JASHC 2022 Abstracts19

16th JOINT ANNUAL SCIENTIFIC HEALTH CONFERENCE 2022
28th UNACOH CONFERENCE,

3rd MinOSH INTERNATIONAL CONFERENCE
20th DR. MATHEW LUKWIYA MEMORIAL LECTURE
1st NATIONAL ANTIMICROBIAL RESISTANCE SYMPOSIUM
21ST- 23RD SEPTEMBER 2022
ABSTRACTS
ABSTRACTS
16th JOINT ANNUAL SCIENTIFIC HEALTH CONFERENCE
2022
28th UNACOH CONFERENCE,
3rd MinOSH INTERNATIONAL CONFERENCE
20th DR. MATHEW LUKWIYA MEMORIAL LECTURE
1st NATIONAL ANTIMICROBIAL RESISTANCE SYMPOSIUM
THEME
Makerere @100: The Role of Health Professions Education
in Strengthening Health Systems, Research, Global and
Community Health for Economic development
21ST- 23RD SPEKE RESORT

SEPTEMBER MUNYONYO
2022 KAMPALA UGANDA
ACKNOWLEDGEMENT
GOLD LEVEL
COLLEGE
I N B U I L D I NOF
G A THEALTH
R A N S F O R M E DSCIENCES
LEVERAGING 100 YEARS OF EXCELLENCE
SOCIETY
SILVER LEVEL
UNACOH
“Health for All & By All”
BRONZE LEVEL
SCHOOL OF PUBLIC HEALTH
MINISTRY OF HEALTH
03
ORAL
PRESENTATIONS
16TH JOINT MAKCHS AND 28TH UNACOH ANNUAL SCIENTIFIC HEALTH CONFERENCE
Kampala, Uganda, 21st-23rd September 2022 PARALLEL SESSION 1A
DAY 1 SESSIONS
Day 1
WEDNESDAY
21ST September 2022
Parallel Sessions
1A - 2C
05
DAY 1 SESSIONS
PARALLEL SESSION 1A:

Sub-Theme 1: HIV and
HIV related illnesses
FACTORS INFLUENCING THE UPTAKE OF VOLUNTARY MEDICAL MALE

CIRCUMCISION AMONG BODA-BODA RIDERS AGED 18-49 YEARS IN
HOIMA, WESTERN UGANDA
Joan Tusabe1, Herbert Muyinda4, Joanita Nangendo2 Doris Kwesiga1, Sharifah
Nabikande1, Michael Muhoozi1,3 , Winnie Agwang1, Tom Okello2, Elizeus Rutebemberwa1
DAY 1 SESSIONS
Makerere University, College of Health Sciences School of Public Health, Kampala,
1
Uganda
Makerere University, College of Health Sciences, School of Medicine, Clinical
2
Epidemiology Unit, Kampala, Uganda

3
Makerere University Center for Health and Population Research
4
Makerere University, College of Health Sciences, Child Health and Development Center
Introduction: Despite high levels of awareness about availability and benefits of

voluntary medical male circumcision (VMMC), uptake is low. We assessed factors
influencing the uptake of VMMC among boda-boda riders aged 18-49 years in
Hoima, western Uganda.
Methods: We employed mixed methods design among boda-boda riders in

Hoima district between August and September 2020. We administered structured
questionnaires to 316 boda-boda riders to determine factors associated with
uptake of VMMC. We also conducted eight focus group discussions (FGDs) and
six key informant interviews (KIIs) to explore perceptions of VMMC. We conducted
modified poisson regression analysis at 5% level of significance. We identified
sociocultural barriers and facilitators for VMMC using thematic content analysis.
Results: Uptake of VMMC was at 33.9% (95% CI; 28.6-39.1); and was associated
with higher level of education; adjusted prevalence ratio (APR) 1.63, 95% CI; 1.12-
2.40), concern about being away from work; APR 0.66 (95 % CI; 0.49-0.88) and the
non-belief that VMMC diminishes sexual performance APR 1.78 (95% CI; 1.08-2.9).
Facilitators of VMMC were health education and awareness creation, improved
penile hygiene and perceived sexual functioning; and reduced chances of HIV and
sexually transmitted infections (STIs). Barriers were fear of pain and compulsory
HIV testing, financial loss during the healing period, fear of sexual misbehavior after
circumcision, and interruption of God’s creation.
Conclusion: Although VMMC is largely perceived as protective against HIV and

other STIs, deliberate measures using multiple strategies should be put in place to
address the barriers to its uptake among this key population.
07
PARALLEL SESSION 1A Kampala, Uganda, 21st-23rd September 2022
PREVALENCE OF CARDIOVASCULAR DISEASES (CVDS) AND HIV

AMONG AGING INDIVIDUALS IN A PROSPECTIVE RURAL AND URBAN
LONGITUDINAL COHORT STUDY IN UGANDA
R. Bulamba1, 5, G. Nakigozi1, A. Miller2, F. Nalugoda1, S. Mugamba1, 4, G.N. Kigozi1,
A. Katarina3, Z. Leo3, F.S. Carl3, J. Nkale1, S. Watya1, G. Kigozi1, J. Wagman2, A.M.
DAY 1 SESSIONS
Ekström3, E. Kyasanku1
Africa Medical and Behavioral Sciences Organization (AMBSO), Hoima and

1
Wakiso Districts, 2University of California Los Angeles, US; 3Karolinska Institute,

Stockholm Sweden; 4Makerere University Walter Reed Project (MUWRP, Kampala,
Uganda; 5Makerere University, Kampala Uganda.
Introduction: Antiretroviral therapy has dramatically changed the clinical and

epidemiological features of HIV infection from a subacute fatal to a chronic
survivable illness. Successful antiretroviral therapy allows HIV-infected persons live
longer, closely achieving normal lifespans, but increasing chances of developing
age-related comorbidities. We analyzed the profile of CVDs and HIV infection in
adults (35 years +).
Objective: To determine the prevalence of CVDs and HIV among adults in Hoima
and Wakiso districts, Uganda.
Methods: Between 2019 and 2020 1,412 adults individuals (35+ years) participating
in an on-going AMBSO Population Health Surveillance (APHS) longitudinal cohort
study. Consenting Participants provided a blood sample for HIV testing and their
status was established using Uganda MOH standard algorithm. Blood pressure
measurements were taken and participants asked for any history of heart disease,
hypertension and stroke. Bivariate analysis was used to determine prevalence of
CVDs, HIV and other socio-demographics.
Results: Majority (57.4%) were females, (mean age 48.1, median 45, SD 10.4)
and 56.2% were from the rural communities. Overall, HIV prevalence was14.8%;
significantly higher among females vs males (17.8% vs 10.8%, P<0.001), while
CVDs prevalence was 13%; significantly higher among females than males (17.5%
vs 7%, P<0.001). Overall HIV-CVD co-morbidity was 11% (95% CI: 7.4-16.0) and
significantly higher among older (50 years+) HIV-infected persons, (21.4% vs 7.2%,
P=0.004).
Conclusion: CVDs are common among adults especially among those ageing
with HIV. There is need to integrate routine non-communicable disease (NCD)
screening in HIV care, so as to support early diagnosis and treatment of NCDs
among PLHIV in this setting.
08
HIV PREVALENCE AMONG CHILDREN ADMITTED WITH SEVERE ACUTE

MALNUTRITION AND RISK FACTORS FOR HIV TRANSMISSION AT
MULAGO HOSPITAL, UGANDA: A MIXED METHODS STUDY
Victor Musiime1*, Joseph Rujumba1, Lawrence Kakooza2, Henriator Namisanvu2, Loice
Atuhaire3, Erusa Naguti3, Judith Beinomugisha2, Andrew Kiggwe2, Sharafat Nkinzi2, Ivan
DAY 1 SESSIONS
Segawa2, Nicholas Matsiko4, Esther Babirekere-Iriso3, Philippa Musoke1
1
Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda;
2
Makerere University Lung Institute, Kampala, Uganda; 3Mulago National Referral
Hospital, Directorate of Paediatrics and Child Care, Kampala, Uganda; 4Joint Clinical
Research Centre, Data Department, Kampala, Uganda; *presenting author
Background: Despite global efforts to eliminate mother to child transmission of

HIV(EMTCT), many children continue to become infected. We determined the
prevalence of HIV among children with severe acute malnutrition (SAM) and that
of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital,
Uganda. We also assessed child factors associated with HIV-infection, and
explored factors leading to HIV-infection among a subset of the mother-child dyads
that tested positive.
Methodology: We conducted a cross-sectional evaluation within the ongoing

REDMOTHIV clinical trial (NCT05051163). We consecutively tested children with
SAM, and the mothers who were available, for HIV at admission to the nutrition unit.
Children and mothers had a rapid HIV antibody test done, and the children under 18
months of age had a confirmatory HIV-DNA PCR test done. The children who tested
positive and/or whose mothers tested positive, were enrolled in REDMOTHIV. In-
depth interviews (IDIs) were conducted with mothers of mother-child dyads that
tested positive, until data saturation. Interviews were audio recorded and later
transcribed. The quantitative data was analyzed using descriptive statistics and
logistic regression in STATAv14, while a content thematic approach was used to
analyze the qualitative data.
Results: Of 601 children, 346(58%) were male and 473(79%) were ≤18months
of age; 61 (10.2%) tested positive. Of 528 mothers, median (IQR) age 26(22,30)
years, 138(26.1%) were HIV positive. Child age >18months was associated with
HIV-infection (OR=2.50,95% CI: 1.43,4.39), p-value = 0.001). The IDIs from 16
mothers revealed risk factors for HIV transmission at multiple levels. Individual level
factors: inadequate information regarding EMTCT, limited perception of HIV risk,
and fear of antiretroviral drugs. Relationship level factors: lack of family support and
unfaithfulness among sexual partners. Health facility level factors: negative attitude
of health workers and missed opportunities for HIV testing. Community level factors:
poverty and health service disruptions due to the COVID-19 pandemic.
09
Conclusion: In this era of universal antiretroviral therapy for EMTCT, a 10%

HIV prevalence among severely malnourished children is substantially high. This
reaffirms the need for routine HIV testing of severely malnourished children, with
special emphasis on those over the age of 18months. To eliminate vertical HIV
transmission, more efforts are needed to address challenges at the individual,
relationship, health facility, and community levels.
DAY 1 SESSIONS
BARRIERS TO AND FACILITATORS OF UPTAKE FOR ASSISTED PARTNER

NOTIFICATION AMONG HIV POSITIVE PERSONS WITH SEVERE MENTAL
ILLNESS AT BUTABIKA NATIONAL REFERRAL MENTAL HOSPITAL,
UGANDA- A MIXED METHODS STUDY.
Rachel Wangi Nante, Hebert Muyinda, Juliet Nakku, Regina N. Ndagire, Emmanuel
Ssendikwanawa, Kevin Ouma Ojiambo, Joanita Nangendo, John M. Kiweewa, Fred C.
Semitala
Background: HIV more negatively affects people with severe mental illnesses
(SMI) than the general population. World Health Organization (WHO) introduced
assisted partner notification (APN) in order to increase HIV testing. APN strategy
has been effective in the general population. However, the extent to which it is
used among people living with HIV (PWH) who have SMI is not known. It is clear
that mental health impairment leads to negative health outcomes at every stage
of HIV continuum of care, including active participation in APN. This study sought
to assess the associated socio-behavioral factors and barriers to uptake of APN
strategy among PWH with a diagnosis of SMI at Butabika National Referral Mental
hospital.
Methods: We conducted a cross-sectional study with descriptive and analytic

components. Data on sociodemographic and clinical characteristics of PWH
diagnosed with SMI was abstracted from the patient’s clinical charts, Antiretroviral
therapy (ART) registers and APN registers. We used summary statistics to measure
uptake of APN, whereas associated factors were determined using modified Poisson
regression. We supplemented quantitative data with 6 key informant interviews,
which included health workers and 10 in-depth interviews which included stable
PWH with a diagnosis of SMI. Qualitative findings were analyzed by inductive
thematic analysis.
Results: Between November 2021 and January 2022, we identified 125 PWH and
SMI. Majority of the participants were females 66.4% and 42.4% were between
24-34 years. APN uptake was 32.8% (95% CI: 25.052 – 41.614). Over 80% of
10
participants had been on psychiatric medication for ≥ 6 months and only 52% of
them had a record of good adherence to ART on their last visit. APN uptake was
associated with; 1) religion, which had two significant levels, Pentecostal PR=0.441,
95%CI; 0.217-0.981), and SDA; PR=0.532, 95% CI: 0.453-0.712), 2) being married
(PR=0.65, 95%CI: 0.596-0.808), 3) nature of relationship with next of kin, which
also manifested with two extremes; being accompanied by distant relatives
DAY 1 SESSIONS
(PR=0.550, 95% CI: 0.390-0.802) or a friend/neighbor (PR=0.322, 95%CI: 0.195-
0.534), 4) people spending more than 6 months on anti-psychotic drugs (PR=0.781,
95%CI: 0.437-0.904)), 5) poor adherence (PR=0.918, 95%CI: 0.844-0.995) and 6)
counselling (PR=1.84495%CI: 1.718-1.980). Qualitative data confirmed that being
married and nature of relationship with next of kin greatly influence uptake of APN.
Fear of domestic violence, stigma and discrimination, lack of trust in HCW and
inadequate support from care givers were key barriers to APN uptake.
Conclusion. The overall uptake of APN among PWH and SMI was low. Having
good adherence and receiving at least three counselling sessions before clients
are offered APN services may improve uptake in this group. There is need for
continuous health education and communication strategies to address socio-
cultural barriers to APN among PWH with SMI.
LONG-TERM EFFECT OF GROUP SUPPORT PSYCHOTHERAPY ON

DEPRESSION AND HIV TREATMENT OUTCOMES: SECONDARY
ANALYSIS OF A CLUSTER RANDOMIZED TRIAL IN UGANDA
Etheldreda Nakimuli-Mpungu PhD1, Colin M. Smith, MD2,3, Kizito Wamala MSc4, James
Okello PhD5, Josephine Birungi MPH6, Micheal Etukoit MPH6, Ramin Mojtabai PhD7,
Jean B Nachega PhD8,9,10, Ofir Harari PhD11, Musisi Seggane FRCP (C )11, Edward J
Mills PHD12
Affiliations
1
Department of Psychiatry, College of Health Sciences, Makerere University, Kampala,
Uganda
2
Department of Medicine, Duke University Medical Center, Durham, NC, USA
3
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center,
Durham, NC, USA
4
Department of Psychology, Center for Victims of Torture, Gulu, Uganda
5
Department of Mental Health, Faculty of Medicine, Gulu University, Gulu, Uganda
6
The AIDS Support Organization (TASO), Kampala, Uganda
⁷Department of Mental Health, Bloomberg’s School of Public Health, Johns Hopkins
University, United States
⁸Department of Epidemiology, Pittsburgh Graduate School of Public Health, University
of Pittsburgh, United States
⁹Stellenbosch Center for Infectious Disease, Department of Medicine, Stellenbosch
University, South Africa
10
Department of International Health, Bloomberg’s School of Public Health, Johns
Hopkins University, USA
11
11
MTEK Sciences Inc, Vancouver, BC, Canada
12
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton,
ON, Canada
Corresponding Author:
Etheldreda Nakimuli-Mpungu, MMED (Psych), PhD
Makerere University College of Health Sciences
Department of Psychiatry, Mulago Hospital Complex
DAY 1 SESSIONS
P.O.BOX 7072, Mulago Hill Road, Kampala, Uganda

Phone: 256 788994050, Email: etheldreda.nakimuli@mak.ac.ug
TRIAL REGISTRATION:
The Pan African Clinical Trials Registry, number PACTR201608001738234.

Objective: To determine the effect of group support psychotherapy (GSP) compared
to group HIV education (GHE) on depression and HIV treatment outcomes 24
months after treatment. We further aimed to investigate the mediating role of
depression and anti-retroviral therapy (ART) adherence in the relationship between
GSP and viral load suppression.
Methods: Thirty HIV clinics across three districts were randomly assigned to deliver
either GSP or GHE for depression. Depression and optimal (≥95%) ART adherence
was assessed at baseline, 6, 12, 18, and 24 months post-treatment. Viral load
was drawn from the medical charts at baseline, 12 and 24 months post-treatment.
Multilevel mixed effects regression models and generalised structural equation
modelling were used to estimate 24 months outcomes and mediation effects.
Results: We recruited 1140 PLWH from HIV clinics offering either GSP (n=578
[51%]) or GHE (n=562 [49%]). Fewer GSP than GHE participants met criteria for
depression at 24 months post treatment [1% versus 25%; adjusted odds ratio (aOR)
=0·002, 95% CI 0·0002-0·018]. More GSP than GHE participants reported optimal
(≥95%) ART adherence [96% versus 88%; aOR =20.88, 95% CI 5.78- 75.33] and
improved viral suppression [96% versus 88%; aOR =3.38, 95% CI 1.02- 11.02]. The
indirect effects of GSP through sequential reduction in depression and improvement
in ART adherence at 12 months may partially explain the higher viral suppression
rates at 24 months in GSP than GHE groups.
Conclusion: In settings where the HIV epidemic persists, depression treatment with
group support psychotherapy may be critical for optimal HIV treatment outcomes.
Keywords: depression; group support psychotherapy; HIV/AIDS; anti-retroviral

therapy adherence; viral suppression; Uganda
12
HIV viral load non-suppression at six months post-antiretroviral therapy

regimen optimization among treatment-experienced HIV-infected clients
aged 0–19 years, Kampala, Uganda, February 2020-October 2021.
Allan Komakech1,3*, Esther Nasuuna2, Petranilla Nakamya1,3, Edirisa Junior Nsubuga1,3,
Lilian Bulage1,3, Benon Kwesiga1,3, Alex Riolexus Ario1,3, Donna Kabatesi4, Julie R.
Harris4
DAY 1 SESSIONS
¹Uganda Public Health Fellowship Program, Kampala, Uganda
²Infectious Diseases Institute, Kampala, Uganda
³Uganda National Institute of Public Health, Kampala, Uganda
⁴U. S Centers for Disease Control and Prevention, Kampala, Uganda
*Correspondence: Allan Komakech, +256789185617, akomackech@musph.ac.ug
Background: Regimen optimization programs aim at extending optimal HIV drugs
where they exist. In treatment-experienced clients, optimal drugs are offered to
those with suppressed viral loads. For pediatric and adolescent HIV-infected clients,
previous challenges in finding suitable regimens have existed. We assessed viral
load non-suppression at six months among treatment-experienced HIV-infected
clients aged 0-19.
Methods: We conducted a retrospective cohort study at four HIV clinics in Kampala

district during February 2020-October 2021. All patients had different dates of
initiation on optimal regimen. Non-suppression after six months of initiation of
optimal regimen was defined as viral load measurement exceeding 1000 copies
of HIV RNA per millilitre of blood. Using patient records, we collected data on
demographic, individual clinical and drug-related characteristics. We established
descriptive summary statistics and associations established using chi square tests
and logistic regression.
Results: We reviewed records of 1,013 clients. The mean age was 11±4.7 years.
Majority (409, 40%) were in the age group 10-14 years. Most (599, 59%) were
females. Most (871; 86%) were at WHO clinical stage 1 at enrollment and most
(985; 97%) had a good adherence to ART. Fifty-eight (6%) clients were non-
suppressed after six months year on optimal regimen, with most 955 (94%)
remaining suppressed. No factors were found to be associated with viral load non-
suppression.
Conclusion: Fewer than 1 in 10 clients had non-suppressed viral loads after

six months; most viral load readings remained suppressed. We recommend
strengthening the regimen optimization program, with a focus on clients with non-
suppressed viral loads.
Key words: Viral load non-suppression, pediatric, adolescents, regimen

optimization, Uganda
13
HIGH BURDEN OF CRYPTOCOCCAL MENINGITIS AMONG ART-

EXPERIENCED HIV-INFECTED PATIENTS IN NORTHERN UGANDA IN
THE ERA OF “TEST AND TREAT”
Mark Okwir1,2,3, Francis Kiweewa2, Abigail Link4,5, Betty Nabongo2, Jimmy Alal2, David
Meya3,4, Paul R. Bohjanen3,4,6
DAY 1 SESSIONS
¹Department of Medicine, Lira University, Lira, Uganda,

²Lira Regional Referral Hospital, Lira, Uganda,
³Infectious Diseases Institute, Makerere University, Kampala, Uganda,
⁴University of Minnesota, Minneapolis, USA,
⁵University of Washington, Seattle, USA.
⁶University of Rochester, Rochester, USA
Introduction: Little is known about the impact of the “Test and Treat” HIV treatment
program on cryptococcal meningitis (CM) burden or implications for cryptococcal
antigen (CrAg) screening in rural Uganda.
Purpose: We evaluated the burden of CM among ART-experienced patients at Lira

Regional Referral Hospital (LRRH) in rural, northern Uganda.
Methods: Using secondary data, we evaluated clinical factors, including ART-

experience in 212 HIV-infected patients diagnosed with CM from February of 2017
to November of 2019 at LRRH.
Results: Among 212 patients diagnosed with CM, 58.5% were male, the median
age was 35 years, and the median CD4 count was 86 cells/μL. Ten (10%) of
patients had previous history of CM. Of 209 patients where information on ART
experience was available, 90.9% (190/209) were ART- experienced and the rest
(19/209) were ART naïve. Overall, 90 of 212 (42.5%) patients died in-hospital
with a median time to death of 14 days. Increased risk of death was associated
with altered mental status (HR 6.6, 95% CI 2.411-18.219, p-value <0.0001), and
seizures (HR 5.23, 95% CI 1.245 – 21.991, p-value, 0.024). Mortality was similar in
ART-experienced CM patients (81 of 190, 42.6%) compared to ART-naïve patients
(9 of 19, 47.4%; p <0.315).
Conclusion:
In rural, northern Uganda, the majority of HIV-infected patients with CM were

ART-experienced (90%) at presentation. Thus, guidelines that recommend CrAg
screening only ART-naïve patients miss almost all patients who will develop CM.
Despite implementation of the “Test and Treat” program, mortality among ART-
experienced patients with CM remains high.
14
PrEP UPTAKE AMONG MEN WHO HAVE SEX WITH MEN (MSMS)
Author: Sairo Halima
Co-authors: Kwesiga Pacificus, Nalweyiso Jalia
INTRODUCTION
DAY 1 SESSIONS
MSMs are 27 times more at risk of contracting HIV, as well as other Sexually
Transmitted Infections (Mayo Clinic, October 2017). PrEP is a highly effective way
for HIV negative people at risk to prevent HIV from sex. MSMs are one of the
Key Populations (KP) to whom AIDS Information Center-Kampala, Uganda (AIC)
provides HIV prevention services like testing, care and treatment as well as PrEP.
We therefore assessed the uptake of PrEP among the MSMs to measure their
vigilance in taking HIV prevention initiatives.
OBJECTIVE
• To assess retention levels of MSMs on PrEP

• To identify the age group more involved in gay activities
METHODS
Data of 72 MSMs captured KP tracker for the whole of 2020 and 2021 was used to
descriptively analyze PrEP uptake among different age groups; 41(20-24), 18(25-
29), 5(30-34), 5(15-19), 3(40-44). 66 MSMs were on PrEP out of which 62 kept their
appointment by the end of 2021. Of those on PrEP, 5 were aged 15-19, 36(20-24),
18(25-29), 4(30-34), 3(40-44). None those aged 15-19 kept appointment for their
refills, 20-24 year olds all came for refills by end of 2021.Only one MSM is on ART
of all PLHIV at AIC. The data therefore gave us a general picture of PrEP uptake
among the above KP group.
RESULTS
92% of the total number of MSMs was on PrEP of which 94% (retention) promptly
keep their appointments for refill. 57% of the total MSMs are aged 20-24, 25% (25-
29), least represented are 40-44 with 4% while the rest are at 7% each.
CONCLUSION
MSMs are very active in PrEP uptake probably due to the high risks involved in their
sexual encounter and most of them are aged 20-24 years which causes a need to
sensitise the future generation of adolescent boys and young men about infection,
prevention and risks involved.
15
BARRIERS AND FACILITATORS TO ORAL PREP UPTAKE AMONG

HIGH-RISK MEN AFTER HIV TESTING AT WORKPLACES IN UGANDA: A
QUALITATIVE STUDY
Racheal Nabunya¹, Victoria M. S. Karis¹, Lydia Joslyline Nakanwagi², Pius Mukisa² and
Patience A. Muwanguzi¹
DAY 1 SESSIONS
¹Department of Nursing, Makerere University. ²Clinical Epidemiology Unit, Makerere

University.
Introduction: The national PrEP rollout for HIV prevention started in 2017 and has
expanded to other most at-risk populations. Men in Uganda contribute significantly
to new HIV infections annually yet PrEP uptake among them is low and those
initiated are likely to discontinue usage.
Objectives: To explore the barriers and facilitators to PrEP uptake among high-risk
men employed in private security services at workplaces in Uganda
Methods: An explorative qualitative study comprising in-depth participant

interviews. Data were collected via telephone calls and manually analyzed by
inductive content analysis.
Results: Fifty-six (56) men participated, 27(48.21%) had heard about PrEP, and
29(51.79%) were willing to initiate it. Four categories emerged for the facilitators
including perceived need for HIV prevention, awareness creation, availability, and
sexual freedom. Six categories that emerged for the barriers were: Inaccessibility
of PrEP services, Misinformation, Knowledge deficit, Medication-related barriers,
Potential for increased risky sexual behavior, and Perceptions about PrEP use.
Conclusions: There’s need for health care providers to offer information regarding
PrEP and HIV prevention services and mass sensitization campaigns to facilitate
uptake. Participants recommend mass roll-out of PrEP to lower-level facilities and
accessible pick-up points such as workplaces, use of longer-acting PrEP modalities
such as an injectable option or one that is utilized specifically by the female partner.
The stigma surrounding PrEP use could be reduced by the separation of PrEP and
ART services at health facilities, or special pick-up days to reduce waiting times.
16
Kampala, Uganda, 21st-23rd September 2022 PARALLEL SESSION 1B
DAY 1 SESSIONS
PARALLEL SESSION 1B:
Sub Theme 2: Malaria and
Other Infectious Diseases
17
PARALLEL SESSION 1B Kampala, Uganda, 21st-23rd September 2022
BURDEN, ETIOLOGIES AND OUTCOMES OF MENINGITIS IN RURAL,

NORTHERN UGANDA
Abigail Link¹, Mark Okwir3,4, David Meya2,5, Betty Nabongo³, Fred Okello³, Jimmy
Alal³, Paul R. Bohjanen2,5,6
¹Division of Infectious Diseases and International Medicine, Department of
DAY 1 SESSIONS
Medicine, University of Minnesota Medical School, Minneapolis, MN, United

States of America
²Division of Infectious Diseases, Department of Medicine University of Rochester
Medical Center, Rochester, NY, United States of America
³Lira Regional Referral Hospital, Lira, Uganda
⁴Lira University Faculty of Health Sciences, Lira, Uganda
⁵Makerere University, Infectious Diseases Institute, Kampala, Uganda
⁶University of Minnesota School of Public Health, Minneapolis, MN, United States
of America
Introduction: Meningitis is a major cause of death in Uganda, but little is known

about the prevalence of specific causes of meningitis, especially in rural areas such
as northern Uganda.
Purpose: To identify the burden, etiologies, and outcomes of meningitis at Lira

Regional Referral Hospital (LRRH) in order to establish protocols to improve patient
outcomes.
Methods: We enrolled 167 patients of all ages at LRRH with meningitis from
September of 2021 to July of 2022 and used diagnostic testing including gram
stain, culture, tuberculosis (TB) Gene Xpert, CrAg lateral flow assay, Pastorex latex
agglutination assay, and Biofire multiplex PCR to assess etiologies of meningitis.
In-hospital and outpatient mortality up to 6 months were measured.
Results: Of 167 patients with meningitis, 43 patients (25.7%) had a confirmed

etiology of meningitis based on diagnostic testing (CM: 23, BM: 15, TB meningitis:
4, and varicella zoster virus: 1). In-hospital mortality was 21.7% for patients with CM
and 27.8% for those with other forms of meningitis. Mortality at up to 6 months of
follow-up was 38.9% for those with CM and 38.5% among those with other forms
of meningitis. The most common etiology of BM was Streptococcus pneumoniae
(8/15, 66.7%), which affected 5 adults (≥18 years) and 3 children.
Conclusion: The most common type of meningitis with a confirmed diagnosis

was CM, followed by BM. CM could potentially be prevented with improved CrAg
screening protocols, and the most common BM type, Streptococcus pneumoniae,
could be prevented with routine pneumococcal vaccine administration.
18
RESURGENCE OF MALARIA BURDEN IN FIVE DISTRICTS IN UGANDA

DESPITE SUSTAINED INDOOR RESIDUAL SPRAYING AND REPEATED
LONG LASTING INSECTICIDAL NET DISTRIBUTIONS
Adrienne Epstein1*, Catherine Maiteki-Ssebuguzi², Jane F. Namuganga³, Joaniter

I. Nankabirwa3,4, Samuel Gonahasa³, Jimmy Opigo², Sarah G. Staedke⁵, Mame
DAY 1 SESSIONS
Niang, Damian Rutazaana², Emmanuel Arinaitwe3, Kassahun Belay6, Moses R.
Kamya3,4, Samir Bhatt7,8, Isabel Rodriquez-Barraquer⁹, Bryan Greenhouse⁹, Martin J.
Donnelly10, Grant Dorsey⁹
¹Department of Epidemiology and Biostatistics, University of California San
Francisco, San Francisco, California, United States of America
²National Malaria Control Division, Ministry of Health, Kampala, Uganda
³Infectious Diseases Research Collaboration, Kampala, Uganda
⁴Makerere University, College of Health Sciences, Kampala, Uganda
⁵London School of Hygiene and Tropical Medicine, London, United Kingdom
⁶US President’s Malaria Initiative, USAID/Uganda Senior Malaria Advisor
⁷Department of Infectious Disease Epidemiology, Imperial College, St Mary’s
Hospital, London, UK
⁸Section of Epidemiology, Department of Public Health, University of Copenhagen,
Copenhagen, Denmark
⁹Department of Medicine, University of California San Francisco, San Francisco,
California, United States of America
10
Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool,
United Kingdom
*Adrienne.Epstein@ucsf.edu
Background: Five years of sustained indoor residual spraying (IRS) of insecticide

from 2014 to 2019, first using a carbamate followed by an organophosphate, was
associated with a marked reduction in the burden of malaria in five districts of
Uganda. We assessed malaria burden over an additional 21 months, corresponding
to a change in IRS formulations using clothianidin with and without deltamethrin.
Methods: Using enhanced health facility surveillance data, our objectives were to
1) estimate the impact of IRS on monthly malaria case counts at five health facilities
over a 6·75 year period, and 2) compare monthly case counts at five facilities
receiving IRS to ten facilities in neighboring districts not receiving IRS. For both
objectives, we specified mixed effects negative binomial regression models with
random intercepts for health facility adjusting for rainfall, season, care-seeking, and
malaria diagnostic.
Findings: Following the implementation of IRS, cases were 84% lower in years
19
4-5 (adjusted incidence rate ratio [aIRR]=0·16, 95% CI 0·12-0·22), 43% lower in
year 6 (aIRR=0·57, 95% CI 0·44-0·74), and 39% higher in the first 9 months of year
7 (aIRR=1·39, 95% CI 0·97-1·97) compared to pre-IRS levels. Cases were 67%
lower in IRS sites than non-IRS sites in year 6 (aIRR=0·33, 95% CI 0·17-0·64) but
38% higher in the first 9 months of year 7 (aIRR=1·38, 95% CI 0·90-2·11).
DAY 1 SESSIONS
Interpretation: We observed a resurgence in malaria to pre-IRS levels despite

sustained IRS. The timing of this resurgence corresponded to a change of active
ingredient. Furthur research is needed to determine causality.
COMPARING MEASURES OF MALARIA TRANSMISSION, INFECTION,

AND DISEASE IN AN AREA BORDERING TWO DISTRICTS WITH AND
WITHOUT SUSTAINED INDOOR RESIDUAL SPRAYING OF INSECTICIDE
IN UGANDA
* Joaniter I Nankabirwa, Teun Bousema, John Rek, Emmanuel Arinaitwe, Bryan

Greenhouse, Phillip R Rosenthal, Moses R Kamya, Sarah Staedke, Grant Dorsey
Introduction: Tororo, a historically high transmission district in Eastern Uganda

has experienced a dramatic decline in the burden of malaria since indoor residual
spraying (IRS) was first implemented in December 2014. However, information on
the impact of IRS on the borders and areas proximal to Tororo is limited. In this
study, we compared measures of malaria transmission, infection, and disease in
a contiguous area that included two parishes in Tororo District (with 6 years of
sustained IRS) and one parish in Busia District (no IRS).
Methods: Between August 2020 and January 2021, we followed a cohort of 483
participants from 80 randomly selected households (20 from Buteba Parish, Busia
District; 40 from Kayoro Parish, Tororo District; and 20 household from Osukuru
Parish, Tororo District). Mosquitoes were collected every 2 weeks using CDC
light traps in all rooms where participants slept, parasitemia was measured by
microscopy and quantitative PCR (qPCR) every 4 weeks using active surveillance,
and symptomatic malaria was measured passive surveillance.
Results: Over approximately five months of follow-up, 19,566 female anopheline

mosquitos were collected. In Buteba, most mosquitoes were Anopheles gambiae
s.s. (85.4% of total). In Osukuru and Kayoro, less than 50% of mosquitoes were
Anopheles gambiae s.s. with An. arabiensis and An. funestes making up 66.9%
and 49.5% of mosquitoes, respectively. The annual entomological inoculation rate
was significantly higher in Buteba (108.2 infective bites/person/year), compared to
20
Osukuru (59.0, p=0.001) and Kayoro (27.4, p<0.001). Overall, parasite prevalence
was 19.5% by microscopy and 50.7% by qPCR with no significant differences
across the three parishes. However, the incidence of malaria was significantly
higher in Osukuru (2.46 episodes/person/per year) compared to Buteba (1.47,
p=0.005) and Kayoro (1.09, p<0.001). Among participants < 5 years of age, the
risk of symptomatic malaria if microscopic parasitemia was present was similar
DAY 1 SESSIONS
across the three parishes. However, for participants over 15 years of age, the risk of
symptomatic malaria if microscopic parasitemia was present was higher in Osukuru
(relative risk [RR] = 2.99, p=0.03) and Kayoro (RR = 1.53, p=0.40) compared to
Buteba parish.
Conclusion: Transmission intensity was moderately higher in the border parishes

of Tororo where IRS has been sustained for 6 years compared to what we have
observed in other areas of Tororo. Interestingly measures of infection were similar
across the three border parishes but the incidence of symptomatic malaria was
higher in one parish of Tororo compared to Busia which could be explained by
less “clinical immunity” resulting in an increased risk of symptomatic malaria if
parasitemic. These observations could have several explanations which may need
further exploration including IRS being less effective along the border compared
to the interior of a district and/or a recent decrease in the effectiveness of IRS
resulting in a relative “rebound” of symptomatic malaria due to loss of naturally
acquired immunity.
URINARY TRACT INFECTIONS AMONG PATIENTS WITH

DECOMPENSATED LIVER CIRRHOSIS AT KIRUDDU NATIONAL
REFERRAL HOSPITAL IN UGANDA.
Maria Sekimpi¹, Emmanuel Seremba ², Ponsiano Ocama¹, Pauline Byakika-Kibwika¹

Author affiliations:
¹Department of Internal Medicine, Makerere University, Kampala Uganda
²Kiruddu National Referral Hospital, Kampala Uganda

Corresponding author information:
Maria Sekimpi
Department of Internal Medicine, Makerere University, Kampala, Uganda
Tel: +256705684284
Email: tsekimpi@yahoo.com
21
Key words:
Decompensated liver cirrhosis; Urinary tract infection; Drug susceptibility; Multidrug
resistance
Background: Bacterial infections are a frequent complication among patients
with decompensated liver cirrhosis increasing short term mortality, and urinary
tract infections (UTI) are the second most common infection in this population
DAY 1 SESSIONS
with a prevalence of 27% in some European studies. Uganda has no data on

the prevalence of UTI among these patients thus the uropathogens and their
antibacterial susceptibility profiles are unknown.
Purpose: To determine prevalence, microbiologic spectrum and antibacterial

sensitivity patterns of bacterial UTI among patients with decompensated liver
cirrhosis in Kiruddu National Referral Hospital (KNRH).
Patients and methods: Patients with decompensated liver cirrhosis presenting to

the hospital Gastroenterology service had their clinical features captured and urine
samples collected for a year. Urine samples were analysed by urinalysis and culture
studies. Urinalysis test results of ≥5 white cells per high power field or cultures
findings of ≥104 defined UTI.
Results: Prevalence of UTI was 37.1% on either urinalysis, urine culture or both
and only 10.1% of patients diagnosed were diagnosed on urinalysis. The most
common bacteria isolated were Escherichia coli (40.1%) and Enterococcus spp
(22.9%). The majority of isolates were resistant to fluoroquinolones and third
generation and multidrug resistant organisms such as ESBL and MRSA constituted
32.7% of the isolates.
Conclusion: UTI are common among patients with decompensated liver cirrhosis
at KNRH and are commonly caused by gram negative bacteria resistant to
commonly recommended antibacterials. Screening of patients with liver cirrhosis
for UTI should be done by urine culture where possible at presentation to health
care facilities.
22
ORAL ENCOCHLEATED AMPHOTERICIN B FOR CRYPTOCOCCAL

MENINGITIS: A PHASE II RANDOMIZED TRIAL.
Atukunda M¹, Kagimu E¹, Rutakingirwa M¹, Musubire AK¹, Ssebambulidde K¹,
Kasibante J¹, Tugume L¹, Akampurira A¹, Nsangi L¹, Mugabi T¹, Gakuru J1, Mpoza E¹,
Ellis J¹, Skipper CP², Williams DA², Fieberg A², Abassi M², Hullsiek KH², Meya DB¹,
Boulware DR²
DAY 1 SESSIONS
¹Infectious Disease Institute, Kampala, Uganda
²University of Minnesota, Minneapolis, MN, USA
Corresponding author: Mucunguzi Atukunda, mucungua@gmail.com, 0703182949
BACKGROUND: Intravenous (IV) amphotericin B is the gold standard treatment of
severe mycoses. A new orally absorbed, less-toxic formulation of amphotericin has
been developed (Matinas Biopharma).
OBJECTIVE: To evaluate the efficacy of this novel anti-fungal agent amongst

adults with cryptococcal meningitis.
METHODS: We conducted a phase II randomized clinical trial testing oral

encochleated amphotericin B (cAMB) versus IV amphotericin B for first episode
cryptococcal meningitis in Kampala from December 2020 to August 2021.
Participants were HIV-positive, CSF cryptococcal antigen (CrAg) positive, and
had capacity to consent and take oral medications (GCS=15). Participants in the
experimental arm received two loading doses of either IV deoxycholate amphotericin
B 1mg/kg/day or liposomal amphotericin 3mg/kg/day, followed by 1.8g oral cAMB
daily in 6 divided doses through 2weeks with flucytosine (5FC) at 100mg/kg/day,
and thereafter cAMB at 1.2g daily in 4 divided doses through 6weeks. Participants
in the control arm received 7days of IV amphotericin B (deoxycholate or liposomal)
with 5FC, then 7days of fluconazole 1200mg/day. After 14days, all participants
received fluconazole 800mg/day through 10weeks and thereafter a maintenance
dose of 200mg/day.
RESULTS: We randomized 40 participants to oral cAMB + 5FC and 30 control

participants to IV amphotericin + 5FC. With cAMB the 30-day survival was 97.5%
(39/40) and 18-week survival was 90% (36/40) compared with 87% (26/30) 18-
week survival in IV amphotericin controls.
The CSF Early Fungicidal Activity (EFA) was lower with oral cAMB (mean EFA =
0.42 log10 Cryptococcus CFU/mL/day; 95%CI, 0.29 to 0.54) versus IV amphotericin
(mean EFA = 0.52 log10 CFU/mL/day; 95%CI, 0.39 to 0.66). Among those CSF
culture positive at baseline, CSF sterility was achieved by 2 weeks in 65% (24/37)
of cAMB participants and 68% (17/25) of controls.
CONCLUSION: Novel oral cAMB appears to be a safe agent with promising
efficacy for HIV-related cryptococcal meningitis.
23
EMERGENCE AND EXPANSION OF P. FALCIPARUM WITH PFK13

POLYMORPHISMS ASSOCIATED WITH ARTEMISININ RESISTANCE IN
UGANDA
Victor Asua, Melissa Conrad, Jennifer Legac, Deborah Chin, David Giesbrecht, Sawyer
Smith, Emmanuel Arnaitwe, Shreeya Garg, Patrick Tumwebaze, Roland Cooper, Adoke
Yeka, Moses R Kamya, Grant Dorsey, Sam Nsobya, Jeff Bailey, Philip J. Rosenthal
DAY 1 SESSIONS
Artemisinin-based combination therapies are the first-line treatments for

uncomplicated malaria in Uganda. However, recent studies have demonstrated
the emergence in Rwanda and Uganda of P. falciparum with PfK13 mutations
previously associated in Asia with artemisinin resistance (delayed clearance after
artemisinin treatment or in vitro exposure). In both countries these polymorphisms
have been associated with clinical and in vitro resistance. We continued spatio-
temporal surveillance to track P. falciparum isolates with PfK13 mutations in
Uganda. Since 2016, we have collected blood samples from up to 100 subjects
diagnosed with malaria by microscopy or rapid diagnostic test at up to 16 health
facilities across Uganda. Parasites were genotyped by dideoxy and molecular
inversion probe deep sequencing of the pfK13 gene and 8 microsatellites flanking
this gene. Of the 1357 samples collected in 2020, 1179 were successfully analysed.
We observed 11 mutations in the propeller region of the pfk13 gene, 6 of which
(F442L, C469F, C469Y, A675V, L713F, A724P) were seen at a prevalence of >5%
in at least one site. Most noteworthy were three mutations previously associated
with delayed clearance in southeast Asia, with prevalence of C469Y (0-45.6%)
highest in northern Uganda, A675V (0-26.6%) highest in northern Uganda, and,
newly in 2020, C469F (0-28.2%) highest in southwestern Uganda. Prevalences
of the C469Y and A675V mutations remained stable in northern Uganda and
these mutations were detected at more sites than in prior years. Analysis of 8
microsatellites flanking the pfk13 gene suggested single emergences and then
spread of C469Y and A675V mutant parasites. Analysis of parasites from around
the world using genome-wide putatively neutral SNPs suggested African origins for
the mutant Ugandan parasites.
Our results provide evidence of multiple local emergences and spread of P.

