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Virological non-suppression is a critical factor in driving HIV transmission rates, yet there is limited data available on the determinants of this phenomenon, particularly in fishing communities where the incidence of HIV is disproportionately high. We aimed to determine the prevalence and determinants of virological non-suppression among adult males (≥15 years) attending HIV care services in the fishing communities of Bulisa district. We conducted a cross-sectional study among all adult males (≥15 years) living with HIV who were resident within the fishing communities, and in care for atleast 6 months at the six health facilities offering HIV services in the fishing communities in Bulisa district. To obtain data on patient and health facility characteristics, we reviewed patients' records and conducted face-to-face interviews with the participants. We conducted descriptive and regression analyses using modified Poisson regression, accounting for data correlation of observation at the facility level to obtain prevalence ratios (PR) with 95% confidence intervals in Stata version 14.0. 413 participants were studied and 379 (91.8%) were interviewed. The participant's average age (SD) was 40 (10.7) years and 70.5% (267/379) were engaged in the fishing business. The prevalence of virological non-suppression was 88/413-21.3% (95% CI: 18%-26%). Factors associated with higher odds of virological non-suppression included: Age 26-50 years (adj.PR = 1.53, 95%CI: 1.11-2.08) and 15-25 years (adj.PR = 2.99, 95%CI: 1.27-7.05) compared to age above 50 years; unemployment (adj.PR = 1.28, 95%CI: 1.10-1.49); hazardous use of alcohol (adj.PR = 1.34, 95%CI: 1.10-1.62); non-mobility between fish landing sites (adj.PR = 1.37, 95%CI: 1.003-1.87); distant HIV treatment services (adj.PR = 1.37, 95%CI: 1.11-1.69) and TB diagnosis (adj.PR = 1.87, 95%CI: 1.33-2.64). Virological non-suppression among people living with HIV in fishing communities along the shores of Lake Albert is alarmingly high, exceeding the UNAIDS threshold of 10% by two-fold. Several key determinants were identified, including hazardous alcohol use, unemployment, and access barriers to HIV treatment services.

Background The sexual and reproductive health (SRH) needs of adolescents remain largely unmet. For instance, over 20 million female adolescents in need of, a modern contraceptive method are not using any. This study determined the factors associated with utilization of modern contraceptives among female adolescents in Uganda. Methods A cross sectional study was conducted using the Uganda Demographic and Health Survey (UDHS) 2016 data of 4, 264 adolescents aged 15 to 19 years. Multistage stratified sampling was used to select study participants. Multivariable logistic regression was used to determine the factors associated with modern contraceptive utilization. All our analyses were done using SPSS version 25. Results The prevalence of modern contraceptive utilization among female adolescents was 9.4% (401/4264: (95% CI: 8.6–10.3). The odds of contraceptive utilisation were 1.6 times (AOR = 1.60; 95% CI: 1.09–2.34) higher among married adolescents compared to unmarried adolescents. Adolescents whose age at first birth was less than 15 years (AOR = 2.01; 95% CI: 1.01–3.99) were twice more likely to utilize a modern contraceptive compared to those whose age at first birth was above 15 years. Women belonging to the Central region (AOR = 1.93; 95% CI: 1.01–3.69) and those in the middle wealth quintile (AOR = 1.91; 95% CI: 1.06–3.46) were 93% and 91% more likely to utilize a modern contraceptive compared to those in the Northern region and those in the poorest wealth index respectively. Conclusion The prevalence of modern contraceptive utilization was 9.4%. The findings show the need for designing targeted interventions due to differences in adolescents according to their wealth index, regions and marital status.

