo, Nelson K.
Introduction We assessed the effects of the Informed Health Choices (IHC) secondary school intervention on students’ ability to think critically about choices 1 year after the intervention. Methods We randomized eighty secondary schools to the intervention or control (usual curriculum). The schools were randomly selected from the central region of Uganda and included rural and urban, government, and privately-owned schools. One randomly selected class of year-2 students (ages 14–17) from each school participated in the trial. The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in classrooms during one school term (May–August 2022). The lessons addressed nine prioritized IHC concepts. We used two multiple-choice questions for each concept to evaluate the students’ ability to think critically about choices at both the end of the school term and again after 1 year. The primary outcome was the proportion of students with a passing score (≥ 9 of 18 questions answered correctly) on the “Critical Thinking about Health” (CTH) test. Results After 1-year, 71% (1749/2477) of the students in the intervention schools and 71% (1684/2376) of the students in the control schools completed the CTH test. In the intervention schools, 53% (934/1749) of students who completed the test had a passing score compared to 33% (557/1684) of students in the control schools (adjusted difference 22%, 95% CI 16–28). Conclusions The effect of the IHC secondary school intervention on students’ ability to assess health-related claims was largely sustained for at least 1 year. Trial registration Pan African Clinical Trial Registry PACTR202204861458660. Registered on 4 April 2022.
Association between childhood sexual violence and low educational attainment among young people aged 18–24: Evidence from the 2018 Uganda violence against children survey
(Elsevier, 2025-02-21) Ndibalekera, Maria; Bangirana, Clare Ahabwe; Amollo, Mathew; Olido, Kenneth; Kafuko, Agatha; Opobo, Timothy; Ssenyonga, Ronald
Background Researchers have identified various factors that contribute to low levels of educational attainment. However, studies examining the association between childhood sexual violence victimization and educational attainment remain scarce. Understanding this relationship is vital since experiencing violence during childhood is associated with poor educational outcomes and a higher likelihood of financial difficulties and employment issues later in life. Objective This study sought to understand the association between childhood sexual violence victimization and low educational attainment for male and female young adults. Participants and setting. The study uses data from the Uganda Violence Against Children Survey (2018), focusing on participants aged 18–24. Methods Secondary analysis was done using STATA 14 among participants aged 18–24 years from whom responses on childhood sexual violence (CSV) victimization were solicited. CSV was measured in its different forms i.e., unwanted sexual touches, attempted forced sex, physically forced sex, pressured sex and sexual exploitation, while low educational attainment was defined as being out of school and having primary or less as the highest level of education. Bivariable analysis and multivariable logistic regressions were conducted. Results The majority (67.2%) of the sample of 2312 young adults had low educational attainment. Basing on the different forms of childhood sexual violence victimization (sexual exploitation, unwanted sexual touches, attempted forced sex, physically forced sex and pressured sex), low education attainment ranged between 59.2% and 72.3% for males and 50.9% and 72.4% for females. The different forms of CSV were not significantly associated with low educational attainment except attempted forced sex among females (P = 0.011) in the bivariate analysis and child marriage in the multivariate model (P = 0.022). Conclusion Low levels of educational attainment in Uganda are prevalent and could be influenced by various factors that warrant further investigation. There is a need for additional research to clarify the association between childhood sexual violence victimization and low educational attainment. Considering the well established advantages of education for individuals and communities, it is essential to strengthen initiatives aimed at increasing both access to and the quality of educational services.
