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Background Unplanned pregnancy remains a common problem in many resource-limited settings, mostly due to limited access to modern family planning (FP) services. In particular, use of the more effective long-acting reversible contraceptive (LARC) methods (i.e., intrauterine devices and hormonal implants) remains low compared to the short-acting methods (i.e., condoms, hormonal pills, injectable hormones, and spermicides). Among reproductive-age women attending FP and antenatal care clinics in Uganda, we assessed perceptions and practices regarding the use of modern contraceptive methods. We specifically aimed to evaluate factors influencing method selection. Methods We performed a mixed-methods cross-sectional study, in which we administered structured interviews to 180 clients, and conducted 4 focus group discussions (FGDs) with 36 clients and 8 in-depth personal qualitative interviews with health service providers. We summarized quantitative data and performed latent content analysis on transcripts from the FGDs and qualitative interviews. Results The prevalence of ever use for LARC methods was 23%. Method characteristics (e.g., client control) appeared to drive method selection more often than structural factors (such as method availability) or individual client characteristics (such as knowledge and perceptions). The most common reasons for choosing LARC methods were: longer protection; better child-spacing; and effectiveness. The most common reasons for not choosing LARC methods included requiring a client-controlled method and desiring to conceive in the near future. The most common reasons for choosing short-acting methods were ease of access; lower cost; privacy; perceived fewer side effects; and freedom to stop using a method without involving the health provider. The personal characteristics of clients, which appeared to be important were client knowledge and number of children. The structural factor which appeared to be important was method availability. Conclusions Our results suggest that interventions to improve uptake of LARC among reproductive age women in this setting should consider: incorporating desired method-characteristics into LARC methods; targeted promotion and supply of LARC; and increased counselling, sensitization, and education.

Interest is growing at national and international level in the role of indigenous knowledge in participatory development. But information scientists are paying more attention to the conceptual understanding of indigenous knowledge than the practical aspects of building a knowledge base for it. This is attributed to the absence of an agreed framework for documenting indigenous knowledge. Consequently documenting, preserving and disseminating indigenous knowledge are less than satisfactory. A framework for developing a knowledge base is needed to bring a combination of the best practices from the traditional and modern knowledge. The article presents a framework for documenting indigenous knowledge in Uganda. It raises issues to document and using them to develop the framework. With such a framework information scientists can document, preserve and disseminate indigenous knowledge.

This article reports the results of a study aimed at identifying the information needs and uses of the informal sector in Uganda. The demographic and business characteristics of these entrepreneurs are highlighted and empirically tested with regard to their information needs. This study has largely employed qualitative research methodologies, such as the critical incidence technique for interviews with 602 informal sector entrepreneurs from a variety of trades. Observations of the entrepreneurs' work environments and historical methods were also employed. The results suggest that modern/exotic models of information transfer based on textual media and ICT exhibit less impact on the entrepreneurs' information needs and use at macro levels because of poverty, illiteracy and poor information infrastructure. It is however noted that most ‘elite’ models share a platform with information behaviour of entrepreneurs at the micro levels. The study concludes that an appropriate model for information behaviour for the information poor community must be grounded on oral traditions and indigenous knowledge and be sensitive to poverty, infrastructure and illiteracy. Recognition is also made of the need for information repackaging and the use of appropriate media for information provision.