falciparum with pfk13 mutations shown previously to associate with artemisinin
resistance. Evaluation of the treatment efficacies of artemisinin-based antimalarial
therapies in regions of Uganda with high prevalence of mutant parasites is an
urgent priority.
24
IMPACT OF A CRYPTOCOCCAL MENINGITIS DIAGNOSIS AND

TREATMENT PROGRAM AT LIRA REGIONAL REFERRAL HOSPITAL IN
RURAL, NORTHERN UGANDA
Abigail Link1,2, Mark Okwir3,4, David Meya2,5, Betty Nabongo3, James Okello³, Danuta
Kasprzyk¹, Paul R. Bohjanen2,5,6
DAY 1 SESSIONS
¹University of Washington, School of Nursing, Seattle, WA, United States of America,
²Division of Infectious Diseases and International Medicine, Department of Medicine,
University of Minnesota Medical School, Minneapolis, MN, United States of America
³Lira Regional Referral Hospital, Lira, Uganda
⁴Lira University Faculty of Health Sciences, Lira, Uganda
⁵Makerere University, Infectious Diseases Institute, Kampala, Uganda
⁶University of Minnesota School of Public Health, Minneapolis, MN, United States of
America
Introduction: In rural, Uganda, infrastructure and resources for treatment of

cryptococcal meningitis (CM) are often lacking. We introduced a CM diagnosis and
treatment program (CM-DTP) at Lira Regional Referral Hospital (LRRH) in rural
Uganda to improve CM treatment and care.
Purpose: To identify the burden of CM at LRRH and determine if implementing

high-quality standard of care protocols improve patient outcomes.
Methods: Information from hospital charts and clinical record forms were extracted
to identify diagnoses, treatments, and outcomes for all patients diagnosed with
meningitis (n = 281) over a two-year period after initiation of the CM-DTP in
February of 2017 in comparison with patients diagnosed with meningitis (n = 215)
in the two preceding years.
Results: We observed increased confirmed diagnoses of CM from 22.2% (48/215)

to 35.2% (99/ 281), (p = 0.002) after initiation of the CM-DTP among all patients
diagnosed with meningitis. The proportion of patients with CM who received
standard of care treatment with amphotericin B plus fluconazole increased from
63/127 (49.6%) prior to 109/146 (74.7%), (p <0.001) after implementation of CM-
DTP. Mortality improved from 66/127 (52.0%) to 57/146 (39.0%), (p = 0.04) after
implementation of the CM-DTP. The CM-DTP was associated with increased
number of lumbar punctures, decreased use of antibiotics in CM patients, and
decreased mortality among patients with meningitis from all causes (29.9% vs.
42.8%).
Conclusion: Improved diagnosis, treatment, and mortality were observed following

implementation of the CM-DTP. We demonstrated that quality treatment of CM in
rural Uganda is feasible.
25
SCALE-UP OF 99DOTS FOR TB TREATMENT SUPERVISION:

INTERVENTION REACH AND TREATMENT OUTCOMES
Muhammad Musoke¹, Alex Kityamuwesi¹, Rebecca Crowder², Suzan Nakasendwa³,
Joyce Nannozi¹, Joseph Waswa¹, Maureen Lamunu¹, Amon Twinamatsiko1, Stavia
Turyahabwe⁴, Noah Kiwanuka³, Adithya Cattamanchi1,2, Achilles Katamba1,5 (12/12)
¹Uganda Tuberculosis Implementation Research consortium, Kampala, Uganda
DAY 1 SESSIONS
²Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San
Francisco General Hospital, University of California San Francisco, San Francisco,
CA USA, ³Department of Epidemiology and Biostatistics, School of Public Health,
Makerere University College of Health Sciences, Kampala, Uganda.
⁴National Tuberculosis and Leprosy Program, Uganda Ministry of Health, Kampala,
Uganda, ⁵Clinical Epidemiology and Biostatistics Unit, Department of Medicine,
Makerere University College of Health Sciences, Kampala, Uganda.
Background: Evaluations of 99DOTS, a digital adherence technology for supporting

and supervising TB treatment adherence, have shown variable uptake and
effectiveness. We evaluated whether a multi-component implementation strategy
(i.e., enhanced 99DOTS) including 1) provision of low-cost phones to patients
who lack access, 2) task-shifting of adherence monitoring and patient follow-up to
community health workers, and 3) automated task lists to facilitate follow-up could
improve the uptake and effectiveness of 99DOTS-based TB treatment supervision
in Uganda.
Methods: We introduced enhanced 99DOTS at 18 health facilities already using

99DOTS for TB treatment supervision (99DOTS experienced facilities) and 12
health facilities using routine community-based DOT (99DOTS naïve facilities). We
compared reach (proportion enrolled on 99DOTS) and effectiveness (proportions
completing treatment, completing intensive phase and lost to follow-up) outcomes
before and after the introduction of enhanced 99DOTS using data on all adults
initiating treatment for drug-susceptible pulmonary TB. Confidence intervals
(CIs) were adjusted for clustering at the facility level by bootstrapping with 1,000
repetitions.
Results: At the 18 99DOTS experienced facilities, the proportion of patients enrolled

on 99DOTS in the first month of treatment increased from 48.7% (n=1156/2373) in
the routine 99DOTS period (August 2019-April 2020) to 85.1% (n=2175/2556) in
the enhanced 99DOTS period (July 2020-June 2021), a difference of 36.4% (95%
CI 33.9-38.8, p<0.001). At the 12 99DOTS naïve facilities, 85.9% (n=1713/1994)
of patients were enrolled on 99DOTS in the enhanced 99DOTS period. At both
99DOTS experienced and naïve facilities, the proportions completing treatment,
completing the intensive phase, and lost to follow-up were similar before and after
the introduction of enhanced 99DOTS (Table).
26
Conclusions: Our enhanced 99DOTS implementation strategy resulted in high

uptake (>85%) of 99DOTS but did not improve treatment outcomes. 99DOTS is a
viable alternative to DOT for most patients, but other interventions are needed to
meet END TB targets.
DAY 1 SESSIONS
27
PARALLEL SESSION 1C Kampala, Uganda, 21st-23rd September 2022
DAY 1 SESSIONS
PARALLEL SESSION 1C:

Sub Theme 3: Community
and Mental Health
28
Kampala, Uganda, 21st-23rd September 2022 PARALLEL SESSION 1C
PREVALENCE AND FACTORS ASSOCIATED WITH FERTILITY DESIRES

AMONG MARRIED MEN OF REPRODUCTIVE AGE IN UGANDA; DATA
FROM UGANDA DEMOGRAPHIC HEALTH SURVEY (UDHS) 2016.
Mutesi S.
Introduction: Married men have higher fertility desires (desire to have another
DAY 1 SESSIONS
child) than women in Uganda. This has resulted into low uptake of family planning
due to ability of men to effect compliance from their wives.
Objective: To determine the prevalence and factors associated with fertility desires
among married men of reproductive age in Uganda.
Methods: I conducted a cross-sectional study using UDHS 2016 data among a

sample of married men aged 15-54 years with at least six children. Men were asked
if they preferred to have another child irrespective of the timing and fertility desires
were recorded as a binary outcome. I conducted a modified Poisson regression to
generate prevalence ratio (PR) to measure factors associated with fertility desires
at 95% confidence interval (CI). I used STATA version 14.0 for all analysis.
Results: Overall, fertility desire was 33.5% (n=281/813, CI=31.4%-37.9%). Majority

of the men were from rural Uganda (87.9%, n=715) and most of them (74.3%,
n=604) had had their first sex between 16-24 years. Fertility desires were negatively
associated with: age 35-39 (adjusted prevalence ratio [aPR]=0.58, CI=0.35-
0.96), 40-44(aPR= 0.35, CI=0.20-0.59), 45-49(aPR= 0.27, CI=0.16-0.46) and 50-
54(aPR= 0.18, CI=0.10-0.34); Residing in the eastern(aPR=0.62, CI=0.45-0.86),
northern(aPR=0.66, CI=0.47-0.94) and western(aPR=0.50, CI=0.33-0.77) regions.
Being Catholic (aPR=1.72, CI=1.22-2.40); having more than one union (aPR=1.36,
CI=1.06-1.75) were positively associated with fertility desires.
Conclusion: There is need to strengthen family planning programs that target the
segment of married men who are below 24 years, residing in central Uganda, in
more than one union and of catholic faith.
Key words: Fertility desires, Married men, UDHS 2016
29
THE FEASIBILITY AND EFFECTIVENESS OF A FAMILY PSYCHO-SOCIAL

INVOLVEMENT INTERVENTION (FAPII) FOR SEVERE MENTAL ILLNESS
IN UGANDA.
Musisi S¹*, Turiho A¹, Alinaitwe R¹, Bird V², Priebe S², and Sewankambo N³.
¹Department of Psychiatry, Makerere University College of Health Sciences, Kampala,
DAY 1 SESSIONS
Uganda
²Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental
Health Services Development, Queen Mary University of London, London, UK
³Department of Medicine, Makerere University College of Health Sciences, Kampala,
Uganda
*Corresponding e-mail:segganemusisi@yahoo.ca
Introduction: Neuropsychiatric disorders contribute 14% of the disease burden

globally accounting for 13.0% of disability adjusted life years. Many low-income
countries like Uganda lack resources to provide mental health care for people
affected by severe mental illness. It may therefore be helpful to explore resource-
oriented approaches like family involvement approach. We set out to determine
the feasibility and effectiveness of a family psycho-social involvement intervention
(FAPII) for severe mental illness in the Ugandan context.
Methods: We conducted an open proof of concept study with a before and after
design. Thirty patients with their family members (1-2) were recruited at Masaka
Hospital and divided into 6 groups. Each group had 2 clinicians, 5patients and
their family members. The groups met monthly for 6 months to discuss different
topics on mental illness including relapses and care for patients. The intervention
was compared with the standard care at Mityana Hospital. We did a baseline, 6
months and 12 months assessment. Qualitative data was collected on a subset
of participants. The primary outcome was quality of life of the patients and other
outcomes included decreased symptom severity, medication adherence and
internalised stigma.
Results: Participants in FAPII had a significantly higher quality of life (p=0.001,

C.I; 0.40 – 1.48) at 6 month compared to the control arm and this was sustained
post-intervention at 12 months. There was significant improvement in the other
outcomes as well compared to the control.
Conclusion: FAPII had a significantly positive impact on improving QOL, symptom

reduction, medication adherence and reduction of internalized stigma in our SMI
respondents.
30
GEOGRAPHIC DISTRIBUTION AND PREDICTORS OF DELAYS IN

SEEKING CARE AMONG PRESUMED TB PATIENTS IN UGANDA
Emmanuel Ochom¹, Katherine O Robsky¹̛̛,², Amanda J Mayer¹̛̛,³, Patricia Turimumahoro¹,
Muttamba Winters⁴, Moses Joloba⁵, J. Lucian Davis¹̛̛,⁶, Achilles Katamba1,⁷
Affiliations:
¹Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
DAY 1 SESSIONS
²Johns Hopkins Bloomberg School of Public Health
³Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New
Haven, CT, USA, ⁴Lung Institute, College of Health Sciences, Makerere University
⁵School of Biomedical Sciences, Makerere University, College of Health Sciences,
Makerere University, Kampala, Uganda, ⁶Pulmonary, Critical Care and Sleep Medicine
Section, Yale School of Medicine, New Haven, CT, USA, ⁷Clinical Epidemiology and
Biostatistics Unit, Department of Medicine, Makerere University, College of Health
Sciences Kampala, Uganda
Background: Delays to Tuberculosis (TB) care are associated to untimely response

from patients or health system. We sought to determine geographic distribution
and predictors of presumed TB patient and health system delays to diagnostic
evaluation at referral hospitals of Uganda.
Methods: We conducted a secondary analysis of data from five referral hospitals

in Uganda participating in a GeneXpert MTB/RIF implementation project. We
described geographical distribution at sub-county level of presumed TB patients,
care-seeking delays (≥21 days from onset of cough symptom to referral hospital
presentation) and health-system delays (≥15 days from referral hospital presentation
to acquiring results), using Getis-Ord GI* statistic. We performed bivariate and
multivariate logistic regression adjusting by referral hospital to identify predictors
for both types of delays.
Results: Of 1602 adult pulmonary TB patients (median age 36; IQR 20), 719 (45%)
experienced care-seeking delays and 1017 (63%) health-system delays. There
were sub-counties of high concentration of presumed TB patients seen in sub-
counties close to referral hospitals. However, there was no statistically significant
clusters of care-seeking and health system delays across all five referral hospitals.
Being married (OR 0.8, 95%CI; 068-0.92, P=0.003), living with HIV (OR 0.7, 95%CI;
0.56-0.97, P=0.03) and having noticeable weight loss (OR 0.7, 95%CI; 0.48-0.97,
P=0.04) all reduced care-seeking delays. Seeking initial care at lower-level facilities
(OR 6.5, 95%CI; 2.95-14.54; P<0.0001) and illiteracy (OR 1.6, 95%CI; 1.17-2.04,
P=<0.0001),
Conclusions: Patient and health system delays was scattered. Delays were more
associated to individual factors than location. Health provider training may reduce
delays to TB diagnosis.
31
THE RELATIONSHIP BETWEEN AGE AT INITIATION OF REGULAR

DRINKING OF ALCOHOL AND VIRAL SUPPRESSION STATUS,
DEPRESSION SYMPTOMS, AND GENDER AMONG PEOPLE LIVING WITH
HIV IN SOUTH-WESTERN UGANDA
Raymond F. Odokonyero¹*, Robin Fatch², Nneka I. Emenyonu², Debbie Cheng³, Christine
DAY 1 SESSIONS
Ngabirano⁴, Julian Adong⁴, Winnie R. Muyindike4,5, Noeline Nakasujja¹, Carol Camlin7,8,

Moses Kamya¹, and Judith A. Hahn2,6.
¹Department of Psychiatry, School of Medicine, Makerere University College of health
Sciences, Uganda; ²Department of Medicine, University of California, San Francisco,
CA, USA; ³School of Public Health, Boston University, Massachusetts, USA; ⁴Mbarara
University of Science and Technology, Uganda; ⁵Mbarara Regional Referral Hospital,
Uganda; ⁶Department of Epidemiology and Biostatistics, University of California,
San Francisco, CA, USA; ⁷Bixby Center for Global Reproductive Health, Department
of Obstetrics, Gynecology & Reproductive Sciences, University of California, San
Francisco, CA, USA; ⁸Center for AIDS Prevention Studies, University of California, San
Francisco, CA, USA
*Corresponding Author: Raymond F. Odokonyero, MBChB. MMED(Psych), Lecturer.

Makerere University College of health Sciences, School of Medicine, Department of
Psychiatry. P.O.BOX 7072, Kampala. Telephone: +256701547646 Email: rodokonyero@
gmail.com
Background: Among persons with HIV (PWH), alcohol use is often associated with
male gender, viral non-suppression, and depression symptoms. Although early age
at first regular use of alcohol is an important indicator of risk of long term physical
and mental health outcomes, no studies have attempted to explore its’ effect on
viral suppression and depression, among PWH in sub Saharan Africa, with the aim
of targeting interventions to improve the physical and mental health of PWH.
Objective: This paper aims to explore the association between age at first regular
drinking of alcohol and a) viral suppression, and b) probable depression; and
whether these associations are moderated by gender in a sample of PWH in care.
Methods: We conducted secondary analysis with data from the alcohol drinkers’
exposure to preventive therapy for Tuberculosis (ADEPT-T) study, which aimed
to investigate the safety and tolerability of isoniazid preventive therapy among
PWH with latent tuberculosis (TB) reporting current alcohol use (past 3 months) or
abstaining (at least past 1 year) (N = 302). We explored for an association between
age at first regular drinking and viral suppression (<550 copies/ml), and with
depression symptoms (Center for Epidemiologic Studies Depression, CES-D). We
ran logistic regressions to examine for associations and whether these associations
were moderated by gender.
32
Results: We analyzed data of 262 persons who reported alcohol use within the
past 1 year. The median age at first regular drinking was 20.5 years (IQR: 17 – 27).
Majority (91.7%) had undetectable viral load; and 11% had symptoms of probable
depression (CESD score ≥ 16). We found no significant association between age at
first regular drinking and viral suppression. We also found no significant association
between age at first regular drinking and depression symptoms. However, male
DAY 1 SESSIONS
sex was associated with depression symptoms, and those who were married had
reduced odds of depression symptoms.
Conclusion: Regardless of the developmental stage, age at first regular drinking

among PLWH seems to have no association with either viral suppression status or
depression symptoms.
Key words: Age at first regular drinking, Alcohol use, viral suppression, Depression,
Uganda
SOCIAL AND BEHAVIOURAL FACTORS ASSOCIATED WITH RETENTION

IN CARE AMONG ADULTS LIVING WITH HIV AND SEVERE MENTAL
ILLNESS: A MIXED-METHOD STUDY
Kevin Ouma Ojiambo¹*, Juliet Nakku ⁵, Rachel Wangi¹, Ivan Segawa¹, Regina
Ndagire¹, Joan Nangendo, Anne R. Katahoire⁵, Fred C. Semitala3,4
Author Affiliations
¹Clinical Epidemiology Unit, School of medicine, Makerere University College of Health

Sciences
²Department of Medicine, School of Medicine, Makerere University College of Health

Sciences
³Mulago Immune Suppression Syndrome Clinic, Mulago National Referral Hospital
⁴Butabika National Mental Referral Hospital
⁵Child Health and Development Centre (CHDC), Makerere University College of Health
Sciences
*Corresponding Author: Mr. Kevin Ouma OJIAMBO, graduate student at Clinical

Epidemiology Unit, School of medicine, Makerere University College of Health
Sciences Email: ojambok@gmail.com Tel: +256781790927. Postal Address: P.O Box
7072, Kampala (U)
Background: Uganda has made significant strides towards HIV epidemic control.
However, sustaining these gains requires tailoring HIV services to subpopulations
of PLHIV who may have unique needs. For example, one out of every ten PLHIV
in Uganda has had a diagnosis of severe mental illness (SMI). SMI has been
33
showed to negatively affect access to health services. We sought to determine the

proportion of PLHIV with a known diagnosis of SMI who were retained in HIV care
and the associated factors at Butabika National Referral hospital and Mulago ISS
clinic.
Methods: In this mixed methods study, we evaluated the proportion of retention in

DAY 1 SESSIONS
care, sociodemographic and clinical characteristics associated with retention in care

and reasons for loss to follow up among adults living with HIV with diagnosis of SMI
initiated on ART between 2017 and 2020. Data on patient characteristics at the time
of ART initiation were gathered by abstracting information from patient clinic charts.
These data were supplemented by in-depth interviews and key informant interviews.
Multilevel mixed-effects Poisson regression model was used to determine factors
associated with retention in care among PLWHIV and SMI reporting incidence risk
ratios (IRR) using Stata v15. The qualitative data was synthesized using inductive
thematic analysis approach using Open Code v4.02.
Results: We collected data from 328 eligible participants. Saturation for the
qualitative study was reached at 35 participants. At six months, retention was 43.3
percent (95 percent CI: 38.0-48.7), compared to 35.7 percent (95 percent CI: 30.7-
41.0) at 12 months in the two clinics. Having an unsuppressed viral load (>/=1000
copies/ml) (IRR=1.54, CI: 1.17 - 2.03, P0.01), being aged </=36 (IRR=0.94,
CI:0.94-0.95, P0.01), initial presentation through OPD (IRR=0.74, CI: 0.57 - 0.96,
P=0.02), presence of TB at baseline (I (stages I&II) (IRR=1.08, CI: 1.02 - 1.14,
P=0.01) at ART initiation were significantly associated with retention in care at 6
and 12 months. Lack of social support, long waiting hours at the clinic, perceived
stigma and discrimination, competing life activities like work and family, being of low
socioeconomic status and poor adherence to mental health drugs were identified as
psychosocial factors that influence retention in care.
Conclusion: Approximately one-third of participants were retained in care after 12

months, compared to the WHO target of 90%. Addressing critical but manageable
barriers such as waiting time, stigma, and discrimination as part of integrated
HIV and mental health care will go a long way toward improving retention among
PLWHIV and SMI.
34
URBAN COMMUNITY KNOWLEDGE AND PERSPECTIVES ABOUT

ORGAN DONATION AND TRANSPLANTATION IN UGANDA
Dr. Olivia Kituuka, Dr. Moses Ocan, Prof. Charles Ibingira, Dr. Ronald Mbiine, Mr.
Mordecai Tayebwa, Dr. Misaki Wayengera
Background: Uganda’s Health Sector Development Plan (2015/16 -2019/2020)
DAY 1 SESSIONS
noted that most referrals for treatment abroad were for organ transplant services
costing government over 5.6 million US dollars. The government of Uganda has
invested in building capacity for Organ donation and transplantation services by
training human resource and setting up the infrastructure in Kampala where these
services can be accessed. However, there is no information on the readiness of
communities and the scientific community to embrace (communities) or undertake
(science) organ transplantation in the country. We set out to assess Knowledge and
Attitudes about organ donation and transplantation among the urban population in
Kampala.
Methods: We conducted a cross-sectional survey among 395 participants from

the urban population of Kampala at Garden City Mall, Wandegeya market and
Nakawa market 28th May - 7th June 2021. We asked about knowledge about organ
donation and transplantation, collected sociodemographic data and did a sentiment
analysis of participants’ attitudes towards organ donation and transplantation.
Results: The M:F ratio of participants was 1:1, majority (55.9%) of participants were
Baganda, two thirds of participants knew about organ donation, 90% of participants
did not know of any government policy on organ donation and transplantation.
Radio/television was the commonest source of information. The commonest organ
donated was the kidney. Overall there was 94.3% and 93.2% positive sentiments
towards organ transplantation and organ donation respectively. The need for stricter
laws governing organ donation and transplantation, corruption and fear were the
main negative sentiments expressed by participants.
Conclusions: Sensitization of the community is required about government policy

on organ donation and transplantation and this should be communicated through
radio/television and social media. There was a positive attitude towards organ
donation and transplantation.
35
STUDENT-LED WATER SANITATION AND HYGIENE (WASH) EMERGENCY

RESPONSE IN BUNAGANA TOWN COUNCIL, KISORO DISTRICT,
SOUTHWESTERN UGANDA: JULY 2022
Authors:
Joseph Ngabirano¹*, Paul Tumwesigye¹, Umuhire Joanah¹, Obiro Emmanuel¹, Patience

DAY 1 SESSIONS
D Nalumaga¹, Yahaya Matsiko¹ Andrew Chris Wesuta¹, Femus Agaba¹, Angela

Tushabe¹, Moses Ntaro¹, Gad Ruzaaza¹, Peter Chris Kawungezi¹, Edgar Mugema
Mulogo¹
¹Department of Community Health, Mbarara University of Science and Technology
*Corresponding author: njose502@gmail.com +256 772210 954
Objective: The team from MUST faculty of Medicine, Department of Community

Health did an emergence response to support the Kisoro District in six villages in
Bunagana Town Council after rapid analysis assessment and carried out sanitation
and hygiene interventions;
Method: Using a Community-Led Total Sanitation (CLTS) Model the following

activities were carried out disinfection using 0.5% chlorine Spraying, deworming of
children aged between 1-5years and health education aimed at behavior change
in relation to the hygiene aspect where both hosting communities and refugees
benefited. Using a simple questionnaire and observation, we were able to assess
the hygiene status of the community
Results/findings: The team managed to reach 290 households who were health
educated, 532 children under five were dewormed, and six villages were disinfected.
Through observation many hygiene and sanitation challenges like open defection,
poor waste management were identified.
Conclusion: The war has had a great impact negatively on the way people are
living both the hosting communities and the refugees around the Bunagana border
and thus the government of Uganda working UNHCR should come in to render
respective solutions for the prevailing challenges since most of them are workable.
36
DAY 1 SESSIONS
Sub Theme 1: HIV and HIV
Related Illnesses
37
THE IMPACT OF INTENSIVE ADHERENCE COUNSELING (IAC) AMONG

VIRALLY NON-SUPPRESSED CLIENTS ACCESSING ART SERVICES AT
BWINDI COMMUNITY HOSPITAL – KANUNGU DISTRICT.
Asiimwe P.
Background: HIV/AIDS remains one of the most devastating infectious disease that
DAY 1 SESSIONS
humanity has ever had to face. This is further worsened by non-viral load suppression
that can result into drug resistance, eruption of fatal opportunistic infections, and
compromise to the quality of life, as well as increase in the risk of transmission to
spouse and the unborn babies in pregnant mothers. WHO recommends initiation of
IAC involving monthly sessions for three months among individuals with a high viral
load. This is key to the last “95” of UNAIDS “95-95-95”strategy, which entails attaining
95% viral suppression. The purpose of this evaluation was to look at the completion
of IAC and the viral load results of those invited to start on IAC.
Method: A retrospective cross sectional study design was employed to analyze

charts of all clients who had been invited to start IAC following non-suppressed viral
load results from January 2021 – January 2022. All clients were tested four months
after the initial IAC session.
Results: Of the 40 clients’ charts sampled, 30 (75%) had all the 3 IAC sessions
conducted. All the 30 (100%) had a subsequent suppressed repeat viral load result.
Of the 10 clients who did not complete the 3 IAC sessions, 9 (90%) had a non-
suppressed repeat viral load result.
Conclusion: Results suggest that completion of IAC is effective in achieving viral

load suppression. However, there is need to study the effect of other factors that are
likely to influence viral load.
38
ASSESSING COMPLIANCE TO TUBERCULOSIS/HIV STANDARDS OF

CARE THROUGH CLINICAL AUDITS AT REFERRAL HOSPITALS IN
UGANDA
Veronica Kembabazi, Andrew K. Tusubira, Proscovia M. Namuwenge

Background
DAY 1 SESSIONS
Continuous monitoring of Tuberculosis (TB)/HIV standards of care at facilities
enhances the quality of TB/HIV care. Uganda has, for over a decade, implemented
TB/HIV integrated care at ART clinics; however, little is known about the performance
of these facilities regarding such care.
Objective
To assess compliance to standards of integrated TB/HIV care at referral hospitals in

Uganda.
Methods
We conducted clinical audits, between July and August 2020, at 15 referral hospitals
in Uganda. We assessed files of TB/HIV co-infected patients who were diagnosed
between January and December 2019. Lot quality assurance sampling(LQAS)
principles were used to guide the sampling and auditing of files, and to determine the
compliance level. Each file was audited against 18 criteria for integrated TB/HIV care.
A hospital was compliant when it met the 80% target based on the LQAS decision
rules. We estimated rates of compliance to standards across hospitals.
Results
A total of 591 files of TB/HIV co-infected patients were assessed. Only four of
591 files met all the standard criteria. None of the hospitals met the 80% LQAS
compliance target; with the highest having 40% and the lowest 0%. The compliance
rates to the TB/HIV standards of care were lower among children(39%) compared to
men(52%) and women(53%). Across hospitals, the compliance rate was highest for
“patient weight measurement at every visit”(94.3%) but lowest for “Monitoring for side
effects”(30.2%).
Conclusion
Compliance to TB/HIV standards of care was low. Strategies to improve quality of

TB/HIV care should target pharmacovigilance and sputum monitoring, particularly
among adolescents and children.
39
PREDICTORS OF DELAYED ART INITIATION AMONG ADULTS

REFERRED FOR HIV TREATMENT IN UGANDA: A CROSS-SECTIONAL
MIXED METHODS STUDY.
Authors: Micheal Kiyingi, Fred Semitala, Christine Ssekaggya, Anne Katahoire,
Joaniter Nankabirwa.
DAY 1 SESSIONS
Institution: Department of Medicine, Makerere University College of Health

Sciences.
Background: Little is known about ART timing and factors influencing delayed
initiation in the ‘test and treat era’ in Uganda. We assessed the prevalence and
factors associated with delayed ART initiation among PLHIV referred for ART.
Methods: A mixed methods study among PLHIV, >18years, referred to Mulago ISS
clinic for ART. Quantitative data was collected using a questionnaire and analyzed
using STATA v9. Qualitative data was collected by conducting in-depth interviews;
the socio-ecological model was applied to understand barriers to ART.
Results: Of the 312 patients, 62.2% were female. The median (IQR) age and
baseline CD4 count were 35 (28-42) years, and 315 (118.8-580.5) cells/μL
respectively. The prevalence of delayed ART initiation was 15.4% with a median
(IQR) time to ART of 92 (49 – 273.5) days. Higher odds of delayed ART initiation
were among; 1)patients who had their HIV diagnosis made from a private health
facility versus public health facility; aOR = 2.5 (95% CI: 1.1 – 5.7, p = 0.036); 2)
patients who denied their positive HIV test results versus those who accepted; aOR
=5 (95% CI: 1.7 - 14.9, p = 0.003); 3)patients who never received a follow up phone
call from the place of HIV diagnosis versus those who received; aOR = 2.8 (95%
CI: 1.2 - 6.8, p = 0.022). Barriers to timely ART initiation included psychological
distress, fear of ART side effects, poor social support, inadequate counselling and
ambiguous referral instructions.
Conclusion: Delayed ART initiation among PLHIV remains a major problem in

spite of policy recommendations. Barriers to timely ART initiation exist at all levels
of influence.
Recommendation: Multi-level interventions including development of referral

guidelines, sensitization, training and support of HIV testing service providers to
link more patients into care, towards achieving the second 95% UNAIDS target.
40
NURSES’ REFLECTIONS BEFORE AND AFTER SENSITIVITY TRAINING

TO REDUCE STIGMA IN HIV PREVENTION AND CARE PROVISION TO
MSM AND TRANSGENDER PERSONS IN UGANDA
Patience A. Muwanguzi¹, Racheal Nabunya¹, Allen Nabisere¹, Victoria M. S. Karis¹, Joan
Nangendo¹, Mathew Nyashanu² and Andrew Mujugira¹
DAY 1 SESSIONS
¹Makerere University, Kampala, Uganda.
²Nottingham Trent University, Nottingham, UK
Introduction: Men who have sex with men (MSM) and transgender women (TGW)
have been shown to have a large HIV burden worldwide. Data from eight countries
across sub-Saharan Africa found a pooled HIV prevalence of 14% among MSM and
25% among TGW. Stigma and discrimination among healthcare providers have
been identified as barriers to healthcare access by these populations. We sought
to explore nurses’ attitudes before and after sensitivity training to reduce stigma in
HIV prevention and care provision to MSM and transgender persons in Uganda.
Methods: An explorative qualitative study comprising in-depth interviews with

19 nurses who underwent training in caring for sexual and gender minorities in
Uganda. All participants were interviewed before and after the sensitization training.
Results: Eight (8) themes emerged from the reflections before the training namely,
‘the definition of MSM and transgender persons’, ‘legal concerns’, ‘mental illness’,
‘attitude in health care provision’, ‘personal perceptions’, ‘self-efficacy in LGBT
care’, ‘insufficient training preparation’, and ‘reasons for gender or sexual orientation
preference’. The post-training reflections suggested a change in knowledge and
attitude. Five themes emerged for MSM: ‘stigma reduction’, ‘sexual practices and
sexuality’, ‘the need for tailored health approaches’, ‘MSM and the law’ and corrected
misconceptions. For transmen, ‘reproductive health needs’, ‘social needs’, ‘safety
needs’, ‘Gender identity recognition’ and ‘reduced stigma, discrimination, and
barriers to care’. Finally, the reflections on their attitudes towards transwomen were
on five topics; Gender affirming care’, ‘Healthcare provision for transwomen’, ‘Need
for further training’, ‘New knowledge acquired’ and ‘Sexual violence’.
Conclusions: The Nurses recommended further training with supervision and

mentorship, and more practical sessions. The involvement of the government and
policymakers to manage structural challenges and provide clinical care guidelines
will improve nurses’ confidence in caring for SGM populations. Interventions to
reach more health care professionals with such training are recommended.
41
Access to ART services: LIVED EXPERIENCES AND COPING

STRATEGIES OF HIV POSITIVE PERSONS WITH VISUAL IMPAIRMENT IN
LIRA DISTRICT, NORTHERN UGANDA; A QUALITATIVE STUDY.
Acila Gloria Ketty
Introduction: HIV/AIDS remains a global health concern with a devastating social
DAY 1 SESSIONS
and economic impact on the African continent with close to 38 million people living
with HIV/AIDS globally, 21.7 million people having access to HIV treatment.
17% of persons with disability are infected with HIV with women disproportionately
affected.
Objectives: To describe the lived experiences of visually impaired HIV-positive

persons on access to ART services attending Lira Regional referral Hospital.
Methods:
A qualitative descriptive study was conducted among 30 visually impaired HIV-

positive patients attending Lira Regional Referral hospital.
Data were collected using a structured interview guide & analysed using a thematic
approach.
Results: Out of 30 interviewed participants, 13 were males & 17 females, ages

ranging from 19-68 years old & majority were (18) were peasant farmers.
The participants reported feelings of disappointment, disorganization, disorientation,

and even cursing life, challenges including negative attitudes from health workers,
transport, and lack of knowledge about CDDPs & VHTs and used various coping
strategies like spirituality, Community rehabilitation, and social support.
Conclusion: Visually impaired persons are at an increased risk of HIV infection,

and face a complexity of psychological, social, physical, and emotional challenges
as they try to access ART services.
Therefore, Community-based drug distribution points, home-based health care and
a psychosocial support system would be of great benefit to them in helping them
cope with the situation.
42
“The intersection of late initiation of antenatal care in pregnancy and

poor ART adherence among women living with HIV in South Africa and
Uganda.
* Yussif Alhassan¹, Adelline Twimukye², Thokozile Malaba³, Landon Myer³, Catriona
Wait2,5, Mohammed Lamorde², Angela Colbers⁶, Helen Reynolds4, Saye Khoo4,5, and
DAY 1 SESSIONS
Miriam Taegtmeyer7,8
¹Department of International Public Health, Liverpool School of Tropical Medicine,

Liverpool, UK; PhD, ²Infectious Diseases Institute, Makerere University, Kampala,
Uganda; MSc, ³School of Public Health and Family Medicine, University of Cape
Town, Cape Town, South Africa; MSc, ⁴School of Public Health and Family Medicine,
University of Cape Town, Cape Town, South Africa; PhD, ⁵Institute of Systems,
Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; PhD,
⁶Radboud University Nijmegen Medical Centre, Radboud Institute for Health Sciences,
Nijmegen, Netherlands; PhD, ⁷Department of International Public Health, Liverpool
School of Tropical Medicine, Liverpool, UK, ⁸Tropical Infectious Diseases Unit,
Liverpool University Hospitals Foundation Trust, Liverpool, UK; PhD
Introduction: Many women in sub-Saharan Africa initiate antenatal care (ANC)

late in pregnancy, undermining optimal prevention of mother-to-child-transmission
(PMTCT) of HIV.
Objective: To explore how late initiation of ANC in pregnancy is related to adherence

to antiretroviral therapy (ART) in the era of national dolutegravir rollout.
Methods: This study employed a qualitative design involving individual interviews

and focus group discussions conducted between August 2018 and March 2019. We
interviewed 37 pregnant and lactating women living with HIV selected purposively
for early or late presentation to ANC from poor urban communities in South Africa
and Uganda. Additionally, we carried out seven focused group discussions involving
67 participants in both countries. Data were analysed thematically in NVivo12.
Results: Women described common underlying factors influencing both late ANC
initiation and poor ART adherence in South Africa and Uganda. These included
poverty and time constraints; inadequate health knowledge; perceived low health
risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes.
Conclusions: We found clear links between late initiation of ANC and the potential
for poor adherence to ART. Women who present late are a potential target group for
better access to antiretroviral that are easy to take and decrease viral load rapidly,
and adherence counselling support. A combination of strengthened health literacy,
economic empowerment, improved privacy and patient-provider relationships as
well as community interventions that tackle inimical cultural practices on pregnancy
and unfair gender norms may be required.
43
DAY 1 SESSIONS

Sub Theme 2: Malaria
and Other Infectious
Diseases
44
ADHERENCE TO MALARIA MANAGEMENT GUIDELINES BY HEALTH

CARE WORKERS IN THE BUSOGA SUB-REGION, EASTERN UGANDA
Arthur Mpimbaza, Harriet Babikako, Damian Rutazana, Charles Karamagi, Grace
Ndeezi, Anne Katahoire, Jimmy Opigo, Robert W. Snow, Joan Nakayaga Kalyango.
DAY 1 SESSIONS
Background: Appropriate malaria management is a key malaria control strategy.
The objective of this study was to determine health care worker adherence levels to
malaria case management guidelines in the Busoga sub-region, Uganda.
Methods: Health facility assessments, health care worker (HCW), and patient
exit interview (PEI) surveys were conducted at government and private health
facilities in the sub-region. All health centres (HC) IVs, IIIs, and a sample of HC IIs,
representative of the tiered structure of outpatient service delivery at the district level
were targeted. HCWs at these facilities were eligible for participation in the study.
For PEIs, 210 patients of all ages presenting with a history of fever for outpatient
care at selected facilities in each district were targeted. Patient outcome measures
included testing rates, adherence to treatment, dispensing and counselling services
as per national guidelines. The primary outcome was appropriate malaria case
management, defined as the proportion of patients tested and only prescribed
artemether-lumefantrine (AL) if positive. HCW readiness (e.g., training, supervision)
and health facility capacity (e.g. availability of diagnostics and anti-malarials) to
provide malaria case management were also assessed. Data were weighted to
cater for the disproportionate representation of HC IIs in the study sample.
Results: A total of 3936 patients and 1718 HCW from 392 facilities were considered
in the analysis. The median age of patients was 14 years; majority (63.4%) females.
Most (70.1%) facilities were HCIIs and 72.7% were owned by the government.
Malaria testing services were available at >85% of facilities. AL was in stock at
300 (76.5%) facilities. Of those with a positive result, nearly all were prescribed
an anti-malarial, with AL (95.1%) accounting for most prescriptions. Among those
prescribed AL, 81.0% were given AL at the facility, lowest at HC IV (60.0%) and
government owned (80.1%) facilities, corresponding to AL stock levels. Overall,
86.9% (95%CI 79.7, 90.7) of all enrolled patients received appropriate malaria case
management. However, only 50.7% (21.2, 79.7) of patients seen at PFPs received
appropriate malaria management.
Conclusion: Adherence levels to malaria case management guidelines were good,

but with gaps noted mainly in the private sector. The supply chain for AL needs
to be strengthened. Interventions to improve practise at PFP facilities should be
intensified.
45
Barriers and facilitators to implementing 99DOTS for tuberculosis

treatment supervision in Uganda
Authors:
Agnes Sanyu Nakate¹, Anna Leddy³, Joseph Ggita ¹, Christopher Berger ², Alex
Kityamuwesi ¹, Amon Twinamasiko ¹, Maureen Lamunu ¹, Lynn Kunihira Tinka ¹,
DAY 1 SESSIONS
Rebecca Crowder ², Stavia Turyahabwe ⁴, Achilles Katamba 1,3, Adithya Cattamanchi1,2

¹Uganda Tuberculosis Implementation Research Consortium, Walimu, Research,
Kampala, Uganda
²University of California, San Francisco, Division of Pulmonary and Critical Care
Medicine, San Francisco, United States of America
³Makerere University College of Health Sciences, School of Medicine, Kampala,
Uganda.
⁴National Tuberculosis and Leprosy Programme, Uganda Ministry of Health, Kampala,
Uganda
Introduction: 99DOTS is a low-cost digital adherence technology (DAT) that

is a promising tool for monitoring and supporting TB treatment completion. We
conducted a qualitative study to explore the barriers and facilitators to 99DOTS
implementation in Uganda.
Methods: Between April 2021 and August 2021, we conducted in-depth interviews
(IDIs) with 30 TB patients and key informant interviews (KIIs) with 12 health workers
and 7 District and Regional TB officers involved in the implementation of 99DOTS
at 18 health facilities in Uganda. Semi-structured interview guides were informed
by the COM-B model (Capability, Opportunity, Motivation, Behavior) and explored
perceptions of and experiences with 99DOTS including barriers and facilitators to
its use. Qualitative analysis was conducted using the framework approach.
Results: All participants asserted that 99DOTS supported patients in taking their
anti-TB medication, facilitated treatment monitoring, and improved patient and
health worker relationships. Participants also liked that the platform was free, easy
to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation
included limited literacy including technology literacy; limited access to electricity to
charge one’s phone to make dosing confirmation calls; and poor network connection
(Table 1). Gender differences in uptake also emerged. Some female patients
feared that using 99DOTS would expose them to TB stigma, and most women
had limited access to phones, including because their male partners confiscated
the phone given to them by the study. In contrast, most men had access to phones
and support from their female partners to take their anti-TB medications and make
99DOTS dosing confirmation calls.
Conclusion: 99DOTS appears to be a feasible and acceptable strategy to support
46
anti-TB medication adherence in Uganda for most patients. To further increase

uptake, there is a need to address access to phones (particularly for some women)
as well as network and charging issues.
THE UGANDA HOUSING MODIFICATION STUDY – PILOTING 4 DIFFERENT
DAY 1 SESSIONS
HOUSING MODIFICATION DESIGNS FOR MALARIA CONTROL IN
PREPARATION FOR A CLUSTER RANDOMIZED TRIAL
Agaba Katureebe¹, Samuel Gonahasa¹, Catherine Maiteki-Sebuguzi 1,2, Joaniter I.

