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ItemBurden of infants at risk of poor growth and development among children under six months of age in selected health facilities within Kampala(Makerere University, 2026)Background: Globally, infants under six months face a high burden of morbidity and mortality driven by complications of poor growth and development, yet previous research and nutrition programs have focused predominantly on children aged 6-59 months. However, infants under six months are not a homogenous group they include those with poor birth outcomes, known risk factors, poor growth patterns, or poor anthropometry each requiring different management. The World Health Organization's 2023 revised guidelines introduced the categorization of infants under six months "at risk of poor growth and development" to enable early detection and intervention. However, data on the prevalence and factors associated with this at-risk population in Uganda remain limited. Objectives: To determine the prevalence of “infants at risk of poor growth and development (PGD)” and associated factors among infants under six months of age attending outpatient clinics in selected health facilities within Kampala, Uganda. Methods: A cross-sectional study was conducted among 832 infants aged 6 weeks to under 6 months attending outpatient clinics at Kawempe National Referral Hospital, Kisenyi HC IV, and Kisugu HC III in Kampala. Consecutive sampling was used. A semi-structured questionnaire collected data on infant, maternal, and household factors. Infants at risk were defined using WHO 2023 criteria (poor birth outcomes, known risk factors or poor anthropometry). Data were analyzed using STATA 17.0 with modified Poisson regression to estimate adjusted prevalence ratios (aPR). Results: The prevalence of infants at risk of poor growth and development was 46.2% (95%CI 42.8-49.6%). Factors significantly associated with increased risk were: non-maternal caregiving (aPR 1.77, 95%CI 1.25-2.52, p-value 0.001), maternal illness during pregnancy (aPR 1.43, 95%CI 1.17-1.76, p-value 0.001), and household history of loss of a child under five years (aPR 1.52, 95%CI 1.09-2.13, p-value 0.014). Protective factors included adequate antenatal care visits (4-7 visits: aPR 0.73, 95%CI 0.60-0.89, p-value 0.002; ≥8visits: aPR 0.71, 95%CI 0.51-0.99, p-value 0.042) and mosquito net use (aPR 0.70, 95%CI 0.55-0.88, p-value 0.002). Conclusion: The high prevalence (nearly 1 in 2 infants) suggests that risk begins very early in life and may be under-ascertained by current surveillance systems focusing on older children. The findings highlight the need for broader screening criteria and targeted interventions addressing maternal health and caregiving environments to ensure infants reach their developmental potential.
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ItemInterprofessional education and collaborative practice in a clinical learning environment: a situational analysis at mwana mugimu nutritional unit of Mulago national referral hospital(Makerere University, 2026-07-23)IPE occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. Interprofessional Collaborative Practice (IPCP) happens when multiple health workers from different professional backgrounds work together with patients, families, careers and communities to deliver the highest quality of care. Through IPECP, health training institutions can support health systems to achieve the health-related Millennium development goals. Core competencies like Interprofessional communication, teamwork, values/ethics, roles/responsibilities guide the implementation of IPECP. In clinical settings, health workers care for patients collaboratively, but trainees from different health professions in the same clinical setting are still practising, studying and caring for patients in isolated disciplines. Despite the need for IPECP in the clinical learning environment, concepts are not well programmed, health professions engaged in teaching have a poor attitude towards IPECP and poor communication between students and teaching health professionals. How IPECP key competencies are being implemented in clinical learning environments among health trainees and health workers needs to be explored. The study assessed the current status of IPECP among health trainees and workers on the Mwana Mugimu nutritional unit of Mulago national referral hospital. Methodology: purposive sampling technique, eight nursing, eight medical students and ten qualified health professional workers will be included in the study. Data was collected through focus group discussions, observation and individual semi-structured interviews with the help of research assistants. Thematic data analysis of raw data and analysis of focus group and interview data using R studio.Findings:The study findings revealed that nursing students, medical students, and healthcare professionals are rarely aligned towards Interprofessional education and collaborative practice. While none of the WHO competencies on IPECP were not completely met, the study found Studying/teaching students of different health professionals is an enabler of IPECP. The following subthemes were barriers towards attainment of a good environment for IPECP; Inferiority Complex among different health-related professionals, Unwillingness to learn new areas of practice from other different health professions, Lack of alignment around goals and objectives, A big workload is a challenge for IPECP Lessons are not conducted together, limiting interprofessional education Conclusion: In conclusion, It is recommended that all health training nursing and medical students programs include a common core principal of the curriculum to facilitate communication and collaboration in order to eliminate undermining/ inferiority complex so that IPECP can shrive. The government should also promote the concept of multi-professional education all curriculum for classroom and clinical learning environments in various institutions, including institutions like universities, and other schools for health professionals. Lastly, continuous in-joint service training, workshops, and refresher courses should be provided for different health care professionals with a view to strengthening collaborative practice.
