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Background Pregnancies among mothers of advanced age (≥ 35 years) are inherently associated with poor perinatal outcomes. In this study, we determined the proportion of adverse perinatal outcomes and identified associated factors among pregnant mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH) in Southwestern Uganda. Methods We conducted a cross-sectional study at KRRH’s Maternity Ward from March to August 2023. We enrolled post-delivery mothers aged ≥ 35 years. We collected data on socio-demographic, obstetric, and medical characteristics, as well as fetal outcomes, using interviewer-administered structured questionnaires. We defined an adverse perinatal outcome as the occurrence of any of the following complications: early neonatal death, preterm birth, congenital anomalies, macrosomia, low APGAR score, or low birth weight, sustained by the fetus or neonate during pregnancy, delivery, or the immediate post-delivery period before discharge from the hospital. We performed multivariable logistic regression to identify factors associated with adverse perinatal outcomes. Results We enrolled 417 participants, of whom 206 (49.4%) were aged 35–37 years. The majority ( n  = 273; 65.5%) were multiparous (parity ≥ 5). Adverse perinatal outcomes occurred in 8.4% ( n  = 36; 95% CI: 6.1–11.5%) of participants, with early neonatal death being the most common (3.6%), followed by low birth weight (2.4%), congenital anomalies (2.6%), macrosomia (1.4%), low APGAR score (1.4%), and preterm birth (1.2%). Prolonged labor (adjusted odds ratio [aOR] = 3.71, 95% CI: 1.40–9.85) and a history of abortion (aOR = 2.56, 95% CI: 1.17–5.60) were significantly associated with adverse fetal outcomes. Conclusion Approximately 1 out of every 10 advanced-aged mothers surveyed experienced a poor perinatal outcome, with mothers who had prolonged labor or history of abortions having increased odds of the poor perinatal outcomes. We recommend strengthening close monitoring of labour and timely interventions to reduce adverse perinatal outcomes including early neonatal deaths.

Anthrax is a zoonotic disease that remains endemic in Uganda, particularly in cattle-keeping areas. On December 28, 2023, the first suspected human case of anthrax was detected in Amudat District. We investigated to determine the outbreak's magnitude, identify risk factors, and recommend prevention and control measures. We defined a suspected cutaneous anthrax case as acute onset of ≥2 of the following: skin lesions (papule, vesicle, or eschar) on exposed areas such as the hands, forearms, shoulders, back, thighs or face, localized itching, redness, swelling, or regional lymphadenopathy, in Amudat residents from December 2023-June 2024. A confirmed case was a suspected case with PCR-positive test for Bacillus anthracis. In unmatched case-control study (1:3 ratio), we compared exposures among 40 cases and 120 controls. We identified cases through house-to-house search, medical record reviews, and snowballing among case-persons. Human and animal samples were collected and tested, alongside an environmental assessment. We used multivariable logistic regression to identify associated risk factors. We identified 102 cutaneous anthrax cases, including 7 confirmed cases; none died. The outbreak lasted 7 months, peaking in March 2024, with an overall attack rate of 169/100,000 (males: 196/100,000; females: 138/100,000). Use of cattle hides as bedding (OR=12; 95% CI:2.7-52) and butchering cattle carcasses (OR=6; 95% CI:1.8-19) were significantly associated with anthrax. The highest infection risk was observed among individuals with multiple exposures: butchered only (OR = 6.9, 95% CI:2.6-18), butchered and carried cattle parts (OR = 11, 95% CI:1.2-96), butchered and skinned (OR = 14, 95% CI:3.5-56), and butchered, carried, and skinned (OR = 17, 95% CI:1.6-219). No livestock had been vaccinated prior to the outbreak. The outbreak was associated to use of cattle hides as bedding and the butchering of cattle carcasses. We recommended community education, livestock vaccination, and safe carcass handling to prevent future outbreaks.