Hearing impairment and neurodevelopmental disorders pose a significant global health burden in children. The link between postnatal cytomegalovirus (CMV) infection and these outcomes remains unclear. This study explored the association of postnatal CMV infection with hearing and neurodevelopmental outcomes in term infants aged 3 to 10 months. This was a cohort sub-study within the BabyGel cluster randomised trial in Eastern Uganda. From 1265 term infants screened for CMV, 219 were negative at birth but positive at 3 months, and were age-matched with 219 CMV-negative controls. CMV status was determined by PCR screening of saliva samples, with positive results confirmed using urine samples (Chai Open qPCR, Santa Clara, CA). From the established cohort, 424 infants were successfully followed up between 3 to 10 months of age. Clinical assessments included neurodevelopmental evaluation using the Malawi Developmental Assessment Tool, the Hammersmith Infant Neurological Examination, and hearing screening using Otoacoustic Emission testing (Otoport Lite, Otodynamics Limited). Statistical analyses were performed using descriptive statistics, chi-square tests and log binomial regression models with Stata 18. Of the 424 infants included in the study, 206 were postnatal CMV-infected and 218 were uninfected. Neurodevelopmental assessments indicated no differences between postnatal CMV-infected infants and uninfected groups (ARR 0.88, 95% CI [0.67, 1.15], p = 0.346). Hearing screening revealed a 1.99-fold increased risk of a positive result for postnatal CMV-infected infants compared to uninfected infants (67/106 vs. 39/106, 95% CI [1.27, 3.12], p = 0.003). Postnatal CMV infection was associated with more positive hearing screenings, though no significant differences in neurodevelopmental outcomes were observed in early infancy. Exploration into the feasibility of incorporating hearing and CMV screening into routine care will play a vital role in early identification and intervention, improving the management of both hearing and CMV-related conditions in resource-limited settings.

In sub-Saharan Africa, stillbirth rates remain high. To design effective interventions to reduce stillbirths, accurate determination of their aetiology is important. Conventional autopsy for accurate confirmation of cause is not acceptable or feasible in several societies in sub-Saharan Africa; minimal invasive tissue sampling (MITS), is a recently developed, less invasive alternative. In this study, we explored the acceptability of MITS in the community and among healthcare workers in Uganda to guide the future implementation. A qualitative study was done among community members and healthcare workers in Mbale in Eastern Uganda. We undertook in-depth interviews and focus group discussions in English or local languages. Interviews were audio-recorded, transcribed as necessary prior to formal content analysis. The themes were organised using NVivo software and presented according to Sekhon's theoretical framework. Overall, participants preferred the idea of MITS to conventional autopsy because of the perception that it was fast, maintained the facial appearance and kept the body intact. It was thought that the procedure would improve the detection of the cause of stillbirths, which in turn would help to prevent future stillbirths. It would also resolve conflicts in the community between community members or the women and the healthcare workers about the cause of a stillbirth. It was suggested that some community members may not approve of MITS because of their religious beliefs; the fear that the body parts may be extracted and stolen for witchcraft or organ donation; and a lack of trust in the healthcare system. To implement the procedure, it was suggested that extensive community sensitization should be done, space limitations in healthcare facilities overcome, healthcare workers should be trained and limited human resource should be addressed. The implementation of MITS in Mbale, Eastern Uganda, is likely to be acceptable given sufficient training and sensitisation.

A continuum of maternal care approach can reduce gaps and missed opportunities experienced by women and newborns. We determined the level of coverage and factors associated with the continuum of maternal care in Uganda. We used weighted data from the Uganda Demographic and Health Survey (UDHS) 2016. We included 10,152 women aged 15 to 49 years, who had had a live birth within five years preceding the survey. Stratified two-stage cluster sampling design was used to select participants. Continuum of maternal care was considered when a woman had at least four antenatal care (ANC) visits, had delivered in a health facility and they had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression analysis to determine factors associated with completion of the continuum of maternal care using SPSS version 25. The level of coverage of complete continuum of maternal care was 10.7% (1,091) (95% CI: 10.0-11.2). About 59.9% (6,080) (95% CI: 59.0-60.8) had four or more antenatal visits while 76.6% (7,780) (95% CI: 75.8-77.5) delivered in a health facility and 22.5% (2,280) (95% CI: 21.5-23.2) attended at least one postnatal care visit within six weeks. The following factors were associated with continuum of maternal care; initiating ANC in the first trimester (AOR 1.49, 95% CI: 1.23-1.79), having secondary level of education (AOR 1.60, 95% CI: 1.15-2.22) and tertiary level of education (AOR 2.08 95% CI: 1.38-3.13) compared to no formal education, being resident in Central Uganda (AOR 1.44, 95% CI:1.11-1.89), Northern Uganda (AOR 1.35, 95% CI: 1.06-1.71) and Western Uganda (AOR 0.61, 95% CI: 0.45-0.82) compared to Eastern Uganda, and exposure to newspapers and magazines. The level of coverage of the complete continuum of maternal care was low and varied across regions. It was associated with easily modifiable factors such as early initiation of ANC, exposure to mass media and level of education. Interventions to improve utilisation of the continuum of maternal care should leverage mass media to promote services, especially among the least educated and the residents of Western Uganda.