Nankabirwa1, Henry Mawejje ¹, Jimmy Opigo², Peter Mutungi¹, Simon Peter Kigozi¹,
Susan Nayiga¹, Katherine Snyman ³, John Gimnig 4, Seth R. Irish ⁵, Jenny Carlson
⁶, Ryan Wiegand⁴, Walter Ochieng⁴, Mame Niang 5,7, Kassahun Belay 6,7, Eleanor
Hutchinson ³, Sarah G Staedke 1,3, Moses R Kamya 1,8, Nelli Westercamp⁴
¹Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda

²Ministry of Health (MOH/NMCP), Kampala, Uganda
3London School of Hygiene & Tropical Medicine (LSHTM), London, United Kingdom
⁴US Centers for Disease Control and Prevention, Atlanta, Georgia
⁵US President’s Malaria Initiative, US Centers for Disease Control and Prevention,
Atlanta, Georgia
⁶US President’s Malaria Initiative, USAID, Washington, DC
⁷US President’s Malaria Initiative, Kampala, Uganda
⁸Department of Medicine, Makerere University, Kampala, Uganda
*Corresponding author: Agaba Katureebe (Email: agabaik@gmail.com)
Once a key pillar of malaria control, housing modification remains underutilized

in most endemic areas. In advance of a cluster-randomised trial to evaluate the
impact of housing modification on malaria incidence in Uganda, we conducted a
pilot study to assess the acceptability, feasibility, cost, and entomological impact
of four types of housing modifications. Between January – July 2021, 200 houses
were randomized to: 1) full screening: screening eaves or ceilings, windows and
ventilation openings, and patching holes in the walls; 2) partial screening: screening
eaves or ceilings; 3) eave tubes; 4) eave ribbons; or 5) control arm. Evaluations
included baseline and endline household surveys, monthly entomological surveys,
installation process and costing analysis, durability assessment, and qualitative
evaluation. All four interventions were acceptable, feasible and had significant
entomologic impact. Full screening was most accepted, used locally available
47
materials, and gave the highest reductions in vector density compared to the
control arm (for An. gambiae, density ratio: full screening 0.25 [95% CI 0.12; 0.53];
partial screening 0.36 [95% CI 0.17; 0.76]; eave tubes 0.45 [95% CI 0.21; 0.99];
eave ribbons 0.39 [95% CI 0.17; 0.90]; similar results for An. funestus). Eave
tubes were most feasible, quickest to install (on average, per house: full screening
7.65hrs; partial screening 7.73hrs; eave tubes 3.91hr; eave ribbons 13.2hr), were
DAY 1 SESSIONS
durable, and had the second lowest cost (average societal economic cost per
house projected to trial conditions: partial screening $42.41; eave tubes $45.25;
full screening $87.70; eave ribbons $102.27). Partial screening was well received
initially but showed poor durability and was redundant for houses with closed
eaves. Eave ribbons were moderately accepted and durable, but time-consuming
and labour-intensive to install, and expensive. Full screening and eave tubes were
selected for further evaluation in a large-scale trial (ongoing). Beyond informing the
trial intervention selection, the pilot has contributed to the wider knowledge base of
housing modifications for malaria prevention.
THERAPEUTIC LUMBAR PUNCTURES IN HIV-ASSOCIATED

CRYPTOCOCCAL MENINGITIS: SHOULD OPENING PRESSURE DIRECT
MANAGEMENT?
Authors: Enock Kagimu¹, Nicole Engen², Kenneth Ssebambulidde¹, John Kasibante¹,

Tadeo K Kiiza¹, Edward Mpoza1, Lillian TugumeL1, Edwin Nuwagira 3, Laura Nsangi ¹,
Darlisha A Williams1,4, Kathy Huppler Hullsiek 2, David R Boulware 4, David B. Meya 1,4,5,
Joshua Rhein 1,4, Mahsa Abassi 1,4, Abdu K Musubire¹
Affiliations:
¹Infectious Diseases Institute, College of Health Sciences, Makerere University,
Kampala, Uganda
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis,
2
MN, USA
3
Mbarara University of Science and Technology, Mbarara, Uganda
Division of Infectious Diseases, Department of Medicine, University of Minnesota
4
Medical School, Minneapolis, MN, USA

5
School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
Author; Kagimu Enock ,Email : kanockenock@gmail.com , Tel : 0704383726
BACKGROUND: Increased intracranial pressure (ICP) frequently complicates

cryptococcal meningitis. Therapeutic lumbar punctures (LPs) have acute survival
48
benefits in the first week, and we sought to understand the longer-term survival
impact of therapeutic LPs.
METHODS: We prospectively enrolled HIV-seropositive adults with cryptococcal

meningitis from 2013 to 2017 in Uganda. CSF opening pressure was measured at
diagnosis. Therapeutic LPs were scheduled on days 3, 7, 10, 14, and performed
DAY 1 SESSIONS
additionally as clinically indicated. We assessed the association between clinical
characteristics, CSF parameters, and 14- and 30-day mortality by baseline ICP. We
also assessed 30-day mortality by number of follow-up therapeutic LPs performed
within 7 days.
RESULTS: Our analysis included 533 participants. Participants with baseline

ICP>350 mmH2O were more likely to have Glasgow Coma Scale score (GCS) <15
(p<.001), seizures (p<0.01), and higher quantitative cryptococcal cultures (p<.001),
while participants with ICP <200 mmH2O were more likely to have baseline sterile
CSF cultures (p<.001) and CSF WBC >=5 cells/mcL (p=0.02). 30-day mortality
was higher in participants with baseline ICP >350 mmH2O and ICP <200 mmH2O
as compared with baseline ICP 200-350 mmH2O (Hazard Ratio 1.55; 95%CI,
1.10–2.19; p=0.02). Among survivors at least 7-days, the 30-day relative mortality
was 50% higher among participants who didn’t receive any additional therapeutic
LPs compared to those with >=1 additional follow up LP (33% vs 22%; p=0.04),
irrespective of baseline ICP.
CONCLUSION: Management of increased ICP remains crucial in improving clinical

outcomes in cryptococcal meningitis. Guidelines should consider an approach to
therapeutic LPs that isn’t dictated by baseline ICP.
49
EXPERIENCE AND PERCEPTION OF SAFE PARTNER DISCLOSURE

AMONG WOMEN DIAGNOSED WITH HIV LATE IN PREGNANCY IN SOUTH
AFRICA AND UGANDA.
*Adelline Twimukye¹, Yussif Alhassan², Thokozile Malaba³, Beate Ringwald², Landon
Myer³, Catriona Wait1,4, Mohammed Lamorde¹, Andrew Kambugu¹, Helen Reynolds⁴,
Saye Khoo4,5, and Miriam Taegtmeyer2,5
DAY 1 SESSIONS
¹Infectious Diseases Institute, College of Health Sciences, Makerere University,

Kampala, Uganda, ²Department of International Public Health, Liverpool School of
Tropical Medicine, Liverpool, UK, ³Division of Epidemiology and Biostatistics, School of
Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
⁴Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool,
UK, 5Tropical Infectious Disease Unit, Liverpool University Hospital Foundation Trust,
Liverpool, UK6
Introduction: Despite the benefits of partner disclosure of HIV sero-status in

promoting the prevention of mother-to-child HIV transmission, rates of disclosure
among women during pregnancy are still low in many low-and-middle income
countries.
Objective: We sought to explore women experiences and perceptions of safe
partner disclosure when they are diagnosed with HIV late in pregnancy in South
Africa and Uganda.
Methods: Between August 2018 and March 2019, we conducted semi-structured
interviews and focused group discussions (FGD) involving HIV positive pregnant
and lactating mothers (n=42). Additionally, we carried out key informant interviews
with healthcare workers involved in ANC and ART care (n=30) and community
health workers (n=23). Participants were chosen purposively, data was analysed in
NVivo version 12 through a thematic analytic approach.
Results: Our findings indicate women find it particularly challenging to disclose

their HIV status when diagnosed later in pregnancy. Participant’s responses indicate
an intersection of factors at individual, interpersonal, community and provider levels
that complicate partner disclosure of HIV status among women diagnose later in
pregnancy. Respondents preferred health worker mediated disclosure including
couple counselling and HIV testing. The need for a stepwise approach to disclosure,
women economic empowerment and skills to disclose was emphasized.
Conclusion: The study highlights the unique challenges that women who are
diagnosed with HIV late in pregnancy face with safe partner disclosure compared
with early presenters. Healthcare workers should recognize differences in individual
circumstances and work with women to identify the right time and approach to
disclose as well as address structural barriers that underpin non-disclosure.
50
DAY 1 SESSIONS
Sub Theme 3:
Community and Mental
Health
51
ENROLLMENT AND RETENTION OF FEMALE SEX WORKERS IN HIV/

AIDS CARE IN HEALTH FACILITIES IN MBARARA CITY
Arinaitwe Bridget
BACKGROUND
DAY 1 SESSIONS
Female sex workers(FSWs) living with HIV in sub-Saharan Africa have poor
engagement to HIV care and treatment, enrollment and retention into HIV care is
a challenge has been a major contributing factor to increased new HIV infections
UNAIDS 95-95-95 strategy to end HIV/AIDS has been elusive despite efforts to
enroll and retain female sex workers (FSWs) into HIV care.
METHODS
We conducted a cross sectional qualitative survey in three selected health centers

Mbarara City. 30 FSWs and 21 health workers were selected following snowball &
purposive sampling techniques 0w. ATLAS-ti was used for data analysis.
RESULTS
Findings revealedl high enrollment rates among FSWs after discovering their
sero-status to be HIV positive. Facilitators to retention included availability of
HIV clinics for key populations, aspiration to stay healthy, keep business, raising
families. Barriers were identified for example high mobility, stigma, alcohol and drug
abuse. Behavioral change was possible if flexible referral system were introduced
to deal with high mobility, inclusion of peer support into healthcare and continuous
education among FSWs.
CONCLUSION
There is HIV care in prequalified health centres. This gives FSWs access to obtain
HIV care. However due to stigma associated with fear to lose their business most
FSWs drop out of care which increases the adverse effects of HIV among FSWs or
even death. Therefore, increased health education among FSWs that can improve
further enrolment and adherence towards HIV care seeking behaviour.
52
‘I GOT TO UNDERSTAND WHAT IT MEANS TO BE A CANCER PATIENT’.

PHENOMENONOLOGICAL EVIDENCE FROM HEALTH PROFESSIONAL
CANCER PATIENTS AND SURVIVORS
Natuhwera G.
OBJECTIVE
DAY 1 SESSIONS
The study sought to (1) examine healthcare professionals’ lived experiences of
cancer and (2) generate evidence to inform policy and clinical practice for cancer
care.
METHODS
This was a qualitative study conducted between January and December 2020 on
HCPs who were ill with, or who had survived cancer in Uganda. Purposive sampling
was used. A demographic form and an open-ended topic guide were used to collect
data. Face-to-face and telephone interviews were conducted in English; audio-
recorded Data was collected until saturation was reached. Colaizzi’s framework of
thematic analysis was used.
RESULTS
Eight HCP cancer patients from medical, allied health, and nursing backgrounds
participated in the study. Their mean age was 56 years (29-85). Five were female.
Four broad themes emerged from the interviews: (1) experience of pre-diagnosis
and receiving bad news, (2) impact on self and role identity, (3) healthcare system
and treatment experiences, and (4) the gaps and what should be done.
CONCLUSION
Cancer patient-hood introduces vulnerability and remarkable disruptions and

suffering in nearly all domains of quality-of-life i.e., in professional identity and work,
social, emotional, physical, and economic facets of life. Participants identified how
they experienced a healthcare system which was costly and staffed by unmotivated
staff with limited access to resources, which resulted in many unmet needs and a
poor overall experience. Participants identified how, in their view, the healthcare
system in Uganda needed to be better resourced, protected by policy and legislation
and how cancer awareness among the population needed to be improved.
53
LIVED EXPERIENCES OF NEWLY DIAGNOSED TYPE 1 DIABETES

MELLITUS CHILDREN AND ADOLESCENTS IN UGANDA: A
PHENOMENOLOGICAL STUDY
Jonathan Nsamba1,2
¹Department of Public Health & Community Medicine, Central University of Kerala- India
DAY 1 SESSIONS
²Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel
University London, UK
Introduction: The first year after diagnosis is the most traumatising in the lifetime
of a young diabetic patient. To improve adherence to treatment, psychosocial
factors affecting newly diagnosed children and adolescents need to be understood
and addressed. However, data concerning psychosocial experiences among
young patients with diabetes in Uganda are scarce. This study aims to explore
the perceptions and experiences of newly diagnosed children and adolescents in
Uganda.
Methods: A qualitative study design was undertaken. We recruited only participants

aged 6- <18 years and diagnosed within twelve months. Participants were recruited
from three study sites; Mulago National Referral Hospital, Wakiso HCIV, and St
Francis Nsambya Hospital. Twenty in-depth interviews were held, and data were
analysed thematically.
Results: We identified 152 codes and four themes named battling with symptoms,
emotions at diagnosis, a torch in daily life and changes I have made. It was realised
that young diabetics face a whole new world of adjustments, including insulin
therapy, routine blood glucose monitoring, and dietary changes that are often
difficult to deal with, especially in the first year after diagnosis.
Discussion: Participants found it stressful, frustrating, and hard to live with T1DM
because of disruptions to everyday living. Therefore, it is vital to continuously support
young patients at school and at home through counselling. Unless we address
psychosocial challenges, adherence to treatment regimens will be challenging.
Conclusion: Study findings have demonstrated the mixed experiences that young
diabetic children and adolescents go through, from anxiety and stigmatisation to
pain and independence.
54
LACK OF EDUCATION, KNOWLEDGE, AND SUPPLIES ARE BARRIERS

TO CRYPTOCOCCAL MENINGITIS CARE AMONG HEALTHCARE
PROVIDERS IN RURAL UGANDA: A MIXED METHODS STUDY
Abigail Link, RN, MPH, PhD1, 4; Mark Okwir, MBChB, MMED2; Sarah Iribarren, RN,
MPH, PhD¹; David Meya, MBChB, MMED, PhD3, Paul Bohjanen, MD, PhD4,5, Danuta
DAY 1 SESSIONS
Kasprzyk, MS, PhD¹
¹University of Washington, School of Nursing, Seattle, WA, USA
²Lira University Faculty of Health Sciences, Lira, Uganda
³Makerere University, Infectious Diseases Institute, Kampala, Uganda
⁴University of Minnesota, Medical School, Division of Infectious Diseases and
International Medicine, Minneapolis, MN, USA
⁵University of Minnesota School of Public Health, Minneapolis, MN, USA
Introduction: Cryptococcal meningitis (CM) is one of the deadliest opportunistic

infections related to HIV/AIDS. A research gap exists surrounding the barriers to CM
diagnosis, treatment delivery, and care from the healthcare provider’s perspective.
Purpose: This study elucidated provider’s behaviors, to identify barriers and

facilitators to diagnose and treat CM, and to assess their knowledge of CM,
cryptococcal screening, and treatment.
Methods: A convergent mixed-methods study among 20 healthcare providers who

referred CM patient between 2017-19 to Lira Regional Referral Hospital, Uganda
were purposively selected. Surveys followed by interviews were conducted to
obtain information on their education, knowledge, barriers to CM care, and patient
education to understand providers’ experiences.
Results: Nurses had the least amount of CM knowledge with half knowing the
cause of CM compared to medical and clinical officers. Approximately half the
participants knew about CM transmission, but only 15% knew the duration of CM
maintenance therapy. Most participants (74%) last had CM education during didactic
training. Also, 25% never educate patients due to time constraints (30%) and lack
of knowledge (30%). Most providers acknowledged their lack of CM knowledge due
to a lack of education and perceived CM inexperience.
Conclusions: Providers’ gaps in knowledge due to the lack of education and

experience contributes to decreased patient education, and the lack of access to
appropriate supplies affects their provision for CM diagnosis, treatment, and care.
Recommendations for standardized CM education should be developed for both
providers and patients in collaboration with professional boards and the Uganda
Ministry of Health.
55
HOME-BASED MANAGEMENT AND HEALTH SEEKING BEHAVIOR

AMONG CAREGIVERS OF CHILDREN ADMITTED WITH BURN INJURIES
AT SELECTED HOSPITALS, RWANDA
Agnes Uwamaliya3, Joselyne Rugema 1, Anita Collins 1,2, Godfrey Katende 1,2
1
University of Rwanda, School of Nursing and Midwifery
DAY 1 SESSIONS
2
Rory Meyers, University of New York
3
University Teaching Hospital Kigali
Corresponding author: maducy87@gmail.com
Introduction: Burn injuries among children are associated with major complications.
Early health care seeking and appropriate management are crucial in saving lives
and preventing complications.
Objective: To assess home-based management practices and health seeking

behaviors among caregivers of children admitted with burn injuries at selected
hospitals in Rwanda.
Methods: A cross-sectional descriptive study was conducted among caregivers of

children admitted with burn injuries at three hospitals in Kigali. A semi-structured
questionnaire was used to collect the data that were analyzed using SPSS version
25. Statistical software
Results: Most of the children with burn injuries had median age of 36 months, and
89.9% had second-degree burns. 92.4% of burns happened at home and 63.3%
were scalds. Only 18% of the caregivers seek care immediately after children’s
burn injuries. About 2.5% reported not seeking any care after burn injuries and
3.8% sought care from traditional healers. 65.9% of the participants used wrong
practices before seeking care such as applying honey, cooking oil and urine to the
burn injuries. Transportation difficulties before consulting health facilities were the
main reported faced barriers to success health care (86.1%).
Conclusion: Immediate health seeking behavior was low. Wrong practices including
application of harmful products to burn injuries are common in the community.
There is a need for community based interventions to prevent burn injuries at home
and to empower the community with appropriate actions to take after injuries.
56
DAY 2 SESSIONS
Day 2
THURSDAY
22nd September 2022
Parallel Sessions
3A- 7B
57
DAY 2 SESSIONS
PARALLEL SESSION 3A
Sub Theme 4: Mining,
Occupational Health and Safety
58
IMPLEMENTING A MERCURY-FREE METHOD IN TWO SMALL-SCALE

GOLD MINING COMMUNITIES IN MOZAMBIQUE
Diálogos has experience with implementing a mercury-free method for extracting

gold and was asked by Medicus Mundi to collaborate on a project in two mining
communities in Capo Delgado, Mozambique. The aim was to stop mercury-pollution
DAY 2 SESSIONS
from small-scale gold mining by technical training of miners, strengthening of the
civil society, and awareness rising about health effects and environmental impact.
It became clear through the final evaluation visit that follow-up by the local partner
might not have been continuous; one sign was that both communities mentioned
lack of borax as an obstacle. In Nanlia there was no use of mercury in mining, in
Macorongo the miners had taken on a Canadian agriculture project. The motivation
to mine seemed less in Macorongo, probably due to the agriculture that sustained
them quite well. The conclusion was that it is possible to eliminate use of mercury
with a short training course introducing and training an organisation of miners in
the mercury-free method. Diálogos learned the necessity of keeping the control of
the full implementation process with continued support, health and environment
teaching, and master trainings in order to support the communities properly and
provide the full benefit of our knowledge and expertise.
Bio. Margrethe Smidth is physical therapist with a MSc and a PhD

in Public Health specialized in management of the health services.
Margrethe is a voluntary project leader in the mercury-pollution projects in the
Danish NGO Diálogos and chair of the board.
CHALLENGES IN ORGANISING RELIEF AND REHABILITATION

FOR SILICOSIS VICTIMS IN UNORGANISED SECTOR : THE INDIAN
EXPERIENCE
Prahlad Sishodiya, Consultant, Expert in Silicosis, Directorate of Specially Abled
Persons, Department of Social Justice and Empowerment, Government of Rajasthan, G
3/1 A, Rajamahal Residency Area, Jaipur – 302006, India
E-mail Address – pksishodiya@gmail.com
Introduction: Silicosis is a debilitating but totally preventable occupational lung
disease caused by inhalation of silica dust. High prevalence of silicosis has been
reported from many industries in unorganised and small scale sector where
occupational health services are deficient and enforcement of legislation is
inadequate.
In India, almost 90% of workers in sandstone mining and construction industry

belong to unorganised and small scale sector. In Rajasthan, the western most
state of India, it is estimated that about 3.0 million workers are employed directly
59
or indirectly in mining and mineral processing and another 3.2 million workers are
employed in construction industry who are at risk of developing silicosis.
Materials and Methods: Following systematic studies showing high prevalence of

silicosis among sandstone mining and stone carving units, the state government
formulated “Policy on Pneumoconiosis including Silicosis Detection, Prevention,
DAY 2 SESSIONS
Control and Rehabilitation - 2019” covering all workers who may be at the risk of
developing silicosis.
Under the policy, the government started an online portal for registration for
certification and disbursement of relief. The initial screening of the person is
conducted at Community Health Centre and if suspected, the person is referred
to Pneumoconiosis Board for certification. The payment of relief to the victim is
made from centralized “Pneumoconiosis Fund”. The entire process is online with
minimum human interface.
A silicosis victim is given one-time financial assistance of ₹ 300,000 (US$ 4000)

and further ₹ 200,000 (US $ 2667) and ₹ 10,000 (US$ 135) as funeral expenses
to the dependent in the event of death. The victim and family is also entitled to
disability pension, free treatment and benefits of various welfare schemes.
Results: As on 30th June 2022, 181,687 persons had registered for silicosis
screening examination and 23,436 cases of silicosis including 6876 cases of deaths
due to silicosis have been certified. Further, 17,687 cases were certified prior to
start of online system including 1857 cases of death due to silicosis. Though, exact
figures are not available but it is estimated that more than ₹ 5,500 Million (US$ 73.3
Million) have been paid as a relief to the silicosis victims.
Conclusions: Detection and relief to silicosis victim from unorganised and small
scale sector is always a challenge a systematic approach is required to provide
relief.
Key Words: Silicosis, Victims, Relief, Indian
60
SANDSTONE MINING & SILICOSIS DEATHS IN RAJASTHAN: A

CRITICAL ANALYSIS OF LEGAL AND POLICY FRAMEWORK
Shamim Mohammad, Associate Professor, Jindal School of Public Health & Human
Development, OP Jindal Global University, Sonipat, Haryana, India Email: shamim_ifff@
yahoo.co.in
DAY 2 SESSIONS
Abhay Saraf,, Director, School of Allied Health Sciences, Dr. D.Y. Patil Medical College,
Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune ( Deemed to be
University), Pune, India; Email: abhay.saraf@dpu.edu.in
Siddiqui Sabeela, Assistant Lecturer, Jindal School of Government and Public Policy, OP
Jindal Global University, Sonipat; Email: siddiquisabeela@gmail.com
Shivaraj S. Huchhanavar, Assistant Professor of Law, Jindal Global Law School,

OP Jindal Global University, Sonipat; Email: shivashk100@gmail.com
Rajasthan contributes more than 90% of the total stone production in India. Its
sandstones are at par with international standards. A million jobless, poor, and
illiterate enter the mining sector in the state and get exposed to siliceous dust
particles. Crystalline silica has been categorized as a group one human carcinogen
which causes disabling, non-reversible, and fatal disease ‘Silicosis’. Artificially
fractured quartz cause more health threat than respirable quartz generated
through natural geological processes. Silicosis has emerged at an epidemic level
in Rajasthan.
This study critically examined the loopholes in the laws on mining and silicosis and
their implementation at the grassroots. The research has been conducted through
a desk review method and unstructured interviews with the activists working in the
sector.
The study finds that there are around 100 state and 40 central labor laws which
were archaic, complex, compartmentalized, and outdated clauses with inconsistent
definitions. The key convention of ILO on OS&H in mining remains unratified by the
Government of India. The subsumed laws such as Factories Act, 1948 and Mines
Act, 1952 were redundant since their definitions left out most of the sandstone
mining beyond the reach of the laws. Regulators tasked to enforce the laws are ill-
equipped and understaffed. The DGFALI’s labs, equipment, and other facilities do
not match modern requirements. DGMS is understaffed, lacks technical capacity
and its legal department require overhauling. The OSHWC Codes, 2020, enacted by
the parliament, subsumed 13 laws; however, there are no significant changes from
the subsumed laws concerning checking illegal mining. Most of the mines continue
to operate beyond the reach of the laws; however, it made notable provisions to
form national level and state level apex bodies of Occupational and Health Advisory
61
Boards. These boards are yet to shape into an influential entity.
The DM&G of the Government of Rajasthan is required to oversee the highest number
of mines in the country; however, it continues to operate with grossly insufficient
human resources. The Pneumoconiosis Policy of Rajasthan provisions regarding
the compensation to the Silicosis victims is grossly inadequate and arbitrary. It does
DAY 2 SESSIONS
not mention any scientific method for determining compensation. Earlier funds were
made available to the victims from the Rajasthan Environment and Rehabilitation
Board; now, the funds come from the DMFT. The PCB are usually untrained medical
professionals since there are shortages of Pulmonologists and Radiologists in the
state. The findings of the paper will have far-reaching implications in increasing
awareness amongst activists, lawyers, academicians, legislators, lobbyists, and law
enforcement.
Key words:
DGFALI: Director General of Factory Advise and Labor Institute,
DGMS: Director General of Mines Safety,
PCB: Pneumoconiosis Boards,
ILO: International Labor Organization,
DMFT: District Mineral Foundation Trust
WHY ARE WOMEN INVOLVED IN MERCURY FREE CAMPAIGN/

PROCESSING OF GOLD IN SMALL SCALE MINING AREAS” LIKE
UGANDA AND HONDURAS
Debbie Lardizabal
Small scale gold miner
Philippines
eaglesharvest79@gmail.com
*Women are the light of the communities and the home they represent (In or out of
the country)
*Women are the best advocates thus they could easily attract others.
*Women are men’s helpers not a great competitor.
*Women are good housekeepers not only in their homes but in the mining sites.
*Women carry a symbol of hope and not dis -grace
62
*Women are money magnets and financial solvers
*Women have unique leadership skills that men need
*Women are great advisers, role models, and educator
*Most especially Women are involved in manual processing
DAY 2 SESSIONS
1.hand sorting of ores.
2.Crushing
3.Grinding
4.Sluicing
5.Panning
Women play a vital role in and out of the small scale mining communities.
MERCURY FREE GOLD EXTRACTION ON TWO CONTINENTS

Leoncio Na-Oy Small-scale gold miner, Philippines
Peter W. U, Appel, Geologist, Denmark
appelglobal@.com
During 2022 Appelglobal has carried out intensive courses in mercury-free gold
extraction for small-scale gold miners
In Mauritania a project financed by German CIZ has been carried out in two areas
within the Sahara Desert. During two field seasons intensive training of local small-
scale gold miners were made. It is planned to make two follow up missions during
2022 and 2023.
In Uganda Appelglobal has carried out intensive training in in several areas over
several years.
In Honduras Appelglobal has carried teaching in mercury-free gold extraction in the

Amazon part of the country.
In Honduras Appelglobal has embarked on a several year project financed by

the Danish ministry of Environment. The main focus is to measure the mercury
pollution a a major river draining several large areas of small-scale gold mining.
The project focus on testing techniques in extracting mercury from river sediments
in central Honduras. In addition, a set if processing stations for mercury-free gold
extraction will be erected.
63
HYPOXEMIA AND RADON EXPOSURE DURING UNDERGROUND WORK

IN ARTISANAL COBALT MINES
Paul Musa Obadia, Joseph Pyana Kitenge, Trésor Carsi Kuhangana, Tony Kayembe
Kitenge, Patrick de marie Katoto, Boris Dehandschutter, Celestin Banza Lubaba Nkulu,
Benoit Nemery
DAY 2 SESSIONS
Introduction: More than half the cobalt (needed for electric vehicles) originates
form the southern part of DR Congo, and a substantial part of the cobalt is extracted
by artisanal miners. We investigated working conditions and health parameters
among cobalt artisanal miners around Kolwezi.
Methods: In a cross-sectional study of 85 artisanal miners from two underground

mines and 42 from open pits, we measured oxygen saturation (SaO2) by pulse
oximetry at four different time points: prior to descent into the shaft or quarry (T1),
at 50 minutes in the shaft (T2); upon leaving the shaft (T3) and 10 minutes after
having left the shaft (T4). In one underground mine, air radon concentrations were
monitored for 75-76 days at 10 different locations.
Results: Miners working underground (at depths of 36 to 112 m) were somewhat

older (34.8±6.8y) than those working in open pits (32.0±7.6y), and they worked
more hours daily (12.6±1.2h) than controls (9.1±0.8h). All participants had SaO2
above 95% at T1 and T4, but SaO2 was below 90% in 25 (29%) underground
miners at T2 and in 5 underground miners at T3. Values of SaO2 decreased linearly
with depth of work at T2 (R2=0.14; p<0.0001), and also at T3 (R2=0.08; p=0.0021).
Mean radon concentrations correlated with shaft depth (Spearman r = 0.70, p =
0.03).
Conclusion: Substantial oxygen desaturation occurred during underground work

in a high proportion of artisanal mineworkers. This indicates poor ventilation of the
shafts. In addition to hypoxia, insufficient ventilation also leads to the accumulation
of radon and risk of lung cancer.
64
DAY 2 SESSIONS
Alchemy Mining Group, Inc.
Duly Incorporated in British Columbia, Canada
An “innovation provider with a scalable ESG-driven climate action initiative designed to eliminate
mercury used by artisanal ore processors and to recover more gold safely and sustainably”
July 14, 2022
Environmental Remediation with Profitable Gold and Silver Production
The Company is an innovation provider with a scalable ESG-driven climate action initiative
designed to safely leach more gold and silver from; (i) crushed and milled ore than by using
mercury, a deadly neurotoxin as a lixiviant, and (ii) processed ore tailings waste to reclaim
precious metals sustainably creating greater income than by the current mercury
amalgamation and cyanidation methods in use.
This innovation for the first time in the mining industry, uses an aqueous free cyanide solution
extracted from the bitter cassava plant, commonly known as manipueira, as a lixiviant to
leach precious metals and replace the use of mercury and hard to handle cyanide salts.
By adopting the Company initiative, ore processors and hence artisanal miners globally will;
recover more gold safely and sustainably resulting in the generation of more income, improve
their health and the well-being of their communities, mitigate future local & global biodiversity
destruction, & deadly toxic global mercury pollution improving the health of our Planet by
switching from mercury ore processing to manipueira leaching.
To enable impact investment capital to fund the implementation of the climate action
initiative, the Company drafted design schematics in a flow chart outlining the conversion of
a whole ore mercury amalgamation Chilean processing center to the world’s 1st 80
tonnes/day mercury free Sustainable Manipueira Precious Metals Leaching Center.
The symbiosis of artisanal ore processors and flour makers is a win-win situation to reduce
environmental pollution, human health threats, and mitigating an unintended consequence
of harvesting bitter cassava plant.
Thank you for your consideration.
Alchemy Mining Group, Inc.
Member: ICOH MinOSH
+1.778.829.5666
Bruce A. Cosgrove, M.Sc., (Solution Chemistry) President/CEO,

alchemist@alchemymininggroupinc.com
Alchemy Mining Group, Inc., 1060 Barclay Street, Suite 510 Vancouver British Columbia Canada V6E 1G5
65
ACCIDENTS, INJURIES, AND ASSOCIATED RISK FACTORS AMONG

ARTISANAL AND SMALL-SCALE GOLD MINERS IN ZIMBABWE
(Under Review, International Journal of Environmental Research and Public Health)
Josephine Singo, John Bosco Isunju, Dingani Moyo, Stephan Bose-O’Reilly,

Nadine Steck-ling-Muschack, Antony Mamuse
DAY 2 SESSIONS
Artisanal and small-scale gold mining (ASGM) employs 14–19 million people
globally. There is little research on accidents, and injuries in ASGM in Zimbabwe.
This study assesses the association between risk factors and the prevalence of
accidents and injuries. A cross-sectional questionnaire survey was applied among
artisanal and small-scale gold miners. Data from 401 participants were analyzed
using descriptive statistics and regression analysis. The prevalence of accidents
and injuries was 35% (n= 140) and 25.7% (n= 103). Workplace roles associated
with experiencing injuries were digging (Odds Ratio [OR] = 2.1 [1.3–3.4]), blasting
(OR= 1.8 [0.9–3.6]), moving ore manually (OR= 3.0 [1.7–5.5]), and loading (OR=
2.6 [1.3–5.2]). Additional risk factors associated with injuries were being male
(Adjusted OR [AOR]= 4.3 [1.4–13.6]); being 18–35 years old (AOR =0.2 [0.07–0.9]);
crushing (AOR=9.4 [2.6–34.0]); underground transportation of workers (AOR=4.9
[2.1–11.2]), and transportation of ore from underground shafts (AOR=0.04 [0.005–
0.3]). Injuries were reported highest among the miners working 16 to 24 hours a
day, 40.9% (18). The key finding of this study was that injuries were associated with
underground mining risks. We recommend prioritizing underground mining safety
for ASGM in Zimbabwe.
THE REGULATORY PERSPECTIVE ON THE RISK OF EXCESSIVE RADON

EXPOSURE TO MINERS AND TOUR GUIDES IN UGANDA
Authors: Joshua Birungi, Noah Deogratias Luwalira, Natharius Nimbashabira, Abdul

Byamukama, Richard Menya, Dornum Katusiime, Susan Nassuna, Dr. Joseph Kigula
INTRODUCTION:
Radon gas is a well-substantiated carcinogen known to increase lung cancer risk

when inhaled in large quantities. The gas is radioactive and emits alpha particles
which damage the lining of the lungs as it decays. It originates from underground
rocks and builds up in confined, enclosed spaces near the ground surface.
Therefore, ground cavities such as mines and caves are prone to high Radon gas
concentrations. Consequently, miners and tour guides who work at cave sites risk
excessive exposure to Radon.
66
OBJECTIVE:
This paper’s purpose is to present the findings of the study we conducted to

establish whether the concentrations of Radon in selected mines and tourist caves
in Uganda showed any risks of acute health effects to the people whose occupation
involves spending several hours in the areas.
DAY 2 SESSIONS
METHODS:
Radon gas concentrations were measured in seven caves and twenty-five mining
sites around the country. The risk of excessive exposure was assessed based on
the regulatory safety limits for occupational radiation exposure doses established
by the Atomic Energy Regulations, 2012.
RESULTS AND CONCLUSION:
The study’s preliminary results indicated that the Radon gas dose rates at all
the sites were within the established regulatory limits for occupationally exposed
workers. However, the assessment was only conducted from the regulatory
perspective. It did not conclusively represent the epidemiological risk of cancer
from Radon gas on the health of the mining and tourism communities.
ASSESSMENT OF FACTORS INFLUENCING UPTAKE AND COMPLIANCE

TO MERCURY FREE GOLD EXTRACTION AND HEALTH, SAFETY AND
ENVIRONMENT AND BUSINESS PRACTICES AMONG ARTISANAL
SMALL – SCALE GOLD MINERS IN THREE DISTRICTS (BUHWEJU,
BUSIA AND KASSANDA) IN UGANDA.
Authors:
Victoria Mukasa¹, Geoffrey Kamese¹, Deogratias Sekimpi¹, John Ssempebwa², Wycliffe
Mugume³, Noah Wandera⁴, James Natweta Baguma 1, 2 Margrethe Smidth⁵
¹Uganda National Association of Community and Occupational Health

²Department of Disease Control and Environmental Health, Makerere University
School of Public Health;
³Busitema University, Department of Mining Engineering;
⁴Enterprise Uganda; 5 Dialogos, Denmark
67
INTRODUCTION:
The majority of Artisanal Small scale gold miners (ASGMs) worldwide, including
those in Sub-Saharan Africa, use mercury to extract gold. 37% of the global mercury
emission is from small-scale gold mining.
OBJECTIVES:
DAY 2 SESSIONS
This study was aimed at identifying the perceptions, attitudes, and practices about
mercury free gold mining, facilitators and the barriers to the uptake of mercury
free gold mining technologies, occupational and environmental hazards affecting
the ASGMs, mitigation measures to the occupational and environmental hazards
identified and also the livelihoods of ASGMs and other stakeholders.
METHODS:
A cross-sectional study that employed both qualitative and quantitative methods

was used. Semi-structured questionnaires, KII guides, FGD guides and observation
checklists were used for data collection. A total of 161 miners, 9 FDGs, and 36 KIs
were involved in the study. The qualitative data was analyzed using Atlas ti version
7.0 and the quantitative data was run through STATA 15.0.
RESULTS:
The uptake of the mercury free gold processing method is still low, despite the
risky work environment, and the knowledge sharing and awareness raising on the
OSH guidelines and practices and on aspects of income and livelihoods. However
only 47.5% respondents had been trained on OSH, while 42.9 % of respondents
knew about the mercury free methods, and only 16% were using it. 76.4% were
aware of occupational hazards, but PPE use was less than 5%. 80.1% respondents
have organized savings, but only 21.5% have investments. FGDs highlight that
most of the miners use mercury for acquiring quick money for daily survival, while
KII highlight the need for the government to get involved and restrict the entry of
mercury into the country for the safety of its people.
CONCLUSION:
The use of mercury in gold extraction is gradually reducing in the different gold
mines as the miners are slowly adapting to the mercury free gold processing
methods. There is need for more refresher trainings using a multidisciplinary
approach with different stakeholders at national, district, and local levels, to make
policies, ordinances and byelaws that will guide ASG Miners in observing safe gold
mining practices, as well as developing a longer term perspective on quality of life,
saving, investment and livelihood.
68
MERCURY ADDED SKIN LIGHTENERS STILL WIDELY AVAILABLE

DESPITE GLOBAL RESTRICTIONS
Introduction
Mercury compounds are frequently added to skin lightening products (SLPs)
DAY 2 SESSIONS
because they suppress the production of melanin, despite substantial health risks.
The World Health Organization recognizes that mercury added to SLPs is a “major
public health concern.” The European Environmental Bureau/Zero Mercury Working
Group (EEB/ZMWG) published a report about SLPs and compiled a database
gathering the results of these analyses, available online.
Objectives
Protect consumers.
Support governments to better regulate, control and effectively enforce legislation

banning the manufacture and trade of mercury-added SLPs at global level.
Involve health professionals and academics in collecting and reporting exposure

data, signs and symptoms of mercury poisoning and informing patients and
colleagues.
Methods
SLPs have been purchased from 40 e-commerce platforms in 17 countries,

covering all global regions. Their mercury concentration has been determined by
X-ray fluorescence and/or laboratory based Atomic Absorption Spectrophotometer
analysis.
Results
In 2021, 271 samples were purchased and tested and 48% were found to have
mercury levels over 1ppm. These results confirm the findings from our earlier two
reports in 2017-18 and 2019.
Conclusion
Despite substantial health risks and global restrictions, mercury-added SLPs are
easily available and widely used. There is an urgent need for legal and programmatic
reforms, enforcement and national, regional and international coordination to ensure
compliance with the Minamata Convention in order to better protect consumers
and their families from unsafe, illegal and counterfeit products. Awareness raising
supported by scientific evidence can be key to tackle the problem.
69
BEHAVIORAL PROBLEMS AMONG CHILDREN WORKING IN COPPER

AND COBALT ARTISANAL MINES AROUND KOLWEZI, DR CONGO
Paul Musa Obadia, Eunice Bilonda Mbuyamba, Joseph Pyana Kitenge, Jean-Paul Ngoy
Mande, Trésor Carsi Kuhangana, Tony Kayembe Kitenge, Abdon Mukalay, Laurence
Ris, Daniel Okitundu , Celestin Banza Lubaba Nkulu, Benoit Nemery
DAY 2 SESSIONS
Background: According to the latest research by the United Nations Children’s

Fund (UNICEF), from 2014 roughly 40,000 young boys and girls were used for
dangerous mining activities in southern DR Congo, primarily extracting cobalt. We
investigated trace metal exposure and possible behavioral problems among child
miners in copper and cobalt artisanal mines around Kolwezi.
Methods: In a cross-sectional study conducted in January 2020, we compared

40 children (9-11 y) working in an artisanal mine in Tshabula around Kolwezi,
with 43 control children working in farming in Lubango (50 Km from Kolwezi). We
administered a behavioral screening questionnaire, the Strengths and Difficulties
Questionnaire (SDQ), to their parents after receiving their consent. Concentrations
of 25 trace metals were measured by inductive coupled plasma - mass spectrometry
in spot samples of urine.
Results: Geometric mean (GM, with IQR) concentrations (µg/g creatinine) of

cobalt were 4.7-fold higher in child miners [31.7 (16.1-50.9)] than in child farmers
[6.9 (4.1-10.2)]. Urinary manganese (Mn) concentrations were 2.6-fold higher in
miners [6.8 (3.2-14.4)] than farmers [2.6 (1.1-6.1)]. Median SDQ scores showed
more hyperactivity [7 (5-7.3)] and sociability problems [3 (3-4)] among miners than
among farmers [4 (3-5) and 8 (6-9), respectively]. However, within the group of
child miners inverse correlations (Spearman) were found between urinary Mn
concentrations and conduct problems (r=-0.52, p=0.001) and also total difficulties
(r=-0.41, p=0.008).
Conclusion: In this cross-sectional study, we found evidence of higher exposure

to trace metals, especially cobalt and manganese, in children working in mines
than in children working in farming. We also found inverse correlations, among
child miners, between behavioral problems and urinary concentrations of Mn, a
neurotoxic metal present in the ores mined in the region. The significance and
mechanisms of the latter counter-intuitive observation need further investigation.
70
DAY 2 SESSIONS
Sub Theme 5: Bio- Ethics
Kampala, Uganda, 21st-23rd September 2022
ATTITUDES AND PRACTICES OF BASIC SCIENCES GRADUATE

