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Background The use of insecticide-treated bed nets has been proven to be effective in reducing malaria transmission in highly endemic areas. Use of long-lasting insecticidal nets (LLINs) has been embraced by many malaria endemic countries. LLINs are up to 95% effective in inhibiting blood feeding, when used consistently even after 7 years. The challenge, however, is enhancing their consistent use, especially by the most vulnerable groups (children under 5 years and pregnant women). The study established factors associated with consistent use of bed nets for malaria control among children under 5 years in Soroti district. Methods The study employed a cross-sectional design, with multi-stage sampling of households. A total of 400 households (HH) were sampled and the HH head in each household interviewed. Key informant interviews (KIIs) were conducted with 7 key informants who were knowledgeable on the subject matter. Data analysis was done using SPSS 17.0 at Univariate, Bivariate and Multivariable levels; after entry and cleaning. Key informants’ data were summarized manually; verbatim quotes and text used to reinforce quantitative data in line with objectives. Results Only 56.8% of the 690 children under 5 years used bed nets consistently. The factors affecting consistent bed net use were age of the child, their use of bed nets the previous night, occupation of caretaker, respondents’ perceived susceptibility, perceived risk of getting malaria, size and shape of the bed nets. Rectangular nets were difficult to hang daily in huts according to most key informants. Conclusion Consistent bed net use among under fives is still below the RBM target of 85% by 2015 and can be enhanced by providing conical bed nets and setting aside a health education programme to emphasize the effectiveness of even one mosquito in spreading malaria at night to the entire household and ability of bed nets to stop transmission better than other methods.

Antimicrobial resistance (AMR) is escalating especially in waterborne bacteria, feared to cause over ten-million annual global deaths by 2050. In Eastern Uganda, bacterial contamination of household drinking water containers and sources such as boreholes is increasingly reported, but data on related AMR and contamination enables are scarce, complicating redress. On 260 random water samples, conventional culture and Kirby-Bauer disk diffusion assays were applied at Makerere University. Pre-validated semi structured questionnaires aided studying the contamination enablers. Thematic synthesis, descriptive and inferential statistics ( p  < 0.05), were used to analyze data, with STATA version-15. Bacterial (167 isolates), representing eleven species were obtained from 41.2% of samples (mainly from jerricans), mostly Escherichia coli ( N  = 47, 28.1%), and Klebsiella spp ( N  = 34, 20.4%). Over 59 (49.2%) of isolates were resistant to at least one high-powered drug; 34% were multi-drug resistant. E. coli showed highest resistance to Cefoxitin (48%), K. pneumoniae to Ceftazidime (28%), and Salmonella spp to Nalidixic acid (70%). Contamination enablers emerged in seven themes, the largest being type of water source ( N  = 11), and sociodemographic ( N  = 7). Hence, this water is largely unsafe, and some of these bacteria are associated with persistent epidemics, including typhoid fever in Eastern Uganda, warranting concerted efforts to avert the burden.

The authors acknowledge the part-funding for this research provided by TagDev Project supported by Regional Universities Forum (RUFORUM) for Capacity Building in Agriculture. The funder did not play any role in conception and design, analysis and interpretation, drafting of the manuscript.

This study investigated the socioeconomic determinants of fruit tree adoption amongst smallholder farmers in Budaka District, Eastern Uganda. Specific objectives included describing the characteristics of fruit tree gardens, mapping their spatial distribution, and analysing socioeconomic factors influencing adoption. This study is one of the first empirical studies in agroforestry to relate socioeconomic factors in Eastern Uganda to the spatial distribution of fruit trees. The study employed a combined approach incorporating GIS‐based spatial mapping and socioeconomic analysis. A cross‐sectional design was employed, with data collected from 276 randomly selected farmers, key informants, and focus groups. GIS was used to visualise the spatial patterns and descriptive statistics, and chi‐square tests were applied to identify differences between adopters and nonadopters. Results indicated that fruit farming is predominantly undertaken by males aged 40 and above. Fruit tree distribution is concentrated in the north and northwest, grown on small holdings averaging 0.5 acres with 10–40 trees. Chi‐square tests confirmed significant differences in age, labour type, farm size, and income between adopters and nonadopters, whilst there were no significant differences in gender, family size, and access to credit. Policy interventions should expand youth‐ and gender‐inclusive extension services that support climate resilience and sustainable fruit tree farming, and address land tenure limitations to increase adoption.