Total cholesterol/high-density lipoprotein cholesterol ratio is a significant predictor of metabolic syndrome among people on dolutegravir-based antiretroviral therapy: A cross-sectional study in southwestern Uganda
(Sage, 2025-08-29) Bagenda, Charles Nkubi; Nantongo, Carol; Ssemwanga, Elastus; Mugisa, Michael Junior; Ojuko, Samuel; Sempijja, Fred; Nzaramba, Daniel; Kiconco, Ritah; Ssedyabane, Frank; Musinguzi, Benson; Akiteng, Winnie; Tusubira, Deusdedit; Osuwat, Lawrence Obado; Rugera, Simon Peter
Objective: The total cholesterol/high-density lipoprotein cholesterol ratio is a predictor of nonalcoholic fatty liver disease—a hepatic manifestation of metabolic syndrome. This study investigated the association between total cholesterol/high-density lipoprotein cholesterol ratio and metabolic syndrome among people living with human immunodeficiency virus on dolutegravir-based antiretroviral therapy in southwestern Uganda. Methods: We conducted a secondary analysis of data obtained from a cross-sectional study of 377 adults who had been on dolutegravir-based antiretroviral therapy for at least 1 year at Ruhoko Health Centre IV, southwestern Uganda. Results: The median total cholesterol/high-density lipoprotein cholesterol ratio was significantly higher in individuals with metabolic syndrome (3.92) than in those without (2.96, p < 0.001). A statistically significant association was observed between high total cholesterol/high-density lipoprotein cholesterol ratio and metabolic syndrome (adjusted odds ratios: 2.06, 95% confidence interval: 1.08–3.91, p 1⁄4 0.028). The total cholesterol/high-density lipoprotein cholesterol ratio at an optimal cutoff of 3.30 had a significant ability (area under the curve 1⁄4 0.696, 95% confidence interval: 0.642–0.750) to differentiate participants with metabolic syndrome from those without at a sensitivity of 73% and specificity of 60%. Conclusion: The total cholesterol/high-density lipoprotein cholesterol ratio is a significant pre-dictor of metabolic syndrome and serves as a potential blood-based biomarker.
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.
Pou2f3 modulates mosquito host-seeking behavior by regulating skin microbiota and their production of volatiles: Implications for eco-friendly pest control strategies
(ACS Publications, 2025-06-26) Wang, Hui; Ruixi, Qian; Wang, Yuxiang; Li, Lanxi; Wu, Wenxuan; Chen, Yunxuan; Li, Wenqing; Wijewardana, Chanuka Nisalanka; Zhou, Yinghui; Padde, John Roberts; Wang, Yuxiang; Hou, Min; Xu, Zhipeng; Ji, MinJun; Chen, Lu; Chen, Lin
Skin microbiota-derived volatile metabolites are critical for mosquito host-seeking and disease transmission. Similar volatile organic compounds (VOCs)-mediated mechanisms may apply to agricultural pests (e.g., aphids, whiteflies). We demonstrate that Pou2f3, a skin-enriched transcription factor, regulates β-defensin1 expression, shaping microbiota composition and volatile production. Pou2f3-deficient mice exhibited increased Staphylococcus abundance and elevated 1-methoxy-2-propanol levels, enhancing attraction in Culex and Aedes mosquitoes. This VOC, alongside other microbiota-derived compounds, could inspire targeted attractants for eco-friendly pest control via species-specific lures in integrated pest management (IPM). By bridging medical entomology and agricultural chemistry, this work advances sustainable solutions against vector-borne diseases and agricultural pests through precision chemical ecology strategies.
Prevalence of malaria and associated risk factors among febrile under-five refugee children attending Panyadoli Health Centre III, Kiryandongo District, Mid-western Uganda
(Springer Nature, 2025-05-25) Acan, Dorcus; Opiro, Robert; Musinguzi, Benson; Agaba, Bosco B.; Alarakol, Simon Peter
Background: Malaria presents a big threat to the health of refugees, internally displaced persons, returnees and other such persons affected by humanitarian emergencies, with almost two thirds of these groups of persons living in malaria endemic regions. The aim of this study was to determine the prevalence of malaria and associated risk factors among refugee children < 5 years attending a Health Centre in Panyadoli Refugee Settlement Camp, Kiryandongo District, Uganda. Methods: A cross-sectional survey was done between February to April 2022, targeting refugee children < 5 years old seeking healthcare at Panyadoli Health Centre III in Kiryandongo District. Simple random sampling was employed to select 380 participants, who were then tested for the presence of malaria parasites using malaria rapid diagnostic tests and microscopy techniques. Data on risk factors of malaria was collected using a pre-tested and standardized semi-structured questionnaire. Bivariate and multivariate logistic regression analyses was used to identify the risk factors for malaria infections, at 95% confidence interval and p < 0.05. Results: Malaria prevalence among the refugee children < 5 years attending Panyadoli HCIII was 12.6% [95% CI: 8.7–18.0]. The associated risk factors for malaria infection included: non-application of indoor residual spraying over the last 12 months [AOR = 4.323; 95% CI 1.231–7.212], history of malaria in children (AOR = 5.861; 95% CI 1.562—8.433], and not sleeping under insecticide-treated nets (AOR = 3.141; 95% CI 0.865—5.221). Conclusion: Malaria remains a threat to refugee children < 5 years old at Panyadoli Refugee Settlement Camp. Sustained implementation of IRS should be pursued through expanded geographic coverage and increased application frequency, in conjunction with complementary malaria control measures such as enhanced ITN distribution and IPT for pregnant women, to support long-term malaria reduction.