STUDENTS ON THE INFORMED CONSENT OPTIONS USED IN
BIOBANKING RESEARCH AT MAKERERE UNIVERSITY COLLEGE OF
HEALTH SCIENCES
Brian Kintu, Dr. Fred Nakwagala, Dr. John Barugahare, Dr. Erisa Mwaka
DAY 2 SESSIONS
Introduction: The collection and storage of human biological materials (HBM)

have increasingly become important for biomedical research. This study assessed
the attitudes and practices of graduate students towards the informed consent
options used in biobanking research in Uganda.
Methods: A cross-sectional study conducted at Makerere University College of

Health Sciences among 80 basic sciences graduate students involved in biobanking
research. Data were collected using a self-administered questionnaire. Data were
analyzed using descriptive statistics and Pearson’s chi squared test.
Results: The was almost equal male to female representation. The mean age of
respondents was 29.9 years (SD 4.9, IQR 24-45). 78.8% were master’s students,
predominantly from the Department of Immunology and Molecular Biology (68.8%).
89% were currently using stored HBM for research, 60% had ever collected HBM
for future research and 92.5% had attended ethics-related training. Respondents
gave their perceptions on what should be included in the consent form for sample
storage for future use. Respondents also gave several opinions on the intricacies
involved in consenting donors to the storage and future use on their samples. 80%
agreed that donors should only be able to provide consent to future research if their
samples are de-identified. In regard to re-consent, 60% agreed that re-consent
places unnecessary burden on researchers and that it could be prohibitively
expensive (66.3%). There were significant differences in opinion between
respondents on the conditions under which donors should only be able to provide
consent to future research on their samples.
Conclusion: The majority of the participants did not provide sample donors
with an option to consent for their samples to be used in future research, yet it
is a requirement in the UNCST guidelines. These findings emphasize the need
to provide participants with as much information as possible in order to provide
voluntary informed consent.
72
PARTICIPANTS’ PREFERENCES FOR RECEIVING INDIVIDUAL RESULTS

FROM PHARMACOGENOMICS RESEARCH USING A CONVERGENT
PARALLEL MIXED METHOD DESIGN: A CASE STUDY FROM A
UGANDAN HIV RESEARCH INSTITUTE.
Sylvia Nabukenya1,2, Catriona Waitt², David Kyaddondo¹, Erisa S. Mwaka1
DAY 2 SESSIONS
1
Makerere University, 2Infectious Diseases Institute
Introduction: Little is known on whether people living with HIV would like to receive
their individual results from pharmacogenomics research. This study explored the
factors influencing participants’ preferences and reasons for desire to receive
individual results from pharmacogenomics research.
Methods: A convergent parallel mixed methods study design was conducted. A

survey was conducted among 225 participants using an assisted questionnaire.
Five focus group discussions were also conducted with 30 purposively selected
participants. Quantitative data was analysed using a modified Poisson Model.
Thematic analysis was used for the qualitative data. Triangulation was done for
clear understanding of the data.
Results: 225 participants enrolled in the survey, majority were female (60%)
with a median age of 38 years. 50% of the participants had attained post primary
education, 51% were not married, 72% were self-employed and 65% were living
in nuclear families. Majority 149 (66%) wanted to receive all their results, 72 (32%)
wanted to receive some but not all results and only four (1.8%) did not want to
receive any results at all. Among those who wanted to receive some of the results,
93% preferred well-established results and 96% preferred results of treatable
and preventable conditions. Participants’ preferences were influenced by religion
(p=0.036), duration on antitroviral therapy (p=0.001) and the duration of receiving
care at the HIV treatment and care clinic (p=0.045). There were three emergent
theme: awareness about feedback of individual results; reasons for participants’
desire to receive results; and reasons for not wanting to receive results from
pharmacogenomics research.
Conclusion: Participants desire to receive feedback from pharmacogenomics

research; specifically, results that are well established and medically actionable.
Researchers should educate participants about genomics research and the
implications of such results first before soliciting their preferences of the different
types of results for effective management of their expectations.
73
MORAL DISTRESS AND COPING STRATEGIES AMONG NURSES AND

MIDWIVES AT KAWEMPE NATIONAL REFERRAL HOSPITAL
Prosper Mubangizi¹, Frederick Nakwagala², Erisa Mwaka¹
1Makerere University College of Health Sciences, 2Mulago National Referral Hospital
DAY 2 SESSIONS
Background: Moral distress is a major issue in nursing practice

Objective: To determine the prevalence and factors contributing to moral distress,
coping strategies and institutional mechanisms to support nurses and midwives
with moral distress at Kawempe National referral hospital, Kampala district
Methods: This was a convergent mixed-methods study conducted at Kawempe
National Referral Hospital (KNRH) among 126 nurses and midwives. A survey was
conducted using the Moral Distress Scale- Revised (MDS-R) tool and informant
interviews with seven ward managers and unit heads. Qualitative data was analysed
using the Chi-squared test and ordered logistic regression. Qualitative data was
analyzed using thematic analysis. Triangulation of both datasets was done.
Results: 89.7% were female and had a mean age of 35.3 years (SD 9.3). 68.3%
had a working experience of more than 5 years. 96% of respondents had moral
distress with the 21-39 age group (62.9%) being the most affected. Assitant nursing
officers (54%) and Enrolled nurses/midwives (30.2%) were the most affected. Low
moral distress was common among respondents who had worked at KNRH for
more than 2 years (49.4%) while those that had stayed for >2 years had more
moderate moral distress (40.5%). The factors only that significantly contributed to
moral distress was working in the Post-natal unit (Adj. OR 0.20, p= 0.048). The
theme that emerged from the KII included: nurses and midwives’ experience of
moral distress; factors contributing to moral distress; moral courage and decision
making during patient care; and institutional mechanisms for addressing moral
distress among nurses and midwives.
Conclusion: The prevalence of low and moderate moral distress among nurses
and midwives working in a public women’s hospital is high with assistant nursing
officers and those in the younger age group being the most affected. Institutions
should develop mechanisms to support nurses with moral distress.
74
PERCEPTIONS AND EXPERIENCES OF RESEARCHERS ON THE

INFORMED CONSENT PROCESS FOR GENETICS AND BIOBANKING
RESEARCH
Erisa Mwaka, Ian Munabi, Joseph Ochieng, Janet Nakigudde, David Mafigiri-Kaawa,
Nelson Sewankambo
DAY 2 SESSIONS
Introduction: The informed consent process is one of the recognized strategies
currently in use, aimed at avoiding the exploitation of research participants. However,
there are concerns about research participants’ ability to understand the concepts
of genomic research, biobanking and the potential risk of stigma or exploitation
of study communities. The study explored the perceptions and experiences of
researchers on informed consent process for genomics and biobanking research.
Methods: This was a descriptive convergent parallel mixed methods study that
randomly recruited 187 researchers involved in biobanking and or genetics
research. Data were collected using a self-administered tool. In-depth interviews
were also conducted with 15 genomic/genetics researchers.The results of the
quantitative analyses were summarized as tables capturing different descriptive
statistics and the odds ratios. Odds ratios were generated by the glm-function in R.
Qualitative data were analyzed using thematic analyses. Triangulation was done to
get a deeper understanding of the data.
Results: Most participants were male scientists (53.5%) and the overall mean
research experience was 12.2 (SD 6.75) years. About 89% had ever worked in
international collaborative research. There were varying views on the types of
consent and what should be included in the consent forms for biobanking research.
There were five themes: general understanding of genetic research and consent
options for sample storage: Information disclosure; pertinent ethical, legal and
social issues in informed consent; challenges in informed consent processes for
genetic research and recommendations for enhancing comprehension of consent.
Conclusion: Overall, most investigators did not understand broad consent and
were not well conversant with the informed consent processes of their studies
and nurses had limited understanding of genetic concepts. There is need to train
research teams in research ethics.
75
DAY 2 SESSIONS

Sub Theme 6: Health Systems
76
KNOWLEDGE TRANSFER ON LABORATORY QUALITY MANAGEMENT

SYSTEMS FROM ACCREDITED LABORATORIES TO PUBLIC HEALTH
LABORATORIES IN UGANDA: THE MUWRP MODEL
Nanteza C¹, Nabirye H¹, Kayondo W¹, Mayanja R¹, Kagabane S¹, Atukunda S¹,
Tumubeere L¹, Nabukenya S¹, Nabuuma H¹, Tumusiime R¹, Wandege J¹, Naluyima P¹
DAY 2 SESSIONS
¹Makerere University Walter Reed Project, Kampala
BACKGROUND: According to the International Organization of Standardization

(ISO) 15189, laboratory quality management systems (LQMS) are required
by all medical laboratories. In 2011 the World Health Organization (WHO), in
conjunction with the Ministry of Health Uganda, enacted the Stepwise Laboratory
Improvement Process Towards Accreditation (SLIPTA), for ensuring that all public
health laboratories in Uganda improve their LQMS in preparation for international
accreditation. However, although SLIPTA was implemented, by 2013, only 3 of
954 laboratories in Kampala met international quality standards due to challenges
like insufficient numbers of well-trained laboratory staff, few available mentors to
provide followup and lack of managerial and government support for sustainability.
This analysis seeks to highlight the strategies and impact of knowledge transfer
from Makerere University Walter Reed Project (MUWRP), a laboratory that has
maintained College of American Pathologists (CAP) accreditation for 15 years, to
selected medical laboratories in preparation for their accreditation.
METHODS: MUWRP supported two public health laboratories with mentorship

and support supervision. Through this, LQMS knowledge transfer was achieved by
didactic training, hands-on training, implementation of LQMS essentials, and periodic
auditing with recommendations for improvement for identified non-conformities. In
addition, there were regular on-site engagements with the laboratories to guide the
identification of tailor-made solutions for each individual laboratory. Progression
was measured by the ability of a laboratory to independently implement concepts,
apply strategic thinking approaches to observed non-compliances, and identify
potential improvement ideas.
RESULTS: The two selected public health laboratories attained international

accreditation by South African National Accreditation System (SANAS) in 2018 and
2019.
CONCLUSION: Expert mentorships and training are important to implement and
sustain LQMS necessary for attaining international accreditation. This approach
involves laboratories in Uganda that have successfully attained and maintained
international accreditation serving as models for local laboratories newly
implementing LQMS, by providing hands-on training and practical solutions for
challenges identified; this results in more sustainable improvements in LQMS.
77
Strengthening health workforce capacity through global learning in

critical care (SCALE) Project.
Loftus S.
Introduction: The SCALE Project is a collaborative health workforce capacity

DAY 2 SESSIONS
and educational development initiative between the Ministry of Health, Uganda,

UUKHA, HEE and the NHS in the UK. SCALE encompasses four specialities, our
domain being critical care, the lack of workforce for which was highlighted during
the COVID-19 pandemic.
Objectives: This project aims to support development and bidirectional learning

in critical care through a number of avenues including remote and F2F learning,
curriculum development, QI, research and reciprocal fellowships.
Method: SCALE has adopted a phased approach, starting with virtual learning and
monthly grand rounds, nursing equivalent in planning. The next phase includes
short and long-term placements in the UK and Uganda as well as involvement of
physiotherapy. Additionally, plans are ongoing to develop QI and research links
as part of the partnership and standardise critical care training across Uganda,
developing a curriculum with AAU and CANECSA, aiming to use this across East
Africa.
Results: The grand round has run for 6 sessions with great attendance and
excellent feedback on both sides. In June, an MOU was signed between the
Ugandan government, UUKHA, HEE and CGHP. This allows the next phase of
reciprocal fellowships to progress; 2 Ugandan Doctors are accepted for fellowships
in Cambridge University Hospital.
Conclusion: This project has already shown promise, engaging large numbers of
clinicians in grand rounds and next phases are underway. SCALE has the potential
to significantly impact critical care by increasing workforce size, capability and
resilience in Uganda and the UK, hoping to expand across East Africa.
78
MULTISECTORAL APPROACHES TO SUSTAINABLE DEVELOPMENT IN

UGANDA. A FOCUS ON HEALTH
Wanyana Irene1,2*, Daniel Helldén2 ⁴, Rawlance Ndejjo2,3, Marat Murzabekov⁴, Tobias
Alfvén2,4 , Rhoda Wanyenze2,3 and Nina Viberg2,4
DAY 2 SESSIONS
1
Department of Epidemiology and Biostatistics, School of Public Health, College of
Health Sciences, Makerere University, Kampala, Uganda
2
Centre of Excellence for Sustainable Health, a collaboration between Makerere
University and Karolinska Institutet
3
Department of Disease Control and Environmental Health, School of Public Health,
College of Health Sciences, Makerere University, Kampala, Uganda
4
Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
*Correspondance: Wanyana Irene : iwanyana@musph.ac.ug
INTRODUCTION: Despite Uganda’s efforts to achieve Sustainable development

goal 3 (SDG) 3), several health indicators are still below the set targets. While the
country focuses most of its public health efforts on health-related interventions,
several health determinants are outside the health sector boundaries. Multisectoral
approaches are therefore critical to achieving sustainable health. This study aimed
to identify, classify, and document the strength of connections between SDG 3 and
other SDGs within the Ugandan context.
METHODS: We conducted a two-day workshop with 30 stakeholders from public,

private, civil societies organizations, and academia to understand the nature of
connections between the SDGs. Results were analyzed using the SDG synergies
framework.
RESULTS: Generally, the results revealed that SDG 10 had the strongest positive
influence on all SDGs, hence progress on Goal 10 will improve most SDGs. SDG 3
was mostly influenced by, Goal 10 (Reduced inequalities), Goal 1 (No poverty), and
Goal 2 (Zero hunger), therefore efforts to improve these SDGs could significantly
improve the health system in Uganda. On the other hand, progress in Health
had a strong impact on Goal 1, Goal 4, and Goal 8 (Decent Work and Economic
growth). Other SDGs with a highly positive influence on other goals included Goal
11 (Sustainable Cities and Communities) and Goal 15 (Life on land).
CONCLUSION AND RECOMMENDATION: Governance and policymaking

strategies should incorporate multisectoral approaches while dealing with SDG 3
to address health challenges beyond the health sector boundaries.
79
PREVALENCE AND CLASSIFICATION OF MISDIAGNOSIS AMONG

HOSPITALISED PATIENTS IN FIVE GENERAL HOSPITALS OF CENTRAL
UGANDA
Simon Peter Katongole

School of Public Health, Gudie University Project; P.O. BOX 5498, Kampala, Uganda.
DAY 2 SESSIONS
Email: spkatongole@gmail.com
Background: This study sought to determine the magnitude of patients’

misdiagnosis, classify the extent to which patients were misdiagnosed, determine
the major International Classification of Diseases version eleven (ICD-11) diagnostic
groupings and the topmost misdiagnosed diseases.
Methodology: We conducted a retrospective review of 2,431 records of patients

between July 1st 2019 and June 30th 2020 in five hospitals. The initial diagnosis
assigned by admitting clinician at outpatient was compared with the final diagnosis
which had been collectively agreed upon by a team of reviewers. The ICD-11 was
used to code and match the admission and discharge diagnoses. A patient was
adjudged to have been misdiagnosed if there was a difference between the initial
and the final diagnoses.
Results: Nine percent of inpatients were misdiagnosed. Seventy percent had their
initial and final diagnosis belong to different ICD-11 major diagnostic groupings
hence classified as Class I. Seven ICD-11 major diagnostic groupings accounted
for at least 80% of the misdiagnosis. The infectious or parasitic diseases (32%),
diseases of the digestive system (12%), diseases of the circulatory system (11%),
endocrine, nutritional or metabolic disorders (9%), diseases of the respiratory
system (7%), diseases of genitourinary system (7%), and diseases of blood and
blood forming organs (5%).
Conclusion: Findings offer major insights on burden of patient misdiagnosis in the

hospitals. Efforts to improve the diagnosis should focus on the ‘vital few’ topmost
misdiagnosed conditions and ICD-11 major diagnostic groupings that account for at
least 80% of the burden of patient misdiagnosis in the hospitals in Uganda.
80
FACTORS ASSOCIATED WITH MISDIAGNOSIS OF HOSPITALISED

PATIENTS IN GENERAL HOSPITALS OF CENTRAL UGANDA
Simon Peter Katongole

School of Public Health, Gudie University Project, P.O BOX, 27450, Kampala
Email: spkatongole@gmail.com
DAY 2 SESSIONS
Background: Misdiagnosis has been reported as a prevalent problem in developed
country health care system but little is known about the factors associated with it in
most sub-Saharan African hospitals. The objective of this study was to establish the
factors associated with misdiagnosis of inpatients in general hospitals in Uganda.
Methods: A retrospective cross-sectional study was conducted in five hospitals in

central Uganda. Records of 2,431 patients admitted between July 1st 2019 and 30th
June 2020 were selected using simple random sampling and reviewed to obtain
data on variables considered to be associated with misdiagnosis. The admission
diagnosis assigned at the emergency or outpatient department was compared
with the discharge diagnosis. The discrepancy between the two was taken as a
misdiagnosis of the patient. Multivariable logistic regression analysis was used to
establish the disease, patient, health system and environmental factors associated
with misdiagnosis.
Results: Misdiagnosis was detected in 223/2431 (9.2%) of the admitted patients’

records. The factors associated with misdiagnosis included; a patient admitted in
Nakaseke hospital [adjusted odds ratio (aOR)=1.95, 95% confidence interval (CI)
=1.17-3.25, p=0.01], having been admitted at night [aOR=3, 95% CI=1.81-5.02,
p<0.01], male patient [aOR=1.89, 95% CI=1.35-2.64, p<0.01], patient’s age groups
10-19[AOR=2.3, 95% CI=2.3-9.25, p<0.01]; 20-29 [AOR=8.15, 95% CI=4.18-
15.89], p<0.01; 30-39; and 40-49;; AOR=8.12, 95% CI=3.99-16.54, p<0.01;
AOR=7.88, 95% CI=3.71-16.73, p<0.01; and AOR=12.14, 95% CI=6.41-23.01,
p<0.0]. Having multimorbidity (aOR=4.71 95% CI=1.91-11.65, p<0.01) and patients
treated for uncommon diseases [aOR= 2.57, 95% CI=1.28-5.18, p<0.01] were also
associated with misdiagnosis. Patients with no underlying diseases [aOR=0.63;
95% CI=0.43-0.91, p=0.015] and those who had not been referred [aOR=0.51 95%
CI=0.31-0.86, p=0.011] were less likely to be associated with misdiagnosis.
Conclusion: Hospitals have to be cognizant of the factors associated with patient

misdiagnosis and devise means of addressing these factors in order to improve
diagnostic accuracy. This may necessitate re-organizing outpatient care, targeted
training, policy or guideline formation and adoption a diagnostic error prevention
culture.
81
DAY 2 SESSIONS

Sub Theme 7: Non
Communicable Diseases
82
DRIVERS OF CARDIOVASCULAR DISEASE RISK FACTORS IN SLUMS IN

KAMPALA, UGANDA: A QUALITATIVE STUDY
Rawlance Ndejjo¹, Paineto Masengere¹*, Douglas Bulafu¹, Lydia Nabawanuka

Namakula¹, Rhoda K. Wanyenze¹, David Musoke¹, Geofrey Musinguzi¹
¹Department of Disease Control and Environmental Health, School of Public Health,
DAY 2 SESSIONS
*Presenting author: Paineto Masengere

College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
Email: rndejjo@musph.ac.ug
Background: Cardiovascular disease (CVD) risk factors are increasing in many

sub-Saharan African countries, and disproportionately affecting communities in
urban slums. Despite this, the contextual factors that influence CVD risk among
slum communities have not been fully documented to guide interventions to prevent
and control the disease.
Objective: This study explored the drivers of CVD risk factors in slums in Kampala,
Uganda.
Methods: This qualitative study employed focus group discussions (FGDs) to collect
data among slum dwellers. A total of 10 FGDs separate for sex and age group were
held in community public places. Discussions were audio-recorded, transcribed,
and transcripts analysed thematically with the aid of Atlas ti 7.0. Emerging themes
and sub-themes are presented supported by participant quotations.
Results: Six themes highlighted the drivers of CVD risk factors in slum communities.
1) Poverty: a critical underlying factor which impacted access and choice of food,
work, and housing; 2) Poverty-induced stress: a key intermediate factor that led to
precarious living with smoking and alcohol use as coping measures; 3) The role of
interpersonal factors which included socialization through drinking and smoking,
and family and peers modelling healthy behaviours; 4) Influence of the physical
environment such as the high availability of affordable alcohol and access to
amenities for physical activity and healthy foods; 5) Knowledge and perceptions
about CVD behavioural risk factors which included understanding of a healthy diet
and the dangers of smoking and alcohol consumption; and 6) Individual factors
such as age, gender, socio-economic status and CVD status.
Conclusion: To address CVD risk in slums, broad-ranging multisectoral

interventions are required including economic empowerment of the slum population,
83
stress reduction and coping interventions, and alcohol legislation. Also, there is a
need for community CVD sensitization and screening as well as increasing access
to physical activity amenities and healthy foods within slums.
Prevalence of Factor V-Leiden, Prothrombin, and Methylenetetrahydrofolate

reductase mutations among sickle cell disease patients from Kampala,
DAY 2 SESSIONS
Uganda
Oroma Patrick1,2* (BMLS, MSc), Ronald J. Kintu¹ (BSc),; Julius B. Okuni¹ (MSc, PhD);
Dennis M. Kasozi2 (MSc, PhD)
¹Department of Veterinary Pharmacy, Clinical and Comparative Medicine, College of

Veterinary Medicine, Animal Resources and Biosecurity, Makerere University
²Department of Biochemistry & Sports Science, School of Biosciences, College of
Natural Sciences, Makerere University
*Presenting author, Oroma Patrick MSc, patrickcphl2016@gmail.com, Tel. No. 256 784
813680
INTRODUCTION: Genetic polymorphisms are the major cause of thrombophilia

among sickle cell disease (SCD) patients. Methylenetetrahydrofolate reductase
(MTHFR, C677T, rs1801133) Factor V Leiden (G1691A, rs6025) (FVL G1691A)
and Prothrombin G20210A (PTN G20210A, rs1799963) genetic polymorphisms
associated with thrombophilia are known to increase the severity and frequency of
this complication in SCD patients.
OBJECTIVES: To determine the association between the occurrence of MTHFR

C677T, PTN G20210A and FVL G1691A mutations and SCD.
METHODS: A cross sectional study comprising archived DNA samples from 123
SCD patients from Mulago Sickle cell clinic and 152 healthy controls were analysed.
Sickle cell anaemia genotyping was carried out using bi-directional allele specific
Polymerase chain reaction (PCR). Genotyping for detection of MTHFR C677T, FVL
G1691A, and PTN G20210A gene mutations was done using both allele specific
PCR and PCR RFLP.
RESULTS: The frequency of MTHFR C677T gene polymorphisms was 77.69% in

SCD patients and 56% in healthy controls (X2=13.375, P=0.001). The CT genotypes
of MTHFR C677T variants was more likely to occur in SCD patients than controls
(OR=2.739, 95%CI: 1.57-4.76, P<0.001). Prevalence of PTN G20210A gene
mutation was 6.2% in SCD and 2.14% in healthy controls (X2=2.832, P=0.243).
There was no FVL G1691A gene polymorphism. Haplotype CGG (OR=0.657,
95%CI: 0.435-0.992, P=0.045) and TGA (OR=1.5, 95%CI: 1.01-2.99, P=0.045)
84
were significantly high among the SCD than in healthy controls.
CONCLUSION: The MTHFR C677T polymorphisms may be a risk factor for severe
vascular complications in SCD. We recommend screening of MTHFR C677T as
biomarker for venous thrombosis in SCD.
DAY 2 SESSIONS
PREVALENCE AND RISK FACTORS FOR GLYCEMIC CONTROL AMONG
TYPE 2 DIABETES MELLITUS PATIENTS ATTENDING SELECTED HEALTH
CENTERS IN MBARARA, UGANDA
Daphine Nabukenya¹, Davis Nduhuura¹ , Derrick Turyasingura¹ , Lillian Racheal Sabano1

,Bernard Kutuusa¹, Joseph Ndarubweine¹, and Ritah Kiconco¹.
¹Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of

Science and Technology, P.O.Box 1410, Mbarara city, Uganda.
Introduction: Diabetes Mellitus is a growing problem worldwide with rising

prevalence rates in sub-Saharan Africa. Glycemic control as measured by glycated
hemoglobin (HbA1c) is one of the widely used clinical indicators for the quality
of diabetes care. Poor glycemic control is a determinant of diabetes-related
complications and death. This study aimed at determining glycemic control among
type 2 diabetes mellitus (T2DM) patients attending selected health centers in
Mbarara, Uganda.
Research design and methods: A cross-sectional survey was conducted on

consented patients diagnosed with T2DM at selected health centers in Mbarara.
Questionnaires were used to collect sociodemographic data on age, gender, level
of education, and qualitative data on alcohol consumption, cigarette smoking,
diet, physical activity, and other underlying diabetes complications. Blood was
drawn from participants and assessed for random blood sugar (RBS), glycated
hemoglobin (HbA1c) levels. Data were statistically analyzed using the Statistical
Package for the Social Sciences (SPSS) version 23 and significance set at p <0.05.
Results: The overall prevalence of poor glycemic control among T2DM patients
attending
Selected health centers was 80%. Our study enrolled 46(32.9%) males and
94(67.1%) females. 87% of males and 76.6% of females had poor glycemic
control. Bivariate and multivariate statistical analyses were done. Significantly
85
associated risk factors with poor glycemic control (Odds Ratio >1) were alcohol
intake OR=1.292 (95%CI; 1.175-1.420, P=0.034), random blood sugar OR=2.500
(95%CI; 1.072-5.830, P = 0.031) and T2DM treatment duration OR=2.826 (95%CI;
0.620-12.887, P= 0.002). There was a positive correlation between HbA1c levels
and anti-hyperglycemic therapy, however this relationship was insignificant (r=
DAY 2 SESSIONS
0.097, P= 0.480).
Conclusion: Eight in every ten T2DM patients have poor glycemic control. Alcohol
intake, Long-term duration of T2DM treatment, and hyperglycemia impact negatively
on a patient’s glycemic control. Health strategies should devote more attention
to alleviating the poor glycemic control among T2DM patients in impoverished
communities.
TRAINING AND PRACTICE GAPS AMONG JUNIOR DOCTORS IN
86
KAMPALA REGARDING THROMBOSIS AND ANTICOAGULATION
Jerome Roy Semakula, Joseph Waswa, Geraldine Kisa, Phiona Kukundakwe,

Christine Sekaggya-Wiltshire, Catriona Waitt
Introduction: Prescribers’ knowledge and attitudes about use of anticoagulation
DAY 2 SESSIONS
are among the factors affecting the quality of anticoagulation among patients on
warfarin. Health providers’ high skill and competence around anticoagulation is
associated with better patient compliance with warfarin.
Objectives: This study aimed to 1) Explore junior house officers’ (JHOs) and
senior house officers’ (SHOs) attitudes about anticoagulation 2) Describe key
challenges faced in managing patients on anticoagulation; 3) Describe prescribers’
anticoagulation learning needs.
Methods: We conducted a paper-based survey on thrombosis and anticoagulation

among junior and senior house officers working in medical wards at tertiary hospitals
in Kampala prior to their participation in a thrombosis and anticoagulation training
workshop organised under the NIHR-funded ‘War-PATH’ research project.
Results: There were 122 workshop attendees with 37/38 (97%) SHO and
79/84 (94%) JHO respondents respectively. Overall, 92.2% of respondents had
prescribed an anticoagulant in the recent 6-month period, warfarin in 67.2%
instances. More than two-thirds were confident in assessing risk of thrombosis
and starting and monitoring patients on anticoagulation. Only 51.7%% reported
confidence in knowing when to stop anticoagulation. Reported challenges included
difficulty with INR monitoring of warfarin patients; high costs of DOACs, heparins
and INR monitoring; initiation and maintenance dosing of anticoagulants; and
management of bleeding in anticoagulated patients. The training needs reflected
the key challenges identified by respondents.
Conclusion: This study identified challenges and training needs of doctors

managing patients requiring anticoagulation that are not currently met through
clinical training. War-PATH provides a good example of integrating clinical capacity
building into the clinical research program.
87
DAY 2 SESSIONS

Sub Themes 6 and 7:
Health Systems and Non
Communicable Diseases
88
ASSESSING HEALTH SYSTEM RESPONSIVENESS FOR PEOPLE WITH

DISABILITY ATTENDING HIV/AIDS TREATMENT AND CARE SERVICES IN
SOUTHWESTERN UGANDA.
Background: People with disabilities have inequitable access to HIV/AIDS

Treatment and Care Services (HATCS), which is a barrier to ending the pandemic
DAY 2 SESSIONS
by 2030. The goal of this study was to evaluate the health system’s responsiveness
and associated factors for PWD attending HATCS at health facilities in South
Western Uganda.
Objectives:
1. To determine the health service accessibility –related characteristic of PWD

attending HATCS at public health facilities in South western Uganda
2. To evaluate the health system responsiveness(HSR) of HATCS to PWD

attending Public health facilities in South Western Uganda
3. To assess the association between socio-demographic, clinical characteristics

and HSR of HATCS to PWD attending public Health facilities in South Western
Uganda.
Methods: Quantitative cross-sectional study. A total of 106 people were enrolled,

and data was collected using the WHO health responsive questionnaire. The
distribution of the variables was determined using descriptive analysis, and the
correlation of independent factors with the outcomes was assessed using binary
and multivariable logistic regression. The significance level was set at 0.05, and
odd ratios were calculated with a 95% confidence interval (CI).
Results: The overall Health system responsiveness (HSR) was 47.62% (40/84)
acceptable. Across the domains, the best performance was reported in social
consideration (68.57%) and autonomy (67.62%). The least performance was
registered in dignity (2.83%), confidentiality (2.91%), prompt Attention (17.35%) and
Choices (30.48%). Whereas, performance in communications (53.92%) and quality
of basic amenities (42.27%) were average. There was no socio- demographics or
disability variables that were predictive of HATCS responsiveness
Conclusion: The HSR was comparatively low, with dignity, confidentiality, prompt
attention, and choice ranking worst. To address the universal and legitimate
requirements of PWDs in accessing care, urgent initiatives are required to create
awareness among all stakeholders.
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DEVELOPING THE NEXT GENERATION OF AFRICA’S HEALTH

WORKFORCE THROUGH CHAMPIONING PATIENT-CENTERED CARE.
Muganzi David1, Nabakka Vivian¹
¹PaCeM-AFro
DAY 2 SESSIONS
Introduction: Patient-centered care (PCC) is one of the dimensions of quality of

care. It is a core competency of health workers. Despite the global advocacy for
PCC, the concept has barely received attention in Africa, with little research and
strategies to promote it. Patient-Centered Care Movement-Africa (PaCeM-Afro) is
a multidisciplinary community of health professional students across Africa with a
shared vision to build a rising generation of health workers committed to advancing
PCC in Africa.
Objective: To show the role of healthcare students in developing the next generation
of Africa’s health workforce through championing PCC.
Methods: PaCeM-Afro established 16 University chapters across eight countries,

including Kenya, Uganda, Nigeria, Malawi, and South Africa. The semi-autonomous
chapters run activities aimed at promoting PCC.
Results: The chapters’ activities increased the knowledge and skills of health
profession students in delivering PCC. This was done through workshops, roundtable
discussions, PCC campaign that engaged over 2000 health profession students
across Africa. PaCeM-Afro research hub is working on three continental studies
exploring the inclusion of PCC in African health profession students’ curricula and
country policies and determining the knowledge, attitudes and practices of African
health profession students towards PCC.
Conclusion: PaCeM-Afro offers a platform for health profession students to learn

about PCC, cause change in health delivery and provide thought leadership within
their communities. It demonstrates how health profession students are resourceful
in strengthening health systems.
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A HEALTH SYSTEMS APPROACH TO STRENGTHENING COMMUNITY

HEALTH IN WAKISO DISTRICT, UGANDA
Authors: Filimin Niyongabo¹, Belinda Twesigye¹, Grace Biyinzika Lubega¹, Micheal

Brown Obeng², David Musoke¹, Linda Gibson²
Affiliations:
DAY 2 SESSIONS
¹Makerere University School of Public Health
²Nottingham Trent University, School of Social Sciences
Corresponding Author: Filimin Niyongabo filiminniyongabo@gmail.com
+256751985106
Background: The World Health Organization building blocks of health workforce,

health information systems, health service delivery, governance and leadership are
critical for strengthening community primary health. A project aimed at strengthening
the health system approach at the community level was implemented in Bussi sub-
county and Kyengera Town council in Wakiso district, Central Uganda.
Objectives: The objectives of the project were to enhance the capacity of

community health workers (CHWs), their coordinators and their supervisors;
support the completeness and timely submission of data from CHWs; enhance
timely delivery of drugs and other commodities to CHWs; improve performance of
CHWs in relation to quality of care, respective care, and timely referral of patients
and support the supervision and coordination of community health.
Methodology: Conducted baseline and endline surveys among households CHWs

and supervisors; training workshops of community health workers (CHWs), their
coordinators and their supervisors; pre and post training assessments; monitoring
and evaluation exercises and providing incentives.
Results: Total of 4O CHW coordinators, 16 supervisors and 386 CHWs were

trained on their roles including establishment of model households. Post-training
assessment results showed that 70.6% (225/361) of the CHWs understood their
roles and responsibilities very well compared to 6.9% (26/379) in the pre-training
assessment. Total of 1886 model households were established by the trained
CHWs. All the trained CHWs received branded t-shirts and Identification cards
while 3 motorcycles were handed over to support timely delivery of services.
Conclusion: Improving the performance of CHWs promotes the functioning of the

community health systems in Uganda.
91
COMPARISON OF PREVALENCE OF KIDNEY DISEASE BY PROTEINURIA

AND DECREASED ESTIMATED GLOMERULAR FILTRATION RATE
DETERMINED USING THREE CREATININE-BASED EQUATIONS AMONG
PATIENTS ADMITTED ON MEDICAL WARDS OF MASAKA REGIONAL
REFERRAL HOSPITAL.
DAY 2 SESSIONS
SSenabulya F. Ronny¹@, Nankabirwa I. Joaniter1,2, Kalyesubula Robert¹, Wandera

Bonnie³, Kirenga Bruce1,3, Kayima James 1,5, Ocama Posiano¹, Bagasha Peace 1,4
¹Department of Medicine, Makerere University College of Health Sciences, Kampala

Uganda, ²Infectious Disease Research Collaboration, Kampala Uganda. 3Makerere
NCD Training program, Makerere Lung Institute, Kampala Uganda. ⁴ Mulago National
Referral Hospital, Kampala Uganda. ⁵Uganda Heart Institute, Mulago Hospital, Kampala
Uganda.
Introduction: No studies in sub-Saharan Africa have compared the performance of

various creatinine-based equations used to determine eGFR.
Objectives: We compared prevalence of kidney disease determined by proteinuria

of ≥ + 1 and or kidney disease improving global outcomes (KDIGO) eGFR criteria
of < 60 ml/minute/1.73m2 determined using three creatinine-based equations.
Methods: Prospective study was conducted was between September 2020 to

March 2021. Spot urine proteinuria and serum creatinine levels were determined.
Kidney disease was defined as proteinuria of ≥ 1 + and or eGFR of < 60 ml/
minute/1.73m2 by KDIGO criteria. eGFR was calculated using a) Full Age Spectrum
equation (FAS), b) chronic kidney disease-Epidemiology collaboration (CKD-EPI)
2021 equation, c) CKD EPI 2009 (without and with race factor) equation. CKD was
determined after followed up at 90 days post enrollment.
Results: Out of 357 patients enrolled, KDIGO eGFR criteria of < 60mls / minute
determined using FAS and CKD-EPI 2009 without race factor equations and or
proteinuria of ≥ + 1 showed the highest overall prevalence of kidney disease at
27.2% at baseline. CKD at 90 days was highest at 15.1% with proteinuria ≥+1 and
or KDIGO eGFR criteria of < 60mls/min determined using CKD EPI 2009 without
race factor Equation.
Conclusions: In Africa eGFR should be calculated using FAS and CKD-EPI 2009
without race equations in order to capture a large number of patients with kidney
disease.
Key words: kidney disease, comparison of prevalence of kidney disease, estimated

glomerular filtration rate equations.
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DAY 2 SESSIONS
Sub Theme 8: COVID -19 and
other Emerging and Re-emerging
Diseases
93
IMPACT OF COVID-19 PANDEMIC ON MOBILITY PATTERNS IN THE

KAMPALA METROPOLITAN AREA, UGANDA
*Ezekiel Musasizi¹, Anthony Mugeere², Rogers Nsubuga¹, Bonny Enock Balugaba¹, Otto
Busingye¹, Olive Kobusingye¹
*Corresponding author: Ezekiel Musasizi: emusasizi@musph.ac.ug;

DAY 2 SESSIONS
¹Makerere University School of Public Health, Kampala, Uganda

²Makerere University School of Social Sciences, Kamala, Uganda
Introduction: From March 2020, mobility patterns abruptly changed due to the
enforcement of transport restrictive measures to contain the COVID-19 pandemic.
This study sought to assess the impact of COVID-19 lockdown measures on
mobility patterns in the Kampala Metropolitan area.
Methods: A cross sectional survey was conducted comparing mobility patterns
among 576 commuters (market vendors, health-workers) and 278 transporters
(taxi, boda-boda operators) who were operational before the lockdown and during
the lockdown stages. Data were analyzed using Stata version 14.
Results: We screened 1282 and enrolled 875 participants; market vendors (33.6%),
health-workers (33.4%), taxi operators (16%) and boda-boda operators (16%).
Average age was 36 years (SD=9.8). Taxi operators experienced a decrease in
average working hours, completed trips per day and daily net profit across all stages
(p<0.001) while average duration per trip increased (p<0.001). Boda-boda riders
experienced a consistent decrease in working hours and complete trips made per
day across all lockdown stages from before lockdown to second lockdown (p<0.001
vs p<0.001) respectively. More market vendors 180 (64.4%) and 15 (5.6%) resorted
to walking and cycling respectively during the second lockdown compared to 69
(86.3%) and 6 (7.5%) during the first lockdown (p<0.001). During the first lockdown,
health workers and market vendors spent an average of four times more money on
transport compared to the pre-pandemic costs.
Conclusion: There was a drastic decrease in number of working hours, trips, and
an increased duration of trips for transporters. Walking and cycling became more
predominant as coping mechanisms during the lockdown restrictions.
94
UPTAKE OF COVID-19 VACCINES AND ASSOCIATED FACTORS AMONG

ADULTS IN UGANDA: A CROSS-SECTIONAL SURVEY
Rawlance Ndejjo¹*, Nuole Chen², Steven N. Kabwama³, Alice Namale¹, Solomon T.

