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ItemHealth worker's practices and perspectives on the allocation of solid organs based on Govind Persad et al. criteria: a case of Mulago Hospital(Makerere university, 2026)Allocation of solid human organs is complex due to global scarcity amidst high demand necessitating transparent, equitable and efficient allocation policies. In Uganda, the absence of a formal organ distribution framework raises concerns about fairness and consistency in decision-making. This study explored the practices and perspectives of health workers in Uganda regarding organ allocation, guided by Govind Persad’s ethical criteria. A qualitative cross-sectional study was conducted with 15 health workers involved in organ transplant services at Mulago National Referral Hospital, Kampala. Key-informant interviews were audio-recorded, transcribed verbatim, and analyzed by two independent coders. Analysis was primarily deductive, guided by Ajzen’s Theory of Planned Behaviour and Persad et al.’s multi-principle framework, complemented by inductive analysis to capture emergent themes. NVIVO 14 software supported data management and organization. Four themes emerged: practices for organ transplant scheduling, attitudes towards organ allocation based on Persad’s ethical principles, perceived control and ethical dilemmas encountered. Current practices at Mulago Hospital are largely influenced by an institutional culture that prioritizes first-degree relatives identified by patients. Compatibility screening and psychosocial support are provided and standard operating procedures emphasize voluntarism, informed consent, and respect for religious values. Health workers expressed positive attitudes toward adopting global organ allocation models but emphasized the need for contextual adaptation. Perceived control over transplant scheduling was limited due to systemic constraints, including resource scarcity and infrastructure limitations, which negatively affect equity. Ethical dilemmas commonly arose from challenges in identifying familial coercion and managing emotional distress linked to transplant disqualifications or delays. Formal organ allocation frameworks are essential for promoting equity and transparency in transplant scheduling. Adjusting global allocation models to align with the resource, cultural, and systemic constraints represents a pragmatic approach to strengthening organ allocation practices at Mulago National Referral Hospital and similar resource-limited settings.
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ItemUnderstanding stakeholder perspectives, preferences and experiences on the return of individual pharmacogenomic research results(Makerere University, 2025)Globally, the return of results from genomic analyses including pharmacogenomics research has been approached with several debates in the past decades. Despite research participants’ high demand for individual genomic and pharmacogenomic research results, there is little consensus on whether results should be returned at all in research setting and if so, what kinds of results, how they should be returned, and under what circumstances should results be returned. This study aimed to analyse stakeholder perspectives, experiences, and preferences to develop an institutional procedural guidance for the return of individual pharmacogenomic research results to people living with HIV. We carried out three sub studies at Makerere University College of Health Sciences and affiliated HIV research institutions located on Mulago Hill. In sub-study I, a convergent parallel mixed methods study was conducted where 225 participants were enrolled in a survey and 30 of them participated in deliberative focus group discussions (dFGDs). Qualitative data were analysed using thematic analysis method. Quantitative data were analysed using a Poisson model and a multinomial logistic regression model to determine the factors influencing the primary outcome (preferences for either all results, partial results or none of the results) and secondary outcome (preference for either the active role, collaborative role or passive role) respectively. In Sub-study II, an exploratory descriptive qualitative study was conducted with 12 REC members, 12 researchers and 30 CAB members to analyse the stakeholder perspectives and ethical considerations on how individual results should be safely returned to people living with HIV. The data were analysed using thematic analysis. In sub-study III, a modified ADAPTE process methodology was employed to develop an institutional procedural guidance for the return of individual pharmacogenomic research results in three phases. These included the set-up phase, adaptation phase, and finalization phase. We utilized the findings from sub-study I and II in the adaptation phase to develop the first draft of the procedural guidance. We also utilized the feedback from the panelists and potential end-users to develop the second and final draft of the procedural guidance. Sub-study I: For the primary outcome; the majority (98%) participants wanted to receive individual primary pharmacogenomics research results. Factors that significantly influenced preference for all results were antiretroviral experience for than five years (PR: 1.69, p=0.001), attending the IDI clinic from more than five years (PR: 1.19, p=0.045), and religion (PR: 0.76, p=0.036). Reasons for the desire to receive results were reciprocity for valuable time and effort, preparing for future eventualities, and the right to health information. For the secondary outcome; most participants 55.2% (122/221) preferred the collaborative role, 