Malaria transmission is highly heterogeneous, generating malaria hotspots that can fuel malaria transmission across a wider area. Targeting hotspots may represent an efficacious strategy for reducing malaria transmission. We determined the impact of interventions targeted to serologically defined malaria hotspots on malaria transmission both inside hotspots and in surrounding communities. Twenty-seven serologically defined malaria hotspots were detected in a survey conducted from 24 June to 31 July 2011 that included 17,503 individuals from 3,213 compounds in a 100-km2 area in Rachuonyo South District, Kenya. In a cluster-randomized trial from 22 March to 15 April 2012, we randomly allocated five clusters to hotspot-targeted interventions with larviciding, distribution of long-lasting insecticide-treated nets, indoor residual spraying, and focal mass drug administration (2,082 individuals in 432 compounds); five control clusters received malaria control following Kenyan national policy (2,468 individuals in 512 compounds). Our primary outcome measure was parasite prevalence in evaluation zones up to 500 m outside hotspots, determined by nested PCR (nPCR) at baseline and 8 wk (16 June-6 July 2012) and 16 wk (21 August-10 September 2012) post-intervention by technicians blinded to the intervention arm. Secondary outcome measures were parasite prevalence inside hotpots, parasite prevalence in the evaluation zone as a function of distance from the hotspot boundary, Anopheles mosquito density, mosquito breeding site productivity, malaria incidence by passive case detection, and the safety and acceptability of the interventions. Intervention coverage exceeded 87% for all interventions. Hotspot-targeted interventions did not result in a change in nPCR parasite prevalence outside hotspot boundaries (p ≥ 0.187). We observed an average reduction in nPCR parasite prevalence of 10.2% (95% CI -1.3 to 21.7%) inside hotspots 8 wk post-intervention that was statistically significant after adjustment for covariates (p = 0.024), but not 16 wk post-intervention (p = 0.265). We observed no statistically significant trend in the effect of the intervention on nPCR parasite prevalence in the evaluation zone in relation to distance from the hotspot boundary 8 wk (p = 0.27) or 16 wk post-intervention (p = 0.75). Thirty-six patients with clinical malaria confirmed by rapid diagnostic test could be located to intervention or control clusters, with no apparent difference between the study arms. In intervention clusters we caught an average of 1.14 female anophelines inside hotspots and 0.47 in evaluation zones; in control clusters we caught an average of 0.90 female anophelines inside hotspots and 0.50 in evaluation zones, with no apparent difference between study arms. Our trial was not powered to detect subtle effects of hotspot-targeted interventions nor designed to detect effects of interventions over multiple transmission seasons. Despite high coverage, the impact of interventions targeting malaria vectors and human infections on nPCR parasite prevalence was modest, transient, and restricted to the targeted hotspot areas. Our findings suggest that transmission may not primarily occur from hotspots to the surrounding areas and that areas with highly heterogeneous but widespread malaria transmission may currently benefit most from an untargeted community-wide approach. Hotspot-targeted approaches may have more validity in settings where human settlement is more nuclear. ClinicalTrials.gov NCT01575613.

Schistosomiasis and intestinal parasitic infections remain major public health concerns in Uganda, particularly among school-aged children, where they contribute to anemia, malnutrition, and poor cognitive development. The Lango sub-region of Northern Uganda is endemic for Schistosoma mansoni, yet epidemiological data remain scarce. We conducted this study to determine the prevalence, intensity, and risk factors of infection to guide targeted control strategies. We conducted a cross-sectional study between January and March 2023, involving 802 primary school children from randomly selected schools in Lira District, Lira City, and Kole District. Stool samples were examined using the Odongo-Aginya method to detect Schistosoma mansoni and intestinal parasites. Urine samples were screened using the Point-of-Care Circulating Cathodic Antigen (POC-CCA) test for Schistosoma mansoni and urine filtration for Schistosoma haematobium. Data on potential risk factors were collected via structured interviews and analyzed using logistic regression in SPSS version 25.0. The overall prevalence of schistosomiasis was 34.5% (S. mansoni), with light (11.6%), moderate (5.4%), and heavy (2.9%) infection intensities. Other intestinal parasites were detected in 20.3% of participants, including Ascaris lumbricoides (11.6%) and hookworms (6.4%). Children in P.3 (OR = 3.19, 95% CI: 1.67-6.08), P.4 (OR = 3.22, 95% CI: 1.71-6.08), and P.6 (OR = 2.62, 95% CI: 1.26-5.47) had significantly higher odds of S. mansoni infection compared to P.7, with Ayara pupils most at risk (OR = 35.05, 95% CI: 9.30-132.14). Elevated risks occurred in Apedi, Aberdyangotoo, and Bala schools, while pupils in Kole (OR = 0.46, 95% CI: 0.33-0.63) and Lira City (OR = 0.48, 95% CI: 0.20-1.14) had reduced odds. Low paternal education increased risk, whereas recent praziquantel treatment markedly reduced infection (OR = 0.10, p = 0.027). The study highlights the persistent and focal nature of schistosomiasis transmission in northern Uganda, shaped by school and district-level factors, socioeconomic disparities, and irregular MDA implementation. Strengthening and sustaining praziquantel distribution, expanding WASH infrastructure, and introducing targeted, school-focused interventions are essential to reduce reinfection and sustain control efforts. Addressing these factors is critical for Uganda to progress toward schistosomiasis elimination goals.