Wafula¹, Irene Wanyana⁴, Susan Kizito¹, Suzanne Kiwanuka⁵, William Sambisa⁶, Lily L.
Tsai², Rhoda K. Wanyenze¹
DAY 2 SESSIONS
²Massachusetts Institute of Technology, Massachusetts Avenue, Cambridge, USA
³Department of Community Health and Behavioral Sciences, Makerere University
School of Public Health, Kampala, Uganda
⁴Department of Epidemiology and Biostatistics, School of Public Health, College of
Health Sciences, Makerere University, Kampala, Uganda
⁵Department of Health Policy, Planning and Management, School of Public Health,
⁶Bill & Melinda Gates Foundation, Seattle, Washington, USA
Introduction: The Coronavirus Disease (COVID-19) pandemic remains one of the

most significant public health challenges ever faced globally. The introduction of
COVID-19 vaccines in Africa started with limited access to sufficient quantities, but
is increasingly affected by vaccine hesitancy. It is thus paramount to understand
vaccine uptake. This study assessed the uptake of COVID-19 vaccines and
associated factors among adults in Uganda.
Methods: We conducted a cross-sectional mobile phone survey among adults
across the four regions of Uganda. Data were collected in November 2021, using a
survey questionnaire programmed in SurveyCTO and uploaded on mobile devices.
Respondents were selected using quota sampling based on the COVID-19 case
distribution as of February 2021. Modified Poisson regression analysis was
employed to determine the associated factors with COVID-19 vaccines uptake.
Results: Of the 1,173 respondents, 49.7% had received COVID-19 vaccines with
19.2% having obtained a full dose and 30.5% an incomplete dose. Among the
unvaccinated, 91.0% indicated intention to vaccinate. Major reasons for vaccine
uptake were protection of self from COVID-19 (86.8%) and a high perceived risk
of getting the virus (19.6%). On the other hand, non-uptake was related to vaccine
unavailability (42.4%), lack of time (24.1%), and percieved safety (12.5%) and
effectiveness concerns (6.9%). The factors associated with receiving the COVID-19
vaccines were older age (≥ 65 years) (APR = 1.32 (95% CI: 1.08 – 1.61), secondary
(APR = 1.36 (95% CI: 1.12 – 1.65), or tertiary education (APR = 1.62 (95% CI:
1.31 – 2.00), and health workers as a source of information on COVID-19 (APR
= 1.26 (95% CI: 1.10 – 1.45). Also, those who reported having a medium-income
(APR = 1.24 (1.02 – 1.52) and those resident in Northern (APR = 1.55, 95%CI 1.18
– 2.02) and Central regions (APR = 1.48, 95%CI 1.16 – 1.89) had a higher uptake
of COVID-19 vaccines.
95
Conclusions: Uptake of COVID-19 vaccines was moderate in this sample and

was associated with older age, secondary and tertiary education, medium-income,
region of residence, and health workers as a source of COVID-19 information.
Efforts are needed to increase access to vaccines and should utilise health workers
as champions to enhance uptake.
DAY 2 SESSIONS
ENHANCING THE CAPACITY OF CHWS ON EPIDEMIC AND PANDEMIC

PREPAREDNESS AND RESPONSE (INCLUDING COVID-19) IN WAKISO
DISTRICT
Grace Biyinzika Lubega¹ , David Musoke1 , Filimin Niyongabo¹ , Michael Brown² , Linda
Gibson²
¹Makerere University School of Public Health, ²Nottingham Trent University
Background: Due to the COVID-19 travel restrictions, Community Health Workers

(CHWs) became one of the most important and central human resources for health
especially in places without walkable distances to health facilities (geographic
barriers) and inadequate healthcare workers. However, many CHWs were not
knowledgeable about COVID-19.
Objective and Methodology
To enhance the capacity of communities to prepare and respond to epidemics and

pandemics, Makerere University School of Public Health (MakSPH) in partnership
with Nottingham Trent University UK, trained 766 CHWs in Wakiso district in 2021,
on epidemic and pandemic preparedness and response including COVID-19. Each
2-day participatory training had approximately 30 CHWs. The main topics included:
introduction to epidemics and pandemics; community engagement; contact
tracing; risk communication; frontline protection; and community awareness and
sensitization. Among the CHWs, 7.5% said they had adequate knowledge on
epidemics and pandemics in the pre-training assessment compared 92.8% in the
post-training assessment. Pre-training assessment results also showed that CHWs
who said they had knowledge and skills required in community engagement, risk
communication and contact tracing were 65.7%, 55.6% and 30.0% compared to
99.4%, 99.4% and 97.9% in the post-training assessment respectively. Furthermore,
65.9% said that they knew how to protect themselves while responding to epidemics
and pandemics during the pre-training assessment compared to 100% in the post-
training assessment.
Conclusion: It is evident from the assessments that CHWs were able to enhance
their capacity on their knowledge and skills on epidemics and pandemics. This
96
reinforces CHWs can prevent, detect, investigate and respond to pandemics when
trained and knowledgeable.
PATTERNS OF TB CASE NOTIFICATION AND TREATMENT OUTCOMES

IN THE CONTEXT OF COVID-19 PANDEMIC: ANALYSIS OF THE
DAY 2 SESSIONS
NATIONAL SURVEILLANCE DATA FOR JANUARY 2019-JUNE 2021
Veronicah Masanja1,2*, Benon Kwesiga¹, Robert Majwala², Stavia Turyahabwe², Daniel

Kadobera¹, Alex R. Ario¹
¹Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda

²National TB and Leprosy Control Program, Ministry of Health, Kampala, Uganda
*Correspondence: Veronicah Masanja, +256775511542, vmasanja@ musph.ac.ug
Background: TB case notification and outcomes monitoring are critical for

TB control, but can both be disturbed by interruptions to normal health system
functioning. The first major wave of COVID-19 in Uganda occurred during August-
December 2020. The government-imposed lockdown measures during March-
June 2020 during which residents were required to stay at home. Kampala was
particularly affected by lockdown. We investigated trends and distribution of TB
case notification rates (CNR) and treatment success rates (TSR) during January
2019-June 2021 to determine the association with COVID-19 cases and lockdown.
Methods: We extracted and analysed TB case notification data and treatment
outcomes for January 2019-June 2021 from the District Health Information System.
We computed the TB CNR per 100,000 population. Treatment success was defined
as the proportion of patients initiated on TB treatment that successfully completed
treatment or cured. We described the quarterly trends and distribution of TB CNR
and TSR pre and during COVID-19. We used Interrupted time series analysis to
determine the significance of the trends before and during COVID-19. We defined
time periods by year (2019, 2020, or 2021) and quarter (Q).
Results: The overall TB CNR was 165/100,000; TSR was 79.4%. CNR ranged
from 133/100,000 (2020Q2) to 190/100,000 (2021Q2). CNR declined by 22% from
2020Q1 to 2020Q2, concurrent with the lockdown and rising COVID-19 cases. This
decline was primarily driven by Kampala district for which the CNR declined sharply
from 426/100,000 (2020Q1) to 265/100,000 (2020Q2). In contrast to districts
outside of Kampala, in which CNR increased from 166/100,000 to 188/100,000
over the study period, Kampala’s CNR declined consistently over the study period
from 511/100,000 to 329/100,000. TSR increased by 1.6% (95%CI 1.3-1.9%) on
average each quarter (p<0.0001).
97
Conclusion: CNR appeared to be impacted by the initial lockdown, but recovered

quickly. However, this decline was heavily driven by declines in CNR in Kampala
district. Kampala district CNR trends are not reflective of the rest of the country
during 2019-2021 and should be examined separately. TSR increased over time
but was still below the 90% target. There may be a need to focus continuity of TB
care interventions in the future in areas heavily affected by lockdowns.
DAY 2 SESSIONS
Keywords: TB case Notification, Treatment success rates, Trends, Uganda
LEVERAGING DIGITAL TOOLS TO HARNESS COMMUNITY FEEDBACK

AND INFORM PROGRAM DESIGN DURING THE COVID-19 PANDEMIC
RESPONSE IN UGANDA.
J.Banonya¹, J.Atuhaire¹, L.H.Kamulegeya¹, M.Amutorine³,I.Epejja⁴, P.Mugabe⁶,
L.Bufumbo⁶, B.Asiimwe⁶, J.Ssekinkuse⁵, B.Tushabe⁵, J.Nakate⁷, J.Ssenkumba¹,
N.Umuhoza¹, I.Kagolo¹, A.Tugume⁷, T.Bakyaita⁷, D.Musinguzi¹,J.M Bwanika1,2, G.
Mkandawire⁶
¹The Medical Concierge Group Limited, Kampala, Uganda, ²Infectious Diseases Institute
Limited, Kampala, Uganda., ³UNICEF ,⁴RedCross Uganda, ⁵Community for Development
Foundation Uganda ,⁶John Hopkins University-Centre for Communications programs,
⁷Ministry of Health.
Introduction: Community involvement in disease outbreaks is key to achieving
control and early recovery. Digital tools offer great potential as platforms that
facilitate feedback collection at scale to support prompt decision-making.
Methodology: Digital platforms (social media, hotlines, SMS, radio) were used to
collect audience conversations on COVID-19 by a consortium of partners led by the
Uganda Ministry of health social listening and evidence generation subcommittee.
Results: Between June 2021 and June 2022, 1619 Covid-19 conversations were
captured into the DHIS2 about beliefs, misconceptions, gender-norms issues
and feedback suggestions. Of the 1619 conversations captured,1337(83%)
were beliefs, 220(14%) misconceptions, 28(2%) gender-norms issues, 3(0.2%)
feedback suggestions and 31(2%) were questions that needed expert feedback.
Generally, the public had concerns about understanding COVID-19 in its broad
sense, and some 124(8%) continued to deny COVID-19 as an illness, 52(3%) had
fear for the perceived severity of the disease while 45(3%) got so worried about
its mode of transmission. On introducing the vaccine, 371(22%) raised concerns
about the vaccine’s side effects, 316(20%) were concerned about the vaccine’s
original development and safety while others were concerned about the vaccine’s
deployment, eligibility, and access. Most of such concerns arose from the beliefs
and misconceptions that the public held about covid-19 such as 93(6%) believed
98
that covid-19 doesn’t exist, 52(3%) believed that Covid-19 only affected specific
people and 14(0.9%) believed that certain foods/drinks could cure or prevent
covid-19.
Conclusion: Digital channels allow for a wider audience reach when collecting
feedback to inform decisions making during epidemic outbreaks.
DAY 2 SESSIONS
SEXUAL AND GENDER-BASED VIOLENCE AMONG ADOLESCENT GIRLS
AND YOUNG WOMEN DURING THE MAIN COVID-19 PERIOD IN BUKEDI
SUBREGION, EASTERN UGANDA
Patience Mwine1,3*, Benon Kwesiga1,2, Richard Migisha1,2, Juliet Cheptoris³, Daniel
Kadobera1,2, Lillian Bulage1,2, Peter Mudiope3, Rose Apondi4, Alex R. Ario1,2, Julie R.
Harris4
¹Uganda Public Health Fellowship Program, Kampala, Uganda, ²Uganda National

Institute of Public Health, Kampala, Uganda, ³AIDS Control Program, Ministry of Health,
Kampala, Uganda, ⁴United States Centers for Disease Control and Prevention, Kampala,
Uganda
*Corresponding author: Patience Mwine, +256702449738, pmwine@musph.ac.ug
Background: Police reports of Sexual Gender-Based Violence (SGBV) in Uganda

increased during the COVID-19 pandemic. Uganda’s Bukedi subregion reports the
highest rates of SGBV in the country among women (40% in 2016). Adolescent
girls and young women (AGYW) aged 10-24 years are at the highest risk of SGBV.
We investigated factors associated with SGBV among AGYW in Bukedi subregion
during the COVID-19 pandemic.
Methods: We collected descriptive data on all AGYW aged 10-24 years who had
obtained SGBV health services at ten high-volume health facilities from March
2020 to December 2021, when most COVID-19 cases were reported in Uganda.
We conducted a case-control study among AGYW during this period. A case was
≥1 SGBV episode (coerced sexual intercourse) experienced by an AGYW aged
10-24 years residing in Tororo and Busia Districts. For every case, we identified two
neighbourhood-matched AGYW controls who reported no SGBV. We interviewed
108 randomly-selected cases from health facility line lists and 216 controls on
socio-demographic characteristics, socioeconomics, and SGBV experiences
during COVID-19. We conducted logistic regression to obtain adjusted odds ratios
and confidence intervals.
Results: Among 389 SGBV cases, mean age was 16.4 (SD± 1.6: range 10-24)
years, and 350 (90%) were aged 15-19 years. Among 108 cases interviewed, 79
99
(73%) reported forced sex. Most (73; 68%) knew the perpetrator. In multivariate
analysis, self-reported SGBV before the COVID-19 period [aOR=5.8, 95%CI: 2.8-
12)] and having older siblings [aOR=1.9, 95%:CI 1.1-3.4] were associated with
SGBV during the COVID-19 period. Living with a family that provided all the basic
Conclusion: Previous SGBV and having families who could not provide basic
DAY 2 SESSIONS
needs were associated with increased odds of SGBV during the COVID-19
pandemic in Uganda. Finding, supporting, and enacting protective interventions for
existing SGBV victims and socioeconomically vulnerable AGYW could reduce the
burden of SGBV during similar events in the future.
Keywords: Sexual Gender-Based Violence. Adolescent Girls and Young Women,

COVID-19
LEVERAGING CAPACITIES BUILT DURING COVID-19 PANDEMIC AND

PAST EBOLA VIRUS DISEASE PREPAREDNESS AND RESPONSE
FOR FUTURE PUBLIC HEALTH EMERGENCIES: A CASE OF KASESE
DISTRICT, UGANDA, 2021.
Daniel Eurien1*, Peter Elyanu¹, Wilbrod Mwanje², Issa Makumbi2,3, Denis Okethwangu3,
Maureen Nyonyintono3, John Anguzu³, Samuel Muhindo⁴, Yusuf Baseka4, Atek
Kagirita3, Allan Muruta3, Solome Okware4, Lilian Bulage⁵, Sandra Nabatanzi⁶, Joseph
Ojwang⁶, Amy Boore⁶, Alex Riolexus Ario3,5, Felix Ocom2,5
¹Baylor College of Medicine Children’s Foundation, Kampala, Uganda

²Public Health Emergency Operations Center, Ministry of Health, Uganda
³Ministry of Health, Kampala, Uganda
⁴Kasese District Local Government
⁵World Health Organization Country Office, Kampala, Uganda
⁶Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
⁷United States of America Centers for Disease Control and Prevention, Kampala, Uganda
Background: Uganda faces a constant threat of Ebola Virus Disease (EVD)

importation from the neighbouring Democratic Republic of Congo (DRC), a hotspot
for EVD outbreaks. In February 2021, DRC confirmed its 12th EVD outbreak, and
Uganda especially Kasese District was listed as high risk for EVD importation due
to proximity to the hotspot in DRC. To inform the National EVD preparedness and
response plan, we assessed the preparedness of Kasese district to determine
if preparedness and response capacities built during the past EVD outbreak in
2019 and during the COVID-19 pandemic in 2020 could be leveraged in case of
an outbreak.
Methods: We cross-sectionally assessed EVD preparedness in Kasese district using
100
an adapted World Health Organization (WHO) EVD Consolidated Preparedness

Checklist, and WHO strategic risk assessment tool for ground crossing and cross-
border collaboration during February, 2021. The checklist consisted 12 preparedness
domains including contact tracing, surveillance, logistics, management, risk
communication, rapid response teams, safe burials, infection prevention and
control (IPC), Points of Entry (PoE), laboratory, coordination, case management,
DAY 2 SESSIONS
and the budget component. Each of the 12 domains comprised a varying number
of components. The outcomes were scored as complete or incomplete. The
checklist was administered to 6 key informants in the districts including the District
Surveillance focal person, District COVID-19 task force chair, Two PoE officials, the
Bwera Hospital EVD treatment unit lead, and one partner supporting COVID-19 and
EVD response. We computed the completeness of preparedness for each domain
by calculating the proportion of completed components and the overall score by
calculating the average score of the 12 domains. A score equal to or greater than
80% indicated operational readiness to respond to an EVD outbreak.
Results: A total of 6 Key informants were interviewed. The district overall

preparedness score was 89%. Eleven out of 12 domains scored ≥ 80%, above the
minimum national prepared threshold score (Fig 1). This is due to the crosscutting
functions of domain components for both EVD and COVID-19 preparedness and
response. Investments made during the COVID-19 pandemic, therefore, reinforced
those made during the 2019 EVD preparedness and response. Only the budget
domain scored 60%. This is because the district had depleted contingency funds in
response to COVID-19. Secondly, the district lacked an established compensation
mechanism in case of infection or death of responders.
The results from the assessment were used for updating both the national and
district EVD preparedness and response plan with a focus on integrating COVID-19
and EVD activities.
Conclusion: EVD preparedness and response capacities in Kasese district were

above the national threshold and was ready to respond to an EVD outbreak.
Sustained capacities were those built during the 2019 EVD outbreak and COVID-19
pandemic. Budgetary capacities should therefore be strengthened through ring-
fencing contingency funds using an “all hazard” approach. Kasese district has
demonstrated that preparedness and response investments of past emergencies
can be sustained and used to prepare and respond to any future public health
emergencies.
101
ASSESSMENT OF PREPAREDNESS OF BORDER DISTRICTS TO

RESPOND TO PLAGUE-WEST NILE REGION, UGANDA- AUGUST, 2021
Immaculate Atuhaire¹* Doreen N. Gonahasa¹, Sandra Nabatanzi⁴, Bob o. Amodan¹John
Opolot¹, Felix Ocom³, Linda Atiku⁵, Titus Apangu⁵, Jimmy Felix Okoth⁵, Gordian Candini⁵,
Ignatius Wadunde1, Andrew Kwiringira1, Shaban Senyange¹, Patience Mwine1, Edirisa
Nsubuga¹, Hildah Nansikombi¹, Sherry Ahirirwe¹, Godfrey Ekuka³, Alfred Wejuli³, Benon
DAY 2 SESSIONS
Kwesiga¹, Daniel Kadobera, Julie Harris⁴, and Alex R. Ario1,3
¹Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda

²Public Health Emergency Operations Center, Ministry of Health, Kampala, Uganda
³Ministry of Health, Kampala, Uganda
⁴US Centre for Disease Control
⁵Uganda Virus Research Institute
Background: Ituri Province in Democratic Republic of Congo (DRC) is a hotspot

for plague, with occasional crossing of case-patients into Uganda. As of June 2021,
117 cases were reported in Ituri Province, DRC. In August 2021, we evaluated the
risk of plague importation into West Nile region of Uganda and assessed the level
of preparedness to respond.
Methods: We used the Population Connectivity Across Borders toolkit to assess

risk of plague introduction in 6 West Nile districts and one city. We categorized
risk in districts based on previous cases, volume of cross-border movements, and
proximity to the outbreak epicenter in DRC. We assessed districts’ preparedness to
respond using an adapted WHO checklist and Readyscore criteria (scores <40%=
’not prepared’). We assessed 47 health facilities across six West Nile districts for
response readiness in terms of healthcare worker training, availability of standard
operating procedures, and training of village health teams.
Results: Two districts (Arua and Zombo) in West Nile were in the highest-risk
category for plague importation. All districts scored as ‘not prepared’, although
Zombo and Arua scored higher (both 39%) than other districts. Of 47 health facilities
assessed, 21 were ‘not ready’, and no facility was ‘prepared’. Only 10 had staff who
had been trained in plague-related activities.
Conclusion: No districts or health facilities in the area assessed were prepared to

respond to potential plague importation. The risk of importation is high, especially
in Arua and Zombo Districts. Arua and Zombo Districts should be prioritized for
preparedness activities for a potential plague outbreak.
Key words: Plague, Cross border, preparedness and readiness, Uganda
102
DAY 2 SESSIONS
Sub Theme 9: Antimicrobial
Resistance
103
Molecular basis of the Rhesus D negative phenotype in the Ugandan

population
Sanyu M. Nassuuna¹*(BSc, MSc) Lillian A Nairuba¹ (BSc), Sam L. Nsobya² (MSc, PhD),
Dennis M. Kasozi¹ (MSc, PhD)
¹Department of Biochemistry and Sports Science, School of Biosciences, College of

DAY 2 SESSIONS
Natural Sciences, Makerere University Kampala.

²Department of Pathology, School of Biomedical sciences, College of Health Sciences,
Makerere University Kampala.
*Presenting author: Sanyu M. Nassuuna, mariam.sanyu2@gmail.com, Tel. No. 256
706 181040
INTRODUCTION: The human Rhesus (Rh) system is an important blood group

after the ABO blood group system in transfusion therapy. Routinely at blood
transfusion centers, RhD phenotype is tested resulting into RhD-positive or RhD-
negative depending on the presence or absence of the D antigen. However, there
is limited information on molecular basis of Rhesus D negative phenotype in the
Ugandan population.
OBJECTIVES: To determine frequency of RHD gene deletion (RHD*01N.01),

RHDΨ pseudogene (RHD*08N.01) and RHD-CE-Ds hybrid gene underlying RhD-
negative phenotype.
METHODS: Rh D-negative blood samples were collected from Nakasero blood

Bank in Kampala, Uganda. A total of 200 blood samples were analyzed by allele
specific Polymerase chain reaction (PCR) methods. RHD gene deletion was
determined by genotyping RhD intron 4 and exon 10. Multiplex PCR was for six
exons of RhD. RHDΨ pseudogene and RHD-CE-Ds hybrid gene were analyzed by
allele specific PCR.
RESULTS: The study revealed that the most prevalent cause of RhD negativity
was due to the presence of the RHDΨ gene (48%) followed by complete deletion of
the D gene (33%). In addition, 12% were due to deletion of exons 3, 4, 5, & 7; 2.5%
due to deletion of exons 3,4,&7; 1.5% to deletion of exon 5 ; 1% to deletion of exon
4; 0.5%deletion of exons 3&4 and 0.5% to deletion of exons 4&7 from the D gene.
CONCLUSION: In conclusion, our study reported that the cause of RHD negativity
in the study population was majorly due to presence of RHDΨ gene.
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ANTIBIOTIC RESISTANCE PATTERNS IN COMMENSAL AND PATHOGENIC

BACTERIA IN POULTRY IN UGANDA
Ceaser A Nyolimati¹, Jonathan Mayito¹, Richard Erechu², Deo Birungi Ndumu²,
Emmanuel Isingoma², Christopher Lubega¹, Esther Nabatta¹, Hannington Kato¹, Simon
Kasango¹, Stella Atim², Richard Walwema¹, Francis Kakooza¹, Anna Rose Ademun²,
DAY 2 SESSIONS
Denis Byarugaba³, Mohammed Lamorde¹
¹Infectious Diseases Institute, ²Ministry of Agriculture, Animal Industry and Fisheries,

³Makerere University, College of Veterinary Medicine, Animal Resources and
Biosecurity.
Background: Antimicrobial resistance (AMR) in food-animals threatens public
health and food security. Poultry farming uses antimicrobials for disease prevention,
treatment, and growth promotion. We determined AMR profiles of commensal and
pathogenic bacteria in poultry on Ugandan farms.
Methodology: Between June 2019 and March 2020, faecal samples were collected
from healthy chicken from 145 farms in Wakiso and Mbarara districts. Conventional
methods were employed for bacterial identification while susceptibility testing was
by Kirby-Bauer disc diffusion on Mueller-Hinton agar.
Results: 1,138 isolates were recovered from 715 samples. Escherichia coli, 38.6%
(n=439), was recovered most from non-pooled samples, then Enterococcus spp.,
37% (n=425), Salmonella spp., 8.5% (n=97), and Campylobacter spp., 4.1% (n=47).
Only E. coli, 7.9% (n=90), and Enterococcus spp. 3.3% (n=38) were recovered
from pooled samples.
Non-pooled samples E. coli was 95.9% resistant to cotrimoxazole, 95.4% to

tetracycline, and 51.9% to ciprofloxacin. Salmonella spp., (n=97), was 100%
resistant to tetracycline, 86.6% to cotrimoxazole, and 63.9% to chloramphenicol.
Campylobacter spp., (n=46) had 100% resistance to tetracycline, 100% to
ciprofloxacin and 90% to streptomycin. Enterococcus spp. were 38.8% and 23.1%
resistant to ampicillin and vancomycin respectively. Pooled samples E. coli (n=90)
was 98%, 96% and 88% resistant to tetracycline, cotrimoxazole, and ampicillin
respectively.
E. coli (n=41) resistance to tetracycline (100%) and cotrimoxazole (95%) was

higher in layers than broilers (n=41) at 95% and 85% respectively. Ciprofloxacin
resistance was similar at 78%.
Conclusion: Poultry commensal and pathogenic bacteria showed high resistance

to common antibiotics. Antimicrobial resistance surveillance in animal sector needs
to be strengthened.
105
THE UTILITY OF THE BIOFIRE FILMARRAY PNEUMONIA PANEL IN

DETECTION OF ANTIMICROBIAL RESISTANCE IN PATIENTS WITH HIV
HOSPITALIZED WITH PNEUMONIA
William Worodria1,2,3,4, Alfred Andama2,4, Ingvar Sanyu², Daniel Orit⁴, Richard Kwizera³,
Abdul Sessolo², Patrick Byanyima², Josephine Zawedde², Sylvia Kaswabuli², Fred
DAY 2 SESSIONS
Semitala2,4, Adithya Cattamanchi⁵, David R Boulware⁶, Laurence Huang⁵
¹Department of Medicine, Mulago National Referral Hospital, Kampala, Uganda,

²Infectious Disease Research Collaboration, Kampala, Uganda, ³Infectious Disease
Institute, Kampala, Uganda, ⁴Department of Medicine, Makerere College of Health
Sciences, Kampala, Uganda, ⁵University of California, San Francisco, California, United
States, ⁶University of Minnesota, Minnesota, USA
Background: Lower respiratory infections (LRTIs) are a leading cause of mortality

in patients living with HIV (PLWH) despite increasing use of Antiretroviral Therapy.
This is further compounded by increasing antimicrobial resistance (AMR) globally.
Culture and drug susceptibility testing (DST) of respiratory samples is critical for
timely decision making in PLWH who are hospitalized with pneumonia. However,
these tests have a long turn around during which may delay appropriate switch
of antibiotics in patients with AMR. The Biofire FilmArray Pneumonia Panel
(FilmArrayPN-PCR) is a molecular test that detects seven genomic markers of
resistance in common respiratory pathogens which can rapidly inform clinicians on
the choice of therapy for LRTIs.
In a prospective cohort we set out to determine the prevalence of AMR and
associated factors in PLWH hospitalized with pneumonia by sputum culture and the
FilmArrayPN-PCR.
Methods: We enrolled PLWH hospitalized with clinically diagnosed pneumonia with
respiratory symptoms less than two months and excluded those with a diagnosis
of tuberculosis, chronic obstructive lung disease, cardiac disease, or underlying
malignancy. Spontaneously expectorated sputum was collected for culture and
DST and for FilmArrayPN-PCR. We compared characteristics of participants who
had AMR resistance detected with those without, and determined the sensitivity
and specificity of the FilmArrayPN-PCR for detection of AMR, considering sputum
culture and DST as the gold standard.
Findings: The 107 participants enrolled had a median age 39.7 years (interquartile
range (IQR), 31.0-45.9 years) and 50.5% (54/107) were female. The median
duration of cough was 3 weeks (IQR, 1-4), and 74.8% (80/107) had prior antibiotic
use.
AMR was detected in 31.7% (34/107) participants, 18.6% (20/107) were detected
on culture and 25.2% (27/107) by FilmArrayPN-PCR. Thirteen participants (38.2%)
had resistance detected by both methods. A majority of participants detected by
106
both methods 12/13 (92.3%) were diagnosed with K pneumoniae and had multi
drug-resistance and all had CTX-M resistance mutations.
The sensitivity of FilmArrayPN-PCR compared to culture was 65% (95%CI 40.8%-
84.6%) and the specificity was 83.9% (95%CI 74.5%-90.9%). The ROC was 0.75
(95%CI 0.63-0.86). The positive and negative predictive values were 48.1% (95%CI
DAY 2 SESSIONS
28.7%-68.1%) and 91.3% (95%CI, 82.8%-96.8%) respectively.
Conclusion: FilmArrayPN-PCR has moderate sensitivity but a high specificity for
diagnosis of AMR in hospitalized PLWH with pneumonia.
Recommendation: FilmArrayPN-PCR should be used for surveillance of AMR but
cost effectiveness studies need to be conducted to establish its role in antimicrobial
stewardship.
Anti-mycobacterial and synergistic activity of synthetic acridine-9-

carboraldehyde and 9-hydroxy-4-methoxy acridine alkaloids against
clinical isolates of multidrug-resistant Mycobacterium tuberculosis
Lydia Bunalema, Moses Ocan, Godfrey S. Bbosa, Aloysious Lubega , Hindum Lanyero,
Immaculate Neheza
Background: Tuberculosis treatment has become difficult due to development

of strains that are resistant to both first and second-line anti-TB drugs. This calls
for a continued development of new drugs with novel targets against multi and
extensively drug-resistant strains of M. tuberculosis. The aims of the study were; i)
to determine the antimycobacterial activity of two synthetic alkaloids i.e., acridine-
9-carboraldehyde and 9-hydroxy-4-methoxy acridine on both susceptible and
multidrug-resistant TB clinical isolates and ii) to determine interactions between the
alkaloids and anti-TB drugs iii) to determine the toxicity profile of the most active
alkaloid
Methods: Resazurin reduction microplate assay (REMA) was used to determine
the minimum inhibitory concentrations of acridine-9-carboraldehyde and 9-hydroxy-
4-methoxy acridine as well as their interactions with conventional anti-TB drugs ie
isoniazid, rifampicin and ciprofloxacin.
Results: Acridine-9-carboraldehyde was active on both susceptible and multidrug-
resistant strains of TB with minimum inhibitory concentrations of 0.238 µg/mL and
0.108 µg/mL on the pan-sensitive and clinical susceptible strains and 0.157 µg/
mL and 0.196 µg/mL on the rifampicin resistant and multidrug-resistant strains
respectively. In addition, acridine-9-carboraldehyde was synergistic to both
rifampicin and levofloxacin with a fractional inhibitory concentration index of ≤ 0.5.
107
Conclusion: Acridine-9-carboraldehyde is active against clinical isolates of

multidrug-resistant M. tuberculosis. And it is synergistic with rifampicin and
levofloxacin on susceptible and multidrug-resistant M. tuberculosis.
CHARACTERIZING PYRETHROID RESISTANCE AND MECHANISMS IN

DAY 2 SESSIONS
ANOPHELES GAMBIAE S.S. AND ANOPHELES ARABIENSIS FROM 11

DISTRICTS IN UGANDA
Henry Ddumba Mawejje1,2*, David Weetman³, Adrienne Epstein³, Amy Lynd³, Jimmy
Opigo⁶, Catherine Maiteki‑Sebuguzi⁶, Jo Lines², Moses R. Kamya,⁵, Philip J. Rosenthal4,
Martin J. Donnelly³, Grant Dorsey⁴ and Sarah G. Staedke²
Background: Insecticide resistance threatens recent progress on malaria control

in Africa. To characterize pyrethroid resistance in Uganda, Anopheles gambiae s.s.
and Anopheles arabiensis were analyzed from11 sites with varied vector control
strategies.
Methods: Mosquito larvae were collected between May 2018 and December
2020. Sites were categorized as receiving no indoor-residual spraying (‘no IRS’,
n=3); where IRS was delivered from 2009-2014 and in 2017 and then discontinued
(‘IRS stopped’, n=4); and where IRS had been sustained since 2014 (‘IRS active’,
n=4). All sites received long-lasting insecticidal nets (LLINs) in 2017. Larvae were
raised to adults and exposed to diagnostic concentrations of pyrethroids; assays
with piperonyl butoxide (PBO) were also performed. An. gambiae s.s. and An.
arabiensis were speciated using PCR. An. gambiae s.s. were genotyped for Vgsc-
995S/F, Cyp6aa1, Cyp6p4, ZZB-TE, Cyp4j5, and Coeae1d, while An. arabiensis
were examined for Vgsc-1014S/F.
Results: In total, 2,753 An. gambiae s.l., including 1,105 An. gambiae s.s., and
1,648 An. arabiensis were evaluated. Species composition varied by site; only
nine An. gambiae s.s. were collected from ‘IRS active’ sites, precluding species-
specific comparisons. Overall, mortality following exposure to permethrin and
deltamethrin was 18.8% (148/788) in An. gambiae s.s. and 74.6% (912/1,222)
in An. arabiensis. Mortality was significantly lower in An. gambiae s.s. than An.
arabiensis in ‘no IRS’ sites (permethrin: 16.1% vs 67.7%, p<0.001; deltamethrin:
24.6% vs 83.7%, p<0.001) and in ‘IRS stopped’ sites (permethrin: 11.3% vs
63.6%, p<0.001; deltamethrin: 25.6% vs 88.9%, p<0.001). When PBO was added,
mortality increased for An. gambiae s.s., and An. arabiensis. Most An. gambiae s.s.
had the Vgsc-995S/F mutation (95% frequency) and the Cyp6p4 resistance allele
(87%), while the frequency of Cyp4j5 and Coeae1d were lower (52% and 55%,
respectively).
Conclusions: Resistance to pyrethroids was widespread across Uganda,
108
and higher in An. gambiae s.s. than An. arabiensis. Where IRS was active,
An. arabiensis dominated. Addition of PBO to pyrethroids increased mortality,
supporting deployment of PBO LLINs in Uganda. Further surveillance of insecticide
resistance and assessment of associations between genotypic markers and
phenotypic outcomes are needed to better understand mechanisms of pyrethroid
resistance and to guide vector control.
DAY 2 SESSIONS
ANTIBIOTIC PREVALENCE STUDY AND FACTORS INFLUENCING
PRESCRIPTION OF WHO WATCH CATEGORY ANTIBIOTIC CEFTRIAXONE
IN A TERTIARY CARE PRIVATE NOT FOR PROFIT HOSPITAL IN UGANDA.
Kizito Mark
Introduction: Excessive use of ceftriaxone contributes to the emergence and
spread of antimicrobial resistance (AMR). In low and middle-income countries,
antibiotics are overused but data on consumption are scarcely available.
Objectives: We aimed to determine the prevalence and factors influencing
ceftriaxone prescription in a tertiary care private not-for-profit hospital in Uganda.
Methods: A cross-sectional study was carried out from October 2019 through
May 2020 at Mengo Hospital in Uganda. Patients admitted to the medical ward
and who had been prescribed antibiotics were enrolled. Socio-demographic and
clinical data were recorded in a structured questionnaire. Bivariate and adjusted
logistic regression analyses were performed to determine factors associated with
ceftriaxone prescription.
Results: Study participants were mostly female (54.7%). The mean age was 56.2
years (SD: 21.42). The majority (187, 73.3%) presented with fever. Out of the
255 participants included in this study, 129 (50.6%) participants were prescribed
ceftriaxone. Sixty-five (25.5%) and 41 (16.0%) participants had a prescription
of levofloxacin and metronidazole respectively. Seven participants (2.7%) had
a prescription of meropenem. Out of 129 ceftriaxone prescriptions, 31 (24.0%)
were in combination with other antibiotics. Overall, broad-spectrum antibiotic
prescriptions accounted for 216 (84.7%) of all prescriptions. Ceftriaxone was
commonly prescribed for pneumonia (40/129, 31%) and sepsis (38/129, 29.5%).
Dysuria [OR= 0.233, 95% CI (0.07- 0.77), p= 0.017] and prophylactic indication
[OR= 7.171, 95% CI (1.36- 37.83), p= 0.020] were significantly associated with
ceftriaxone prescription.
Conclusions: Overall, we observed a high prevalence of prescription of ceftriaxone
at the medical ward of Mengo Hospital. We recommend an antibiotic stewardship
program (ASP) to monitor antibiotic prescription and sensitivity patterns in a bid to
curb AMR.
109
Establishment of an Antimicrobial resistance surveillance program in the

Water and Environment Sector in a resource-limited setting: Uganda’s
experience
Herman Mwanja¹, Godfrey Katumba², Jonathan Mayito¹, Fred Isaasi¹, Judith Namumbya²,
David Musoke³, Jonathan Kabazi⁵, Betty Mbolanyi², Stella A. Atim⁶, Musa Sekamatte4,
DAY 2 SESSIONS
Lillian Idrakua², Richard Walwema¹, Francis Kakooza¹, Simon Etimu S. E², Mohammed
Lamorde¹
¹Infectious Diseases Institute, ²Ministry of Water and Environment, ³Makerere

University School of Public Health, ⁴One Health Coordination Office, ⁵Central Public
Health Laboratories, Ministry of Health, ⁶Ministry of Agriculture Animal Industry and
Fisheries.
Background: Antimicrobial irrational use and poor disposal in human and animal
sectors promote antimicrobial resistance (AMR) in the environment. While AMR
containment programmes in these sectors are well established, those in the water
and environment sector are not. We present Uganda’s experience in establishing
and implementing an AMR surveillance programme in the water and environment
sector.
Methodology: A stepwise approach was employed: a constituted technical working
group oversaw the programme design and implementation, including; surveillance
plan, surveillance protocol, and laboratory standard operating procedures
development. A hybrid of passive and targeted active surveillance was employed.
Passive surveillance targeted remnants of ground, surface, and waste water
samples for water quality assessment while active surveillance supplemented
passive surveillance. One Health sectoral collaboration was critical: human and
animal national reference laboratories and microbiology experts supported training,
testing, isolate storage, and data interpretation.
Results: Overall, isolates (n=158) had 83.0% (95%CI: 75.7-88.5%) resistance to
ampicillin, 39.7% (95%CI: 31.7-48.3%) to trimethoprim/sulfamethoxazole, 32.1%
(95%CI: 22.6-43.3%) to ciprofloxacin and 27.0% (95%CI: 18.4-37.6) to cefotaxime.
Escherichia coli (n=48) had a 79.2% (95%CI: 64.6-89.0%) resistance to ampicillin,
59.1% (95%CI: 43.3-73.3%) to trimethoprim/sulfamethoxazole, 26.3% (95CI: 14.0-
43.4) to ciprofloxacin and 50% (95%CI: 28.8-71.2%) to cefotaxime. Klebsiella
pneumoniae (n=49) had a 98% (95%CI: 87.8-99.9%), 27.1% (95%CI: 15.7-42.1%),
16.7% (95%CI: 0.9-63.5), and 6.8% (95%CI: 0.0-53.7) to ampicillin, trimethoprim/
sulfamethoxazole, ciprofloxacin and cefotaxime respectively.
Conclusion: Initial efforts to implement AMR surveillance in water and environment
succeeded in isolating and detecting resistant pathogens in waste, surface, ground,
and drinking water. Sustained AMR surveillance is needed in the environmental
sector.
110
BACTERIAL CONTAMINATION OF HOSPITAL SURFACES AND THEIR

RESISTANCE PROFILES AT REGIONAL REFERRAL HOSPITALS IN
UGANDA
Daniel Kibombo¹, Jonathan Mayito¹, Simon D. Kasango¹, Dickson Tabajjwa¹, Barigye
Celestine², Namasope Sophie³, James Elima⁴, Stephen Obbo⁵, Onyachi Nathan⁶,
DAY 2 SESSIONS
Michael Mwanga⁷, Francis Kakooza¹, Richard Walwema¹, Mohammed Lamorde¹
¹Infectious Diseases Institute, Makerere University, ²Mbarara Regional Referral

Hospital, ³Kabale Regional Referral Hospital, ⁴Gulu Regional Referral Hospital
⁵Lira Regional Referral Hospital, ⁶Masaka Regional Referral Hospital, ⁷Soroti Regional
Referral Hospital
Background: Hospital-acquired infections (HAIs) complicate hospitalization,

increasing hospital stay, healthcare costs, morbidity and mortality, worsening with
multi-drug resistant infections.
Uganda HAI prevalence is eight-times that for western countries but resistance
profiles of bacteria colonizing hospital surfaces are unknown. Therefore, the aim
was to determine the bacteria colonizing hospital surfaces and their resistance
profiles at six Regional Referral Hospitals.
Methods: Door-handles, wards and theatre beds, patient files, staff hands,
tables and screens were swabbed using sterile swabs with Amies transport
media, emulsified in Brain Heart Infusion, and sub-cultured on 5% sheep blood
and MacConkey agar with Crystal violet. Bacterial identification and antibiotic
susceptibility testing were by conventional methods and Kirby-Bauer disc diffusion
on Mueller Hinton agar respectively.
Results: 296/333 (88.9%) samples had growth, of which 234 (79%) were of clinical
significance, mostly from beds (22%, 66), tables (17%, 50) and hand-washing sinks
(13%, 39). ESKAPE pathogens dominated, (178/234, 76.1%): Klebsiella spp (63,
26.9%), Acinetobacter spp (57, 24.4%), Enterococcus spp (36, 15.4%), Escherichia
coli (24, 10.3 %), Pseudomonas spp (13, 5.6%), and Enterobacter spp (9, 3.8%).
Notably, no Staphylococcus aureus was recovered.
All Gram-negative and Enterococcus spp isolates were multidrug-resistant.
Acinetobacter spp, Klebsiella spp, Escherichia coli and Enterobacter spp resistance
to ceftriaxone was 96%, 69%, 70%, and 89% while resistance to imipenem was
12%, 10%, 13% and 11%; respectively. Enterococcus spp resistance to vancomycin
was 25%, while Acinetobacter susceptibility to doxycycline was 93%.
Conclusion: Multidrug-resistant bacteria colonized Uganda hospitals clinical
environment, posing risk for HAIs spread. IPC measures including environmental
cleaning and hand hygiene need strengthening.
111
ANTIBIOTIC-RESISTANCE IN MEDICALLY IMPORTANT BACTERIA

ISOLATED FROM COMMERCIAL HERBAL MEDICINES IN AFRICA FROM
2000 TO 2021: A SYSTEMATIC REVIEW AND META-ANALYSIS
Abdul Walusansa1, 2, 4*, Savina Asiimwe¹, Jesca. L. Nakavuma³, Jamilu. E. Ssenku¹,
DAY 2 SESSIONS
Esther Katuura¹, Hussein. M. Kafeero², Dickson Aruhomukama⁵, Alice Nabatanzi1,

Godwin Anywar¹, Arthur K. Tugume¹, and Esezah K. Kakudidi¹
¹Department of Plant Sciences, Microbiology and Biotechnology, School of

Biosciences, Makerere University, Kampala, Uganda
²Department of Medical Microbiology, Faculty of Health Sciences, Islamic University in
Uganda, P. O. Box 2555, Kampala, Uganda
³College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere
University, P. O. Box 7062, Kampala, Uganda
⁴Department of Medical Microbiology and Immunology, Faculty of Health Sciences,
Busitema University, Mbale, Uganda
⁵Department of Immunology and Molecular Biology, Faculty of Health Sciences,
Makerere University, Kampala, Uganda
Background:
Antimicrobial resistance (AMR) is swiftly increasing all over the world. In Africa, it
manifests more in pathogenic bacteria in form of antibiotic resistance (ABR). On this
continent, bacterial contamination of commonly used herbal medicine (HM) is on
the increase, but information about antimicrobial resistance in these contaminants
is limited due to fragmented studies. Here, we analyzed research that characterized
ABR in pathogenic bacteria isolated from HM in Africa since 2000; to generate a
comprehensive understanding of the drug-resistant bacterial contamination burden
in this region.
Methods: The study was conducted according to standards of the Preferred
Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). We
searched for articles from 12 databases. These were: PubMed, Science Direct,
Scifinder scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library,
International Pharmaceutical Abstracts, Commonwealth Agricultural Bureau
Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR
traits of bacterial isolates, Cochran’s Q test, and the I2 statistic for heterogeneity
were evaluated using MedCalcs software. A random-effects model was used
to determine the pooled prevalence of ABR traits. The potential sources of
heterogeneity were examined through sensitivity analysis, subgroup analysis, and
meta-regression at a 95% level of significance.
Findings: Eighteen studies met our inclusion criteria. The pooled prevalence
of bacterial resistance to at least one conventional drug was 86.51% (95%CI =
112
61.247% to 99.357%). The studies were highly heterogeneous (I2 = 99.17%; p

< 0.0001), with no evidence of publication bias. The most prevalent multidrug-
resistant species was Escherichia coli (24.0%). The most highly resisted drug
was Ceftazidime with a pooled prevalence of 95.10% (95%CI = 78.51 to 99.87%),
while the drug-class was 3rd generation cephalosporins; 91.64% (95%CI= 78.64 to
96.73%). None of the eligible studies tested isolates for Carbapenem resistance.
DAY 2 SESSIONS
Extended Spectrum β-lactamase genes were detected in 89 (37.2%) isolates,
mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids
were found in 6 (5.8%) isolates; the heaviest plasmid weighed 23130 Kilobases,
and Proteus vulgaris harbored the majority (n=5; 83.3%).
Conclusions: Herbal medicines in Africa harbor bacterial contaminants which
are highly resistant to conventional medicines. This points to a potential treatment
failure when these contaminants are involved in diseases causation. More research
on this subject is recommended, to fill the evidence gaps and support the formation
of collaborative quality control mechanisms for the herbal medicine industry in
Africa.
Keywords: Africa, Antimicrobial resistance, Bacterial contamination, herbal
medicine, Meta-analysis, Systematic review
113
STUDENT INITIATIVES TO TACKLE ANTIMICROBIAL RESISTANCE
Shaharazad Rebelo Ebrahimi
Co-author: Allysia Funge, Suzan Nakalawa, Nabbanja Carol Esther, Dr Jody Winter, Dr
David Musoke, Dr Gareth McVicker
DAY 2 SESSIONS
Correspondence: shazrebelo@hotmail.co.uk
Background: Antimicrobial Resistance (AMR) is on the rise and science

communication is key to tackling this global health crisis. That is where online
collaboration comes in. Digital Technology provides a platform for students from
different countries to tackle global health challenges through distance learning.
Objectives: To collaborate cross-culturally online to share UK and Ugandan
approaches to tackling AMR, learn why AMR is on the rise, and the importance of a
One Health approach in promoting antimicrobial stewardship (AMS).
Methods: A Collaborative Online International Learning (COIL) project was
completed by four students under a partnership between Nottingham Trent
University (NTU), UK, and Makerere University (Mak), Uganda. Zoom meetings
were organised multiple times a week to share knowledge, and projects were
created relating to AMR and promoting AMS. A group presentation summarised the
‘Key Challenges and Recommendations of Antimicrobial Resistance.’
Results: This project inspired students from both cultures to progress with future
research projects. Research obtained within this COIL project was presented to
a global audience during the NTU-Mak World Antimicrobial Awareness Week
(WAAW) partnership event, November 2021. It included the causes, concerns, and
solutions to put into place to fight against AMR.
Conclusion: COIL is a successful initiative providing an accessible means of
developing international perspectives on global health challenges like AMR.
Knowledge on how global problems differ in local communities conveys the creation
and implementation of effective solutions that have a stronger impact worldwide.
Through global collaboration, global problems can be solved with global solutions.
Key words: Collaborative Online International Learning (COIL), Antimicrobial
resistance (AMR), Antimicrobial stewardship (AMS), Science communication,
Cross-cultural communication, International collaboration.
114
DAY 2 SESSIONS
Sub Theme 10: Maternal and
Child Health
115
EFFECT OF MALARIA AND MALARIA CHEMOPREVENTION REGIMENS

IN PREGNANCY AND CHILDHOOD ON NEURODEVELOPMENTAL AND
BEHAVIORAL OUTCOMES IN CHILDREN AT 12, 24 AND 36 MONTHS: A
RANDOMIZED CLINICAL TRIAL
Paul Bangirana, PhD¹, Andrea L. Conroy, PhD², Robert O. Opoka, MMED, PhD³,
DAY 2 SESSIONS
Margaret Semrud-Clikeman, PhD⁴; Jeong H. Jang, PhD⁵; Claire Apayi, MA⁶, Abel Kakuru,
MBChB⁶, Mary K. Muhindo, MBChB⁶, Michael K. Georgieff, MD4; Grant M. Dorsey, MD,⁷;
Moses R. Kamya, MMED, PhD6,8, Diane Havlir, MD7, Chandy C. John, MD, MS2
¹Department of Psychiatry, Makerere University College of Health Sciences, Kampala,
Uganda; ²Ryan White Center for Pediatric Infectious Diseases and Global Health,
Indiana University School of Medicine, Indiana, USA; ³Department of Pediatrics and
Child Health, Makerere University College of Health Sciences, Kampala, Uganda;
⁴Department of Pediatrics, University of Minnesota, Minnesota, USA; ⁵Underwood
International College and Department of Applied Statistics, Yonsei University, Seoul,
Korea; ⁶Infectious Diseases Research Collaboration, Kampala, Uganda; 7Department
of Medicine, University of California San Francisco, California, USA; ⁸Department of
Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Introduction: Malaria in pregnancy is associated with worse cognitive outcomes in

children, but behavioral outcomes and the effectiveness of malaria chemoprevention
on child neurodevelopment are not well characterized.
Objective: To determine if more effective malaria chemoprevention in mothers and

their children results in better neurodevelopment.
Methods: This double-blind randomized trial was conducted in Tororo, Uganda from
November 2015 to June 2018. 305 pregnant women were randomly assigned to
3 doses of sulfadoxine-pyrimethamine, 3 doses of dihydroartemisinin-piperaquine
(DP) or monthly DP during pregnancy. 293 children were assigned to DP every
3 months or monthly DP from 2 to 24 months of age. Cognition, language and
motor function were assessed at 12, 24 and 36 months of age, and attention,
memory, behavior and executive function at 24 and 36 months of age.
Results: As compared to children of mothers without malaria in pregnancy, children

of mothers with malaria in pregnancy had worse cognitive, behavioral and executive
function scores at 24 months. Clinical malaria in children within the first 12 months
was similarly associated with poorer scores in behavior and executive function at
24 months, language at 24 and 36 months, and motor function scores at 36 months.
However, more effective malaria chemoprevention in the mothers and children was
not associated with better outcomes.
Conclusions: Malaria in pregnancy was associated with worse neurodevelopmental

scores. More effective malaria chemoprevention measures did not result in better
outcomes. Malaria chemoprevention early in gestation with even higher efficacy
may be required to prevent neurodevelopmental impairment in children.
116
MALE INVOLVEMENT IN FAMILY PLANNING DECISION MAKING

POSITIVELY INFLUENCES UTILIZATION OF CONTRACEPTIVES AMONG
WOMEN OF REPRODUCTIVE AGE IN RURAL UGANDA.
Betty Nabukeera, Dan Kajungu.