Background Globally, an estimated 53 million children under 5 years live with disabilities. The majority live in low- and middle-income countries. The government of Uganda legislated the Uganda National Social Protection Policy in 2015 and the Persons with Disabilities Act in 2020 to foster an inclusive and non-discriminatory environment. However, challenges and implementation gaps persist. Previous studies highlighted the caring burden on caregivers of infants with disabilities. We explored the lived experiences of parents of children with developmental disabilities in Uganda, focusing on the effects of children’s disabilities on daily life, the strategies they use to cope with these challenges and their unmet psychosocial support needs. By capturing these caregiver perspectives, the study seeks to inform inclusive programme designs and policies, particularly in low-resource settings. Methods This qualitative study was conducted at an outpatient paediatric neurology clinic annexed to a regional referral hospital in Eastern Uganda in March 2024. In-depth interviews were held, using an interview guide, with nine primary caregivers of children between 1 and 6 years old with developmental disabilities to capture insights into their experiences and support needs and two healthcare professionals to obtain their perspectives. Data were transcribed, coded, and thematically analysed using a framework approach. Results Five themes were identified: ‘struggles’, ‘information’, ‘faith’, ‘accepting the situation’ and ‘looking for a solution’. Mothers faced emotional and financial ‘struggles’ caring for children with developmental disabilities and prejudice extending from spiritual beliefs. They found comfort in ‘faith’ and were determined to seek ‘information’ and a cure for the conditions; however, a large knowledge gap existed due to the lack of accurate and trustworthy information, which opened further because of their isolation from the community. Many learned to cope through ‘accepting the situation’, but continued ‘looking for a solution’ to children’s conditions. Healthcare providers also called for health system changes to provide further support. Conclusions Better access to information, education, social care, and counselling services and cross-sector collaboration are needed to remove the stigma and enhance caregivers’ quality of life. The development of holistic cross-sector support interventions are required.

Background Nearly half of all stillbirths occur in sub-Saharan Africa and accurate registration could inform reduction efforts. We explored the beliefs and practices surrounding stillbirths in Eastern Uganda, revealing cultural factors that could influence the accurate counting of stillbirths. Methods We conducted a qualitative study among women with a history of stillbirths, and men, women and community leaders with an experience of childbirth in Eastern Uganda. The study also included healthcare workers from three health facilities. We conducted 30 in-depth interviews and six focus group discussions to explore the beliefs and practices about stillbirths. All discussions and interviews were audio recorded and transcribed into English. Thematic analysis was done using NVivo R1 (2020) software for coding. Results We enrolled a total of 74 participants: 44 in six focus group discussions and 30 in in-depth interviews. Four themes emerged: first, the community believed that stillborn babies can be used for witchcraft or as a source of curses therefore stillbirths were hidden from the public. Second, women were useful in marriage only when they bore live children and were despised when they had a stillbirth leading to discord in marriage and stigma. Third, stillborn babies were not considered human and therefore, the baby was not named or buried in a coffin. Fourth, the spirit of the stillborn baby was considered harmful to the next siblings and their parents sought the services of traditional healers and witch doctors to protect these siblings. Conclusion The immediate tragedy of a stillbirth has long-term personal and societal effects on the mother, resulting in stigma, marital breakup and isolation. The secrecy about stillbirths may also contribute to underreporting of stillbirths. Efforts to improve documentation of stillbirths and support for families who have had stillbirths need to incorporate culturally sensitive interventions.

