School of Bio-Medical Sciences (Bio-Medical) Collections

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    Childhood immune responses to hepatitis B vaccine in Uganda.
    (Makerere University, 2026-10-14) Muwanda, Fahad.
    Introduction: Hepatitis B virus (HBV) infection is still a major global public health problem with approximately 296 million people infected. Sub-Saharan Africa is disproportionately over-burdened by HBV infection, with Uganda’s national prevalence at 10%. The Ministry of Health integrated childhood hepatitis B vaccination into the Uganda National Extended Program on Immunizations (UNEPI) in 2002 to reduce high morbidity and mortality rates. Childhood HBV immunization remains fundamental to elimination of HBV but the levels of African/Ugandan paediatric non-response and the underlying reasons largely remain unknown. This doctoral study sought to determine the extent and persistence of immuno-protection accorded by the vaccine in Uganda. Methods: A cross-sectional study design was utilized to conduct four sub studies. For the first sub study, a systematic review was conducted to synthesize data on African pediatric HBV vaccine responses, by including 19 eligible articles out of the 197 initially downloaded and published from 1999 to 2021 from African Journals Online (AJOL), EMBASE, Scopus, and, PubMed. The second and third sub studies qualitatively and quantitatively determined the serological status of vaccine and HBV exposure among childhood recipients of the hepatitis B vaccine who were under 5 and 15-17 years of age and enrolled on the UNEPI after the vaccine’s inception in 2002. The fourth sub study analyzed archived plasma samples to determine HBV and vaccine serological status among adolescent children living with HIV. For sub study two, three, and four, we assessed participants’ exposure to infection using a 5-panel qualitative hepatitis B Combo RDT methodology. Subsequently, immune responses to the hepatitis B vaccine were assessed in these participants’ serum or plasma using the quantitative electrochemiluminescence immuno assay (ECLIA). Results: Our systematic review revealed significantly higher proportion of HBV vaccine seroprotection (69.07%) among African children under 15 years of age than children 15 to 17 years (32.368%), 95 % CI = [34.2454% to 39.0847%] (p < 0.0001) . Findings from sub studies 2 and 3 showed that qualitative seroprevalence of hepatitis B surface antibody (anti-HBs) was 33.1%, 18.4%, and 5.9% in the under-5, among the 15–17-year-old study groups, and in adolescents living with HIV, respectively. However, quantitative anti-HBs analysis revealed that post vaccination, 74.3% of children under 5 years retained protective anti-HBs levels compared to only 14.6% among adolescents and 16.3% in adolescents living with HIV. The overall prevalence of HBsAg was 1.52%, with higher rates in adolescents (2.78%) than in children under 5 years (0.8%) and 2.0% among adolescents living with HIV. Conclusions: While infant HBV vaccination under UNEPI, like in most African extended programmes on Immunization (EPIs), provides commendable immune protection in children under 5 years, seroprotection wanes significantly by adolescence, increasing infection risks, especially in children 15-17 years of age and adolescents living with HIV. The apparent breakthrough HBV infections further suggest that the development of targeted adolescent strategies and guidelines addressing waning immunity will be essential to achieve the 2030 HBV elimination goals in Uganda and similar African settings.
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    Assessment of antimicrobial prescribing appropriateness for adult urinary tract infections in Moyo general hospital, Northwestern Uganda: A stewardship perspective.
    (Makerere University, 2026-10-12) Kidega, Francis, Kimong.
    Antimicrobial resistance is a growing global challenge, often driven by inappropriate antibiotic use. In Northern Uganda, the extent of guideline adherence and the alignment of empirical therapy with bacterial susceptibility patterns in urinary tract infections (UTIs) remain poorly understood. This study evaluated the appropriateness of antibacterial prescriptions for adult UTIs at Moyo General Hospital by identifying commonly used antibacterials and assessing their alignment with the Uganda Clinical Guidelines (UCG) and in vitro susceptibility patterns.This cross-sectional study assessed antibacterial prescribing for adult UTIs at Moyo General Hospital, evaluating adherence to UCG and concordance with in vitro susceptibility results. Using systematic random sampling, 404 patients were recruited from 958 eligible prescriptions. Data on demographics, clinical features, prescriptions, and laboratory results were collected, with urine cultures analysed at Yumbe Regional Referral Hospital. Descriptive and inferential statistics, including chi-square tests and logistic regression, were used to evaluate prescribing appropriateness. Ethical approval was obtained, and findings were disseminated through a dissertation, peer-reviewed publication, and presentations to local health teams.Escherichia coli (49.5%) and Staphylococcus aureus (31.6%) were the most frequently isolated pathogens. High in vitro susceptibility was observed for cefixime (93.9%), ceftriaxone (84.1%), and levofloxacin (82.4%), whereas nitrofurantoin and ciprofloxacin showed moderate activity (66.7% and 69.4%, respectively). Resistance was high for trimethoprim/sulfamethoxazole (82.3%) and ampicillin (73.8%). Only 40.7% of prescriptions were aligned with susceptibility results, and 39.5% adhered to UCG recommendations. Agreement between guideline-based and susceptibility-driven prescribing was slight (κ = 0.1435).These findings reveal substantial gaps in empirical prescribing, guideline adherence, and microbiological alignment for adult UTIs at Moyo General Hospital (MGH). To optimize UTI management and curb antimicrobial resistance in Northern Uganda, there is an urgent need to strengthen antimicrobial stewardship, improve access to diagnostic testing, update national guidelines using local resistance data, and enhance prescriber training.