Makerere University Centre for Health and Population Research (MUCHAP)
DAY 2 SESSIONS
Background: Use of contraceptives improves reproductive health outcomes. Male
participation is important since men are the main decision-makers at family level.
Objective: To understand the role of male involvement in family planning

(FP) decision making and current family planning utilization among women of
reproductive age.
Methods: A cross-sectional study was nested in Iganga Mayuge Health and

Demographic Surveillance Site – an open population cohort in Uganda. Data were
collected from women of reproductive age (15-49). Multivariable logistic regression
was performed to identify variables associated with FP utilization including male
involvement in FP decisions.
Results: Of the 13,324 women, 33% were adolescents (15-19 years), 54.6% were
either married or living with a man. Only 34.4% were currently utilizing any FP
method. Age, marital status and highest education level attained were associated
with current use of contraceptives. Women whose highest level of education is
primary (OR=1.4, 95% CI=1.29-1.55) or secondary (OR=2.1, 95% CI=1.76-2.44)
were more likely to use FP methods compared to those with none. Women who
had discussed FP with their partners were 43% (OR=1.43 95% CI=1.31-1.53) more
likely to use FP.
Conclusion: Discussing family planning with spouses improves utilisation of any

methods. Utilization is still low in this population. Targeted reproductive health
education interventions which may involve male partners and provision of family
planning products at facilities and communities would improve contraceptive use
in this population.
117
IMPLEMENTING A DIGITAL CHILD BEHAVIORAL HEALTH SCREENING,

LITERACY, AND MANAGEMENT TOOL IN FAITH-BASED SETTINGS: A
FEASIBILITY STUDY
Tusiime Christine¹, Janet Nakigudde¹, Dickson Muyomba¹, Eddie Tinka Mugisa¹, Hafsa
Sentongo², Elizabeth Kasirye³, Sabrina Cheng ⁴, Keng-Yen Huang ⁴,
DAY 2 SESSIONS
1 College of Health Science, Makerere University, P.O. Box 7072, Kampala, Uganda.
2 Uganda Ministry of Health, Plot 6 Lourdel Road, PO Box 7272, Kampala, Uganda
3 Uganda Ministry of Education and Sports, Kampala, Uganda
4 Department of Population Health, New York University School of Medicine, 227 East
30th Street, 1st Floor, New York, NY 10016, USA.
Background: The burden of pediatric mental disorders in low-and middle-income

countries (LMICs) is tremendous, but solutions for addressing the burden remain
limited. Although digital solutions have potential to improve services, such solutions
have not been systematically tested in low-resource settings.
Objective: This study investigates a Pediatric-Mental Health Digital Tool (P-MHDT)

solution to address this pediatric health service gap and study the feasibility and
impacts of the digital approach in faith-based organizations (FBOs) in Uganda.
The P-MHDT is a preventive intervention Toolkit designed to be used by trained
community-health-workers (CHWs) within FBOs to facilitate caregivers’ access
to basic preventive mental health services for their young children. The Toolkit
integrates 4 key mental health service functions: i) screening for child mental
health and family functioning, ii) a strengths and weaknesses profile for a child’s
behaviors, iii) tailored child mental health literacy/parenting materials to discuss
with parents, and iv) parenting resources for families.
Methods: The evaluation was carried out using an experimental design. 255
families were recruited (127 intervention, and 128 control). Results: We found that
parents reported high acceptability, appropriateness, and usefulness in using the
Toolkit. Intervention parents felt safe in using the Toolkit. They also felt comfortable
in having CHWs asking personal questions. In addition, 72% of parents used
recommended service (i.e., parenting groups in church) after the toolkit use. For
impact evaluation, we found expected impact on parenting and child mental health.
Relative to Control, we found intervention parents feel more effective in disciplining
their children (d=.34, p=.06) and perceived some improvement in their parenting
support (d=.41, p=/02) after the intervention. Intervention families also reported
better emotion regulation for their children (d=.24, p=.06) compared to control
families.
Conclusions: Our P-MHDT has potential to provide a cost-effective solution to

promote child mental health in LMICs and similar low-resource settings.
118
SEIZURE CONTROL AMONG CHILDREN ON ANTI-EPILEPTIC DRUGS

AT A TERTIARY HOSPITAL IN SOUTH WESTERN UGANDA- A
RETROSPECTIVE COHORT STUDY.
Namusisi Jane1,2*, Mark Kaddumukasa⁴, Kyoyagala Stella ¹, Nantongo Josephin ²

Kyewalyanga Mike1,3, Sabiiti Stephen¹, Murorunkwere Angelique¹, Josephine Nambi
DAY 2 SESSIONS
Najjuma1, Nakibuuka Jane⁴, Martha Sajatovic⁵, Kalubi Peters¹
¹Mbarara University of science and technology (MUST), P.O. Box 1410 Mbarara, Uganda
²Mbarara regional referral hospital (MRRH), P.O. Box 40 Mbarara Uganda
³Holy Innocents Children’s Hospital (HICH)
⁴Department of Medicine, College of Health Sciences, Makerere University P. O. Box
7072 Kampala.
⁵Neurological and Behavioral Outcomes Center, University Hospital Case Medical
Center, Case Western Reserve University 11100 Euclid Ave, Cleveland, OH 44106, USA.
Background: Seizure control among children with epilepsy on anti-epileptic drugs

(AEDs) remains a challenge in low resource settings. Uncontrolled seizures are
significantly associated with increased morbidity and mortality among children with
epilepsy (CWE). This negatively impact their quality of life and increases stigma.
Aims: This study set out to determine the seizure control and factors associated
with poor seizure control among children on AEDs at Mbarara Regional Referral
Hospital (MRRH).
Methods: A retrospective study was done using social demographic and clinical
data obtained from medical records. Children below 18 years of age on AEDs for
at least six months were consecutive enrolled in the study. Physical or telephone
interviews were conducted with the immediate care givers of children to establish
the current medical status of the participants.
Results: A total of 112 participants were enrolled. Of these, three quarters (75%)
had generalized onset seizures, 23% had focal onset seizures and 2% had unknown
onset motor seizures. Poor seizure control occurred among 60.4% (95% CI 50.9-
69.9) of the participants. Having a comorbidity (p-value 0.048 AOR 3.2 (95% CI
1.0-9.9)), history suggestive of birth asphyxia (p-value 0.014 AOR 17.8 (95% CI
1.8- 176.8)) and being an adolescent (P-value 0.006, AOR (95% CI 1.8-26.6)) were
significantly associated with poor seizure control.
Conclusion: Seizure control among CWE on AEDS at MRRH remains poor.

Efforts to address this is especially among children with comorbidities, history of
birth asphyxia and adolescents need to be keenly addressed within this population.
119
COMPETENCE OF MIDWIVES IN ASSISTING VAGINAL BREECH BIRTHS

AND ASSOCIATED FACTORS IN LOWER-LEVEL HEALTH FACILITIES OF
HOIMA DISTRICT: UGANDA
Nandawula Prossy, Ayebare Elizabeth, Mbalinda Scovia Nalugo

Department Of Nursing, School Of Health Sciences, Makerere University, Ayebale
DAY 2 SESSIONS
Elizabeth: lizayeby@gmail.com +256704878874, MBALINDA SCOVIA: snmbalinda@

gmail.com +256752212151
BACKGROUND: Globally, breech delivery has attracted much debate due to

associated morbidity and mortality. The 2000 Term Breech Trial recommendation
of delivering all term breech presenting fetus by caesarian section is impractical
in low resource settings where mothers deliver in lower-level health facilities with
dysfunctional operating theatres and referral systems.
OBJECTIVES: To assess midwives’ competencies in the application of the

manoeuvers for a vaginal frank breech delivery and identify factors associated with
midwives’ competency in delivering a vaginal frank breech.
METHODS: 143 practicing midwives who were recruited consecutively, participated

in this cross-sectional study. A 30 item checklist assessed the application of
Pinard, Love sets, and Mauriceau Smellie Viet manoeuvers. A self-administered
questionnaire obtained the associated factors. Descriptive statistics were used
to analyze competence. Crude Odds Ratios, and their 95% confidence intervals
measured the association. Variables with a P value < 0.2 at bivariate level were
considered for multivariate analysis. Variables with a P value < 0.05 were considered
to be statistically significant.
RESULTS: 87.4% of midwives knew and mentioned a manoeuvre. About half

72(50.4%) with a mean score of 12.3 (SD: 2.7), were competent. Competence
scores for Pinard, Lovset and Mauriceau Smelie Viet were 69.2%, 44.1%, and
30.8% respectively. Midwives who mentioned any manoeuvre were 11 times more
likely to be competent (Adjusted odds ratio [AOR]: 11.79, 95% CI: 2.23-58.35, P:
0.002). Midwives who felt confident were 5 times more likely to be competent (AOR:
5.95, 95% CI: 1. 23-28.80, P: 0.026).
CONCLUSION: Overall midwives’ competence was average. Majority were

competent with application of Pinard manoeuvre. Lovset and Mauricea Smelie Viet
had below average scores. The significantly associated factors were being able to
mention any type of the manoeuvres, and reported feeling of confidence.
120
RECOMMENDATIONS: Findings highlight the need for in-service vaginal breech

births trainings and hands-on practice of the procedure.
KEY WORDS: Competence, Mal presentation, Breech Presentation, Frank breech,

vaginal breech births.
DAY 2 SESSIONS
ADOPTION AND CHALLENGES TO IMPLEMENTATION OF STRATEGIES
TO PREVENT SEXUAL VIOLENCE AMONG PRIMARY SCHOOL CHILDREN
IN SOUTH-WESTERN UGANDA
Nuwampaire Annah
Background: Globally, sexual violence among children occurs across all societies.
In Uganda, sexual violence against children is a public health problem evidenced
by rampant media reports and police records of child rape, defilement and early
marriages. Uganda has the highest percentage of girls (35%) in East Africa; and the
second highest in Sub-Saharan Africa, who experience sexual violence prior to age
18. This study aimed to identify strategies adopted and challenges associated with
implementation of strategies to prevent child sexual abuse among primary school
children in Uganda.
Methods: We used in-depth interviews to investigate the adoption of child sexual

abuse prevention strategies and associated challenges in primary schools in
Southwestern Uganda. Qualitative thematic content analysis was used to identify
distinct categories and themes.
Results: In our sample, messages against child sexual abuse through role plays,
songs, writings on school buildings; inscriptions on metallic plates planted in
strategic locations on the school compounds; and appointment of focal persons in-
charge of reproductive health education, counseling and guidance for boys (senior
men) and girls (senior women) were the commonest strategies adopted to prevent
child sexual abuse. Inadequate financial support, staff shortages, and lack of
support supervision together with negative attitudes and beliefs by some parents
were the major challenges. Some parents and authorities conspire with child sexual
violence perpetrators to cover up cases in exchange for money and other gifts.
Conclusion: Creation of a dedicated financial budget; and actively bringing parents

and communities into the school-based programs to prevent sexual violence against
children are critical to increase teacher participation, increase social support and
promote the responsibility of parents in preventing sexual violence against children.
Key words: Sexual violence, adoption, Prevention; Sexual abuse; Children;

Uganda; Primary schools.
121
KNOWLEDGE AND PRACTICE TOWARDS PREVENTION OF

PUERPERAL SEPSIS AMONG POSTPARTUM WOMEN AT BWINDI
COMMUNITY HOSPITAL
Desire Namanya¹* and Dr. Kasudha Daniel¹

DAY 2 SESSIONS
¹ Church of Uganda Bwindi Community Hospital, Kinkizi Diocese, Kanungu, Uganda

*Corresponding author:
Desire Namanya, Bwindi Community Hospital, Kanungu, Uganda
Phone: +256 760 327573: Email: desire.namanya@gmail.com
Introduction: Puerperal sepsis is still a major cause of preventable maternal

mortality worldwide.Compliance to prevention practices of puerperal sepsis is crucial
to avert infections that result in long term disabilities, as well as maternal deaths.
Although interventions have been put in place by Ministry of Health Uganda, women
still die of puerperal sepsis. The purpose of the study was to assess knowledge
and practice towards prevention of puerperal sepsis among postpartum women at
Bwindi community Hospital.
Method: A cross-sectional descriptive study design using convenient sampling

procedure was used to select 73 participants and an interviewer administered
questionnaire was used to collect data. Data was analyzed using Microsoft excel,
presented in figures and tables.
Results: Results found that 45.2% of the study participants had poor
knowledge regarding prevention of puerperal sepsis (score of < 50%).
Less than 5% of respondents listed more than 3 correct responses
on preventive measures, risk factors and signs and symptoms of
puerperal sepsis. With respect to practice, 56.2% of respondents had poor practice
towards prevention of puerperal sepsis i.e. has an average practice score of <
60%. Majority (71.2%) of the participants practiced vaginal douching, 64.4% did
not change underwear always after perineal wash and 61.6% resumed sex before
6 weeks.
Conclusion: Generally, respondents’ knowledge and practice regarding

prevention of puerperal sepsis were poor. Therefore, much emphasis
should be put on promoting awareness of women on prevention of
puerperal sepsis mainly on signs and symptoms, risk factors, preventive
measures and when to resume sex after birth as part of the antenatal and post-
partum health education package.
122
NURSES’ KNOWLEDGE AND PRACTICE IN THE MANAGEMENT OF

CHILDHOOD MALNUTRITION IN SELECTED HEALTH CENTERS IN
RWANDA
Bagweneza Vedaste¹, Lakshmi Rajeswaran²
¹University of Rwanda, College of Medicine and Health Sciences, School of Nursing and
DAY 2 SESSIONS
Midwifery, Faculty in the Postgraduate Program
²New York University, Rory Meyers College of Nursing, USA; University of Rwanda,
College of Medicine and Health Sciences, School of Nursing and Midwifery, Faculty for
Human Resources for Health.
Background: Malnutrition contributes significantly to childhood morbidity and

mortality. Nurses usually exhibit inadequate knowledge in childhood malnutrition
management. Nurses require appropriate knowledge and skills to manage
malnutrition using appropriate protocols.
Objectives: To assess nurses’ knowledge and practice in management of childhood

malnutrition in selected health centers in Rwanda.
Methods: The study used a descriptive cross-sectional study design and

quantitative approach among 196 nurses from 24 health centers of one district.
A questionnaire was used to collect data on knowledge and practice towards
childhood malnutrition management. The entire population was used, and SPSS
version-25 helped to analyze data. Descriptive statistics helped to produce the
frequencies and percentages while chi-square helped to determine the relationship
between demographic variables and knowledge and practice scores.
Results: The study findings showed that in 196 participants, 48% had high level
of knowledge about malnutrition management with more than 75% score, 17%
and 35% had low and moderate level of knowledge respectively. 61% of them had
high level of practice about malnutrition management as the acceptable score was
75%. 13% had low level while 26% had moderate level of practice. Most socio-
demographic characteristics have showed a statistical relationship with the level
of knowledge.
Conclusion: The study findings revealed that almost half of the nurses had good
knowledge in childhood malnutrition management and this was associated with
many sociodemographic data while more than half had good practice in that
aspect. However, some nurses who still have gaps in knowledge and practice
require necessary measures to boost these components.
123
DAY 2 SESSIONS

SUB THEMES 7 AND 8: COVID
-19 AND Non Communicable
Diseases
124
IMPACTS OF COVID-19 PANDEMIC ON UGANDAN FAMILIES’ WELLBEING,

PARENTING, AND PRIMARY SCHOOL STUDENTS’ LEARNING AND
BEHAVIORAL HEALTH
Jimmy Mayatsa¹, Solomon Kamya¹, , Eddie Tinka¹, Martha Kyaterekera¹, Rebecca

Akunzirwe¹, Janet Nakigudde¹, Dickson Muyomba¹, Elizabeth Kasirye², Hafsa Sentongo³,
DAY 2 SESSIONS
Sabrina Cheng⁴, Park Hyung⁴, Yesim Tozan ⁵, Keng-Yen Huang⁴
¹College of Health Science, Makerere University, P.O. Box 7072, Kampala, Uganda.
²Uganda Ministry of Education and Sports, Kampala, Uganda
³Uganda Ministry of Health, Plot 6 Lourdel Road, PO Box 7272, Kampala, Uganda
⁴Department of Population Health, New York University School of Medicine, 227 East
30th Street, 1st Floor, New York, NY 10016, USA.
⁵College of Global Public Health, New York University, 708 Broadway, New York, USA.
Background: Since the COVID-19 outbreak, Ugandan primary schools were closed
for almost two school years. This paper examined impacts of the pandemic on
Ugandan families’ finance, wellbeing, and students’ learning and behavioral health
challenges for nearly two years after school closure. This study also examined how
the financial challenges influenced family wellbeing and parenting, and how these
family risks influenced child behavioral health in the context of school closure.
Methods: A total of 1,159 families were recruited from primary schools in three
regions in Uganda between August and December 2021. T-test and regression
analyses were conducted to examine the impacts of pandemic on families, and risk
factors for child behavioral health outcomes.
Results: About 48% of families reported loss of jobs and 86.4% reported loss of
income because of the pandemic, and 25.6% reported food insecurity. Children’s
learning and behaviors were also impacted. Only 33% of families received learning
materials from schools and 32% of parents helped their children learn at home.
Importantly, 45% children screened positively for borderline or abnormal level
of conduct problems. Food insecurity during the pandemic was associated with
poorer family wellbeing and higher child behavioral problems. Family wellbeing
factors were the most robust predictors for child behavioral problems, while positive
parenting behaviors were the strongest predictors for child’s social emotional
competence.
Conclusions: This is the first study to document impacts of the pandemic for
Ugandan families with young children. Our results provide important directions for
policy and program planning to mitigate impacts of the pandemic.
125
ADVERSE EVENTS ASSOCIATED WITH ASTRAZENECA COVID-19

VACCINE IN GREATER KAMPALA, UGANDA: A CROSS-SECTIONAL
STUDY
Allan Komakech1,6,7*, Jonathan Izudi2,3, John Kamulegeya⁴, Freda Loy Aceng⁵, James
Acaye8, Edirisa Junior Nsubuga1,7, Petranilla Nakamya1,7, Daniel Kadobera1,7, Lilian
DAY 2 SESSIONS
Bulage1,7, Benon Kwesiga1,7, Alex Riolexus Ario1,7
¹Uganda Public Health Fellowship Program, Kampala, Uganda, ²Department of

Community Health, Faculty of Medicine, Mbarara University of Science and Technology.
³Data Science and Evaluations Unit, African Population and Health Research Center,
Nairobi, Kenya, ⁴World Health Organization, Kampala, Uganda.
⁵Department of Integrated Epidemiology, Surveillance and Public Health Emergencies,
Ministry of Health, Kampala, Uganda, ⁶Clarke International University, Kampala, Uganda.
⁷Uganda National Institute of Public Health, Kampala, Uganda, 8 Mulago National
Referral Hospital, Kampala, Uganda.
Background: Tracking adverse events helps to assess vaccine safety. In March

2021, Uganda rolled out AstraZeneca vaccination. However, with limited information
about adverse events following the rollout, we assessed adverse events following
among adults in the Greater Kampala region, Uganda.
Methods: We used routinely collected data about AstraZeneca vaccination to

identify persons who received ≥1 dose of the vaccine during March 10 and April
30, 2021. We conducted telephone interviews on a random sample of vaccinated
individuals. We defined adverse events as any untoward medical occurrence after
vaccination and serious adverse events as any event leading to hospitalization,
persistent disability ˃28 days, death, or congenital anomaly. We summarized data
descriptively, performed bivariate analysis, and determined factors independently
associated with adverse events using a multivariable logistic regression.
Results: We studied 374 participants aged 20-85 years and found 235 (62.8%) had
received only the first dose of Astra-Zeneca vaccine while 139 (37.2%) received
two doses of the vaccine. The prevalence of adverse events was 76.5% and the
common adverse events included injection site events and headache but no serious
adverse event was reported. Participants aged 20–29 years (AOR 4.58; 95% CI:
1.92–10.95), 30-39 years (AOR 3.69; 95% CI: 1.81–7.51) and 40-49 years (AOR
2.78; 95% CI 1.26–4.90) were more likely to develop adverse events compared to
those aged ≥50 years.
Conclusion: Approximately 8 in 10 persons vaccinated experienced an adverse

event. However, serious adverse events are rare. We recommend use of the
vaccine based in its safety.
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COMPARATIVE EPIDEMIOLOGIC ANALYSIS OF COVID-19 PATIENTS IN

THE FIRST AND SECOND WAVES –UGANDA, 2020-2021
Sarah Elayeete¹ *, Rose Nampeera¹, Edirisa Juniour Nsubuga¹, Hildah Tendo
Nansikombi¹, Benon Kwesiga¹, Daniel Kadobera¹, Geofrey Amanya¹, Miriam Ajambo²,
Wilbrod Mwanje², Alex Riolexus Ario1,2, Julie R. Harris³
DAY 2 SESSIONS
¹Uganda Public Health Fellowship Program, Kampala, Uganda, ²Ministry of Health,
Kampala, Uganda, ³US Centers for Disease Control and Prevention, Kampala, Uganda
*Corresponding Author: Sarah Elayeete, +256782948872, selayeete@musph.ac.ug,
Background: The first COVID-19 Wave in Uganda occurred during late 2020,
caused by Alpha and Eta variants of SARS-CoV-2. In March 2021, the country
began offering Astra-Zeneca COVID-19 vaccine, and in late April 2021, Uganda
entered a second wave caused by the SARS-CoV-2 Delta variant. Social media
rumours at the time were widespread about Delta variant causing hospitalization in
younger persons, and deaths among fully vaccinated persons. To investigate, we
compared epidemiologic characteristics of hospitalized (HP) and non-hospitalized
(NHP) COVID-19 patients in the two major COVID-19 waves in Uganda.
Methods: We defined ‘Wave 1’ as November-December 2020, and ‘Wave 2’ as

April-June 2021. At each of the two major hospitals in Kampala, we randomly
selected 100 HP in Wave 1 and 100 in Wave 2. We retrieved contact information
for randomly-selected, PCR-confirmed NHP (200 for each wave) from laboratory
records and interviewed them by phone. Demographic, clinical, and self-reported
vaccination data were collected from patients, medical records, and/or next-of-kin.
Results: A higher proportion of HP in Wave 2 than Wave 1 were female (46% vs.
27%, p=0.0001). More Wave 2 than Wave 1 had severe disease or died (65% vs.
31%, p<0.0001). HP were non-significantly older in Wave 2 than Wave 1 (47 vs 42
years, p=0.31), and the median age of HP was significantly older than NHP in Wave
2 (47 vs. 27 years, p<0.0001) but not Wave 1 (42 vs. 35 years, p=0.15). No Wave
2 patients were fully vaccinated.
Conclusion: Demographic and epidemiologic characteristics of COVID-19 patients

differed between COVID-19 waves in Uganda. However, hospitalized patients were
not younger in Wave 2 than Wave 1, and no patients were fully vaccinated. Results
were immediately communicated to the public through Ministry of Health. Different
variants of COVID-19 should be studied independently, and results used for public
risk communication.
Key words: COVID-19, Delta, Waves, Hospitalized, Non-hospitalized, Uganda
127
PREVALENCE AND FACTORS ASSOCIATED WITH SUBOPTIMAL

BLOOD PRESSURE CONTROL AMONG AMBULATORY PARTICIPANTS
WITH DIABETIC KIDNEY DISEASE ATTENDING KIRUDDU NATIONAL
REFERRAL HOSPITAL
David Wamala¹*, Edrisa Mutebi¹, James Kayima¹

DAY 2 SESSIONS
¹Department of Medicine, School of Medicine, College of Health Sciences, Makerere

University, P. O. Box 7072, Kampala, Uganda.
*Corresponding author email: wamala_david@yahoo.com
Background: The burden of suboptimal blood pressure control (SOBP), a driver of

kidney failure and mortality among persons with diabetic kidney disease (DKD) is
not well documented in Uganda.
Objectives: To determine the prevalence of suboptimal blood pressure control

and associated factors among ambulatory participants with DKD attending Kiruddu
National Referral Hospital.
Methods: After ethical approval of this cross-sectional study, 250 consented

participants with DKD were recruited from 6th May 2020 to 15th July 2020.
Definition of SOBP was systolic blood pressure of > 130mmHg and or diastolic
blood pressure of > 80mmHg while DKD was defined as presence of albumin with
negative leucocyte esterase on urine dipstick analysis in participants with Diabetes
mellitus. A pretested questionnaire was administered, blood pressure, height, weight
measured and body mass index calculated. Associated factors were analyzed with
a Poisson regression model.
Results: Mean age was 52(11) years, 199 participants (79.6%) were female. The
overall prevalence of suboptimal blood pressure control was 84.4% (95% CI: 79.3 -
88.4), associated with past (odds ratio (OR) = 1.37, 95% CI: 1.01 - 1.85, p = 0.04) or
current (OR = 1.57, 95% CI: 1.23 - 2, p < 0.001) alcohol use, overweight (OR = 1.82,
95% CI: 1.4 - 2.38, p < 0.001) or obese (OR = 1.89, 95% CI: 1.44 - 2.47, p < 0.001).
Conclusions: The prevalence of suboptimal blood pressure control was high

among the overweight, obese and those using alcohol. There is a need for better
blood pressure control among these persons.
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PREVALENCE AND FACTORS ASSOCIATED WITH OPIOID USE

DISORDER AMONG ADOLESCENTS WITH SICKLE CELL DISEASE IN
MULAGO HOSPITAL
Claire Kwagala, MBchB, Master of Medicine in Psychiatry- Final year Resident

Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere
DAY 2 SESSIONS
University
Introduction: Opioid use disorder among adolescents with Sickle Cell Disease
(SCD) patients increases their risk of complications such as infections, stroke, acute
chest syndrome, sudden death and organ failure. This study aimed to determine
the prevalence and factors associated with opioid use disorder among adolescents
with SCD at Mulago Hospital in Uganda.
Methods: This cross-sectional study was conducted among adolescents aged

10-19years attending SCD Clinic at Mulago hospital. Following informed consent/
assent, a sociodemographic questionnaire, the WHO Alcohol, Smoking and
Substance Involvement Screening Test- Young (ASSIST-Y), the Beck Depression
Inventory II (BDI II), and Generalized Anxiety Disorder-7 (GAD-7) questionnaires
were used to collect data. Data was entered in EpiInfo and analyzed in STATA 15.
Results: The prevalence of opioid use disorder was 5.3%. Female gender (OR:
0.61; 95% CI: 0.01, 0.53), living with a family (OR: 0.03; 95% CI: 0.00, 0.30) were
protective against opioid use disorders. For every unit increase in depression score,
the odds of opioid use disorder increased by 13% (OR: 1.13; 95% CI: 1.02, 1.24).
Conclusion: Our findings are consistent with previous studies that were conducted
in sub-Saharan Africa. The burden and associated factors of opioid use disorder
among adolescents with SCD as highlighted in this study adds to the body of
knowledge in this rather neglected area. Future interventions can be designed
based on these findings.
129
DAY 2 SESSIONS

SUB THEME 10: Maternal And
Child Health
130
Dolutegravir versus Efavirenz in late Pregnancy to 72 weeks postpartum

– DolPHIN-2 Study.
Sylvia Nassiwa²,Elly Nuwamanya² ,Thokozile Malaba¹, Irene Nakatudde²,Kenneth
Kintu2 ,Angela Colbers³,Tao Chen⁴, Helen Reynolds⁵, Lucy Read⁴, Justin Chiong⁵, ,
Duolao Wang⁴, Josaphat Byamugisha⁶, Catriona Waitt2,5, Catherine Orrell8, Mohammed
Lamorde2, Tabitha Ayabo2 ,Diana Namuddu2 ,Landon Myer1,9, Saye Khoo⁵, for the
DAY 2 SESSIONS
DolPHIN-2 study Group
¹Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine,
University of Cape Town Faculty of Health Sciences, Observatory 7925, South Africa
²Infectious Diseases Institute, College of Health Sciences, Makerere University,
Kampala, Uganda
³Department of Pharmacy, Radbound Institute for Health Sciences (RIHS), Radboud
University Medical Center, Nijmegen, the Netherlands
⁴Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool UK
⁵Pharmacology & Therapeutics, University of Liverpool, Pembroke place, Liverpool UK
⁶Department of Gynaecology and Obstetrics School of Medicine, College of Health
Sciences, Makerere University, Kampala, Uganda
⁷Department of International Public Health, Liverpool School of Tropical Medicine,
Liverpool UK
⁸Desmond Tutu Health Centre, Department of Medicine, Institute of Infectious Diseases
& Molecular Medicine, University of Cape Town Faculty of Health Sciences, Observatory
7925, South Africa
⁹Centre for Infectious Diseases Epidemiology & Research, School of Public Health &
Family Medicine, University of Cape Town, South Africa
Introduction: Delayed antiretroviral therapy (ART) initiation in pregnancy is

associated with failure to achieve viral suppression, leading to an increased risk of
perinatal transmission and higher infant mortality.
This study evaluated the efficacy (VL<50copies/ml) and safety (occurrence of

maternal and infant drug-related serious adverse events (SAEs) of dolutegravir
versus efavirenz among women initiating antiretroviral therapy in late pregnancy.
Methods: DolPHIN-2 (NCT03249181) was an open-label randomized trial

conducted in South Africa and Uganda among 268 pregnant women initiating
antiretroviral therapy (ART) in the third trimester. Eligible participants were randomly
allocated (1:1) to dolutegravir versus efavirenz-based therapy. HIV viral load (VL)
at 6, 12, 24, and 72 weeks postpartum was measured, and any occurrence of
maternal or infant SAEs was recorded through the 72 weeks postpartum.
Results: 250 (efavirenz-125, dolutegravir-125 intention to treat cohort) were

evaluated for efficacy. The median time to VL< 50 copies/ml was 4.14 weeks with
dolutegravir and 12.14 weeks for efavirenz. At 72 weeks postpartum, 116 (92.8%)
and 114 (91.2%) women in the dolutegravir and efavirenz arm achieved the VL <
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50 copies/ml.
Overall, 24.4% of women on dolutegravir experienced an SAE as compared to

18.0% on efavirenz. However, only 2.2% (dolutegravir) vs. 3.3% (efavirenz) was
drug-related.
Conclusion: Dolutegravir-based ART initiated in the third trimester was superior to

DAY 2 SESSIONS
efavirenz regarding VL suppression, safety, and tolerability. An extended follow-up

study is underway for the long-term toxicity among these women and their infants.
THE EFFECT OF SYMPTOM SEVERITY ON INFORMAL CAREGIVER

BURDEN IN NEUROCOGNITIVE DISORDERS IN UGANDA
Janet Nakigudde¹, PhD, Associate Professor Noeline Nakasujja¹, Professor Seggane

Musisi¹, Dr Akena Dickens¹, PhD, Dennis Kalibbala², Professor Nelson Sewankambo¹
¹Makerere University, College of Health Sciences
²Global Health Uganda Limited
Background: Approximately 4.6 million people are annually diagnosed with

Alzheimer’s disease and related dementias which are characterized by a cognitive
decline (memory loss or forgetfulness). This commonly begins with an inability to
learn and recall recent events and may progress even onto past events and affect
the behavioural skills of an individual - hence negatively impact on their activities
of daily living.
Aim: We aimed to determine the caregiver burden and patient correlates of

Neurocognitive disorders including Alzheimer’s disease and other related dementia
in a low-resourced setting.
Methods: We conducted a cross-sectional study among 113 primary caregivers of

patients aged 60 years and above seeking care for Alzheimer’s disease and related
dementias at Mulago and Butabika National Referral Hospitals between August
and October 2020. we assessed Caregiver burden, and cognitive and behavioral,
and psychological measures among the patients.
Results: The mean MMSE was 17.5(SD±5.73) and the mean ACE-R was
44.14(±16.40). The common Behavioral and Psychological Symptoms of Dementia
were Dysophoria/ Depression (43.8%), Anxiety (31.4%), Appetite/ Eating (26.7%),
and Irritability/ Lability (24.8%). The mean Carer Burden- Zarith Burden score
was 20.41(±11.20) and 36.2% had mild to the moderate burden while 6.7%
had moderate to severe burden. There was a significant positive correlation
132
between caregiver’s burden with the types of Delusion, Hallucinations, Agitation/

Aggression, Dysophoria/Depression, Anxiety and Disinhibition. In contrast, there
was a significant negative correlation between Apathy/ Indifference. Caregiver’s
burden was also correlated with severity of patient domain symptoms (Spearman’s
rho=0.450).
DAY 2 SESSIONS
Conclusion: The caregiver burden increases with the severity of cognitive decline
in patients with neurocognitive disorders. Interventions addressing caregiver
burden should prioritize caregivers of patients with psychological symptom’s
delusions, hallucinations, agitation, depression, anxiety and disinhibition who are
mainly affected.
HIGH RISK OF STROKE IN UGANDAN CHILDREN WITH SICKLE CELL

ANAEMIA: A CROSS SECTIONAL STUDY
Deogratias Munube¹, Grace Ndeezi¹, Martha Satajovic², Elly Katabira³, James .K.
Tumwine¹
¹Department of Paediatrics and Child Health, College of Health Sciences, Makerere
University, Kampala, Uganda
²Neurological and Behavioural Outcomes Centre, University Hospitals – Case Medical
Centre, 10524 Euclid Avenue Cleveland
³Department of Internal Medicine, College of Health Sciences, Makerere University,
Kampala, Uganda
INTRODUCTION/ BACKGROUND:
Sickle cell anaemia is the most common genetic blood disorder in Africa. It is the
most common cause of stroke in the paediatric population. Trans-cranial Doppler
screening has been identified as a screening tool to identify SCA children who may
be at risk of suffering a stroke. We determined the trans-cranial doppler speeds
for Ugandan children with sickle cell anaemia. Our hypothesis was that Ugandan
children with SCA were at the same risk of stroke as using the STOP trial study of
African American children in North America.
Methodology: We conducted a cross sectional of 100 SCA children aged 2 years

to 15 years who attend the Sickle Cell Clinic of Mulago Hospital. We determined the
cerebral vessel speeds using a Phillips 5 MHZ transducer. The cerebral velocities
were grouped into normal (<170cm/s), conditional( 170cm/s to 200cm/s) and at risk
(>200cm/s).
Results/Findings: A total of 100 children with SCA underwent TCD measurement.