Background Sepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies. Objective To determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda. Methods We conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillin-resistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis. Findings Of the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%), Escherichia coli in seven (15.2%), and Klebsiella pneumoniae in five (10.9%). Of the 46 pathogens, 73.9% were resistant to ampicillin, 23.9% to gentamicin and 8.7% to ceftriaxone. We isolated MRSA from the blood specimens of 19 (5.3%) of the 359 neonates, while 3 (0.8%) grew extended spectrum beta lactamase producers. The case fatality risk among neonates with neonatal sepsis was 9.5% (95% CI: 6.6%, 13.0%). Cesarean section delivery was strongly associated with culture-positive sepsis (adjusted odds ratio 3.45, 95% CI: 1.2, 10.1). Conclusion One in eight neonates with clinical signs of sepsis grew a likely causative bacterial pathogen. S. aureus was the main pathogen isolated and a third of these isolates were MRSA. A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis. There is need to revisit the current treatment guidelines for neonatal sepsis.

Chat Generative Pre-trained Transformer (ChatGPT) is a 175-billion-parameter natural language processing model that uses deep learning algorithms trained on vast amounts of data to generate human-like texts such as essays. Consequently, it has introduced new challenges and threats to medical education. We assessed the use of ChatGPT and other AI tools among medical students in Uganda. We conducted a descriptive cross-sectional study among medical students at four public universities in Uganda from 1st November 2023 to 20th December 2023. Participants were recruited by stratified random sampling. We used a semi-structured questionnaire to collect data on participants' socio-demographics and use of AI tools such as ChatGPT. Our outcome variable was use of AI tools. Data were analyzed descriptively in Stata version 17.0. We conducted a modified Poisson regression to explore the association between use of AI tools and various exposures. A total of 564 students participated. Almost all (93%) had heard about AI tools and more than two-thirds (75.7%) had ever used AI tools. Regarding the AI tools used, majority (72.2%) had ever used ChatGPT, followed by SnapChat AI (14.9%), Bing AI (11.5%), and Bard AI (6.9%). Most students use AI tools to complete assignments (55.5%), preparing for tutorials (39.9%), preparing for exams (34.8%) and research writing (24.8%). Students also reported the use of AI tools for nonacademic purposes including emotional support, recreation, and spiritual growth. Older students were 31% less likely to use AI tools compared to younger ones (Adjusted Prevalence Ratio (aPR):0.69; 95% CI: [0.62, 0.76]). Students at Makerere University were 66% more likely to use AI tools compared to students in Gulu University (aPR:1.66; 95% CI:[1.64, 1.69]). The use of ChatGPT and other AI tools was widespread among medical students in Uganda. AI tools were used for both academic and non-academic purposes. Younger students were more likely to use AI tools compared to older students. There is a need to promote AI literacy in institutions to empower older students with essential skills for the digital age. Further, educators should assume students are using AI and adjust their way of teaching and setting exams to suit this new reality. Our research adds further evidence to existing voices calling for regulatory frameworks for AI in medical education.

Background Limited comprehensive knowledge of HIV/AIDS is highlighted as one of the major factors linked to the high prevalence of HIV among adolescents and young girls. Thus, it is crucial to identify factors that facilitate or hinder adolescent girls from having comprehensive knowledge of HIV/AIDS. We, therefore, assessed the prevalence of comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda. Methods We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 comprising 3258 adolescent girls (aged 15 to 19 years). Comprehensive knowledge was considered if an adolescent girl answered correctly all the six indicators; always using condoms during sex can reduce the risk of getting HIV, having one sexual partner only who has no other partners can reduce the risk of getting HIV, a healthy-looking person can have HIV, can get HIV from mosquito bites, can get HIV by sharing food with persons who have AIDS, and can get HIV by witchcraft or supernatural means. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS (version 25). Results Of the 3258 adolescent girls, 1746 (53.6%, 95%CI: 52.2–55.6) had comprehensive knowledge about HIV/AIDS. Adolescent girls with secondary education (AOR = 1.40, 95% CI: 1.13–3.20), health insurance (AOR = 1.39, 95% CI: 1.12–1.73), a mobile phone (AOR = 1.26, 95% CI: 1.04–1.52), exposure to television (AOR = 1.23, 95% CI: 1.05–1.44), and a history of an HIV test (AOR = 1.26, 95% CI: 1.07–1.49) had higher odds of comprehensive HIV knowledge, compared to their respective counterparts. However, girls residing in Kigali (AOR = 0.65, 95% CI: 0.49–0.87) and Northern (AOR = 0.75, 95% CI: 0.59–0.95) regions, and those of Anglican religion (AOR = 0.82, 95% CI: 0.68–0.99) had less odds of comprehensive knowledge compared to those in Southern region and of the Catholic religion. Conclusions To increase the comprehensive understanding of the disease at a young age, the need for expanded access to HIV preventive education through formal educational curriculum, and mass and social media via mobile phones is highlighted. In addition, the continued involvement of key decision-makers and community actors, such as religious leaders, is vital.