Factors associated with completion of maternal health services, a cross-sectional study among women at an outpatient facility in Northern Uganda
(Springer Nature, 2025-05-15) Acirucan, Polline; Nankumbi, Joyce; Ngabirano, Tom Dennis; Muwanguzi, Patience
Association between childhood sexual violence and low educational attainment among young people aged 18-24: Evidence from the 2018 Uganda violence against children survey
(Child Protection and Practice, 2025-02-18) Ndibalekera, Maria; Bangirana, Clare Ahabwe; Amollo, Mathew; Olido, Kenneth; Kafuko, Agatha; Opobo, Timothy; Ssenyonga, Ronald
Background: Researchers have identified various factors that contribute to low levels of educational attainment. However, studies examining the association between childhood sexual violence victimization and educational attainment remain scarce. Understanding this relationship is vital since experiencing violence during childhood is associated with poor educational outcomes and a higher likelihood of financial difficulties and employment issues later in life. Objective: This study sought to understand the association between childhood sexual violence victimization and low educational attainment for male and female young adults. Participants and setting: The study uses data from the Uganda Violence Against Children Survey (2018), focusing on participants aged 18-24. Methods: Secondary analysis was done using STATA 14 among participants aged 18-24 years from whom responses on childhood sexual violence (CSV) victimization were solicited. CSV was measured in its different forms i.e., unwanted sexual touches, attempted forced sex, physically forced sex, pressured sex and sexual exploitation, while low educational attainment was defined as being out of school and having primary or less as the highest level of education. Bivariable analysis and multivariable logistic regressions were conducted. Results: The majority (67.2%) of the sample of 2312 young adults had low educational attainment. Basing on the different forms of childhood sexual violence victimization (sexual exploitation, unwanted sexual touches, attempted forced sex, physically forced sex and pressured sex), low education attainment ranged between 59.2% and 72.3% for males and 50.9% and 72.4% for females. The different forms of CSV were not significantly associated with low educational attainment except attempted forced sex among females (P=0.011) in the bivariate analysis and child marriage in the multivariate model (P=0.022). Conclusion: Low levels of educational attainment in Uganda are prevalent and could be influenced by various factors that warrant further investigation. There is a need for additional research to clarify the association between childhood sexual violence victimization and low educational attainment. Considering the well -established advantages of education for individuals and communities, it is essential to strengthen initiatives aimed at increasing both access to and the quality of educational services.
One‑year follow‑up effects of the informed health choices secondary school intervention on students’ ability to think critically about health in Uganda: a cluster randomized trial
(Springer Nature, 2025-02-26) Ssenyonga, Ronald; Oxman, Andrew D.; Nakyejwe, Esther; Chesire, Faith; Mugisha, Michael; Nsangi, Allen; Oxman, Matt; Rose, Christopher James; Rosenbaum, Sarah E.; Moberg, Jenny; Kaseje, Margaret; Nyirazinyoye, Laetitia; Dahlgren, Astrid; Lewin, Simon; Sewankambo, Nelson K.
Introduction: We assessed the effects of the Informed Health Choices (IHC) secondary school intervention on students’ ability to think critically about choices 1 year after the intervention. Methods: We randomized eighty secondary schools to the intervention or control (usual curriculum). The schools were randomly selected from the central region of Uganda and included rural and urban, government, and privately-owned schools. One randomly selected class of year-2 students (ages 14–17) from each school participated in the trial. The intervention included a 2-day teacher training workshop, 10 lessons accessed online by teachers and delivered in classrooms during one school term (May–August 2022). The lessons addressed nine prioritized IHC concepts. We used two multiple-choice questions for each concept to evaluate the students’ ability to think critically about choices at both the end of the school term and again after 1 year. The primary outcome was the proportion of students with a passing score (≥ 9 of 18 questions answered correctly) on the “Critical Thinking about Health” (CTH) test. Results: After 1-year, 71% (1749/2477) of the students in the intervention schools and 71% (1684/2376) of the students in the control schools completed the CTH test. In the intervention schools, 53% (934/1749) of students who completed the test had a passing score compared to 33% (557/1684) of students in the control schools (adjusted difference 22%, 95% CI 16–28). Conclusions: The effect of the IHC secondary school intervention on students’ ability to assess health-related claims was largely sustained for at least 1 year. Trial registration: Pan African Clinical Trial Registry PACTR202204861458660. Registered on 4 April 2022.