Background Tuberculosis (TB) treatment and control guidelines recommend screening of contacts of bacteriologically confirmed TB cases and prompt initiation of preventive therapy. However, many children exposed to TB in high-burden settings like Uganda remain unscreened. The extent of the missed opportunity for screening TB-exposed children in Ugandan rural settings remains largely unknown. We determined the burden and associated factors of missed opportunity for TB screening and prevention in rural southwestern Uganda. Methods We conducted a cross-sectional study in four high-volume TB treatment centers in Kanungu District, southwestern Uganda. Using consecutive sampling, we included children aged 0–14 years who were household contacts of bacteriologically-confirmed persons with TB. We defined a missed opportunity as not being screened for TB or not receiving preventive TB treatment despite being eligible. We used modified Poisson regression to identify factors associated with the missed opportunities. Results Among 279 children enrolled from 79 households, 119 (42.7%) were aged < 5 years, 103 (36.9%) were 5–10 years, and 57 (20.4%) were 11–14 years. Overall, 140 (50.2%) were never screened. Of the 139 screened, 25 (18.0%) reported TB symptoms and 6 (24.0%) of these received TB treatment; among the 19 symptomatic but untreated, 3 (15.8%) missed isoniazid preventive therapy (IPT) initiation. Of 114 asymptomatic contacts, 60 were IPT-eligible, yet 34 (56.7%) were not initiated on IPT. Overall, 177/279 (63.4%; 95% CI: 67.6–68.9%) experienced a missed screening or prevention opportunity. Factors independently associated with missed opportunity were living in a household below the poverty line (adjusted prevalence ratio [aPR] = 1.62, 95% CI: 1.19–2.21), lack of formal education among index patients (aPR = 1.41, 95% CI: 1.09–1.83), and being a contact aged < 5 years (aPR = 1.45, 95% CI: 1.12–1.88). Conclusion Our study revealed a high burden of missed opportunity for TB screening and prevention among child contacts in this rural setting, driven by socio-economic disadvantages, including household poverty, lack of formal education, and younger age for household TB contacts (< 5 years). Interventions should target socio-economically disadvantaged households to improve access to TB screening and preventive care.

Background Most respiratory tract infections (RTIs) are viral and do not require antibiotics, yet their inappropriate prescription is common in low-income settings due to factors like inadequate diagnostic facilities. This misuse contributes to antibiotic resistance. We determined antibiotic prescription patterns and associated factors among outpatients with RTIs in Jinja City, Uganda. Methods We conducted a retrospective observational study that involved data abstraction of all patient records with a diagnosis of RTIs from the outpatient registers for the period of June 1, 2022, to May 31, 2023. An interviewer-administered questionnaire capturing data on prescribing practices and factors influencing antibiotic prescription was administered to drug prescribers in the health facilities where data were abstracted and who had prescribed from June 1, 2022, to May 31, 2023. We used modified Poisson regression analysis to identify factors associated with antibiotic prescription. Results Out of 1,669 patient records reviewed, the overall antibiotic prescription rate for respiratory tract infections (RTIs) was 79.8%. For specific RTIs, rates were 71.4% for acute bronchitis, 93.3% for acute otitis media, and 74.4% for acute upper respiratory tract infections (URTIs). Factors significantly associated with antibiotic prescription included access to Uganda Clinical Guidelines (Adjusted prevalence ratio [aPR] = 0.61, 95% CI = 0.01–0.91) and Integrated Management of Childhood Illness guidelines (aPR = 0.14, 95% CI = 0.12–0.87, P  = 0.002), which reduced the likelihood of prescription. Prescribers without training on antibiotic use were more likely to prescribe antibiotics (aPR = 3.55, 95% CI = 1.92–3.98). Patients with common cold (aPR = 0.06, 95% CI = 0.04–0.20) and cough (aPR = 0.11, 95% CI = 0.09–0.91) were less likely to receive antibiotics compared to those with pneumonia. Conclusion The study reveals a high rate of inappropriate antibiotic prescription for RTIs, highlighting challenges in adherence to treatment guidelines. This practice not only wastes national resources but also could contribute to the growing threat of antibiotic resistance. Targeted interventions, such as enforcing adherence to prescription guidelines, could improve prescription practices and reduce antibiotic misuse in this low-income setting.