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    Hypotension and dehydration status in children aged 28 days to 5 years with acute watery diarrhoea at Kisanji Health Centre iv.
    (Makerere University., 2026) Mawanda, Abdul, Nasser.
    Background: Acute watery diarrhoea (AWD) remains a leading cause of morbidity and mortality in children under five in low-resource settings. Severe dehydration from AWD can precipitate hypotension, a late but highly specific sign of shock. Despite established management protocols, blood pressure measurement is rarely integrated into diarrhoea assessment in Uganda. Objective: To determine the prevalence of hypotension, assess dehydration status, and examine the relationship between dehydration and hypotension in children aged 28 days to 5 years with AWD at Kisenyi Health Centre IV. Methods: A descriptive cross-sectional study was conducted among 280 systematically selected children presenting with AWD. Data on socio-demographic, clinical, and anthropometric variables were collected. Blood pressure was measured using a certified and calibrated automated sphygmomanometer, and dehydration was assessed per Uganda Basic Paediatric Protocols. Logistic regression was used to explore associations. Results: The mean age of participants was 29 months (SD = 17), with 51.1% female. The mean systolic blood pressure was 91.75 mmHg (SD = 7.54; range 51-108.7 mmHg). The prevalence of hypotension was 2.5%. Most children were alert (93.2%), 35.7% had sunken eyes, 57.5% were restless/irritable, and 47.1% presented with cold extremities. Skin pinch returned within 2 seconds for 79.3% of participants, and 95.4% had a capillary refill time of 2 seconds. Severe dehydration was notable in 6.8% of the children, while 33.9% had some dehydration. Severe dehydration was strongly associated with hypotension (COR = 30.9; 95% CI: 3.0-315; p = 0.004), but this was not significant after adjusting for referral status (AOR = 8.3; 95% CI: 0.5-138.4; p = 0.141). Conclusion: Hypotension was strongly linked to severe dehydration, pointing to the need for integrating routine blood pressure measurement into AWD assessment. This could complement physical examination to identify children at risk of decompensated shock and improve management outcomes. Keywords: Acute watery diarrhoea, hypotension, dehydration, paediatrics, Uganda, blood pressure monitoring.
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    Kidney function profiling of Prehypertensive adult rural dwellers of Nakaseke, Uganda.
    (Makerere University, 2025-08-02) Mirembe,Joel.
    Kidney Dysfunction, Prehypertension, Prevalence, eGFR, Dipstick Proteinuria, Associated Factors, Rural
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    Extent, associated factors and effect of delayed antibiotic initiation in adult inpatients receiving antibiotic treatment at Kisenyi Health Center IV and Kiruddu National Referral Hospital, Kampala, Uganda
    (Makerere University, 2026) Nsereko, Mansoor Kalimunda.
    Delayed appropriate antibiotic initiation increases morbidity and mortality particularly amongst critically ill adult inpatients; therefore, timely antibiotic initiation is highly recommended. Adult inpatients are usually affected by bacterial infections which require in-hospital treatment. Delays in antibiotic treatment are associated with many factors including delayed system referrals, poor patient education, misdiagnosis, delayed diagnosis and resource scarcity, among others. There is limited data on this in our setting necessitating this study. We determined the extent, associated factors, effects of delayed antibiotic initiation in adult inpatients receiving treatment in Kisenyi Health Center IV and Kiruddu National Referral Hospital (KNRH), Kampala Uganda. A prospective cohort study was conducted among adult inpatients at Kisenyi HCIV and Kiruddu NRH, Kampala, Uganda, between 17th April and 20th June 2023, 606 consented adult inpatients participated in the study. A pre-tested interviewer-administered questionnaire was used to collect the data. The data were entered into Epi-data and exported to STATA 17 software for cleaning and analysis. Frequency tables and summary statistics were used to analyses categorical and numerical data. Chi-square tests and logistic regression were used to assess associations between the outcome (delayed antibiotic initiation) and exposure variables (age, level of education, household income, patient residence, marital status, time to consultation, health facility accessibility, number health worker,). Responses to the open-ended questions were coded and analyzed. Results: The extent of delayed antibiotic initiation was 6 % (36/606), of whom 92% (33/36) were at Kiruddu NRH. Lower household income (adjusted Odds Ratio, aOR= 0.28, p = 0.006 CI =0.12-0.70) and longer patient wait to consultation (aOR= 5.35, p = 0.000 CI =2.10-13.64) were independently associated with delayed antibiotic initiation. Patients who delayed to initiate antibiotics had an average of 81hours (3.38dys) longer in hospital (LOS) than those who received timely antibiotic treatment. The study showed a low extent of delayed antibiotic initiation which was significantly associated with household income and patient wait to consultation. Patients that had delayed antibiotic initiation had longer length of hospital stay. A retrospective mixed methods study at multi-level care should be conducted to explore other effects and associated factors. Keywords: delayed antibiotic initiation, adult inpatients, extent, length of stay (LOS)