Assessment of different genotyping markers and algorithms for distinguishing Plasmodium falciparum recrudescence from reinfection in Uganda
(Research Square, 2025-02-05) Mwesigwa, Alex; Golumbeanu, Monica; Jones, Sam; Cantoreggi, Sara L.; Musinguzi, Benson; Nankabirwa, Joaniter I.; Bikaitwoha, Everd Maniple; Kalyango, Joan N; Karamagi, Charles; Plucinski, Mateusz; Nsobya, Samuel L.; Nsanzabana, Christian; Byakika-Kibwika, Pauline
Antimalarial therapeutic efficacy studies are vital for monitoring the efficacy of antimalarial drugs in malaria-endemic regions. The WHO recommends genotyping of polymorphic markers including msp-1, msp-2, and glurp to aid distinguishing recrudescences from reinfections. Recently, WHO proposed replacing glurp with microsatellites (Poly-α, PfPK2, TA1). However, suitable combinations with msp-1 and msp-2 have not been systematically assessed. Additionally, the performance of different algorithms for classifying recrudescence is unclear. This study investigated various microsatellites alongside msp-1 and msp-2 for molecular correction and compared genotyping algorithms across three malaria-endemic areas in Uganda. Microsatellites 313, Poly-α, and 383 exhibited the highest diversity, while PfPK2 and Poly-α revealed elevated multiplicities of infection across all sites. The 3/3 match-counting algorithm classified fewer recrudescences than the ≥ 2/3, and Bayesian algorithms at both ≥ 0.7 and ≥ 0.8 probability cutoffs. The msp-1/msp-2/2490 combination identified more recrudescences using the ≥ 2/3 and 3/3 algorithms in the artemether-lumefantrine (AL) treatment arm, while msp-1/msp-2/glurp combination identified more cases of recrudescence using the ≥ 2/3 in the dihydroartemisinin-piperaquine (DP) arm. Microsatellites PfPK2 and Poly-α, potentially sensitive to detecting minority clones, are promising replacements for glurp. Discrepancies in recrudescence classification between match-counting and Bayesian algorithms highlight the need for standardized PCR correction practices.
Increasing postgraduate medical mycology research dissertations at Uganda's higher institution of learning
(Elsevier, 2025-01) Achan, Beatrice; Musinguzi, Benson; Itabangi, Herbert; Sande, Obondo James; Meya, David B.
Objectives Postgraduate medical mycology research may also be affected by funding. This study reports the positive impact of funding on postgraduate medical mycology research at Makerere University, Uganda. Methods This retrospective study was conducted on postgraduate medical microbiology dissertation topics from 2023 to 2024 using data collected between September and November 2024. Results A total of N = 60 postgraduate medical microbiology dissertations were analyzed for medical mycology topics, of which a total of 18 (30%) focused on medical mycology. The percentage of dissertations centered on medical mycology increased from 16% (four of 25) in 2023 to 40% (14 of 35) in 2024. Cryptococcal meningitis is the most studied fungal disease (35.7%) (five) in 2024. Notably, molecular-based polymerase chain reaction (50%, two) and semi-automated culture (35.7%, five) were the most commonly used laboratory methods in 2023 and 2024. There were 75% (four) and 71.4% (14) timely completions of the postgraduate students, and the Makerere University Fungal Group was formed to promote the “buddy system of learning” among the postgraduate medical mycology students. Conclusion There has been an increase in medical mycology research among postgraduate medical microbiology students at Makerere University, Uganda, which is attributable to increased funding.
Temporal changes in Plasmodium falciparum genetic diversity and multiplicity of infection across three areas of varying malaria transmission intensities in Uganda
(Springer Nature, 2023-12-30) Mwesigwa, Alex; Kiwuwa, Steven M.; Musinguzi, Benson; Kawalya, Hakiim; Katumba, James Davis; Baguma, Andrew; Mutuku, Irene M.; Adebayo, Ismail Abiola; Nsobya, Samuel L.; Byakika‑Kibwika, Pauline; Kalyango, Joan N.; Karamagi, Charles; Nankabirwa, Joaniter I.