Background Animal African trypanosomiasis (AAT) poses a significant impediment to livestock production and economic progress in sub-Saharan Africa. To reduce the burden of AAT in Uganda and contribute to the AAT progressive control pathway, there is a need to develop effective AAT and tsetse control measures. In this study, we assessed a combination of chemotherapy and Restricted Insecticide Application Protocol (RAP) as a last mile control option for the progressive control of AAT and acute sleeping sickness in south- eastern Uganda. Methods Cattle from fourteen AAT endemic villages in south-eastern Uganda were treated with two doses of diminazene acecurate 40 days apart and sprayed with deltamethrin once monthly for 6 months following chemotherapy. Both cattle and tsetse flies were screened for trypanosomes before and 6 months into the interventions using ITS1-PCR. Tsetse flies trapped per day per trap were counted and the apparent tsetse fly density [Flies/Trap/Day-FTD] determined and mapped. The effect of chemotherapy and RAP on (1) FTD and (2) trypanosome infection in both cattle and tsetse flies was determined using mixed effects regression models. Results RAP and chemotherapy were associated with significantly lower odds of trypanosome infections in cattle (OR = 0.43, 95% CI; 0.35–0.54) and tsetse flies (OR = 0.06, 95% CI; 0.03–0.10). RAP and chemotherapy reduced Trypanosoma species prevalence from 23.38% to 12.70% among cattle and 73.33% to 21.76% in tsetse flies. Additionally, treatment was significantly associated ( P  = 0.04) with a reduction in FTD by 1.02. Unlike T. vivax , both T. congolense and T. brucei infections were reduced by RAP and chemotherapy. There was a single infection with Trypanosoma brucei rhodesiense detected in the cattle and none in tsetse flies. Conclusion Combination of RAP and chemotherapy offers promising approach to control AAT in endemic areas and can support last mile acute sleeping sickness elimination efforts when combined with other available tsetse and AAT control methods. A singular infection with T. b. rhodesiense indicates that there is still a risk of acute sleeping sickness resurgence in south-eastern Uganda unless tsetse and trypanosomiasis control and surveillance efforts are maintained.

Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8–75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.

Background Neurodevelopmental disability (NDD) is increasingly acknowledged as one of the important causes of disease burden in low income countries. None the less, there is a dearth of data on the burden of NDD and its determinants in these settings. We aimed to establish the prevalence and factors associated with NDD among infants in Eastern Uganda. Methods We assessed 487 infants aged 9–12 months within Iganga-Mayuge Health Demographic Surveillance Site in Eastern Uganda using the Malawi Developmental Assessment Tool. The tool has four domains: gross motor, fine motor, language and social domains. An infant failed a domain if she/he failed more than two parameters of the expected at his/her age. We interviewed mothers on factors that could influence the infants’ neurodevelopmental outcomes. Data were analysed using STATA version 14. We used odds ratios and 95% confidence intervals to assess statistical significance of associations. Results Of the 487 infants, 62(12.7%) had an NDD in at least one of the domains. The most affected was social behaviour where 52(10.7%) infants had an NDD. Severe impairment was seen among 9(1.8%) infants with NDD in either three or four domains. Factors associated with NDD at multivariate logistic regression included: parity of more than three children (aOR = 1.8, 95% CI: 1.02–3.18); failure to cry at birth (aOR = 3.6, 95% CI: 1.46–9.17) and post-neonatal complications (aOR = 4.15, 95% CI: 1.22–14.10). Low birth weight, immediate and exclusive breast feeding were not significantly associated with NDD. Conclusion We found a high NDD burden among infants particularly in the social behaviour domain. To optimise the socio-neural development of infants, programs are needed to educate and work with families on how to engage and stimulate infants. Existing immunisation clinics and community health worker strategies provide an excellent opportunity for stemming this burden.

Background We implemented a facility-based intervention aimed at reducing the proportion of patients lost to follow-up at an out-patient HIV clinic in Jinja district, Eastern Uganda, over a period of 6 months (February-July 2012). Methods The intervention was implemented with the aim of decreasing the proportion of patients lost to follow-up from 1% (23/2328) at baseline to 0.25% by July 2012. Simple and innovative strategies were introduced into the HIV clinic. These included retraining of clinic staffs on the importance of patients keeping their appointments; development of new messages on keeping appointments; retrieving patient files a day before the day of appointment; sending two text message reminders a day to the clinic; and actively following up patients who had not kept their appointments through home-visiting. At each follow-up visit, reasons for the patients’ failure to keep appointment were noted and information on age, gender, CD4 count (captured from patient records) and duration in HIV care was obtained. Data were fed into an IQ Care programme and analysed using Microsoft Excel. Results The proportion of patients lost to follow-up decreased from 1% (23/2328) at baseline to 0.4% (9/2528) in 6 months. Men, those with a CD4 > 350, those aged < 30 years and those in care for < 1 year had the biggest decline in proportion of patients lost to follow-up compared to other patients. Conclusion The proportion of patients lost to follow-up declined by 60% through use of simple and innovative strategies introduced in the HIV clinic.