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ItemStakeholders’ experiences in the use of electronic informed consent of research participants at the Makerere University College of Health Sciences(Makerere University, 2025)Informed consent is an important aspect of research, but obtaining it can be challenging, and as such, researchers have tried to make the process more engaging and informative. As a result of the COVID-19 pandemic, electronic informed consent (EIC) has become more popular, and it has been found to increase inclusion and diversity by providing tailored information to participants. However, it has not been globally adopted due to concerns around privacy, confidentiality, and determining the voluntariness of the participants. Despite its acknowledgement as the future for clinical research, there is low adoption of EIC in Uganda. Limited studies have explored the perspectives of researchers and research ethics committees, particularly in developed countries, however, the opinions and experiences of research participants and researchers have not been thoroughly investigated in Sub-Saharan Africa, specifically Uganda. A qualitative study was conducted to explore the experiences and views of researchers and their research team members(medical officers, study coordinators and research assistants) to develop strategies to effectively implement EIC in Uganda. Objectives This study aimed to explore the experiences and ethical challenges of stakeholders at the Makerere University College of Health Sciences regarding the use of electronic informed consent so as to improve its processes. This was a descriptive phenomenology cross-sectional study at the Makerere University College of Health Sciences, and qualitative methods were adopted. Twenty in-depth interviews were conducted with research teams, including principal investigators and their team members, and were carried out using qualitative research methods. The qualitative data was analyzed using thematic analysis to highlight the experiences of the participants. Each interview was audio recorded and transcribed verbatim and then arranged and coded using NVivo software. Four main themes emerged from this study. They include stakeholders’ perceptions about the use of electronic informed consent, experiences with the use of electronic informed consent, ethical challenges of using e-consent, and recommendations for the use of e-consent. Respondents viewed electronic informed consent as a promising approach for the inclusion of individuals despite their geographical location. However, limited access and high costs of digital platforms, lack of formal guidance and training and low digital literacy levels hindered the adoption of electronic informed consent. Other ethical issues highlighted included participants struggling to fully comprehend the consent process due to the lack of formal guidance and training from research ethics committees. Despite these challenges, EIC was seen as a promising method for consenting participants in the near future, especially for geographically dispersed study populations, provided improvements, accessibility, and guidance by the ethical committees are in place.
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ItemPrevalence, determinants, and barriers to healthy food choices among school-going older adolescents within Lubaga division: a cross-sectional study(Makerere University, 2025)Childhood and adolescent obesity is increasing in Uganda, with the Uganda Ministry of Health’s 2022/2023 reports showing 10.4% overweight and 2.3% obesity prevalence among adolescents and young adults. This trend elevates risks for non-communicable diseases. However, limited studies focus specifically on older adolescents’ food choices. Objective: To determine the prevalence, determinants, and perceived barriersto healthy food choices among older school going adolescents within Lubaga Division, Kampala Capital City. Methods: A mixed-methods study was conducted with 299 older adolescents for quantitative analysis and four focus group discussions (FGDs) for qualitative insights. Healthy food choices were measured using a dietary diversity score based on WHO guidelines and adapted USDA and Ugandan food pyramids, emphasizing variety and limiting unhealthy fats, added sugar, and high sodium. Univariate, bivariate and multivariable analyses were conducted to examine associations between different factors and healthy food choices, using SPSS. Variables with P-value <0.05 at multivariable logistic regression analysis were considered statistically significant. Qualitative data was thematically analyzed using ATLAS ti. Software. Results: The study found that 42.1% of the participants made healthy food choices. Factors more likely to influence healthy choices included availability of food (OR = 1.59, CI: 1.15–2.20) and family influence (OR = 1.44, CI: 1.07–1.94). Factors less likely to promote healthy choices were taste preference (OR = 0.68, CI: 0.53–0.89) and cost of food (OR = 0.60, CI: 0.34–0.64). Barriers included poor sensory appeal, limited availability, high cost, and peer/media influence. Conclusion: With adolescence being a critical period for establishing enduring dietary habits, addressing the identified barriers of cost, limited availability of healthy options, and the influence of unhealthy food in canteens and leveraging factors such as nutritional knowledge and positive parental influence are crucial for promoting healthier eating habits and improving the long-term health and well-being of this population. By implementing the evidence-based recommendations, we can create a more supportive environment for adolescents to make healthy food choices, contributing to a healthier future.