Background: Malaria is a significant public health challenge in Uganda, with Plasmodium falciparum (P. falciparum) responsible for most of malaria infections. The high genetic diversity and multiplicity of infection (MOI) associated with P. falciparum complicate treatment and prevention efforts. This study investigated temporal changes in P. falciparum genetic diversity and MOI across three sites with varying malaria transmission intensities. Understanding these changes is essential for informing effective malaria control strategies for the different malaria transmission settings. Methods: A total of 220 P. falciparum-positive dried blood spot (DBS) filter paper samples from participants in a study conducted during 2011–2012 and 2015–2016 were analyzed. Genotyping utilized seven polymorphic markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34–313, and C3M69–383. Genetic diversity metrics, including the number of alleles and expected heterozygosity, were calculated using GENALEX and ARLEQUIN software. MOI was assessed by counting distinct genotypes. Multi-locus linkage disequilibrium (LD) and genetic differentiation were evaluated using the standardized index of association (IAS) and Wright’s fixation index (FST), respectively. Statistical comparisons weremade using the Kruskal–Wallis test, and temporal trends were analyzed using the Jonckheere–Terpstra test, with statistical significance set at p < 0.05. Results: Of the 220 samples, 180 were successfully amplified. The majority of participants were males (50.6%) and children aged 5–11 years (46.7%). Genetic diversity remained high, with mean expected heterozygosity (He) showing a slight decrease over time (range: 0.73–0.82). Polyclonal infections exceeded 50% at all sites, and mean MOI ranged from 1.7 to 2.2, with a significant reduction in Tororo (from 2.2 to 2.0, p = 0.03). Linkage disequilibrium showed a slight increase, with Kanungu exhibiting the lowest IA S in 2011–2012 (0.0085) and Jinja the highest (0.0239) in 2015–2016. Overall genetic differentiation remained low, with slight increases in pairwise FST values over time, notably between Jinja and Tororo (from 0.0145 to 0.0353).
Extracellular hydrolytic enzyme activities and biofilm formation in Candida species isolated from people living with human immunodeficiency virus with oropharyngeal candidiasis at HIV/AIDS clinics in Uganda
(Elsevier, 2024-12-14) Musinguzi, Benson; Akampurira, Andrew; Derick, Hope; Turyamuhika, Laban; Mwesigwa, Alex; Mwebesa, Edson; Mwesigye, Vicent; Kabajulizi, Immaculate; Sekulima, Tahalu; Ocheng, Francis; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
Background: Commensal oral Candida species can become opportunistic and transition to pathogenic causes of oropharyngeal candidiasis (OPC) in individuals with impaired immunity through ecological cues and the expression of extracellular hydrolytic enzyme activities and biofilm formation. Objective: We evaluated phospholipase, proteinase, hemolysin, esterase, and coagulase enzymatic activities and biofilm formation in Candida species isolated from people living with human immunodeficiency virus (PLHIV) with OPC. Methods: Thirty-five Candida isolates from PLHIV with OPC were retrieved from a sample repository and evaluated for phospholipase activity using the egg yolk agar method, proteinase activity using the bovine serum albumin agar method, hemolysin activity using the blood agar plate method, esterase activity using the Tween 80 opacity test medium method, coagulase activity using the classical tube method, and biofilm formation using the microtiter plate assay method in vitro. Results: A total of 35 Candida isolates obtained from PLHIV with OPC were included in this study, and phospholipase and proteinase activities were detected in 33/35 (94.3 %) and 31/35 (88.6 %) Candida isolates, respectively. Up to 25/35 (71.4 %) of the Candida isolates exhibited biofilm formation, whereas esterase activity was demonstrated in 23/35 (65.7 %) of the Candida isolates. Fewer isolates (21/35, 60 %) produced hemolysin, and coagulase production was the least common virulence activity detected in 18/35 (51.4 %) of the Candida isolates. Conclusion: Phospholipase and proteinase activities were the strongest in oropharyngeal Candida species.