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ItemPrevalence and factors associated with poor quality of life among adolescents with epilepsy attending the paediatric neurology and paediatric psychiatry clinics in Mulago national referral hospital(Makerere University, 2026-06)Background: Epilepsy is a major cause of disability among adolescents in low- and middle-income countries, with impacts extending beyond seizure control to physical, psychological, and social well-being. Despite this, evidence on the burden and determinants of poor quality of life (QoL) among adolescents with epilepsy in Uganda remains limited. Aim: To determine the prevalence of poor quality of life and its associated factors among adolescents with epilepsy attending Mulago National Referral Hospital. Methods: A hospital-based cross-sectional study was conducted among 383 adolescents aged 10–19 years attending the Paediatric Neurology and Psychiatry Clinics at Mulago National Referral Hospital. QoL was assessed using the QOLIE-AD-48, with poor QoL defined as a score <60. Data on psychological and clinical factors were collected using validated tools. Modified Poisson regression with robust standard errors was used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: The prevalence of poor QoL was 83.3%. Adolescents aged 15–19 years were less likely to have poor QoL compared to those aged 10–14 years (aPR = 0.84, 95% CI: 0.73–0.97). Higher educational attainment was associated with increased prevalence of poor QoL, including primary (aPR = 1.59, 95% CI: 1.14–2.21), secondary (aPR = 1.90, 95% CI: 1.39–2.59), and tertiary education (aPR = 1.95, 95% CI: 1.42–2.67), compared to no formal education. Adolescents uncertain of their family history of epilepsy had lower prevalence of poor QoL (aPR = 0.87, 95% CI: 0.76–0.99), while normal self-esteem was protective (aPR = 0.84, 95% CI: 0.75–0.94). Other clinical and psychological factors were not independently associated with QoL after adjustment. Conclusion: Poor quality of life among adolescents with epilepsy in this setting is alarmingly high. The pattern of associations suggests that QoL in this population is less driven by traditional clinical markers and more shaped by developmental and psychosocial context, particularly self-perception and lived experience within educational environments. This reframes epilepsy care in adolescents as a multidimensional challenge, requiring integrated models that address not only disease control but also identity, resilience, and social functioning.
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ItemPrevalence and drivers of loss to follow-up among adolescents with tuberculosis at Mulago National Referral Hospital(Makerere University, 2026)Background: Adolescents with tuberculosis (TB) face unique obstacles across individual, interpersonal, health system, community, and policy levels, increasing their risk of loss to follow-up. The World Health Organisation classifies TB cases as pediatric (0–14 years) or adult (15+ years), obscuring the distinct profile of adolescents (10–19 years). Despite therapeutic advances, adolescents have loss to follow-up (LTFU) rates twice those of adults, reflecting unmet care needs. Objective: To determine the prevalence and drivers of LTFU among adolescents with TB at Mulago National Referral Hospital. Methods: A sequential mixed-methods study was conducted. Phase 1 involved retrospective review of TB registers (July 2023 – June 2025) to calculate LTFU prevalence. Phase 2 comprised in-depth interviews with purposively sampled adolescents who had been lost to follow-up, stratified by age, sex, and residence, plus key informant interviews with healthcare providers and community health workers. Quantitative data was analysed using STATA, and the qualitative data was analysed thematically using the Socio-Ecological Model. Results: Among 123 adolescents, the prevalence of LTFU was 9.8% (12/123). Most participants (75.6%) completed treatment, while 9.8% were lost to follow-up, 10.6% transferred out, and 4.1% died. The median duration in care before LTFU was 172 days (IQR: 60–182.5 days). Qualitative findings revealed multi-level drivers: individual (transport and distance barriers, treatment burden, side effects, school commitments); interpersonal (stigma, peer influence, lack of family support); health system (limited provider support, strict clinic appointments, drug stockouts); community (weak facility–community linkage, cultural and religious beliefs); and policy (reduced donor funding for community programs). Conclusion: One in ten adolescents with TB at Mulago Hospital was lost to follow-up. Drivers of LTFU span multiple levels, with transport costs, side effects, stigma, and health system inflexibility being prominent. Multi-level interventions, including decentralising TB services to lower-level health facilities, expanding national TB programs to include all adolescents, adolescent-friendly clinic models, and targeted social media campaigns, are urgently needed to improve treatment completion and align with the 2030 WHO End TB Strategy.
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ItemEarly outcomes and predictors of mortality among preterm neonates with respiratory distress syndrome admitted at Kawempe National Referral Hospital; A prospective study(Makerere University, 2026)Background: Respiratory distress syndrome (RDS) is a severe condition in preterm newborns, marked by a lack of surfactant, which results in high rates of illness and death. The burden of RDS is greater in low- and middle-income countries, where it significantly increases mortality rates and admissions to neonatal intensive care units. Despite global efforts to reduce neonatal mortality, RDS remains a major challenge, particularly in places like Uganda, where there is limited research specifically examining the outcomes of preterm neonates with RDS. The study aimed to determine early outcomes and predictors of mortality among preterm neonates with respiratory distress syndrome admitted to Kawempe National Referral Hospital (KNRH) in Uganda. Methods: This was a hospital-based prospective cohort study conducted at the Neonatal Special Care Unit of Kawempe National Referral Hospital among preterm neonates aged less than 24 hours whose respiratory distress commenced within the first 6 hours of life. Quantitative data were collected using structured questionnaires, focusing on maternal and neonatal characteristics, as well as early outcomes of the preterm babies. Early outcomes comprised survival and mortality assessed within three days of follow-up. The Kaplan-Meier method estimated survival curves, with differences between these curves analyzed using the log-rank test. Bivariate and multivariate Cox proportional hazards regression was used to assess the predictors of mortality with statistical significance set at <0.05. Results: Among the 201 preterm neonates with respiratory distress syndrome admitted to KNRH, 25(12.4%) died within the three-day follow-up, with most of the deaths (24), occurring within the first 2 days. Preterm neonates who did not receive xanthine derivatives had approximately three times higher hazard of death compared with those who received xanthine derivatives (aHR=2.99; p=0.034). Similarly, neonates delivered vaginally had more than four times increased hazard of death compared with those delivered by caesarean section (aHR=4.33; p=0.013). (Table 8). Conclusion: Preterm neonates with respiratory distress syndrome admitted at Kawempe National Referral Hospital experienced early mortality mainly within the first two days of life. The hospital needs to ensure timely access to caffeine therapy and consider safe delivery options for preterm births to improve survival outcomes in this high-risk population.