Background Almost all maternal deaths and related morbidities occur in low-income countries. Childbirth supervised by a skilled provider in a health facility is a key intervention to prevent maternal and perinatal morbidity and mortality. Our study aimed to establish the factors associated with health facility utilization during childbirth in Uganda. Methods We used the Uganda Demographic and Health Survey 2016 data of 10,152 women aged 15 to 49 years. The study focused on their most recent live birth in 5 years preceding the survey. We applied multistage stratified sampling to select study participants and we conducted multivariable logistic regression to establish the factors associated with health facility utilization during childbirth, using SPSS (version 25). Results The proportion of women who gave birth at a health facility was 76.6% (7780/10,152: (95% confidence interval, CI, 75.8–77.5). The odds of women aged 15–19 years giving birth at health facilities were twice as those of women aged 40 to 49 years (adjusted odds ratio, AOR = 2.29; 95% CI: 1.71–3.07). Residing in urban areas and attending antenatal care (ANC) were associated with health facility use. The odds of women in the northern region of Uganda using health facilities were three times of those of women in the central region (AOR = 3.13; 95% CI: 2.15–4.56). Women with tertiary education (AOR = 4.96; 95% CI: 2.71–9.11) and those in the richest wealth quintile (AOR = 4.55; 95% CI: 3.27–6.32) had higher odds of using a health facility during child birth as compared to those with no education and those in the poorest wealth quintile, respectively. Muslims, Baganda, women exposed to mass media and having no problem with distance to health facility had higher odds of utilizing health facilities during childbirth as compared to Catholic, non Baganda, women not exposed to mass media and those having challenges with distance to access healthcare. Conclusion Health facility utilization during childbirth was high and it was associated with decreasing age, increasing level of education and wealth index, urban residence, Northern region of Uganda, ANC attendance, exposure to mass media, tribe, religion and distance to the nearby health facility. We recommend that interventions to promote health facility childbirths in Uganda target the poor, less educated, and older women especially those residing in rural areas with less exposure to mass media.

The World Health Organization (WHO) recommends at least 8 antenatal care (ANC) contacts during pregnancy, but many women in low and middle-income countries do not adhere to this schedule, which may contribute to high rates of maternal and neonatal mortality. This study assessed compliance to the WHO recommended 8+ ANC contacts schedule and associated factors among postpartum mothers in eastern Uganda. This was a cross-sectional multicenter study conducted between July and August 2022 at four selected hospitals in Eastern Uganda using quantitative techniques. We recruited postnatal mothers who had given birth within 48 hours with records of their ANC contacts. Compliance to the WHO recommended 8+ ANC contacts schedule was defined as having received the recommended ANC contacts as per the gestational age at childbirth following the current ANC for a positive pregnancy experience WHO guidelines. We conducted multivariable logistic regression analysis to assess the association between compliance to the WHO recommended 8+ ANC contacts schedule and selected independent variables. A total of 1104 postpartum mothers participated in the study with a mean age (± standard deviation) of 26 ± 6.4 years, and a majority had given birth from a referral hospital (n = 624 56.5%). Compliance to the WHO recommended 8+ ANC contacts schedule was low (n = 258, 23.4%), and only 23.2% (196) of the women had attended their first antenatal care contact within the first trimester. Factors associated with compliance to the WHO recommended 8+ ANC contacts were: attending the first antenatal care contact within 12 weeks of gestation [AOR: 6.42; 95% CI: (4.43 to 9.33)], having 2 to 4 children [AOR: 0.65; 95% CI: (0.44 to 0.94)], having a spouse who is unemployed [AOR: 1.71; 95% CI: (0.53 to1.08)] and having insurance coverage [AOR: 2.31; 95% CI: (1.17 to 4.57)]. Compliance with the 8+ ANC contacts schedule remains very low. Efforts should focus on increasing health education, particularly for multiparous women, and encouraging mothers to begin ANC in their first trimester. Exploring the dynamics of partner support, especially with employment status, may offer insights into improving ANC attendance.