Distribution of Candida species isolated from people living with human immunodeficiency virus with oropharyngeal and oral candidiasis in Africa in the era of universal test and treat policy: a systematic review and meta‑analysis
(Springer Nature, 2024-11-27) Musinguzi, Benson; Obuku, Ekwaro A.; Mwesigwa, Alex; Migisha, Richard; Kinengyere, Alison Annet; Ndagire, Regina; Baguma, Andrew; Okek, Erick Jacob; Olum, Ronald; Itabangi, Herbert; Mboowa, Gerald; Sande, Obondo James; Achan, Beatrice
Background: The introduction of antiretroviral therapy (ART) and the implementation of the human immunodeficiency virus (HIV) universal test and treat (UTT) policy have led to a decline in the incidence of opportunistic infections. However, oropharyngeal and oral candidiasis remain prevalent and continue to pose challenges among people living with human immunodeficiency virus (PLHIV) in Africa, indicating the need for a better understanding of the distribution of Candida species responsible for these infections. This systematic review and meta-analysis aimed to determine the distribution of Candida species isolated from PLHIV with oropharyngeal and oral candidiasis in Africa in the era of UTT policy. Methods: The review followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted to identify eligible studies to be included in the meta-analysis and analysed using a random effects model in STATA version 17. The risk of bias was assessed using the Joanna Briggs Institute quality assessment tool. Results: Fourteen studies with 4281 participants were included in the review. Overall, 2095 Candida isolates were reported, 78.7% (1650/2095) of which were C. albicans, 19.6% (410/2095), non-albicans Candida (NAC), and 1.7% (35/2095) could not be identified to the Candida specific species level. The most prevalent NAC species were C. glabrata (26.3%), followed by C. tropicalis (24.9%), C. krusei (15.6%), C. parapsilosis (11%), and C. dubliniensis (6.3%). The pooled prevalence of oropharyngeal and oral candidiasis was 48% (95% CI 34–62%). The prevalence of oropharyngeal candidiasis was higher in the pre-UTT era, at 56% (95% CI 40–72%, p < 0.001), than in the post-UTT era, at 34% (95% CI 10–67%, p < 0.001). The risk of bias assessment revealed that 71.4% (10/14) of the included studies had a low risk of bias and that 28.6% (4/14) had a moderate risk of bias. Conclusions: While C. albicans remain, the predominant species causing oropharyngeal and oral candidiasis among PLHIV in Africa, NAC species also contribute significantly to the infection burden. Despite ART and UTT policies, oropharyngeal candidiasis remains prevalent, emphasizing the need for targeted interventions.
Plasmodium falciparum genetic diversity and multiplicity of infection among asymptomatic and symptomatic malaria-infected individuals in Uganda
(Springer Nature, 2024-11-14) Mwesigwa, Alex; Ocan, Moses; Cummings, Bryan; Musinguzi, Benson; Kiyaga, Shahid; Kiwuwa, Steven M.; Okoboi, Stephen; Castelnuovo, Barbara; Bikaitwoha, Everd Maniple; Kalyango, Joan N.; Karamagi, Charles; Nankabirwa, Joaniter I.; Nsobya, Samuel L.; Byakika-Kibwika, Pauline
Background: Plasmodium falciparum (P. falciparum) remains a significant public health challenge globally, especially in sub-Saharan Africa (SSA), where it accounts for 99% of all malaria infections. The outcomes of P. falciparum infection vary, ranging from asymptomatic to severe, and are associated with factors such as host immunity, parasite genetic diversity, and multiplicity of infection (MOI). Using seven neutral microsatellite markers, the current study investigated P. falciparum genetic diversity and MOI in both asymptomatic and symptomatic malaria individuals in Uganda. Methods: This cross-sectional study analyzed 225 P. falciparum isolates from both asymptomatic and symptomatic malaria patients, ranging in age from 6 months to ≥ 18 years. P. falciparum genetic diversity, MOI, and multi-locus linkage disequilibrium (LD) were assessed through genotyping of seven neutral microsatellite markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34–313, and C3M69–383. Genetic data analysis was performed using appropriate genetic analysis software. Results: P. falciparum infections exhibited high genetic diversity in both asymptomatic and symptomatic individuals. The mean expected heterozygosity (He) ranged from 0.79 in symptomatic uncomplicated malaria cases to 0.81 in asymptomatic individuals. There was no significant difference (p = 0.33) in MOI between individuals with asymptomatic and symptomatic infections, with the mean MOI ranging from 1.92 in symptomatic complicated cases to 2.10 in asymptomatic individuals. Polyclonal infections were prevalent, varying from 58.5% in symptomatic complicated malaria to 63% in symptomatic uncomplicated malaria cases. A significant linkage disequilibrium (LD) was observed between asymptomatic and symptomatic uncomplicated/complicated infections (p < 0.01). Genetic differentiation was low, with FST values ranging from 0.0034 to 0.0105 among P. falciparum parasite populations in asymptomatic and symptomatic uncomplicated/complicated infections. Conclusion: There is a high level of P. falciparum genetic diversity and MOI among both symptomatic and asymptomatic individuals in Uganda. Asymptomatic carriers harbor a diverse range of parasites, which poses challenges for malaria control and necessitates targeted interventions to develop effective strategies.