Background Cholera is a major public health threat in Uganda, especially in border districts prone to outbreaks from cross-border movement. We investigated and evaluated the initial response to a January 2024 cholera outbreak in Elegu Town, on the Uganda-South Sudan border, using the 7–1–7 timeliness metrics to assess detection, notification, and response capacities, highlighting Uganda's preparedness and challenges in managing cross-border outbreaks. Methods We defined a suspected case as the onset of acute watery diarrhea in an asylum seeker at the Elegu border point from January to February 2024. A confirmed case was a suspected case in which Vibrio cholerae was isolated in the stool by culture or PCR. We actively searched for cases and collected data on person characteristics, symptoms, and outbreak timeliness. We used semi-structured interviews to elicit insights from district health officials on the enabling factors and bottlenecks during the response. We used the 7–1–7 metric to assess detection, notification, and response capacities of the point of entry. Results Thirteen members of a refugee family from South Sudan were diagnosed with cholera within 6 h of arrival at the Elegu border, with 4 (31%) confirmed cases. No death occurred. The authorities detected, notified, and responded to the outbreak within the 7–1–7 timelines, with no major bottlenecks identified. The outbreak was detected and notified within one day and by the fifth day, a full response was mounted. The prompt response was attributed to the availability of a functional emergency operations center and the presence of trained surveillance frontline health workers. Conclusion Response to an imported cholera outbreak at Elegu border point demonstrated Uganda's preparedness in managing cross-border disease outbreaks. Achieving the 7–1–7 targets highlighted the country’s-built capacity to detect, notify, and respond to such events. Continued investment in local-level disease detection, communication, and national-level resource mobilization will be crucial to sustaining future effective cross-border outbreak prevention and control strategies.

Background Cholera is endemic in Uganda with periodic outbreaks occurring annually. On July 24, 2023, Uganda’s Ministry of Health confirmed a cholera outbreak in Sigulu Island, Namayingo District. We investigated to determine its magnitude, identify possible exposures, and recommend evidence-based control interventions. Methods We defined a suspected case as acute onset of watery diarrhea in a resident of Sigulu or Bukana Sub-counties in Namayingo District from July 1–August 15, 2023, and a confirmed case as a suspected case with positive Vibrio cholerae serotype 01 and 0139 stool culture. Cases were identified by active case search and records review at the health centers. We conducted descriptive epidemiology, and environmental assessment at the lakeshore water collection points, and generated hypotheses. In addition, we collected water samples for cholera testing from Jerricans used for domestic water storage and lakeshore water collection points. We conducted an unmatched individual case-control study to compare exposures among case patients and asymptomatic controls residing in Sigulu and Bukana sub-counties. Results We identified 24 cases of which 4 were confirmed to have V.cholerae serotype 01 and 0139 ogawa. Fifteen (62%) cases were female and the median age of cases was 27 years (range:2–68 years). Nine (37%) had received the oral cholera vaccine (OCV) 2 to 3 years ago. The epidemic curve showed a point source outbreak after the contamination of a communal water collection point on July 8, 2023, by the primary case who had recently traveled back from a neighboring country with a cholera outbreak. Eighteen (75%) were residents of Secho Village in Sigulu sub-county. All case patients drank lake water. Compared to other water collection points, drinking water from water point A in Secho, Sigulu Sub-county increased the odds of getting cholera (aOR = 4.3, 95% CI: 1.3–15). Treatment of drinking water by any means (aOR = 0.085, 95% CI: 0.097–0.74) and receiving OCV (aOR = 0.16, 95% CI: 0.051–0.56) were protective. We observed residents directly drawing lakeshore water for laundry, bathing, and drinking. Conclusion This cholera outbreak in an island community was associated with a traveler’s introduction of Vibrio cholerae , followed by community consumption of untreated lakeshore water. Mass distribution of water treatment tablets, repeated OCV, and community mass sensitization about risks associated with drinking untreated lake water helped stop the outbreak.