In the Right and Left middle cerebral (MCA) 58% and 66% of the children had
133
timed mean average velocities (TMAV) of > 200cm/s. 19% and 32% had conditional
values , while 13% and 8% had normal values. In the Right and Left anterior
cerebral artery (ACA) 2% and 2% of the children had TMAV of >200cm/s. In the
Right and Left posterior cerebral artery (PCA) 0% and 0% of the children had
TMAV of > 200cm/s.
DAY 2 SESSIONS
Conclusions/Recommendation: Children with SCA in Uganda may be at a higher

risk for stroke. There is an urgent need to introduce and scale up TCD screening in
our population to identify those at risk for stroke. Further studies need to be done to
determine if the current ranges are appropriate for populations which have multiple
co-mobidities.
TRENDS AND SPATIAL DISTRIBUTION OF NEONATAL SEPSIS IN

UGANDA, 2016-2020
Stella M. Migamba¹*, Benon Kwesiga¹, Esther Kisaakye¹, Allan Komakech¹, Miriam
Nakanwagi¹, Robert Mutumba², Julie Harris³

²Ministry of Health, Reproductive and Infant Health Department, Kampala, Uganda
³Centers for Disease Control and Prevention, Kampala, Uganda
*Corresponding Author: Stella M. Migamba, +256774662488, smigamba@musph.

ac.ug
Background:
Neonatal sepsis is the third-leading cause of newborn deaths in Uganda. It is

caused by infection acquired perinatally (early-onset sepsis, or EOS, occurring at
0-7 days postpartum) or in the hospital or community (late-onset sepsis, or LOS,
occurring 8-28 days postpartum). We described trends and spatial distribution of
neonatal sepsis in Uganda from 2016-2020.
Methods: We analysed routinely-reported surveillance data on in-patient neonatal

sepsis from the District Health Information System 2 from 2016-2020. We
calculated incidence rates for EOS, LOS, and total sepsis at national, regional, and
district levels as cases per 1,000 live-births. We determined significance of national
and regional trends using logistic regression and interpreted odds ratios as change
in incidence/1,000 live-births/year. We analysed sepsis geographic distribution by
district.
134
Results: During 2016-2020, 95,983 neonatal sepsis cases were reported,

including 71,262 (74.2%) EOS and 24,721 (25.8%) LOS. Overall incidence was
17.4/1,000 live-births. EOS increased from 11.7 to 13.4/1,000 LB (OR:1.2, CI:
1.1- 1.2) during 2016-2020; LOS declined from 5.7 to 4.3/1,000 LB (OR: 0.7, CI:
0.7-0.8). Regionally, total sepsis increased in Central (OR: 1.5, CI: 1.4-1.6) and
North (OR: 1.2, CI: 1.2-1.3) Uganda, but decreased in the East (OR: 0.6, CI: 0.6-
DAY 2 SESSIONS
0.6) and West (OR: 0.7, CI: 0.7-0.7). While EOS followed a similar trend to total
sepsis, LOS decreased in Eastern, Northern and Western Uganda, but increased
in Central Uganda. Districts that consistently reported >45 sepsis cases/1,000
live-births were located in Eastern (Kapchorwa and Mbale), Western (Mbarara
and Hoima), and Northern (Gulu) Uganda.
Conclusion and Recommendations: During 2016-2020, EOS comprised three-

quarters of neonatal sepsis cases and increased in Uganda; LOS decreased
everywhere except central Uganda. Prevention and treatment interventions in
Central and Northern regions, as well as in the most affected districts should be
strengthened. Clean delivery and hospital environments should be emphasized.
Key words: Neonatal sepsis, Early-onset sepsis, Late-onset sepsis, Uganda
EVALUATION OF CESAREAN SECTION USING ROBSON CLASSIFICATION

SYSTEM IN 3 CEMONC HEALTH FACILITIES IN KYOTERA AND RAKAI
DISTRICTS.
Daniel Murokora1,2, Michael Webba Lwetabe1,3,4, Richard Kimaka¹, Nakintu Eleanor1,2,4

₁Babies And Mothers Alive Foundation (BAMA)
²Department of Reproductive Health, Ministry of Health
³St. Francis Hospital Nsambya
⁴Mother Kevin Postgraduate Medical School, Uganda Martyrs University
Background: The last 30 years have seen heightened public concern on the
persistent upward trends in global CS rates characterized by country and regional
variations. The aim of this study was to evaluate caesarean section (CS) rates using
Robson 10-group classification in three Comprehensive Emergency Obstetric and
Newborn Care facilities in Kyotera and Rakai districts.
Methodology: A cross sectional study involving three Comprehensive Emergency

Obstetric and Newborn Care sites of Kakuuto Health Centre IV, Kalisizo and Rakai
Hospitals in Kyotera and Rakai districts carried out between September 2019 to
August 2020. Robson 10-group classification based on four obstetric concepts
of category of the pregnancy, previous obstetric history, course of labour and
135
gestational age was used to categories CS. Descriptive statistics was carried out
with results presented as frequencies, percentages, means and standard deviation.
Results: Out of the 502 caesarean sections reviewed, 71.7% (360/500) were
carried out in Kyotera and 28.3% (142/502) in Rakai district. The overall CS rate
was 34% with facility specific CS rates of 21.8%, 38.5% and 35.6% for Kakuuto
DAY 2 SESSIONS
HCIV, Kalisizo Hospital and Rakai Hospital respectively. The major contributors
to that CS rate increase in these two districts were (i) multiparous women with
single cephalic at term pregnancy with history of CS (group 5) with 31.1%; (ii)
single, nulliparous women, at term in spontaneous labor (group 1) 29.5%; and (iii),
single cephalic multiparous women, at term in spontaneous labor (group 3) with
19.9%. Eighty percent of overall CS rate was contributed by group 1, 3 and 5.
Main reasons for caesarean section were Failure to progress in pregnancy (31.1%)
repeat caesarean section (22.9%) and Obstructed labour (12.6%)
Conclusion: The use of the Robson criteria allows standardized comparisons of

data across health facilities and identification of subpopulations driving changes in
CS rates. The overall CS rates in health facilities was greatly affected by the women
who have previously had a caesarean section.
136
DAY 2 SESSIONS
SUB THEME 11: Emergency
Care And Health Worker
Wellbeing
137
UNDERSTANDING DROWNING IN UGANDA: BURDEN AND

CIRCUMSTANCES
Frederick Oporia, Anthony Mugeere, and Olive Kobusingye

Introduction: Drowning deaths in Africa are among the highest globally. However,
limited data obscures the true size of the problem. No study has comprehensively
DAY 2 SESSIONS
assessed the circumstances of drowning in both lakeside and non-lakeside districts

in Uganda.
Objective: To understand the burden and circumstances of drowning in Uganda.
Methods: We collected data on drownings that occurred between January 1, 2016

and June 30, 2018. Data were collected in two phases: first, we abstracted data
on drowning cases from district-level administrative sources (district police offices,
marine police detachments, fire/rescue brigade detachments, and the largest
mortuaries) in 60/112 districts in Uganda based on the 2014 national census. In
phase two, we identified all drowning cases through village health teams (VHTs)
and confirmed through individual interviews with witnesses/family members/friends,
and drowning survivors in 14/60 districts.
Results: In phase one, we identified 1,435 recorded drowning cases. The availability
of information on the characteristics of drowning victims and the circumstances of
the drowning incident varied by source. In phase two, we identified 2,066 cases of
drowning through community interviews. Almost two-thirds, 64% (1,332/2,066) were
fatal. Overall, young adult males were the majority. In lakeside districts, drownings
were most frequent in lakes, while rivers were commonest in non-lakeside districts.
Almost half of the drownings involved occupational boating.
Conclusion: Drowning is a major cause of premature death, especially among

young adults at work. Targeted contextually appropriate interventions are needed
to reduce drowning risk in Uganda.
DETERMINANTS OF LIFEJACKET USE AMONG BOATERS ON LAKE

ALBERT, UGANDA. A QUALITATIVE STUDY
Frederick Oporia*, Simon P. S Kibira, Jagnoor Jagnoor, Fred Nuwaha, Fredrick Edward
Makumbi, Tonny Muwonge, Lesley Rose Ninsiima, Kjell Torén, John Bosco Isunju, and
Olive Kobusingye
Introduction: Drowning is a major cause of unintentional injury death worldwide.
The toll is greatest in low- and middle-income countries. Over 95% of people who
138
drowned while boating in Uganda were not wearing a lifejacket.
Objective: To explore the determinants of lifejacket use among boaters on Lake

Albert, Uganda.
Methods: We conducted a qualitative enquiry with a hermeneutic phenomenological

undertone leaning on relativism ontology and emic subjectivism epistemology. Focus
DAY 2 SESSIONS
group discussions (FGDs) and in-depth interviews (IDIs) were held with boaters at
ten landing sites. We explored experiences and perspectives on lifejacket use. We
used thematic analysis technique to analyse data and report results according to
the Consolidated Criteria for Reporting Qualitative Research.
Results: We recruited 88 boaters in ten FGDs, and 11 boaters to take part in the
IDIs. We identified three themes: motivators and opportunities for lifejacket use,
barriers and threats to lifejacket use, and strategies to improve lifejacket use. Many
boaters attributed their lifejacket use to prior experience or witness of a drowning.
Perceived high costs of lifejackets, limited knowledge, reluctance to use lifejackets
because of distrust in their effectiveness, and the belief that it is women who should
wear lifejackets were among the barriers and threats. Participants mentioned the
need for mandatory enforcement alongside community sensitizations to improve
lifejacket use.
Conclusion: Determinants of lifejacket use among boaters include experience

or witness of drowning, limited knowledge about lifejackets, and distrust in the
effectiveness of the available lifejackets. Mandatory lifejacket wearing alongside
educational interventions might improve lifejacket use.
PERSONAL AND WORK-RELATED CONSEQUENCES ASSOCIATED

WITH BURNOUT AMONG HEALTH CARE WORKERS IN HOSPITALS IN
KITGUM MUNICIPALITY, KITGUM DISTRICT, NORTHERN UGANDA
Raymond F. Odokonyero1*, Arthur Kiconco2, Mathias Lwenge2, Juliet Ndibazza2, and
Catherine Abbo1.
¹Department of Psychiatry, School of Medicine, Makerere University College of health
Sciences, Uganda; ²Faculty of Health Sciences, Uganda Martyrs’ University
*Corresponding Author: Raymond F. Odokonyero, MBChB. MMED(Psych), Lecturer.

Makerere University College of health Sciences, School of Medicine, Department of
Psychiatry. P.O.BOX 7072, Kampala. Telephone: +256701547646 Email: rodokonyero@
gmail.com
Background: Burnout is a long-standing occupational health issue among health
139
care workers globally. Burnout is an important mediator of personal and work-related

consequences. Prevention and control of these consequences call for contextual
understanding of the consequences yet there is limited evidence. We examined
personal and work-related consequences of burnout among health care workers at
three health facilities in Kitgum District.
DAY 2 SESSIONS
Methods: An analytical cross-sectional study employing quantitative data collection

methods was used to study 186 health care workers at Kitgum General Hospital, St.
Joseph’s Hospital Kitgum, and Yot Kom Medical Centre between December 2020
and February 2021. The health facilities were purposively sampled while the health
care workers were proportionately randomly sampled. Interviewer guided interviews
were conducted, and data was collected using standardized questionnaires.
Frequencies and proportions were used to describe the data. Generalized linear
models were fitted to assess associations. All analyses were conducted using
STATA version 15.
Results: A total of 186 health care workers were interviewed. Majority were female
(63.4%) with a female to male of 2:1. The median age was 33 years (IQR 28, 41).
The nursing profession comprised 54.8% of the sample. About 60.7% of the health
workers had spent 10 years or less in the profession. The median monthly salary
was Shs. 600,000 (IQR, 318,000; 1,000,000). The prevalence of burnout was
45.2%. Burnout was associated with the following personal consequences; family
affected (aPR 2.80 CI 1.85, 4.22; p<0.001), relationship affected (aPR 2.88 CI 1.86,
4.46; p<0.001), personal finances affected (aPR 1.76 CI 1.27, 2.43; p-0.001), health
affected (aPR 2.60 CI1.61, 4.20; p<0.001), and probable depression (aPR 2.86 CI
1.43, 5.71; p-0.003). Work-related consequences associated with burnout were;
hesitation to duty call (aPR 2.26 CI 1.57, 3.27; p<0.001), intention to quit (aPR
2.53 CI 1.73,3.71; p<0.001), medical errors (aPR 1.36 CI1.01,1.83; p-0.044), failed
infection prevention and control (aPR 1.40 CI 1.04, 1.88; p-0.025), and mistakes in
routine procedures (aPR 1.72CI1.11, 2.69; p-0.016).
Conclusion: Burnout is prevalent among health care workers in Kitgum district.

Burnout among health care workers in Kitgum district is associated with considerable
personal and work-related consequences.
Key words: Burnout, Consequences, Health care workers, Kitgum district, Northern
Uganda
140
THE INCIDENCE OF NEEDLE-STICK INJURIES AND BODY FLUID

EXPOSURES AMONG HEALTH PROFESSION STUDENTS AT MAKERERE
UNIVERSITY IN UGANDA.
Dianah Rhoda Nassozi

Makerere University, College of Health Sciences
DAY 2 SESSIONS
INTRODUCTION: Needle-stick injuries and mucocutaneous splashes significantly
contribute to the risk of acquiring blood-borne pathogens such as HIV and Hepatitis
B among health care workers, medical students inclusive.
OBJECTIVE: The aim of this study was to determine the incidence of needlestick
injuries and mucocutaneous splashes among medical students over a period of
one year.
METHODS: A cross-sectional study using quantitative techniques was carried

out between July and August 2022 among health profession students pursuing
Bachelor of Medicine and Surgery (MBChB), Bachelor of Dental Surgery (BDS)
and Bachelor of Science in Nursing (BSN) who are in clinical years at Makerere
University. Using simple random sampling, an online self-report questionnaires
were sent to the eligible participants using KoBo Toolbox. Data analysis was
perfumed using STATA 17.0.
RESULTS: A total of 171 medical students with a mean age of 25 years (SD: 3.6),
majority male (n=118, 69%) responded. The majority (n=129, 75.4%) were pursuing
MBChB. And 74.9% were vaccinated against the Hepatitis B vaccine. Overall,
45% (n=77) and 26% (n=45) had sustained mucocutaneous splashes and needle-
stick injuries, respectively. About 15% had sustained both occupational hazards.
One-third (33%) of the needle-stick injuries were at the obstetrics and gynecology
(OBGY) rotation, and mostly caused by needle-recapping (38%), assisting in a
surgery (29%) and withdrawing blood (29%). Blood (80%) and amniotic fluid (55%)
were the most frequent body fluid splashes, and these mostly occurred in the
OBGY rotation (61%).
CONCLUSION: Our findings show that needle-stick injuries and mucocutaneous

splashes are common among medical students. Preventive strategies must be
implemented to protect to reduce the risk of acquiring blood-borne infections in the
future of health workforce.
141
DAY 3 SESSIONS
Day 3
FRIDAY
23rd September 2022
Parallel Sessions
8A - 9A
142
DAY 3 SESSIONS
Sub Theme 12: Health
and Business
143
SOCIO-ECONOMIC INEQUALITIES IN THE COVERAGE OF CERVICAL

CANCER SCREENING AMONG WOMEN LIVING WITH HIV IN FIVE LOW-
AND MIDDLE-INCOME COUNTRIES
Derrick Bary Abila 1,2,+, Elizabeth Nakiyingi Kiyingi ¹, Provia Ainembabazi 2,3, Racheal
Nalunkuma1, Ruth Ketty Kisuza1, Chemutai Beliza1, Eddy Kyagulanyi1, Boaz Mwesigwa
DAY 3 SESSIONS
⁴, Sulaiman B. Wasukira3,5 Henry Wabinga1 ,Nixon Niyonzima 6

¹Makerere University College of Health Sciences, Kampala, Uganda. ²Faculty of Biology
Medicine and Health, University of Manchester, Manchester, UK. ³Infectious Diseases
Institute, Kampala, Uganda. ⁴Cytology Society of Uganda, Kampala, Uganda. ⁵School
of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
⁶Uganda Cancer Institute, Kampala, Uganda.
Corresponding author:Derrick Bary Abila, Email. abilabary@yahoo.com Tel. +256-

75800280
BACKGROUND: Women living with HIV (WLWHIV) are at a high risk of developing
cervical cancer and the World Health Organization (WHO) recommends that they
are screened from the age of 25 years.
OBJECTIVE: To describe the socioeconomic inequalities in the coverage of cervical
cancer screening among WLWHIV in LMICs.
METHODS: We conducted a weighted secondary data analysis of the Demographic
and Health Surveys (DHS) completed in Cameroon, Ivory Coast, Lesotho,
Namibia, and Zimbabwe. These were the only countries that tested women for
HIV and had questions on cervical cancer screening in DHS between 2010 and
2019. Our analysis included WLWHIV aged 25 to 49 years. Absolute and relative
socioeconomic inequalities were calculated using the Slope Index of Inequality and
Concentration Index respectively by wealth quintile.
KEY RESULTS: A total of 2,950 WLWHIV were included in this study. The proportion
of women who had ever been screened for cervical cancer was highest in Namibia
(35·7%) and lowest in Ivory Coast (1·8%.) The pooled estimate of the coverage of
cervical cancer screening was 16·5% [95% Confidence interval (CI): 6·1 – 27·0]. In
all the countries, higher proportions of WLWHIV in the richest wealth quintile were
screened compared to those in the poorest wealth quintile. In all the countries,
higher proportions of WLWHIV in the urban areas were screened compared to
those in the rural areas.
CONCLUSIONS: There exist pro-rich and pro-urban inequalities in the utilization of
cervical cancer screening.
RECOMMENDATIONS: Cervical cancer screening programs in LMICs need to
innovate solutions aimed at reducing the inequalities to accessing cervical cancer
screening by WLWHIV.
144
PATIENT COSTS OF DIRECTLY OBSERVED AND SELF-ADMINISTERED

TB PREVENTIVE THERAPY AMONG PEOPLE LIVING WITH HIV IN
UGANDA
Anne Nakitende¹, Yeonsoo Baik², Allan Musinguzi¹, Jillian L. Kadota³, Fred Welishe¹,
Jane Nakimuli¹, Lydia Akello¹, Joan Kasidi Ritar1, Adithya Cattamanchi³, Fred C.
DAY 3 SESSIONS
Semitala1, 4, Hojoon Sohn⁵, David W Dowdy⁶
¹Infectious Diseases Research Collaboration, Kampala, Uganda
²Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
School of Medicine, Philadelphia, PA, USA
³Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San
Francisco General Hospital, University of California San Francisco, San Francisco, CA,
USA
⁴Department of Internal Medicine, School of Medicine, Makerere University College of
Health Sciences, Kampala, Uganda
⁵Department of Preventive Medicine, Seoul National University College of Medicine,
Seoul, South Korea
⁶Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
Background: Shorter regimens for preventive therapy for tuberculosis (TB) require
medications to be delivered by directly observed or self-administered therapy. The
process of presenting to care for direct observation may require patients to incur
substantial costs. We aimed to understand the magnitude and primary components
of this financial burden, comparing costs incurred by people living with HIV (PLHIV)
who are taking directly observed versus self-administered TB preventive therapy
(TPT) with three months of weekly isoniazid and rifapentine (3HP).
Design/Methods: We enrolled PLHIV in an implementation trial comparing self-

administered therapy (SAT) versus directly observed therapy (DOT) for TPT from
July 2020 to April 2022 at the Mulago AIDS Clinic (Kampala, Uganda). Following an
initial visit at enrollment, patients in the SAT arm made clinic visits at weeks 6 and
12 for refills and evaluation of adverse events, whereas patients in the DOT arm
presented for 11 additional weekly clinic visits. We randomly selected patients from
both SAT and DOT arms at week 6 to participate in a costing survey.
Results: A total of 94 patients completed the survey: 45 (48%) DOT and 49 (52%)
SAT. Accounting for the total number of visits required, the estimated total costs
incurred for clinic visits, medication uptake, and adverse event management were
183,000 Ugandan shillings (UGX, approximately $51.2) for DOT and 53,000 UGX
($14.7) for SAT. The largest component of patient costs was lost wages for DOT
145
(71,000 UGX; 39% of total patient costs) and management of adverse events for
SAT (16,000 UGX; 30% of total patient costs).
Conclusions: PLHIV receiving TPT under DOT incurred costs that were three
times as high as for SAT and higher than the cost of drugs themselves. Mitigation
of patient costs (for example, through monetary incentives) may be required for
DAY 3 SESSIONS
successful TPT uptake in high-burden countries.
CATASTROPHIC HEALTH EXPENDITURES AND THE ASSOCIATED

FACTORS AMONG CANCER PATIENTS AT THE UGANDA CANCER
INSTITUTE, UGANDA
Kabagenyi A., Kiweewa F., Wasswa R., Mubuuke R., Niyonzima N., Nakiyingi L., Matovu
F., Rutebemberwa E.
Background: Despite Uganda’s policy to provide free healthcare services to all
patients at public health facilities, this is not the case due to a number of challenges
including limited government financing for health services. Patients pay for a part
of their care including high costs of diagnostic and treatment services using their
out of pocket. As a result, more than 80% of new cases are presented late. The
objective of this study was to examine the catastrophic health expenditures (CHE)
on cancer treatment and its associated factors among patients diagnosed with
cancer in Uganda.
Method: This was a cross-sectional survey among patients receiving treatment at

Uganda Cancer Institute in Kampala. A total of 423 adult patients with a confirmed
diagnosis of cancer and receiving outpatient or inpatient services were enrolled into
the study. Descriptive analysis was performed as well as multivariate binary logistic
regression to identify the factors associated with CHE at different cut-off household
income (10%, 20% and 40%).
Results: At least half of the participants were experiencing CHE. Further, irrespective
of the threshold used for total household expenditure and out of pocket expenditure
for cancer treatment, working status and stage of cancer significantly influenced
CHE. Using a cut-off of 40% household income, having secondary education
(AOR=0.28, 95%CI=0.13-0.56) and working (AOR=0.46, 95%CI=0.22-0.93)
reduced the odds of CHE. On the other hand, having borrowed money (AOR=1.79,
95%CI=1.01-3.17), being single (AOR=3.75, 95%CI=1.70-8.24), as well as higher
stages of cancer increased the odds of CHE. Specifically, participants with stage
2 (AOR=4.42, 95%CI=2.46-7.94), stage 3 (AOR=4.32, 95%CI=2.33-8.00) or stage
4 (AOR=3.55, 95%CI=1.48-8.52) were more four-times likely to experience CHE
146
compared to their counterparts in stage 1.
Conclusions: Majority of the households and individuals experience financial

hardship which creates inequitable access to quality health care services. There is
need for creation of financial protection and prepayment mechanisms in the form of
social health insurance for all population groups.
DAY 3 SESSIONS
PROCESS AND CONTEXTUAL FACTORS INFLUENCING ACCEPTANCE
AND COMPLETION OF ISONIAZID-RIFAPENTINE (3HP) FOR
TUBERCULOSIS PREVENTION BY PEOPLE LIVING WITH HIV (PLHIV) IN
UGANDA.
Joan R. Kasidi¹, Allan Musinguzi¹, Fred Welishe¹, Jane Nakimuli¹, Anne Nakitende¹,
Lydia Akello¹, Jillian L. Kadota², Christopher Berger², David W. Dowdy³, Adithya
Cattamanchi2,4, Fred C. Semitala1,5,6 Anne Katahoire⁷
1
Infectious Diseases Research Collaboration, Kampala, Uganda
²Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, San
Francisco General Hospital, University of California San Francisco, San Francisco CA
USA
³Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD USA
⁴Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
⁵Department of Internal Medicine, School of Medicine, Makerere University College of
Health Sciences, Kampala, Uganda
⁶Makerere University Joint AIDS Program, Kampala Uganda
⁷Child Health and Development Center, School of Medicine, Makerere University College
of Health Sciences, Kampala, Uganda
Background: Once-weekly isoniazid-rifapentine (3HP) for tuberculosis (TB)

prevention is recommended for people living with HIV (PLHIV). We explored
process and contextual factors influencing acceptance and completion of 3HP
among PLHIV enrolled in the 3HP Options trial, an on-going pragmatic, randomized
trial comparing three optimized 3HP delivery strategies: facilitated directly observed
therapy (DOT), facilitated self-administered therapy (SAT), or an informed choice
between the two using a shared decision-making tool.
Methods: We conducted a qualitative study using semi-structured interviews

with PLHIV in each study arm, purposively selected based on demographic and
treatment completion characteristics. We used study arm-specific interview
guides to understand why PLHIV accepted, completed or stopped 3HP treatment.
147
Interviews were audio-recorded, transcribed and data analyzed using inductive

thematic analysis.
Results: We conducted 72 interviews (24 per study arm). Acceptance of 3HP was
based on: understanding of TB among PLHIV, previous experience of TB, support
DAY 3 SESSIONS
from significant others and the shorter duration of 3HP treatment compared to six
months of daily isoniazid. PLHIV in the choice arm were motivated to complete
3HP by choosing the delivery strategy which was convenient for them and the
ability to switch between DOT and SAT whenever necessary. DOT was convenient
for PLHIV who reside near the clinic and those who had not disclosed their HIV
status. SAT was preferred by PLHIV who needed minimal interruptions of their daily
routines. PLHIV stopped 3HP treatment due to adverse events, inability to change
delivery strategy for DOT and SAT participants, inadequate support from family and
significant others and the disruptive effects of the COVID-19.
Conclusions: 3HP was acceptable for PLHIV with patient awareness about TB
as a key influence for acceptance and patient choice of 3HP delivery strategy as a
key enabler of treatment completion that must be considered for effective scale-up.
Summary: Once-weekly isoniazid-rifapentine (3HP) was acceptable for TB

prevention among PLHIV at a large urban clinic in Kampala, Uganda. Patient
choice between taking 3HP from home versus at the clinic was a key enabler of
treatment completion.
A COST ANALYSIS OF IMPLEMENTING MOBILE-HEALTH FACILITATED

TUBERCULOSIS CONTACT INVESTIGATION IN A LOW INCOME
SETTING.
Patricia Turimumahoro¹, Austin Tucker³, Amanda Meyer1,2, Radhika Tampi³, Diana
Babirye¹, Emmanuel Ochom¹,Joseph Ggita1, Irene Ayakaka¹, Hojoon Sohn1,3, Achilles
Katamba1,4, David Dowdy1,3 , J. Lucian Davis1,2,5
1
Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New
2
Haven, CT, USA, 3Department of Epidemiology, Johns Hopkins Bloomberg School of

Public Health, Baltimore, MD, USA, 4Clinical Epidemiology Unit, Makerere University,
College of Health Sciences Kampala, Uganda, 5Pulmonary, Critical Care and Sleep
Medicine Section, Yale School of Medicine, New Haven, CT, USA
Introduction: Mobile health (mHealth) applications may improve timely access to
health services and improve patient-provider communication but may be costly to
148
implement, especially in resource-limited settings.

Method: We conducted a comprehensive assessment of the costs of development,
implementation, and operation of an mHealth-facilitated (TB) in Kampala, Uganda.
This program included Community Health Worker (CHW)-led home-based
specimen collection and automated short messaging service (SMS) messages for
DAY 3 SESSIONS
delivery of results to household TB contacts. We used key informant interviews and
CHW self-reported time-and-motion (TAM) surveys to estimate program costs from
a top-down and ingredients-based (“bottom-up”) approach, respectively, from the
perspective of the Ugandan health system. We estimated the costs per household
contact (HHC) investigated and per TB-positive HHC identified. Costs are reported
in 2018 US dollars.
Results: The total top-down cost was $472,327, of which $358,504 (76%)
represented program development and $108,584 (24%) program execution. This
corresponded to a $320-$348 per HHC investigated and $8,873-$9,652 per HHC
diagnosed with active TB. In the clinic, CHWs spent approximately 1.2 hours
per HHC investigated with the most time spent evaluating HHC returning to the
clinic (median 30 person-minutes per HHC evaluated enrolled, interquartile range
[IQR] 30-70). In the community, CHWs spent approximately 3.5 hours per HHC
investigated, with sputum collection accounting for a median 29 person-minutes
per HHC investigated: IQR 25-30. Cost estimates were sensitive to infrastructural
capacity needs, program reach, and the epidemiologic yield of contact investigation.
Conclusion: The cost of mHealth-facilitated contact investigation for TB was high,

and over 75% of all costs were dedicated to establishing infrastructure. These costs
could be lowered by expanding the reach of the program after a large investment
in program development.
COMMUNITY-BASED HEALTH INSURANCE INCREASED HEALTH CARE

UTILIZATION AND REDUCED MORTALITY IN CHILDREN UNDER-5,
AROUND BWINDI COMMUNITY HOSPITAL, UGANDA BETWEEN 2015
AND 2017.
Nahabwe Haven ¹*, Andrew E Dobson¹, Kuule Yusuf¹, Scott Kellermann¹, Birungi
Mutahunga¹, Alex G. Stewart², and Ewan Wilkinson³
¹Church of Uganda Bwindi Community Hospital, Kinkizi Diocese, Kanungu, Uganda

²College of Life and Environmental Science, University of Exeter, UK
³Institute of Medicine, University of Chester, Chester, UK

*Corresponding author:
149
Nahabwe Haven, Bwindi Community Hospital, Kanungu, Uganda 15

Phone: +256 772 544 589: Email: hahotice@googlemail.com
Introduction: Out-of-pocket fees to pay for health care prevent poor people from
accessing health care and drives millions into poverty every year. This obstructs
progress towards the WHO goal of universal health care. Community-based health
DAY 3 SESSIONS
insurance (CBHI) improves access to health care primarily by reducing the financial
risk. This study evaluated the impact of eQuality Health Bwindi CBHI scheme on
health care utilization and under-5 mortality in rural south-western Uganda.
Methods: This was a retrospective cross-sectional study using routine electronic
data on insurance status, health care utilization, place of birth, and deaths for
children aged under-5 in the catchment area of Bwindi Community Hospital,
Uganda between January 2015 and June 2017. Data was extracted from four
electronic databases and cross-matched. To assess the association, we measured
the difference between those with and without insurance; in terms of being born
in a health facility, outpatient attendance, inpatient admissions, length of stay and
mortality. Associations were assessed by Chi-Square tests with p-values <0.05 and
95% CI. For variables found significant at this level, multivariable logistic regression
was done to control for possible confounders.
Results: Of the 16,464 children aged under-5 evaluated during the study period,
10% were insured all of the time 19% were insured for part-of the period, and 71%
were never insured. Ever having had health insurance reduced the risk of death by
36% [aOR; 0.64, p=0.009]. While children were insured, they visited outpatients ten
times more, and were four times more likely to be admitted. If admitted, they had a
significantly shorter length of stay. If mother was uninsured, children were less likely
to be born in a health facility [aOR; 2.82, p<0.001].
Conclusion: This study demonstrated that voluntary CBHI increased health care
utilization and reduced mortality for children under-5 but appreciable outside
subsidy for wider application and replicability.
150
DAY 3 SESSIONS
SUB THEME 13: Health
Professional Education
151
“THE UGANDA TOP 500 SCIENTISTS” ACCORDING TO THE AD

SCIENTIFIC INDEX – WHY ARE NELSON SEWANKAMBO, DAVID
SERWADDA, MOSES KAMYA AND MANY OTHERS MISSING?
Prof Thorkild Tylleskär1,2

DAY 3 SESSIONS
¹Centre for International Health, University of Bergen, Norway

²Coordinator for the Makerere – University of Bergen collaboration
Introduction: Recently, a list of “the Uganda top 500 scientists” went viral in the
Ugandan scientific community. This list was produced by the “AD Scientific Index”.
It generated a lot of questions as some of the most prominent and well-known
researchers in the medical field did not even appear among the 500 scientists, yet
they were prominent in other listings like Scopus and Web of Science.
Objectives: We decided to investigate the reasons for this discrepancy.
Methods: We did a careful reading of the methodology of AD Scientific Index and

compared it with other listings.
Results: It turns out that one prerequisite to appear in the AD Scientific Index is that
the individual researcher must have generated a Google Scholar profile and to have
set the profile to “open”. Without this the AD Scientific Index will not identify you. We
went on and identified Makerere CHS researchers with Google Scholar profiles to
check if they invariably appear in the ranking. The answer is ‘no’, which means that
there are other unidentified reasons for not appearing in the AD Scientific Index.
Conclusions: For researchers to be visible, it is a good idea to have a public

Google Scholar profile. It is easy to set up.
AD Scientific Index in its current format is unreliable, rather use Scopus or Web of
Science for a proper assessment of a scientist.
152
FACTORS ASSOCIATED WITH NURSING STUDENTS’ SATISFACTION

ON THE CLINICAL LEARNING ENVIRONMENT IN NURSING TRAINING
HEALTH FACILITIES, MBALE DISTRICT
Sarah Namutebi¹*, Agnes Namaganda
DAY 3 SESSIONS
¹School of Nursing and Midwifery, Islamic University in Uganda
²School of Nursing and Midwifery – Clarke international University
Introduction: Clinical training is an integral part of Nursing education that involves

the real life, hands on or practice-based teaching and learning activities that takes
place within the clinical learning environment. In developed countries clinical
teaching is well utilized where there is good eligibility, selection, preparation and
expectation from the nursing students. In Africa, there is general lack of enough
and well-trained student nurses, In Uganda, the concept of clinical teaching among
student nurses is not well addressed. A study carried out in Uganda showed that
less than 40% of the nursing tutors in Uganda referral hospitals dedicate adequate
time to student nurses. In Mbale district, many student nurses in nursing training
hospitals have been reported to make a lot of mistakes in clinical practices on the
wards.
The purpose of the study: To establish factors associated with Nursing students’
satisfaction on the clinical learning environment in Nursing training health facilities,
Mbale district in order to improve quality of learning in the Nursing training health
facilities.
Results: A total of 246 respondents were included in this study. Factors that were
associated with Nursing students’ satisfaction on the clinical learning environment
included; personal and workplace related factors. Personal related factors included;
year of study (p=0.001), and education level (p = 0.057). Workplace related factors
included; type of mentor (p=0.018), method of supervision used with a mentor
during ward placement (p=0.021) and number of times interacted with a mentor
during clinical placement (p=0.001).
Conclusion: Presence of a nurse tutor was highly related to Nursing students’
satisfaction on the clinical learning environment where as leadership style and
pedagogical atmosphere were less related to Nursing students’ satisfaction on the
clinical learning environment.
153
ANXIETY AND COPING STRATEGIES DURING THE COVID-19 PANDEMIC

AMONG STUDENTS AT A MULTI-CAMPUS UNIVERSITY IN UGANDA
Daniel Ojilong¹*, Andrew Marvin Kanyike¹, Ashley Winfred Nakawuki¹, Dinah Maria
Lutwama¹, Dorothy Nakanwagi¹, Rebecca Nekaka²
DAY 3 SESSIONS
¹Faculty of Health Sciences, Busitema University, Mbale, Uganda

²Department of Community and Public Health, Faculty of Health Sciences, Busitema
University, Mbale, Uganda
Background: Uganda has had the longest COVID-19-induced closures of schools

world over of over 20 months, according to a recent UNICEF report, which has
greatly affected learning and mental health of University students. This study
assessed levels of anxiety, challenges and coping strategies of students at a
university in Uganda during the COVID-19 pandemic lock down. Methods: We
conducted an online, descriptive, cross-sectional study between 26th June and
26th July 2021 using mixed quantitative and qualitative methods among students
of Busitema University in Eastern Uganda. The survey assessed anxiety levels
of students using General Anxiety Disorder 7 (GAD-7) scale, and its associations
using the Chi-Square or Fischer’s exact test and multivariate logistic regression.
We also explored the challenges and coping strategies employed by students
through in-depth interviews.
Results: A total of 338 students participated, 213 (63%) were male with median age
of 23 years (21-25), majority from Faculty of health sciences (n=153, 45%). Overall,
179 (53%) of the students had anxiety which was mostly mild anxiety (n=127,
38%). Students concerned about inadequate internet facilities to support online
learning were twice more likely to have anxiety (aOR 2.0, 95% CI 1.1-3.7; p=0.021).
Among those with anxiety, avoidance coping strategies had higher scores with a
median of 8 (3-12) compared to other strategies (p<0.001). In-depth interviews
revealed challenges with online learning, academic progress, and changes to daily
routine and fear of contracting COVID-19 and getting vaccinated. Conclusion: The
largest number of students had anxiety especially those from faculty of health
sciences and engineering of which most used avoidance strategies to cope with
the anxiety. This highlights areas where the university authorities should gear effort
to design appropriate strategies to maintain mental health of students even after
the pandemic.
154
TRAINING AND PRACTICE GAPS AMONG JUNIOR DOCTORS IN

KAMPALA REGARDING THROMBOSIS AND ANTICOAGULATION
Jerome Roy Semakula, Joseph Waswa, Geraldine Kisa, Phiona Kukundakwe, Christine
Sekaggya-Wiltshire, Catriona Waitt
Introduction: Prescribers’ knowledge and attitudes about use of anticoagulation
DAY 3 SESSIONS
are among the factors affecting the quality of anticoagulation among patients on
warfarin. Health providers’ high skill and competence around anticoagulation is
associated with better patient compliance with warfarin.
Objectives: This study aimed to: 1) Explore junior house officers’ (JHOs) and
senior house officers’ (SHOs) attitudes about anticoagulation 2) Describe key
challenges faced in managing patients on anticoagulation; 3) Describe prescribers’
anticoagulation learning needs.
Methods: We conducted a paper-based survey on thrombosis and anticoagulation

among junior and senior house officers working in medical wards at tertiary hospitals
in Kampala prior to their participation in a thrombosis and anticoagulation training
workshop organised under the NIHR-funded ‘War-PATH’ research project.
Results: There were 122 workshop attendees with 37/38 (97%) SHO and
79/84 (94%) JHO respondents respectively. Overall, 92.2% of respondents had
prescribed an anticoagulant in the recent 6-month period, warfarin in 67.2%
instances. More than two-thirds were confident in assessing risk of thrombosis
and starting and monitoring patients on anticoagulation. Only 51.7%% reported
confidence in knowing when to stop anticoagulation. Reported challenges included
difficulty with INR monitoring of warfarin patients; high costs of DOACs, heparins
and INR monitoring; initiation and maintenance dosing of anticoagulants; and
management of bleeding in anticoagulated patients. The training needs reflected
the key challenges identified by respondents.
Conclusion: This study identified challenges and training needs of doctors
managing patients requiring anticoagulation that are not currently met through
clinical training. War-PATH provides a good example of integrating clinical capacity
building into the clinical research program.
155
TIMELY COMPLETION OF ONLINE ASSIGNMENTS AMONG HEALTH

PROFESSIONAL STUDENTS; AN EVALUATION OF OPEN DISTANCE AND
ELEARNING AT A PRIVATE UNIVERSITY IN UGANDA
Florence Wamuyu Githinji¹, Hilda Kyobe¹, Lubanga Robert¹, Rose Clarke Nanyonga¹
Alimah Komuhangi¹
DAY 3 SESSIONS
¹Clarke International University
Background: To foster continuity of learning in universities during the Covid-19

Pandemic, the Uganda National Council of Higher Education (NCHE) approved
emergency Open Distance and eLearning (ODeL) strategies for universities.
Health professional students spend 60% of the time in a semester on placement.
We therefore determined timely completion of online assignments and associated
factors among health professional students.
Methods: A cross sectional study was conducted from August 2021 to May 2022.
Timely completion of online assignments was defined as… Data were collected
from randomly selected 317 health professional students using a self-administered
questionnaire. The Chi-square or Fisher’s exact tests were performed for
comparison while binary logistic regression was performed to determine factors that
were independently associated with timely completion of online assignments. We
reported adjusted odds ratio (aOR) with corresponding 95% confidence intervals
(CI).
Results: Of the 317 students that responded, 79.8% completed online assignments
on time. Easy access to internet (aOR: 0.01; 95% CI: 0.001 – 0.033) was associated
with timely completion of online assignments. The odds of not completing
assignments on time increased with failure to maneuver on ODeL platform (aOR:
4.8; 95% CI: 1.17 – 19.97) and delayed coursework feedback from instructors
(aOR: 9.97; 95% CI: 1.70 – 58.5).
Conclusion: A substantial number of health professional students complete their
online assignments on time despite the fact that they spend
Successful implementation can be bolstered through enabling student, faculty and

institutional factors. Access to the internet and educational resources remains a
major deterrent. Students and the lecturers need continuous ODeL sensitization to
enable ongoing institutional learning and consolidation as we embark on the post
Covid blended teaching and learning.
156
BARRIERS AND FACILITATORS TO ADOPTION OF POSTGRADUATE

MEDICAL TRAINEES AS SIMULATION EDUCATORS: A QUALITATIVE
STUDY
Muhumuza Albert¹, Najjuma Nambi Josephine¹, Heather Macintosh², Nishan Sharma²,

Nalini Singhal², Gwendolyn Hollar², Ian Mackenzie Wishart², Francis Bajunirwe¹, Data
DAY 3 SESSIONS
Santorino¹
Affiliations
¹Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
²Cumming school of medicine, University of Calgary, Alberta, Canada
Introduction: Simulation-based learning (SBL) is a teaching method used to

improve learning for healthcare professionals. SBL requires adequate numbers of
trained educators to conduct small group sessions. In low resource settings like
Uganda, medical schools are often understaffed thus the inadequate faculty trained
as simulation educators. Postgraduate medical trainees (PGs) may assist with the
teaching including serving as simulation educators. Understanding the barriers and
facilitators to PG involvement as simulation educators will inform the design and
implementation of simulation-based curricula in medical and nursing schools. This
study explored perspectives of PGs and university simulation stakeholders towards
the barriers and facilitators to the adoption of PGs as educators.
Methods: Purposive sampling was used. We used in-depth interviews and focus
group discussion to collect data from stakeholders and PGs. Data collection tools
were developed using the consolidated framework for implementation research
(CFIR) tool. Data was analyzed using the rigorous and accelerated data reduction
(RADaR) technique.
Results: A total of seven PGs and seven key informants participated in in-depth and
key informant interviews respectively. We conducted four focus group discussions
with postgraduate students in small groups of 5 – 10 participants. The barriers
identified were: competing time demands, negative attitude towards transferability
of simulation learning, inadequacy of medical simulation equipment, and the fact that
medical simulation facilitation is not integrated in the PGs curriculum, Facilitators
included: perceived benefits of medical simulation, favorable departmental
attitude, willingness of PGs to become simulation educators; and awareness of the
simulation educator role.
Conclusions: SBL is beneficial and compliments bedside clinical teaching. PGs

are willing to be trained and become simulation facilitators. However, there is
need to realign time tables to enable their participation and obtain departmental
leadership approval for their involvement.
157
QUESTIONNAIRE DEVELOPMENT PROCESS FOR COMPLEX

PHENOMENA: A CASE OF STIGMA MASTERY
Namisi CP, Munene JC, Tumwesigye MN, Wanyenze RR, Parkes-Ratanshi R, Kiragga
NA, and Katahoire RA
DAY 3 SESSIONS
Introduction: Multiple intersecting identities based on gender, age, poverty,

sexual immorality, and HIV discriminate against individuals differently. Thus, the
purpose of this Exploratory Sequential Mixed Methods Design was to explore the
experiences of adult People living with HIV (PLHIV) who had mastered stigma to
understand and construct a culturally congruent theoretical framework that explains
the intersectional stigma mastery.
Methods: First, a qualitative Case Study Research using narrative interviews was
conducted with 16 PLHIV at St. Francis Hospital Nsambya, Home care department
to understand their meaning of stigma mastery. The interviews were inductively
coded and the codes were clustered into categories, and themes to abstract an
8-concept framework. The codes were revised into a 242-item draft questionnaire
that six peer experts rated and PLHIV in Cognitive Interviews confirmed its
relevance and clarity.
Results: Participants’ narratives revealed a novel parsimonious empowerment

theoretical framework with its high-quality questionnaire (Content Validity Index
=0.9). Specifically, gendered social exclusion (antecedent) either exacerbates
social stress, fear of rejection, fear of intimacy, and secrecy behaviors (intervening
negative processes) to render feminine PLHIV powerless (consequence); or drives
men and women with self-control to gain Social Cognitive processes (mediating) for
stigma mastery (consequence).
Conclusions: Our findings by and for PLHIV constructed a novel culturally

congruent empowerment theoretical framework with its high-quality questionnaire.
This empowerment-based perspective expands the gendered sociocultural
systems that dynamically intersect to shape which PLHIV gain or lose stigma
mastery. This empowerment-based conceptual rigor can guide future practitioners
and researchers in intersectional stigma practice in male-dominance contexts.
158
PREVALENCE AND FACTORS ASSOCIATED WITH GENERALISED