The state of patient-centered care and associated factors at a large referral hospital in Northwestern Uganda: Perceptions of patients
(Elsevier, 2024-11-07) Aleni, Mary; Mwebesa, Edson; Twesigye, Deus; Andru, Monicah; Assusi, Mildred Edna; Atuhairwe, Irene; Nsubuga, Allan G.; Ewing, Helen; Roepke, Abbey
Background: A Patient-Centered Care (PCC) approach to health service delivery is considered one of the essential domains of healthcare quality. This has been shown to improve patient satisfaction with health services and patient outcomes, but it has not been fully embraced in many low and middle income countries. Purpose: To evaluate patients’ perceptions of PCC and identify the factors influencing perceived PCC at a large referral hospital in Northwestern Uganda. Materials and Methods: We conducted a descriptive cross-sectional correlational study. Four hundred and eighty (480) patients or their attendants participated in the study. Data was collected using an interviewer administered questionnaire. Statistical analysis was applied at univariate, bivariate and multivariate levels using Stata V.14 to assess the state of PCC, patient perceptions and factors associated with perceived PCC. Results: Sixty five percent (64.8 %) of the participants perceived they received PCC. Most of the dimensions of PCC were rated high on a 5-point Likert scale, with respect for patient’s values and preferences ranked highest; mean score of 3.9 (SD = 0.9) and coordination of care ranked lowest, mean score of 3.5 (SD = 0.9). Being outpatient, single or never in union had a reduced perception score of PCC. Patients who had heard of PCC had a higher perception of PCC. Conclusion: Patient-Centered Care was rated optimally at ARRH. All the PCC dimensions were rated highly except coordination of care and information, education and communication which could be improved by building the capacity of health workers in effective communication and coordination of health care services.
Adaptation and carry over effects of extreme sporadic heat stress in Culex mosquitoes
(Elsevier, 2024-10-09) Padde, John Roberts; Zhou, Yinghui; Chen, Yunxuan; Zhu, Yuxiao; Yang, Yuxuan; Hou, Min; Chen, Lu; Xu, Zhipeng; Zhang, Donghui; Chen, Lin
Mosquitoes, as temperature-sensitive ectothermic vectors, exhibit temperature-dependence. This study investigates Culex pipiens pallens (Cx. pallens) responses to abrupt temperature increases and their implications on mosquito physiology. First instar larvae (24hr post hatching) and newly enclosed adults (24hr post emergence) were separately exposed to heat shock regimes of 33 °C, 37 °C, and 42 °C for 3 days alongside a control temperature of 27 °C. Results showed that mortality was triggered at 42 °C within a day. Adult male mosquitoes were less tolerant to all temperatures than larvae and adult females (p < 0.05). Exposing larvae to constant temperatures for 3 days significantly decreased larvae's development time, growth rate and adult emergence (p < 0.05). Reproductive fitness was significantly reduced (p < 0.05) in males emerging from larvae exposed to 37 °C. Life table parameters showed significant increased mortality rate, kill power and decreased life expectancy at the embryonic stage (p < 0.05). Furthermore, heatwaves deactivated the Transient receptor protein ankyrin 1 at 37 °C (p < 0.05) in larvae but not adults. Calmodium, Heat shock protein 90, and small heat shock protein expression were significantly decreased in larvae at 37 °C (p < 0.05) as compared to larvae raised at 33 °C and 27 °C. In conclusion, we classified the heat waves into three categories: adaptable (33 °C), critical (37 °C), and fatal (42 °C). Prolonged exposure of Culex pallens larvae to extreme heat affects the male reproductive output. These findings may serve as an important reference for forecasting vector and pest dynamics and used to tailor mosquito prevention and control measures.

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