Introduction Early during the COVID-19 outbreak, various approaches were utilized to prevent COVID-19 introductions from incoming airport travellers. However, the costs and effectiveness of airport-specific interventions have not been evaluated. Methods We evaluated policy options for COVID-19-specific interventions at Entebbe International Airport for costs and impact on COVID-19 case counts, we took the government payer perspective. Policy options included; (1)no screening, testing, or mandatory quarantine for any incoming traveller; (2)mandatory symptom screening for all incoming travellers with RT-PCR testing only for the symptomatic and isolation of positives; and (3)mandatory 14-day quarantine and one-time testing for all, with 10-day isolation of persons testing positive. We calculated incremental cost-effectiveness ratios (ICERs) in US$ per additional case averted. Results Expected costs per incoming traveller were $0 (Option 1), $19 (Option 2), and $766 (Option 3). ICERs per case averted were $257 for Option 2 (which averted 4,948 cases), and $10,139 for Option 3 (which averted 5,097 cases) compared with Option I. Two-week costs were $0 for Option 1, $1,271,431 Option 2, and $51,684,999 Option 3. The per-case ICER decreased with increase in prevalence. The cost-effectiveness of our interventions was modestly sensitive to the prevalence of COVID-19, diagnostic test sensitivity, and testing costs. Conclusion Screening all incoming travellers, testing symptomatic persons, and isolating positives (Option 2) was the most cost-effective option. A higher COVID-19 prevalence among incoming travellers increased cost-effectiveness of airport-specific interventions. This model could be used to evaluate prevention options at the airport for COVID-19 and other infectious diseases with similar requirements for control.

Background In August 2022, an epidemiologic investigation into an outbreak of cases of black water fever, a severe and fatal complication of malaria, was conducted in Kakumiro District, Central Uganda. Findings revealed an association between self-medication and the development of severe malaria complications. Factors associated with self-medication for uncomplicated malaria were described for improved malaria management and prevention of malaria related mortality in Uganda. Methods A community-based cross-sectional survey was conducted in Kakumiro District in August 2023. Using multistage sampling, 592 households were selected. A semi-structured questionnaire was used to interview one participant per household about self-medication for malaria in a family member of any age who suffered from malaria 6 months prior to the interview. Data on demographics, socio-economic factors, health-seeking behaviour, self-medication and antimalarial storage at home were obtained. Modified Poisson regression model was used for multivariate analysis. Results Of the 592 participants interviewed, 368 (62%; 95% CI 58.2–65.9%) had self-medicated for malaria. Self-medication was significantly associated with household heads aged ≥ 35 years (adjusted prevalence ratio [APR]: 1.77; 95% CI 1.04–3.01); distances ≥ 5 km to the health facility (APR: 3.05; 95% CI 2.09–4.47), and storage of antimalarial drugs at home (APR: 2.21; 95% CI 1.36–3.59). Having malaria episodes ≥ 6 in the household within 6 months was protective (APR: 0.39; 95% CI 0.23–0.65). The major reason for self-medication was antimalarial stockouts at health facilities. Drugs used for self-medication were commonly known to 65% of the respondents and were bought from drug shops (75%). Although, 85% used the recommended drug for malaria treatment, the dose was inappropriate for 66% of the patients and despite the under dose, 85% of the patients recovered without hospitalization. Conclusion The common occurrence of self-medication for malaria and the high potential for malaria drug resistance and increased malaria mortality due to inappropriate treatment was demonstrated. Adequate antimalarial stock to health facilities, instituting policies prohibiting the sale of incomplete doses by drug shops, social behavioural change campaigns against drug storage in homes and sensitization of communities on the dangers of self-medication and the consumption of inappropriate doses could reduce self-medication practices and its eventual consequences.