30.3% (67/221) preferred the active role, and 14.5% (32/221) preferred the passive role. Factors that significantly influenced preference for an active role compared with a collaborative role were marital status (OR: 0.282, p=0.013), research experience (OR: 4.37, p=0.028), and religion (OR: 2.346, p=0.041). The reasons proffered for the active role included prior experience with antiretroviral treatment and increased exposure to research activities. Sub-study II: The prominent themes from the interviews and deliberative focus group discussions included stakeholder’s attitudes, ethical and social implications, perceived challenges and recommendations to the process of returning individual results. Additionally, five themes emerged regarding the key considerations for a safe return of individual results. These included, (i) defining the nature of research results to return to participants; (ii) obtaining informed consent and preparing research participants to receive their individual results; (iii) opinion on how to communicate results to participants, (iv) community engagement strategies for promoting understanding of pharmacogenomic results; (v) perceived roles of stakeholders in promoting participants’ understanding and utilization of pharmacogenomic research results. Sub-study III: The institutional procedural guidance comprised of three main phases, which include pre-study phase (protocol development phase), the feedback of individual results phase, and the post-feedback of individual results phase. In each phase, several key considerations have been described to guide researchers on how individual results can be safely returned to participants. This study provides insights into stakeholder perspectives, preferences, and experiences on whether and how individual pharmacogenomic research results should be returned to PLHIV safely. These insights contribute to the national and international debates on whether and how genomic and genetic results should be returned to participants. Of interest, all stakeholders agree that individual results provide an opportunity to improve participants’ quality of life and uphold the principle of autonomy. However, there is a need for caution when returning such results, especially the incidental findings whose implications do not only affect an individual but might extend to their families and communities. We recommend further research to explore the feasibility of using various culturally appropriate strategies to enhance participants’ understanding of pharmacogenomic research information and the implications of these results.
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ItemEEG charateristics in patients with CT or MRI localized intra-axial brain tumors at a tertiary hospital in Uganda.(Makerere University, 2022)Introduction: EEG findings in brain tumors vary. The various types of electroencephalographic alterations, when they occur, may include delta slowing, spikes and spike-wave elements & “typical interictal epileptiform discharges” among others. These observations promise a useful insight into the pathophysiology of epilepsy. Objectives: we described EEG findings in 31patient with intra-axial brain tumors with the primary aim of delineating the neuroanatomical structures involved in modulating the observed EEG findings. Methods: This was a cross-sectional study in 31 patients with intra-axial brain tumors. Size and intra-axial positions of the brain tumours was determined and confirmed using CT or MRI scans then surface EEG was done and its characteristics described and documented by a blinded reader in the corresponding cases. Results: For both infratentorial and supratentorial loci we find that the tumor size is not linearly related to the EEG characteristics. The clear cut EEG findings were three (i.e. Normal, polymorphic slowing and interictal epileptiform spikes and sharp waves). The total number of normal EEG was 11 (35.5%) in patients with tumors of both infratentorial and supratentorial locations. Polymorphic slowing was 12 in total (38.7%) mainly in patients with tumors located in the superficial cerebral white matter and at the cerebral white-grey matter boundary. Total interictal epileptiform discharges were 9, of which 4 were overlapping with polymorphic slowing. The interictal epileptiform spikes were mainly in tumors of the cerebral grey matter. Significance: The lack of linearity of the EEG characteristics to the tumor size and the distribution of normal EEGs throughout the brain in our study indicate that certain neuroanatomical pathways must first be compromised before any EEG change can be realized. Reduction of the cholinergic tone in neuromodulation has in previous studies been associated with delta and polymorphic EEG. We now propose and implicate the destruction of cholinergic fibres in the production of polymorphic EEG changes which we observed in the current series. The observation of interictal spikes (some sleep potentiated) on polymorphic slow background EEG activities of 4 patients with white matter tumors implicate polymorphic slowing as a precursor to interictal epileptiform spikes and focal cortical hyper- excitability in cases of white matter & subcortical tumors. We therefore propose that the aforementioned destruction of cholinergic fibres set the stage for this focal cortical hyper excitability by abetting an abnormal form of frequency dependent synaptic plasticity that has previously been described as augmenting response. In cases of purely grey matter tumors where interictal epileptiform discharges were observed without polymorphic background slowing of the EEG the mode of epileptogenesis suggested above therefore may not apply.