Schistosoma infection is associated with immune modulation that can influence responses to non-schistosome antigens. Vaccine responses may be impaired in S. mansoni-infected individuals. We investigated effects of S. mansoni infection on responses to childhood measles catch-up immunisation and of praziquantel treatment on this outcome in a randomised trial. The Immune Modulation and Childhood Immunisation (IMoChI) study was based in Entebbe, Uganda. Children aged 3-5 years (193 S. mansoni-infected and 61 uninfected) were enrolled. Infected children were randomised in a 1:1:1 ratio to receive praziquantel 2 weeks before, at time of, or 1 week after, measles catch-up immunisation. Plasma anti-measles IgG was measured at enrolment, 1 week and 24 weeks after measles immunisation. Primary outcomes were IgG levels and percentage of participants with levels considered protective against measles. Anti-measles IgG levels increased following immunisation, but at 1 week post-immunisation S. mansoni-infected, compared to uninfected, children had lower levels of anti-measles IgG (adjusted geometric mean ratio (aGMR) 0.4 [95% CI 0.2-0.7]) and the percentage with protective antibody levels was also lower (adjusted odds ratio 0.1 [0-0.9]). Among S. mansoni-infected children, anti-measles IgG one week post-immunisation was higher among those treated with praziquantel than among those who were not yet treated (treatment before immunisation, aGMR 2.3 [1.5-4.8]; treatment at immunisation aGMR 1.8 [1.1-3.5]). At 24 weeks post-immunisation, IgG levels did not differ between the trial groups, but tended to be lower among previously-infected children who were still S mansoni stool-positive than among those who became stool-negative. Our findings suggest that S. mansoni infection among pre-school children is associated with a reduced antibody response to catch-up measles immunisation, and that praziquantel treatment improves the response. S. mansoni infection may contribute to impaired vaccine responses in endemic populations; effective schistosomiasis control may be beneficial for vaccine efficacy. This should be further explored. ISRCTN87107592.

Background Cardiovascular disease (CVD) morbidity and mortality are increasing globally, including among patients living with human immunodeficiency virus (HIV). We aimed to determine the risk of all-cause mortality and morbidity in patients with CVD, comparing those with and without HIV infection, and whether mortality differed by HIV status during hospitalization for Major Adverse Cardiovascular Events (MACE) components (stroke, acute myocardial infarction (AMI), and heart failure) in northern Uganda. Methods We conducted a retrospective cohort study at two hospitals in northern Uganda, comparing outcomes in CVD patients with and without HIV hospitalized from January 2015 to June 2023. We utilized a logistic regression model for crude, adjusted, and stratified analyses of MACE components and mortality by HIV status. Results Among 2,127 CVD patient records analyzed, 292 (13.7%) had HIV. During hospitalization, 26.0% of patients living with HIV (PLWH) died compared with 15.8% of those without HIV. Similarly, among patients who experienced MACE, mortality was higher in PLWH than in those without HIV, including heart failure (38.1% vs. 22.9%), AMI (60.0% vs. 36.5%), and strokes (41.8% vs. 27.8%). In multivariable analyses, patients with cardiovascular disease living with HIV had higher odds of all-cause mortality compared with patients without HIV (aOR: 2.30, 95% CI: [1.32, 3.98], p =  0.003). Among individual MACE components, the odds of mortality were higher among those living with HIV, including heart failure (aOR: 3.06, CI: [1.56, 6.32], p =  0.001), AMI (aOR: 9.07, CI: [4.55, 18.77], p  < 0.001), and stroke, (aOR: 2.5, CI: [1.15, 5.42], p =  0.02). We assessed whether HIV modifies the relationship between MACE and odds of mortality, interaction terms (example, HIV*Stroke) showed no statistical evidence of effect modification, with HIV-interaction term p -values: heart failure ( p  = 0.465), stroke ( p  = 0.613), and AMI ( p  = 0.615). Conclusion All-cause mortality risk was higher among CVD patients living with HIV compared to those without. Although patients living with HIV who experienced MACE had higher in-hospital mortality, there was no statistical evidence of effect modification by HIV status. Further research is needed to understand the underlying pathophysiological mechanisms and mortality risks among patients hospitalized with MACE, including both medium- and long-term post hospitalization.