Background Uganda has a high burden of Neglected Tropical Diseases (NTDs), which particularly affect rural populations. Some NTDs are targeted for control/elimination using preventive chemotherapy administered annually or bi-annually to at-risk populations through mass drug administration (MDA). Schistosomiasis and soil-transmitted helminths (STHs) are two of these diseases. MDA for Schistosomiasis is given only to school-age children (SAC) and adults, whereas that for STHs is given only to SAC and pre-school-age children (pre-SAC). The MDA coverage target for both NTDs should be 75%. A decline in the size of the population at risk (PAR) and the number of cases are indicators of effective control/progress towards elimination. We describe the trends in the coverage of MDA and the outcomes of schistosomiasis and STHs. Methods We reviewed available data on MDA coverage, size of population at risk, and disease occurrence (case counts) for schistosomiasis and STHs from 2013 to 2023. We analysed the trends using the Mann Kendal test. Results From 2014 to 2022, there was an apparent increase in MDA coverage for schistosomiasis in both SAC (from 21 to 82%, p  = 0.5) and adults (from 34 to 36%, p  = 0.1); however, both trends were not significant. Similarly, for STHs, MDA coverage increased for both SAC (from 63 to 114%, p  = 0.09) and pre-SAC (from 65 to 76%, p  = 1.0); however, these trends were not significant. The PAR for schistosomiasis increased by 25% for SAC (2014: 4,777,189 vs 2022: 5,979,311, p  = 0.0025) and by 60% for adults (2014: 4,436,444 vs 2022: 7,091,933, p  = 0.03). For STHs, PAR increased by 19% for both SAC (2014:11,287,385 vs 2022:13,397,219, p  = 0.03) and pre-SAC (2014: 5,279,025 vs 2022: 6,299,355, p  = 0.047). From 2013 to 2023, there was a 62% reduction in reported cases of schistosomiasis (2013:6,518 vs. 2023:2501, p  = 0.7) and a 52% reduction in reported cases of STHs (2013:2,457,021 vs. 2023:1,176,463, p  = 0.5), but both trends were not significant. The increase in PAR indicates that transmission is spreading beyond previous extents despite ongoing MDA. Non-significant trends may be attributed to fluctuations across years, precluding a monotonic pattern., Nonetheless, the apparent changes can provide actionable insights to inform improvements in programmatic interventions. Conclusions Current efforts to control schistosomiasis and STHs using MDA should be strengthened to achieve sustainable control. Strategies to improve and maintain MDA coverage for both NTDs to a target of 75% are crucial, while the rise in PAR and unabating case counts necessitate targeted interventions, including improved sanitation, health education, and vaccine development.

Anxiety disorders in pregnancy are common and represent a global concern. However, data regarding the magnitude of anxiety among pregnant women in Uganda are limited, and yet, these data could pave way for implementing effective mitigation measures. We determined the prevalence of anxiety disorders and associated factors among pregnant women at Mulago Hospital Uganda. A cross-sectional study was conducted among pregnant women attending antenatal care clinic at Mulago Hospital between September and November 2015. Systematic sampling was used to enroll eligible women. An interviewer-administered demographic questionnaire and the Hamilton Anxiety Rating Scale for Antenatal Anxiety (HAMA-A) scale were used to assess demographic features and anxiety, respectively. Women with HAMA-A score ≥17 were considered to have anxiety disorder. Factors associated with anxiety disorders were determined using multivariate logistic regression. A total of 501 pregnant women were enrolled into the study; the prevalence of anxiety disorders was 13% (n=65; 95% CI: 9.8-15.7%). Factors that were significantly associated with anxiety disorders were low income of the participants (adjusted odds ratio [AOR]=2.65, 95% CI: 1.16-6.06), bad relationship with spouse (AOR = 2.50, 95% CI: 1.01-5.82) and history of hypertension in previous pregnancy (AOR = 4.17, 95% CI: 1.68-10.37). Approximately one in ten women surveyed exhibited anxiety disorders. Anxiety disorders were associated with low-income levels, bad spousal relationships, and a history of hypertension during previous pregnancies. Multidisciplinary approaches that integrate mental health support, social services, and partner involvement may help address anxiety disorders in pregnancy and contribute to improved maternal and child outcomes.