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ItemAssessment of health workers’ adherence to guidelines for parasitological diagnosis and treatment of uncomplicated and severe malaria in public health facilities in Mukono District(Makerere University, 2024)Background: Uganda national malaria treatment policy guidelines recommend a malaria laboratory test in all patients presenting with fever (history of fever or an axillary temperature≥37.5 °C), and only those with a positive test receive anti-malarial treatment. However, adherence to these guidelines remains suboptimal amongst clinicians in public health facilities with clinical assessment of typical symptoms continuing to account for a significant proportion of malaria diagnosis and treatment practices that contravenes test results. Clinically diagnosed malaria remains the leading cause of morbidity and mortality in Mukono district in Uganda Objective: The study aim was to assess health workers’ parasitological testing and treatment practices for uncomplicated and suspect severe malaria and to determine the factors associated with adherence to the guidelines in public health facilities in Mukono District. Methods: A cross sectional mixed method study design was used. Between July and September 2020, 765 records of suspect malaria patients for the year 2019 were reviewed from across nine health centers in Mukono district. Descriptive data analysis was used to determine the proportion of malaria suspect patients subjected to a malaria diagnostic test and determination of the prescription practices for malaria patients by the clinicians. Multivariable logistic regression and triangulation with qualitative analysis methods were used to explore the factors explaining prescription practices of the clinicians. Results: Of the 765 malaria suspect patient records reviewed, 620 (81%) had a malaria parasitological test done by the clinician. Of the 578 patients diagnosed with uncomplicated malaria, (68%) were treated in accordance with national malaria treatment guidelines with 89% of those tested and confirmed, treated with the recommended first or second line antimalarial drug. Nearly 38% of the patients with negative parasitological test results were given either the first or the second line antimalarial drug, as were 56% of those without a malarial blood test prescribed an antimalarial drug. Of the patients with suspect severe malaria referred for further treatment 56% were provided an appropriate pre-referral treatment while 21% were referred without any. Factors associated with the continued non-adherent prescription practices for malaria patients included; patient age (aOR=1.30, 95% CI: 1.14- 2.06, P=0.023), patient signs and symptoms of fever (aOR = 0.19; 95% CI: 0.52-0.76, P= 0.048), nausea (aOR = 0.48; 95% CI: 0.24-0.92, P=0.026), and sweating (aOR = 0.72; 95% CI: 0.26-0.84, P= 0.036). Conclusion: A considerable proportion of patients presumptively diagnosed and those with negative test results still receive antimalarials. Recommendations: District health authorities should enhance support supervision across all health facilities. The district service commission should allocate more health workers to urban centers to handle high patient volumes. Efforts should also focus on improving the quality of malaria data from public health centers to ensure accurate estimates of medicines and supplies, while scaling up training for health providers in integrated malaria/fever management to improve adherence to diagnostic results.
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ItemComparing performance of generalized linear mixed model and generalized estimating equations in modelling under-five mortality : a case study of Iganga-Mayuge Districts Uganda(Makerere University, 2023)Introduction: Reduction of childhood mortality is a global health priority and an indicator of child survival. Over 5 million in 2021 children under five years died every day from preventable and curable diseases which is undesirable. Between 1990 and 2020, the global mortality rate for children under five years declined by 61 per cent, from 93 deaths per 1,000 live births to 37 deaths per 1,000 live births. Over the last three decades, under-five mortality has steadily been declining in Uganda. Between 1990 and 2020, the rate declined by more than 70%, from 183 to 43.3 deaths per 1,000 live births. This study aimed at determining the association between the predictor variables and under-five mortality rates in the Iganga and Mayuge districts. Methods: Data from Iganga-Mayuge Health and Demographic Surveillance Site (IMHDSS) of 2010 to 2015 collected on women of reproductive age (13 to 49 years) were used. The outcome was death before the fifth birthday and the independent variables were gender, place of residence, birth order, mother’s age, education, wealth index, marital status, place of delivery, attend antenatal care, occupation and year. Village was used as a random effect. For descriptive analysis, proportions were used. Means and standard deviation were used for continuous variables. The explanatory variables were checked for multicollinearity to ensure validity for further analysis. AIC and QIC were used for model selection. Data management and analysis was done using excel and STATA 18. Results: Between 2010 and 2015, 2011 had the highest number of under-five deaths. Mothers from both the rural and Peri_urban areas had an average of one child. The odds of dying before the age of five reduced among the children whose mothers were cohabiting and those whose highest level of education was below primary. Being male, residing in the rural areas and children whose mothers were teenagers increased the odds of dying before the age of five. Conclusion: The choice between these methods should be guided by the underlying data structure, assumptions, research objectives, and the practical significance of the differences observed. Interventions like healthcare access could improve maternal and child healthcare services, enhance education, thus improving future research, guide policy development aimed at improving overall child well-being and reduce under-five mortality in Iganga and Mayuge districts.
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ItemPrevalence and factors associated with malaria in households following scale up of integrated community case management of malaria in Kiruhura District, Western Uganda(Makerere University, 2025)Background: Malaria remains a major public health challenge in sub-Saharan Africa, with a disproportionate burden in rural Uganda. Despite national adoption of integrated community case management implemented through Village Health Teams to improve early diagnosis and treatment, several districts continue to report high malaria burden. This study assessed malaria prevalence and examined household-level factors associated with malaria risk following scale-up of integrated community case management in Kiruhura District, western Uganda. Methods: mixed-methods cross-sectional study was conducted among 327 households registered under integrated community case management between September 2022 and August 2023. Quantitative data were collected using structured questionnaires and analyzed to estimate malaria prevalence and associated factors. Bivariate and multivariable logistic regression analyses identified factors independently associated with malaria, with results reported as odds ratios and 95 percent confidence intervals. Qualitative data were collected through key informant interviews and Focus Group Discussions involving 15 purposively selected stakeholders and analyzed thematically to explore experiences with integrated community case management implementation. Results: A total of 327 households were surveyed across Kiruhura District under the ICCM intervention, achieving a response rate of 98.4%. The majority of households were located in rural areas, with a mean household size of seven individuals. Overall, 410 malaria episodes were reported, corresponding to a prevalence of 26.7% among residents of ICCM-supported households, while 10.1% of households experienced at least one malaria episode during the reference period. Children under five years accounted for 74.8% of reported cases, indicating a disproportionate burden of malaria in this age group. In multivariable analysis, the presence of vegetation near households was associated with increased malaria risk (AOR = 1.17; 95% CI: 1.02–1.34). Conversely, use of long-lasting insecticide-treated nets (AOR = 0.66; 95% CI: 0.48–0.91) and seeking care from public health facilities (AOR = 0.74; 95% CI: 0.66–0.83) were independently protective. Conclusion: Malaria remains highly prevalent in ICCM supported households in Kiruhura District. Efforts to reduce household malaria burden could focus on strengthening the supply chain for ICCM commodities, improving VHT support and motivation and enhancing community education on effective malaria prevention practices, such as the proper use of LLINs.