ANXIETY DISORDER SYMPTOMS AMONG MAKERERE UNIVERSITY
STUDENTS
Dr. Sharon Kezabu,Dr. Dickens Akena
DAY 3 SESSIONS
Background: University students represent a special group of people going
through a critical period of transition from adolescence to adulthood; this transition
period can be stressful for some. Through this transition, students face new
challenges, such as making independent decisions about their lives and studies,
adjusting to the academic demands of a new learning environment, and interacting
with a diverse range of new people. In addition, many students must, often for the
first time, leave their homes, distance themselves from their families, and support
networks. University students also face academic challenges and demands that
make them vulnerable to developing mental illnesses including generalized anxiety
disorder, depression and substance use disorders. These challenges can affect
the mental health and well-being of university students. Despite the fact that there
is a high burden of generalized anxiety disorder in the general population, little
has been done to examine its prevalence and associated factors among university
students in Uganda.
Objective: To determine the prevalence of and factors associated with generalized
anxiety disorder symptoms among Makerere university students.
Methods: This was a cross-sectional descriptive study carried out via online survey
mode in 883 undergraduate students from the 10 colleges of Makerere University,
Kampala Uganda. Generalized anxiety disorder symptoms were assessed using
the Generalized Anxiety Disorder 7 (GAD-7) screening instrument.
Results: The prevalence of severe GAD symptoms was 12.9% while the mean
GAD-7 score was 8.2 (±5.1). Factors independently associated with increased GAD-
7 score included year of study, employment status, perceived social support from
a significant other and family and alcohol and drug use scores. Factors associated
with a decrease in GAD-7 score included gender (being male) and living with both
parents. Social and psychological factors significantly predicted GAD score while
biological factors did not have a significant contribution to an increase or decrease
in GAD-7 score.
Conclusion: This study highlights that pyschosocial factors were significantly

associated with GAD symptoms among Makerere University students. This
emphasizes the need for universities and higher learning institutions to place a
much greater emphasis on mental health promotion among the students. Early
screening and monitoring programs should be done to identify the high-risk students
so that proper management can be given.
159
DAY 3 SESSIONS

SUB THEME 14: ONE HEALTH
(Animal, Human And
Environmental Health
Interaction)
160
HUMAN AND LIVESTOCK RIFT VALLEY FEVER OUTBREAK, KIRUHURA

DISTRICT, UGANDA, MAY - JUNE 2021
Hildah Tendo Nansikombi¹*, Alex Ndyabakira¹, Irene Kyamwine¹, Luke Nyakarahuka²,
Benon Kwesiga¹, Fred Monje³
DAY 3 SESSIONS
²Uganda Virus Research Institute, Entebbe, Uganda
³Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
Background: Rift Valley fever (RVF) is an endemic viral zoonosis in Uganda

causing sporadic outbreaks. On May 14, 2021, a 19-year-old female from Kasaana
Village, Kiruhura District, Western Uganda died at a hospital in Kampala; reverse-
transcriptase polymerase chain reaction (RT-PCR) from a blood sample was
positive for RVF. We investigated to determine the magnitude of the outbreak,
identify the source of infection, and recommend evidence-based control measures.
Methods: A confirmed case was laboratory detection of RVF virus nucleic acid by
RT-PCR or serum IgM antibodies by enzyme-linked immunosorbent assay (ELISA)
in an animal, a resident of or visitor to Kasaana Village from April 24-June 24, 2021.
We collected blood samples from 24 Kasaana villagers (2 with RVF symptoms, 2
neighbors to the index case-patient, and 20 randomly-selected individuals from
the 20 homes closest to the index case-patient’s home) and 57 livestock (33 cows
and 24 goats) from 4 village farms reporting any animals with RVF symptoms.
Human samples were tested for evidence of current RVF infection using RT-PCR or
ELISA and animal samples were tested using ELISA. We interviewed case-patients
or next-of-kin about demographics, history of RVF symptoms, and animal-related
activities. We characterized cases epidemiologically.
Results: We identified 6 confirmed case-patients (2 RT-PCR-positive, 4 IgM-

positive), of whom two were symptomatic; one died (case fatality rate=17%). Four
(67%) were female; median age was 23 years (range: 19–42 years). All case-
patients kept cows and goats. The index case-patient, who milked cows on her
family farm, had hemorrhagic symptoms consistent with RVF for 1 week before
death. She presented to six health facilities during that week but was only diagnosed
after death. Three (9%) cows and five (21%) goats were IgM-seropositive for RVF.
Conclusion: This RVF outbreak likely resulted from contact with infected animal
products. Earlier diagnosis might have prevented the index case-patient’s death.
Training of health workers at facilities within the region, emphasizing the importance
of early diagnosis of haemorrhagic fevers, might avert future RVF deaths.
Key words: Rift Valley Fever, Zoonosis, Uganda
161
An empirical study on the X-ray attenuation capability of n-WO3/nBi2O3/PVA

with added starch
Namuwonge Oliver, Ramzun Maizan Ramli, Nurul Zahirah Noor Azman
In Nuclear engineering and Technology

DAY 3 SESSIONS
Introduction: Nanotechnology has given positive impact that has led to the
development of polymer composites with nanoparticles as shielding materials. The
toxicity, high cost, lack of stability, heaviness, and not being flexible enough has led
to concerns in the use of Pb as a radiation shielding material. Polymer composites
are increasingly finding adoption and application in many fields.
Objectives:
• To study the X-ray attenuation of synthesized polymer composites, which are
the mixture of PVA n-WO3 and n-Bi2O3 with and without the addition of starch.
• To compare X-ray attenuation of the polymer composites of similar composition
but with and without the addition of starch.
Methods: Matrix composites of n-WO3/n-Bi2O3/PVA with different loadings of
n-WO3/n-Bi2O3 mixtures (0 and 15wt %) and starch (0 and 3wt %) were fabricated
by using melt-mixing method. The attenuation capability was evaluated based on
mass attenuation coefficient (m/µ) using a general diagnostic X-ray machine at
40 to 100 kVp. Starch addition effect in were observed by using FESEM through
morphological analysis
Results and Conclusion: The density and HVL values of the samples with
3wt% starch was seen lower than samples without starch (0wt%), however the
former have provided improvement in filler dispersion and better X-ray attenuation
capability compared to the latter. As conclusion, the matrix composite of n-WO3/
n-Bi2O3/PVA with 15wt% of n-Bi2O3, 8wt% of n-WO3 and 3wt% starch can be
selected as the best promising candidate for X-ray shielding materials.
162
HEPATITIS B VIRUS (HBV) SEROLOGICAL PATTERNS AMONG THE HBSAG

NEGATIVE HOSPITAL ATTENDEES SCREENED FOR IMMUNIZATION
Hussein Mukasa Kafeero, Dorothy Ndagire, Ponsiano Ocama, Charles Drago Kato,
Eddie Wampande, Abdul Walusansa, Henry Kajumbula, David Kateete and Hakim
Sendagire
DAY 3 SESSIONS
Introduction: The Hepatitis B virus (HBV) endemic in Uganda and is one of the
major etiological agents for liver diseases including liver cancer. In this work, we
evaluated the prevalence of the HBV serological markers and the associated socio-
demographic factors among hepatitis B surface antigen (HBsAg) seronegative
persons screened during routine immunization against the virus in eastern Uganda.
Objectives:
• To determine the HBV serological markers among the HBsAg seronegative
persons.
• To determine the predictors of HBsAb, HBeAb, HBcAb seroprevalenec among
the apparently HBsAg seronegtive persons.
Methods: Data on the socio-demographic characteristics were collected using
a structured questionnaire, while that on the serological markers were obtained
from serum samples and evaluated by using the 5-panel HBV One Step Hepatitis
B Virus Combo Test Device (FastepR, HBV-P43M). The following markers were
evaluated by the panel: HBsAg, HBsAb, HBcAb, and HBeAb. Data were analyzed
using SPSS (version 26), and multinomial logistic regression was used to elicit the
adjusted odds ratio. All the analysis were performed at a 95% confidence limit, and
a P value ≤0.05 was considered significant.
Results: The HBsAb, HBeAb, HBcAb marker prevalence rates was 48(11.3%),
73(17.2%) and 45(10.6%) respectively. 327(77.1%) did not present with any
marker. Being married was associated with reduced HBsAb seropositvity rate
(p<0.05), young people aged 18-29 years were associated the with increased odds
of HBsAb seropositivity (p<0.05). Male participants were significantly associated
with the HBeAb and HBcAb seropositivity (p<0.05). Similarly, contact with an HBV
infected person was significantly associated with HBeAb and HBcAb seropositivity
(p<0.05). Further still, blood transfusion was significantly associated with the
increased risk of HBcAb seropositivity (P<0.05).
Conclusion: This study has revealed a prevalence of HBV serological markers
among the HBsAg seronegative persons in this community and an increased risk
of transmission of the virus in the community. Our findings have key consequences
pertaining the interventions that are pertinent in the control and prevention of the
spread of the virus among apparently health persons.
163
PARALLEL SESSION 9A PARALLEL
Kampala, Uganda,SESSION
21st-23rd September7C
2022
FACTORS ASSOCIATED WITH DECISION MAKING ABOUT MODERN

FAMILY PLANNING USE AMONG REFUGEE AND HOST POPULATIONS
IN ADJUMANI DISTRICT, WEST NILE, UGANDA
Roselline Achola¹, Elizabeth Nabiwemba², Lynn Atuyambe², Christopher Garimoi Orach²

DAY 3 SESSIONS
¹Makerere University School of Public Health, Uganda

²Makerere University School of Public Health; Department of Community Health and
Behavioral Sciences
Correspondence: Roselline Achola, Makerere University School of Public Health,

P.O Box 7072, Kampala, Uganda. rosellineac@gmail.com
Introduction: Uganda currently hosts over 1.5 million refugees. The majority 62%
come from South Sudan and 80% are hosted in Adjumani district. Family Planning
(FP) is a fundamental human right, life-saving and cost-effective intervention for
women and girls. We investigated factors associated with decision making about
modern FP use amongst refugee and host populations.
Methods: We conducted a comparative cross- sectional study in 3 refugee

settlements and host communities in Adjumani district. A total of 1,307 respondents
(661 refugees and 646 host) were randomly selected using multi stage clustered
sampling and interviewed using structured questionnaires and Open Data Kit
(ODK) during April and May 2021. Data analysis was done using STATA V.14 C.
Multivariable logistic regression was used to establish factors associated with use
of FP.
Results: The study found that mCPR was 28.6% for host and 28.4% for refugees
respectively. Factors significantly associated with decision to use FP were religion,
Anglican were more likely to use modern FP compared to Catholics, AOR = 6.21,
95% CI [1.11-34.57] for host and AOR= 25, 95% CI [4.75-13.23] for refugees, joint
decision by host couples AOR = 0.04, 95% CI [0.89-138.39] and refugees AOR=
6.43, 95% CI [1.78-16.08]. Key barriers to modern FP use by the host, included
harassment of women who did not consult their significant others (AOR = 0.07,
95% CI [0.01-0.79], separation/divorce (AOR = 0.03, 95% CI [0.00-0.35] and fear
of side effect [35.81%]. Whereas amongst the refugees, main barriers to FP use
included not wanting to use FP [45.82%], wanting to become pregnant [6.84%], and
fear of side effects [5.82%].
Conclusions: There is low mCPR among both refugees and host. Level of
education, religion and fear of side effects are key factors that affect decision to
use modern FP methods amongst both refugees and host communities. There is
need to sensitize communities on the benefits of FP, and promote male involvement
164
PARALLEL
Kampala, Uganda, 21st-23SESSION
rd
September 2022 7C PARALLEL SESSION 9A
including couple counseling at community level.
Key words: Decision making, factors associated, family planning, use, refugees
and host population
DAY 3 SESSIONS
MEASLES OUTBREAK IN SEMUTO SUBCOUNTY, NAKASEKE DISTRICT,
UGANDA, JUNE–AUGUST 2021
Edirisa Juniour Nsubuga1*, Job Morukileng1, Josephine Namayanja1, Daniel Kadobera1,2,
Fred Nsubuga3, Irene Byakatonda Kyamwine1,2, Lilian Bulage1,2, Benon Kwesiga1,2, Alex
Riolexus Ario1,2, Julie R. Harris⁴

²Uganda National Institute of Public Health, Kampala, Uganda
³Uganda National Expanded Programme on Immunization, Ministry of Health, Kampala,
Uganda
⁴United States Centers for Disease Control and Prevention, Kampala, Uganda
*Corresponding author: Edirisa Juniour Nsubuga, +256704131375, nsubugaeddiej@
musph.ac.ug
Background: Despite a nationwide measles-rubella vaccination campaign

conducted in late 2019 in Uganda, Semuto Subcounty reported rubella/measles
outbreaks in 2020 and 2021. We investigated the measles outbreak in 2021 to
determine the scope, assess factors associated with the transmission, estimate
vaccine coverage, and effectiveness, and recommend evidence-based control
measures.
Methods: We defined a probable case as acute onset of fever and a generalized

maculopapular skin rash with ≥1 of: cough, cold, or red eyes in a resident of Semuto
Subcounty, Nakaseke District, from June 1–August 31, 2021. A confirmed case
was a probable case with a blood sample positive for measles-specific IgM. We
reviewed medical records and used snowballing to identify cases. We conducted
a 1:4 village-matched case-control study to identify associated factors. A control
was a randomly-sampled person aged 6 months-9 years without signs/symptoms
of measles from June 1–August 31, 2021, residing in the same village as the case.
We used Epi Info to obtain Adjusted Mantel-Haenszel odds ratios (ORMH) and
confidence intervals (CIs), and calculated vaccine coverage and effectiveness.
Results: We identified 30 case-persons (3 confirmed); 16 (53%) were male, and

none died. The overall subcounty attack rate (AR) was 3.2/1000. Children aged
5-9 years were the most affected (AR=5.0/1,000). Twenty-two (79%) case-persons
165
and 116 (97%) control-persons had ever received measles vaccine (ORMH=0.13,
95% CI: 0.03-0.52). Interaction with symptomatic persons at water collection points
(ORMH=4.4, 95% CI: 1.6-12) and playing at community playgrounds (ORMH=4.2,
95% CI: 1.7-11) during the exposure period increased the odds of infection. The
study vaccination coverage was 97% (95% CI: 92-99%) and vaccine effectiveness
was 87% (95% CI: 48-97%).
DAY 3 SESSIONS
Conclusions: Socializing and congregating at water collection points and

community playgrounds facilitated measles transmission in this outbreak. Measles
vaccination was protective. We recommended mass community vaccination (or
re-vaccination) by Nakaseke District for children in Semuto Subcounty to capture
unvaccinated children and act as a second dose in those who received only one
dose. We urged parents/guardians to recognize, isolate, and keep children with
measles-like symptoms at home.
Key words: Measles, Disease outbreaks, Risk factors, Vaccine coverage, Case-
control studies, Uganda
PREVALENCE OF AND FACTORS ASSOCIATED WITH CAREGIVERS’

USE OF COMBINED HERBAL AND CONVENTIONAL MEDICINE IN
TREATING CHILDREN WITH SICKLE CELL DISEASE AT JINJA REGIONAL
REFERRAL HOSPITAL, UGANDA: A CROSS-SECTIONAL STUDY
Consiliate Apolot¹*, Samuel Obakiro²*, Joseph KB Matovu 1,3*

¹Department of Community and Public Health, Busitema University, Mbale, Uganda.
²Department of Community and Public Health, Busitema University, Mbale, Uganda.
³Department of Disease Control and Environmental Health, Makerere University School
of Public Health, Kampala, Uganda
Emails:
Consiliate Apolot: consiliate511@gmail.com, Samuel Obakiro: sobakiro@gmail.com
JKBM: jmatovu@musph.ac.ug
Background: Concurrent use of Herbal (HM) and Conventional Medicine (CM)

poses a huge risk of drug-herbal interactions that can result in therapeutic failure or
toxicity. However, little is known about the prevalence of the use of both therapies
to treat children with sickle cell disease (SCD) and the associated factors. This
study aimed to determine the prevalence of and factors associated with the use of
HM and CM among caregivers of children with SCD attending the Sickle Cell Clinic
(SCC) at Jinja Regional Referral Hospital (JRRH), East-Central Uganda.
Methods: A mixed-method, sequential explanatory design was used. Data were
166
collected between January and March 2022. Quantitatively, a sample size of

394 caregivers of children with SCD aged 1-18 years was targeted. Structured
questionnaires were used to collect data on socio-demographic characteristics,
SCD treatment history, perceptions of and intentions to use HM, CM both, and
community and health-related factors. The primary outcome was the use of both
DAY 3 SESSIONS
HM and CM (i.e. combined therapy). Quantitative data analysis was performed
using Stata version 15. A logistic regression model was fitted to determine the
factors associated with the use of combined therapy and all factors with a p-value
less than 0.05 were considered significantly associated with the primary outcome.
After completion of the structured interviews, qualitative data were collected from
26 purposively selected caregivers who reported use of both HM and CM and had
participated in the quantitative interviews. Four focus group discussions (FGDs)
were conducted to collect data on treatment experiences; cultural, family, friends,
or relatives’ influence on the use of both therapies, and caregivers’ considerations
when choosing both remedies. Qualitative data were analyzed following a thematic
framework approach, using NVIVO software.
Results: A total of 372 (94.4% of sample) caregivers was interviewed; 341 (91.7%)
of whom were females. Respondents’ average age was 34.3 (SD: ±9.8) years.
More than half (55.1%, n=205) of the caregivers were aged 18-34 years while
40.9% (n=152) had primary education. Fifty-eight percent (n=217) of the caregivers
reported use of only CM, 37.1%, (n=138) used combined therapy while 4.6%
(n=17) reported use of HM only. In the multivariate analysis, caregivers aged 60+
years (adjusted odds ratio [AOR] = 11.8; 95% Confidence Interval [95%CI]: 1.2,
115.2), those with lower secondary education (AOR=6.2; 95% CI: 1.5, 26.0), those
who believed that HM is beneficial (AOR=3.3; 95% CI: 1.5, 7.6) and those who
believed that the use of both CM and HM is safe (AOR=7.7; 95% CI: 3.5, 17.0) were
significantly more likely to use combined therapy than their counterparts. Caregivers
who intended to use only CM (AOR=0.1; 95% CI: 0.1, 0.3) were significantly less
likely to use combined therapy. From the qualitative findings, lack of trust in the use
of either CM alone or HM alone and recommendations from relatives and friends
were the main factors that influenced the use of combined therapy.
Conclusion: Slightly more than half of the caregivers used CM only while more
than a third used both. Caregivers’ age and level of education, compliance with
recommendations from significant others, and lack of trust in either therapy alone
were significantly associated with the use of combined therapy. We recommend
that caregivers using combined therapy be sensitized about the dangers associated
with the use of combined therapy. Health care workers should also be informed
about this behavior so as to plan effective interventions to minimize the practice.
167
FOREWORD Kampala, Uganda, 21st-23rd September 2022
POSTER PRESENTATION SCHEDULE

DAY ONE: 21ST SEPTEMBER 2022
Chair: Dr Innocent Besigye
Co - Chairs: Susan Byekwaso and George W.
Kizza
Abstract Presenting
FOREWORD
Title
Number Author
Willingness to Take Pre-Exposure Prophylaxis (PrEP)
G005 Agwang Winnie among High-Risk Young Men aged 10-24 years in
Masese Fishing Community, Jinja District, Uganda
Preterm birth: Using machine learning algorithms to
G006 Akello Mercy identify patterns and characterization using socio-
demographic and health factors
Volunteer support intervention in management of
G010 Alinaitwe Rachel patients with severe mental illness in uganda-a
controlled pre-post study
Single Nucleotide variants (SNVs) of angiotensin
converting enzymes (ACE1 and ACE2); a plausible
G017 Atiku S. explanation for the global variation in COVID-19
prevalence
Psychological distress and coping mechanisms in
G020 Aujo Blessed women with sexual dysfunction using hormonal
contraceptives at Kawempe hospital
Prevalence, factors and tracing of transferred adult
G021 Baguma Syson HIV positive clients in selected health facilities in
South Western Uganda.
Prevalence of Child restraint and Seatbelt use in
G025 Balugaba Bonny Kampala; an observational study
Helmet use among motorcyclist and associated
G026 Balugaba Bonny factors in Kampala
Gaps in the management of emergencies at the
G035 Chebet Fridah medical emergency unit of Mulago National Referral
Hospital
Improving the nutrition of school children in refugee
settlements through the production of the yellow
G040 Gwokyala Violet mealworm. Testing the feasibility through a pilot
intervention in Kyaka II Refugee settlement
Linking Health and Demographic Surveillance Site
G041 Gyezaho Collins Registry and Community Health Facility data for
morbidity surveillance in rural Eastern Uganda.
Readiness for integration of ART services in
G042 Rogers Isabirye departments at selected health facilities in Lira district
Integrating HIV and Hypertension Care in Primary
G043 Jane Kabami Care Clinics –Baseline Results from an Ongoing
Cluster-Randomized Trial in Rural Uganda.
168
Kampala, Uganda, 21st-23rd September 2022 FOREWORD
“I desire to have an HIV free baby”: Barriers and

G045 Jane Kabami Facilitators to Viral Suppression from the women’s
Perspectives.
Experiences and views of health care professionals
G047 Kagoya K. Enid towards the prescription of antibiotics in Eastern
Uganda, A qualitative study.
Using Population-Based Structures to Actively Monitor
FOREWORD
G049 Dan Kajungu AEFIs during a Mass Immunization Campaign—A
Case of Measles–Rubella and Polio Vaccines
Status of malnutrition in children aged under five years
G053 Dan Kajungu in rural Uganda: An assessment of the SDG 2 target
2.2 indicator status using a population-based
Prevalence and factors associated with pre-hospital
G054 Keith T. Kakame delay among acute stroke patients at Mulago and
Kiruddu National Neferral Hospitals, Kampala.
Antimicrobial resistance and rational use of medicine:
Andrew M.
G058 knowledge, perceptions, and training of clinical health
Kanyike professions students in Uganda.
Retention in Care and Viral Load Suppression
among Adult HIV Patients in Southwestern Uganda.
G061 Kasande M. Qualitative Study among Health Workers and Patients
in CCLADS
Prevalence of diabetes among hiv patients on
G062 Kasande M. dolutegravir based antiretroviral therapy at iss clinic
Mulago
HIV prevalence among adults with diabetes mellitus
G067 Kazibwe Andrew (DM) at an outpatient DM clinic in Uganda
Implementation of Tuberculosis Infection Prevention
Kembabazi
G071 and Control standards: An assessment at hospitals in
Veronica Uganda
Trends and distribution of birth asphyxia, Uganda,
G080 Komakech Allan 2017-2020: a retrospective Analysis of Public Health
Surveillance Data
How Uganda is a role model for handling the HIV
G085 Lewis Kelly pandemic and how it can progress
Knowledge, attitude and practices of parents
G091 Loyo E. regarding childhood immunisation at arua Regional
Referral Hospital
A digital aided community-based taxi referral system
G096 Lwetabe Michael improves access to emergency obstetric and neonatal
care in districts of Kyotera and Rakai
Post exposure prophylaxis for the newborns in health
G098 Matsiko Adrian facilities in southwestern Uganda: Experiences and
perceptions of HIV positive mothers
169
Quarterly Trends of Tuberculosis (TB) Case Detection

Rates and Treatment Success Rates Before and After
G103 Mugabe Rashid the TB Linkage facilitators: A case study at Kinoni
Health Center IV in Rwampara District in Western
Uganda 2019-2022
Tackling emerging and Nosocomial Infection using
G104 Mugisha Arnold Vitex-Medical Assistant Tool
DAY 3 SESSIONS
Our bodies are weak, we don’t yet know how the

vaccine will react with HIV, and HIV medications”:
G106 Muhindo Richard Reasons for non-acceptance of COVID-19 vaccination
among people living with HIV in Uganda
Contextualizing a mindfulness and acceptance-based
G109 Musanje Khamis intervention to support adherence to antiretroviral
therapy among adolescents in Uganda
Assessing the diagnostic gaps for common NCDs
G118 Nabukeera B. in rural Uganda: A case of high blood pressure and
diabetes
A Retrospective Cross Sectional Study of the
Robert Effectiveness of Community Health Nurses in
G121 Improving Infant Health in Bwindi, South Western
Kamugisha
Uganda
Factors affecting enrolment into community based
G122 Nahabwe Haven health insurance scheme among of indigenous Batwa
in Kayonza Sub County.
Mentorship of lower-level health facilities on
G124 Suzan Nakalawa antimicrobial stewardship in Wakiso district, Uganda
G150 Nsangi O Tendo No title
Mother-to-infant transfer of anti-infective drugs through
G158 Francis W. Ojara breastfeeding: establishing a framework for adequate
characterisation of infant exposure
Retention at six months and factors influencing among
G161 Okello Tom anti-retroviral treatment clients in rural Uganda
Soil Contamination with infectious and GMO wastes is
G162 Olupot Giregon a potent trigger of Antimicrobial Resistance
Utilization of Maternal Health Care (Mhc) Services
G168 Outa C. utilization among mothers in Petete Sub-County,
Butebo District, Eastern Uganda
Depression and its associated factors among health
Owach and
G169 professional students in a private university in
Komuhangi H Kampala, Uganda
Fibrinogen; a predictor of injury severity and short-
G186 Senyondwa term outcomes among adults with traumatic brain
injury, a prospective study
Teacher Stress and Impact on Teacher Mental Health
Eddie Tinka
G187 and Practices During Post COVID Pandemic and
Mugisa Early School Reopening in Uganda Schools
170
Factors influencing low immunization coverage among

G188 Tuckolon JVT children less than two years in grand Bassa County,
Liberia
Understanding knowledge, perceptions and healthcare
G189 Tusabe J. seeking practices of rural communities in the
management of snakebites in Kamuli, Eastern Uganda
DAY 3 SESSIONS
The experiences faced by caregivers of children living
G196 Vorkpol T. with HIV and AIDS in Liberia: the case of Martha
Tubman Memorial Hospital
Prevalance and factors associated with poor quality of
G198 Wamala Denis life among people living with HIV and having mental
illness attending the Infectious Disease Institute
Prevalence of Cryptococcus gattii in Ugandan
G200 Webambazi HIV-infected Patients presenting with Cryptococcal
Meningitis
Neonatal skin care in eastern Uganda: beliefs,
G201 Wemani Daniel practices and acceptability of emollient use
Nicholus Low-Level Viraemia: Meaning and Perceptions among
G209 People on Antiretroviral Therapy in Uganda
Nanyeenya
Black Water Fever among children in Districts of
G215 Alice Asio Bugisu, Bukedi, and Busoga Regions in Eastern
Uganda, January 2019 – July 2021
Perceptions of females about trauma-informed
S2 Amwine E. services for survivors of sexual violence in south
western Uganda- a qualitative study
Pathways to diagnosis and treatment of dementia
Katugume
S4 among people aged 65 years and above in nyamirima
Prosper ward Ibanda District
Cholera and climate change: a pandemic waiting to
S6 Manvir Sing Sing happen?
Jordan The importance of science communication:
S7 Bacteriophage therapy. Have you heard of it?
Shutt-Mcabe
DAY TWO: 22ND SEPTEMBER 2022

Chair: Dr Innocent Besigye
Co - Chairs: Susan Byekwaso and George W. Kizza
Occupational Radiation Monitoring for Medical
G003 AEC Workers in Uganda
G007 Akoth F. No title
Knowledge, attitudes and practices towards
G009 Ali Moses prevention of Hepatitis B infection among students of
Gulu University, Uganda
Risk Factors for Teenage pregnancies during the
G011 Alunyo Jimmy COVID-19 period in Pakwach District
171
Evaluating the effect of COVID-19 on the trend of

G012 Alunyo Jimmy teenage pregnancy before and during the lockdown in
Pakwach district Uganda
Experiences of HIV Positive Serostatus Disclosure
Atwijukire
G019 to Sexual Partner Among Individuals in Discordant
Humphrey Couples in Mbarara City, Southwestern Uganda
DAY 3 SESSIONS
Continuous medical education on management

of paediatric and adolescent HIV using WhatsApp
G023 Balina Moses among healthcare workers at 20 rural healthcare
facilities in Uganda.
Pedestrian road safety review of selected road
G026 Balugaba Bonny sections in Kampala, Luwero and Gulu
Interventions to reduce pedestrian road traffic injuries:
G027 Balugaba Bonny A global systematic review.
Effects of a COVID-19 public health lockdown on
G030 Beesiga Brian drinking and health behavior among persons with HIV
and with heavy alcohol use in Uganda
Disruptions in Health Services during COVID-19 in
G031 Birungi Deborah Uganda
Preparing Future Health Professionals to Engage in
G036 Cook Natalie Transformative Evaluation
G038 Eudu James No title
Effects of the COVID-19 lockdown on the HIV Care
G044 Jane Kabami Continuum in Southwestern Uganda
Initial experiences of establishing appropriate
pathways for Early Identification and Interventions for
G048 Fred Kagwire Children with Disabilities and Developmental Delays
as part of Community Health Systems in Uganda
Drug and Vaccine Utilization Among Pregnant Women
G050 Dan Kajungu in the Iganga Mayuge Health and Demographic
Surveillance Site (IMHDSS), Uganda
People living with Hypertension are reluctant to seek
G052 Dan Kajungu continuous care and management from healthcare
service delivery system in rural Uganda.
Barriers to birth and death registration in rural Uganda:
G051 Dan Kajungu understanding the bottlenecks
Exploring parental understanding of child sexual
G055 Keith T. Kakame abuse and prevention as a measure For HIV
prevention in Rwampara District.
Health-related quality of life of children with sickle cell
G057 Carol Kamya anaemia in Uganda; Preliminary findings.
Social networks for older adults with and without
G059 Jackline Karungi alzheimers disease in Central Uganda
Health Professions Education: Towards a
Ms. Viola
G060 Multidisciplinary Approach to Health Education and
Karungi Practices for the Complex Globalized 21st Century
172
Implementing a clinical graduate pediatric nursing

program in resource-limited setting: A collaborative
G063 Katende Godfrey approach by US academic institutions and Human
Resource Health (HRH) program in Rwanda
Older adults with diabetes mellitus (DM) have high
G068 Kazibwe Andrew odds of latent tuberculosis infection – findings from an
outpatient DM clinic in Uganda
DAY 3 SESSIONS
Glibenclamide use associated with lower odds
of latent tuberculosis infection among adults with
G069 Kazibwe Andrew diabetes mellitus (DM) – findings from an outpatient
DM clinic in Uganda
Improving breast cancer care coordination in Uganda:
Kibudde
G074 an apprenticeship program for primary care providers
Solomon and patient navigators
Managing conjoint twins at an LMIC Hospital: a case
G075 Kisa Phyllis series from Uganda
Strengthening justification of medical exposures: a
Kisembo N. multicenter study of adequacy of clinical information
G076 and vetting of paper-based CT requisitions for
Harriet
children and young adults in sub-Saharan Africa
Stringency of NPIs for COVID19 response in the
G079 Kizito Susan Democratic Republic of Congo, Nigeria, Senegal and
Uganda
Screening, Diagnosis, and Management of Patients
G083 Kuule Yusufu with Alcohol Use Disorders at Bwindi Community
Hospital, Uganda.
The safety of health care workers a priority for patient
G097 Maiga Ayub safety
Sectoral situation analysis for Corona Virus Disease
G101 Mubeezi Ruth 2019 preparedness and response in workplaces in
Kampala Metropolitan Area (KMA), Uganda
Exposure to cholinesterase-inhibiting insecticides,
impaired pulmonary function and glycemic control:
G102 Martin Hansen A prospective study among Ugandan smallholder
farmers
Mugyenyi Supporting Health Systems in Uganda: A Community
G105 and Health Care Workers based Perspective
Nathan
Patient satisfaction with services at Dental Out Patient
G116 Mwebesa Ernest Department- Mulago Hospital, Uganda.
Prevalence of herbal medicine use and associated
Harriet
G127 factors among cancer patients receiving palliative care
Nalubega at a Hospice.
Proper hospital waste management to control cross
G125 Nakate Norah infection at Gulu Regional Referral Hospital
Embracing virtual training in Global Health programs
G128 Nalugo S. to attain collaborative objectives.
Prevalence and economic impact of bovine fasciolosis
G130 Nambafu J. at the Kampala City abbattoir
173
Occupational safety of radiation workers in practices

G143 Nassuna S. that apply use of ionizing radiation in Uganda
‘It was one after the other’. A triplet success story of
G145 Natuhwera G. three cancer patients in one family recieving palliative
care at Little Hospice Hoima
Assessment of Monitoring and Evaluation system in
DAY 3 SESSIONS
G163 Omara H. C stroke management program at Mubende Hospital in

Uganda
Child pedestrian safety in Uganda: A qualitative
G167 Osuret J. exploration on road safety stakeholder perspectives of
risk factors, opportunities and barriers
Causes of infection of COVID-19 by medical workers
G172 Radinova V. of Dnipro city (Ukraine)
G173 Rugile V. COVID-19 vaccination and pregnant mothers
G174 Sairo Halima Community Linkage Assessment
G176 Sally O’Rourk Filthy Soil: The solution to antimicrobial resistance?
Community engagement and environmental
G181 Semugabo C. modifications to reduce injury risks among children in
a low-income urban community in Uganda
Understanding unintentional childhood injuries in
G182 Semugabo C. Uganda – an exploration of health inequities through
Photovoice
Hazards and Control Measures among Artisanal and
G184 Singo Josephine Small-Scale Gold Miners in Zimbabwe
Organizational readiness to deliver household TB
G206 Ann Johnson contact investigation in Uganda: a survey of health
facilities.
Factors associated with use of modern contracteptives
among female adolescents 15-19years in Rubaga
G210 Turyagenda Faith Division slums of Kampala - Uganda: A cross sectional
study
A systematic approach to health and safety among
G221 Singo Josephine artisanal and small-scale gold miners in Zimbabwe
Antimicrobial use and prescribing practices across six
G240 Malinga A. Regional Referral Hospitals (RRHs) in Uganda
Experience of a nurse student in the community of
S11 Ojwee Monica Sesirida, Mende,Wakiso District
Non-invasive monitoring of blood glucose among the
S12 Sebuliba Reagan diabetics in Uganda using near infrared (nir) sensor
174
JASH CONFERENCE 2022 ORGANISING

COMMITTEE
Chair: Prof. David M. Meya 14. Maureen Kisaakye
Vice Chair: Dr. Innocent Besigye 15. Ikemeri Allan Micah
DAY 3 SESSIONS
Gen. Secretary: Dr. Lydia Nakiyingi 16. Ivaan Pitua
COMMITTEE
17. Andrew Kintu

A. FINANCE COMMITTEE
1. Prof. Annettee Olivia Nakimuli, Dean SOM D. LOGISTICS
2. Susan Nassaka Byekwaso 1. Stella Nahatuba-Chair
3. Michael Settimba 2. Irene Namukinga
3. Norah Namirembe
B. SCIENTIFIC COMMITTEE 4. Andrew Okiror
1. Prof. Victor Musiime-chair 5. Nabunje Joletta Eleanor
2. Prof. Mark Kaddumukasa 6. Nabbanja Esther
3. Dr. Deogratius Sekimpi-UNACOH
4. Dr. Cecilia Nawavvu-UNACOH E. PROGRAMMING
5. Prof. Robert Basaza-UNACOH 1. Dr. Dickens Akena-Chair
6. Dr. Roy Mubuuke 2. Dr. Cathy Kilyewala-Deputy

3. Chemutai Beliza
7. Dr. Lydia Nakiyingi
4. Kyagulanyi Eddy
8. Dr. Richard Muhindo
9. Dr. Nakalembe Miriam
C. PUBLICITY COMMITTEE & ICT

1. Dr. Sabrina Kitaka-Chair
2. George W. Kizza (AMI)
3. Zaam Ssali
4. Mukisa John –UNACOH
5. Asasira Ignatius
6. Eddy Kakooza
7. Juliet Otiti
8. Gakwerere Daniel
9. Atulinda Linda
10. Tebandeke Grace
11. Monica Odella
12. Felicitas Ojwang
13. Rogers Ssenyondo
175
DAY 3 SESSIONS
176
DAY 3 SESSIONS
LEVERAGING 100 YEARS OF EXCELLENCE

IN BUILDING A TRANSFORMED SOCIETY
LAYOUT & DESIGN BY: GEORGE W. KIZZA (ASM)

DEPARTMENT OF MEDICAL ILLUSTRATION, MAKERERE UNIVERSITY
Tel: +256 701 047 333, Email:medart.ug@gmail.com
177

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16th JOINT ANNUAL SCIENTIFIC HEALTH CONFERENCE 2022

28th UNACOH CONFERENCE,

20th DR. MATHEW LUKWIYA MEMORIAL LECTURE

1st NATIONAL ANTIMICROBIAL RESISTANCE SYMPOSIUM

21ST- 23RD SEPTEMBER 2022

28th UNACOH CONFERENCE,

3rd MinOSH INTERNATIONAL CONFERENCE

20th DR. MATHEW LUKWIYA MEMORIAL LECTURE

1st NATIONAL ANTIMICROBIAL RESISTANCE SYMPOSIUM

21ST- 23RD SPEKE RESORT

“Health for All & By All”

SCHOOL OF PUBLIC HEALTH

PARALLEL SESSION 1A:

FACTORS INFLUENCING THE UPTAKE OF VOLUNTARY MEDICAL MALE

Epidemiology Unit, Kampala, Uganda

Introduction: Despite high levels of awareness about availability and benefits of

Methods: We employed mixed methods design among boda-boda riders in

Conclusion: Although VMMC is largely perceived as protective against HIV and

PREVALENCE OF CARDIOVASCULAR DISEASES (CVDS) AND HIV

Africa Medical and Behavioral Sciences Organization (AMBSO), Hoima and

Wakiso Districts, 2University of California Los Angeles, US; 3Karolinska Institute,

Introduction: Antiretroviral therapy has dramatically changed the clinical and

HIV PREVALENCE AMONG CHILDREN ADMITTED WITH SEVERE ACUTE

Background: Despite global efforts to eliminate mother to child transmission of

Methodology: We conducted a cross-sectional evaluation within the ongoing

Conclusion: In this era of universal antiretroviral therapy for EMTCT, a 10%

BARRIERS TO AND FACILITATORS OF UPTAKE FOR ASSISTED PARTNER

Methods: We conducted a cross-sectional study with descriptive and analytic

LONG-TERM EFFECT OF GROUP SUPPORT PSYCHOTHERAPY ON

P.O.BOX 7072, Mulago Hill Road, Kampala, Uganda

Keywords: depression; group support psychotherapy; HIV/AIDS; anti-retroviral

HIV viral load non-suppression at six months post-antiretroviral therapy

Methods: We conducted a retrospective cohort study at four HIV clinics in Kampala

Conclusion: Fewer than 1 in 10 clients had non-suppressed viral loads after

Key words: Viral load non-suppression, pediatric, adolescents, regimen

HIGH BURDEN OF CRYPTOCOCCAL MENINGITIS AMONG ART-

¹Department of Medicine, Lira University, Lira, Uganda,

Purpose: We evaluated the burden of CM among ART-experienced patients at Lira

Methods: Using secondary data, we evaluated clinical factors, including ART-

In rural, northern Uganda, the majority of HIV-infected patients with CM were

• To assess retention levels of MSMs on PrEP

BARRIERS AND FACILITATORS TO ORAL PREP UPTAKE AMONG

¹Department of Nursing, Makerere University. ²Clinical Epidemiology Unit, Makerere

Methods: An explorative qualitative study comprising in-depth participant

BURDEN, ETIOLOGIES AND OUTCOMES OF MENINGITIS IN RURAL,

Medicine, University of Minnesota Medical School, Minneapolis, MN, United

Introduction: Meningitis is a major cause of death in Uganda, but little is known

Purpose: To identify the burden, etiologies, and outcomes of meningitis at Lira

Results: Of 167 patients with meningitis, 43 patients (25.7%) had a confirmed

Conclusion: The most common type of meningitis with a confirmed diagnosis

RESURGENCE OF MALARIA BURDEN IN FIVE DISTRICTS IN UGANDA

Adrienne Epstein1*, Catherine Maiteki-Ssebuguzi², Jane F. Namuganga³, Joaniter

Background: Five years of sustained indoor residual spraying (IRS) of insecticide

Interpretation: We observed a resurgence in malaria to pre-IRS levels despite

COMPARING MEASURES OF MALARIA TRANSMISSION, INFECTION,

* Joaniter I Nankabirwa, Teun Bousema, John Rek, Emmanuel Arinaitwe, Bryan

Introduction: Tororo, a historically high transmission district in Eastern Uganda

Results: Over approximately five months of follow-up, 19,566 female anopheline

Conclusion: Transmission intensity was moderately higher in the border parishes

URINARY TRACT INFECTIONS AMONG PATIENTS WITH

Maria Sekimpi¹, Emmanuel Seremba ², Ponsiano Ocama¹, Pauline Byakika-Kibwika¹

²Kiruddu National Referral Hospital, Kampala Uganda

with a prevalence of 27% in some European studies. Uganda has no data on