Shigella is an important cause of diarrheal morbidity and mortality globally. Data on disease burden across age groups, in different epidemiologic settings, and over time are needed to guide preventive strategies. We examined shigellosis in two sites in Kenya over a 10-year period. We used data from the Population-Based Infectious Disease Surveillance (PBIDS) platform in a rural (Asembo, population ~35,000) and urban (Kibera, population ~23,000) setting. PBIDS participants presenting to surveillance clinics with diarrhea (≥3 loose stools in 24-hour period) had stool collected and cultured; Shigella isolates underwent antimicrobial susceptibility testing. We estimated incidence by dividing Shigella cases by person-years- observation, adjusting for the proportion of diarrhea cases with stool collected and for care-seeking outside surveillance clinics. From January 1, 2010 to December 31, 2019, we isolated Shigella from 23% and 15% of 2,017 and 4,074 stool specimens collected in Asembo and Kibera, respectively; S. flexneri accounted for 61% and 67%, respectively. In Asembo, the adjusted shigellosis incidence was 684/100,000; it was highest in ages 12-23 months (1,873/100,000) and ≥50 years (1,502/100,000). In Kibera, the adjusted incidence was 647/100,000, highest in ages 12-23 (2,828/100,000) and 24-59 months (936/100,000). Incidence declined significantly in Asembo (p = 0.009), but not in Kibera (p = 0.53). Overall, ≥ 97% of isolates were susceptible to ciprofloxacin and ceftriaxone. The shigellosis burden was greatest among young toddlers in both urban and rural areas and was high among older adults in the rural setting. Although resistance to first-line antibiotics was infrequent, continued susceptibility monitoring is warranted.

Reliable mortality data are important for evaluating the impact of health interventions. However, data on mortality patterns among populations living in urban informal settlements are limited. To examine the mortality patterns and trends in an urban informal settlement in Kibera, Nairobi, Kenya, Using data from a population-based surveillance platform we estimated overall and cause-specific mortality rates for all age groups using person-year-observation (pyo) denominators and using Poisson regression tested for trends in mortality rates over time. We compared associated mortality rates across groups using incidence rate ratios (IRR). Assignment of probable cause(s) of death was done using the InterVA-4 model. We registered 1134 deaths from 2009 to 2018, yielding a crude mortality rate of 4.4 (95% Confidence Interval [CI]4.2-4.7) per 1,000 pyo. Males had higher overall mortality rates than females (incidence rate ratio [IRR], 1.44; 95% CI, 1.28-1.62). The highest mortality rate was observed among children aged < 12 months (41.5 per 1,000 pyo; 95% CI 36.6-46.9). All-cause mortality rates among children < 12 months were higher than that of children aged 1-4 years (IRR, 8.5; 95% CI, 6.95-10.35). The overall mortality rate significantly declined over the period, from 6.7 per 1,000 pyo (95% CI, 5.7-7.8) in 2009 to 2.7 (95% CI, 2.0-3.4) per 1,000 pyo in 2018. The most common cause of death was acute respiratory infections (ARI)/pneumonia (18.1%). Among children < 5 years, the ARI/pneumonia deaths rate declined significantly over the study period (5.06 per 1,000 pyo in 2009 to 0.61 per 1,000 pyo in 2018; p = 0.004). Similarly, death due to pulmonary tuberculosis among persons 5 years and above significantly declined (0.98 per 1,000 pyo in 2009 to 0.25 per 1,000 pyo in 2018; p = 0.006). Overall and some cause-specific mortality rates declined over time, representing important public health successes among this population.