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ItemContamination and susceptibility patterns of enterobacteriaceae in uncooked chicken and beef from supermarkets in Kampala central division(Makerere University, 2025)Enterobacteriaceae contaminants such as Escherichia, Salmonella, Shigella, and Klebsiella, are some of the causative agents of gastrointestinal infections. The extent of Enterobacteriaceae contamination of raw chicken and beef in supermarkets of Kampala’s central division and its antibiotic susceptibility pattern still remains largely unknown. The study aimed at determining the prevalence of Enterobacteriaceae contamination and its antibiotic susceptibility pattern in raw chicken and beef in Kampala city central division supermarkets. A cross-sectional study was conducted with a total of 48 samples from Six random supermarkets. Samples were tested for contamination status and reported as Colony forming units per gram (CFU/g). A panel of ten antibiotics was used for susceptibility testing of the isolated contaminants. The general prevalence of Enterobacteriaceae was shown to be 83.33% (40/48) with Escherichia coli at 38% (35/92), klebsiella at 32% (30/92) and Citrobacter at 34% (32/92) being the predominant Enterobacteriaceae. Chicken (100%) was found to be more contaminated as compared to beef (66.67%) with a statistically significant difference among them (p value 0.002). There was no significant difference in the contamination of these foods across supermarkets and parishes (p value 0.549 and 0.441 respectively). The antibiotic susceptibility of Enterobacteriaceae from beef and chicken was generally good with all the organisms being susceptible to most antibiotics used except Ampicillin and ceftriaxone. Escherichia coli showed a 60% and 57.1% resistance to Ampicillin and ceftriaxone respectively while klebsiella showed a 56.7 % resistance to Ampicillin. No statistically significant difference was observed in the antibiotic susceptibility patterns of organisms isolated among chicken and beef (p value 0.00575). This study reveals a high prevalence of Enterobacteriaceae contamination particularly in chicken as compared to beef and a low resistance burden to the antibiotics tested with the exception of Ampicillin and Ceftriaxone. Escherichia coli and Klebsiella are by far the most common contaminants of these foods in Kampala central division. Keywords: Enterobacteriaceae contamination, uncooked chicken and beef, susceptibility patterns, Kampala central division Uganda
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ItemGenetic diversity, evolutionary origins, and transmission patterns of the ECSA Chikungunya virus strain in Cambodia(Makerere University, 2025)Chikungunya virus (CHIKV), a re-emerging arbovirus of global concern, caused a major outbreak in Cambodia from 2020–2022. However, a critical gap remains in our understanding of its genomic diversity, evolutionary origins, and transmission patterns within the region, as comprehensive full-genome phylogenetic and phylodynamic analyses are limited. The phylogenetic investigation of this outbreak might provide critical lessons to inform public health interventions for managing future outbreaks in LMIC settings. This involved the bioinformatic analysis of 68 viral genomes collected from patients at four healthcare facilities in Cambodia. Following quality control (fastqc) and the exclusion criteria, 48 samples were selected for downstream analysis. Variant calling (using bcftools) and functional annotation (using snpEff) were conducted to characterize the mutational landscape of the outbreak CHIKV virus. Phylogenetic analysis (using Nextstrain) was performed to genotype the virus and determine their evolutionary relationship to global lineages. Phylodynamic and phylogeographic models were applied to estimate the time of the most recent common ancestor (TMRCA) and reconstruct transmission patterns in Nextstrain. Of 48 patients, all had high fever, 32% had musculoskeletal symptoms, and 30% had a rash. All viral samples were of the ECSA-IOL genotype. These genomes lacked the Aedes albopictus-adapting E1:A226V mutation but featured other mutations (E1:K211E, E2:V264A, E1:D284E, E2:I211T) linked to increased replication in Ae. aegypti and mammalian adaptation. Phylogenetic analysis showed a close relationship to strains from Thailand. The estimated time of origin was June 2017, suggesting six years of cryptic circulation before the outbreak. Phylogeographic reconstruction identified Thailand as the likely source and Phnom Penh as a major national transmission hub, indicating a rapid superspreading event. The 2020-2022 Cambodian chikungunya outbreak was initiated by the ECSA-IOL lineage virus from Thailand circa 2017, which underwent a prolonged period of cryptic circulation. Our genomic findings confirm a transmission cycle primarily mediated by Aedes aegypti mosquitoes, characterized by adaptive mutations enhancing viral fitness. These results highlight the critical need for strengthened genomic surveillance systems in Cambodia and other LMICs to promptly detect and mitigate future outbreaks.