Faculty of Health Sciences

Mapping hotspots, trends, and drivers of recent HIV infections among TASO clients in Uganda (2021-2024)

Sat, 01 Nov 2025 00:00:00 GMT

Mapping hotspots, trends, and drivers of recent HIV infections among TASO clients in Uganda (2021-2024) Nsubuga, Sydney Background Despite significant progress on HIV control in Uganda, the population-level viral suppression rate remains low at 74.9% and Uganda now records about 50,000 new HIV infections annually, which underscores the need to detect geographic hotspots and programmatically relevant drivers among clients entering care. . Recent HIV infections, defined as those acquired within twelve months, are important indicators of ongoing transmission and the extent of prevention efforts. However, data at the subnational level regarding recent infections, their geographic clustering, temporal trends, and risk factors are limited. This study aimed to map the spatial distribution, identify temporal trends, and explore the drivers of recent HIV infections among clients of The AIDS Support Organization (TASO) in Uganda from 2021 to 2024. Methods: A retrospective, multiple-methods study design was employed, utilizing routinely collected HIV recency testing data from 11 TASO centers across Uganda. Individuals newly diagnosed with HIV were classified according to the national recent infection testing algorithm (RITA) detailed in Figure 1-3. Spatial analysis involved empirical Bayesian smoothing, Global and Local Moran’s I, and Getis-Ord Gi* techniques to identify hotspots. Temporal trends were evaluated using Mann-Kendall tests and time-series clustering. Multivariable logistic regression identified individual-level predictors of recent HIV infection. Data were extracted from electronic medical records and analyzed with ArcGIS Pro, R, and Stata. Results: A total of 8,276 HIV-positive clients were analyzed for hotspot and temporal trend detection, and 5,422 clients for identifying drivers of recent HIV infection. Spatial analysis revealed persistent and emerging hotspots, including a new outbreak in Kyenjojo (2024) and sporadic clusters along the southwestern and eastern cattle corridors. No district showed sustained or increasing hotspots, while districts in the Lake Victoria basin experienced episodic surges. Temporal patterns were mostly oscillatory. Sixty-four districts maintained near-zero incidence over 48 months, indicating epidemic control through stable treatment and low-risk behavior. Forty-five districts showed a gradual increase from late 2022, peaking in mid-2023 before declining, reflecting mobility-driven surges linked to the post-COVID-19 reopening. Another 37 districts experienced short-lived urban and peri-urban spikes in mid-2022 and early 2023, which were quickly contained through responsive health interventions. In multivariable analysis, male clients had significantly lower odds of recent HIV infection compared to females (OR = 0.74; 95% CI: 0.57–0.96; p = 0.021). Other variables, age, education, HIV testing approach, delivery model, pre-test counseling, and ARV adherence, were not significantly associated with HIV recency (p > 0.05). Conclusion: The study found an overall HIV recency prevalence of 10.5% among TASO clients, with significant variation across centers and over time. Centers in the southwestern and eastern regions, especially along the Cattle Corridor and the Lake Victoria basin, experienced episodic surges. At the same time, most other districts consistently maintained low or zero recency rates. A new hotspot appeared in Kyenjojo in 2024, indicating localized outbreaks amid general epidemic control. Temporal analysis revealed oscillating trends, with brief peaks in mid-2022 and early 2023, corresponding to post-COVID mobility and economic reopening. These findings emphasize the fragmented and changing nature of recent HIV infections across Uganda. Targeted surveillance, rapid response, and geographically focused prevention strategies are critical to maintaining epidemic control and progressing toward the 2030 HIV elimination goals. Dissertation

Factors associated with perinatal mortality in Mbale regional referral hospital:

Sun, 01 Jan 2023 00:00:00 GMT

Factors associated with perinatal mortality in Mbale regional referral hospital: Wepondi, Isaac Globally, 2.6 million babies die annually during perinatal period. Majority, (95%) occur in low- and middle-income countries (LMIC) posing a significant public health problem. The East African regional perinatal mortality was 34.5%, Uganda was 38% while Mbale was 41%. Understanding factors associated with perinatal mortality in Mbale was studied and will guide policy formulation and improved local clinical practice. Objectives: To describe factors associated with perinatal mortality in Mbale regional referral hospital. Methods: A cross-sectional study was conducted in Mbale regional referral hospital from August 2022 – December 2022. Three hundred sixty-eight (368) participants were consecutively enrolled into the study. The primary outcome was perinatal mortality, which included stillbirths and early neonatal deaths. Other factors like pre-term births, birth asphyxia and birth trauma were also believed to be contributing to perinatal mortality. We used Stata 15 (Stata Corp, 2015) and carried out logistic regression to measure the association between the independent variables (maternal, health system and newborn characteristics) and dependent variable (perinatal mortality) at 95% confidence interval and p-value of 0.05 Results: About 1 in 10 [42/370(11%)] mothers delivered babies who died during the perinatal period, translating to a perinatal mortality rate of 113 babies per 1000 births. The risk factors included newborn infections [AOR 4.8,95% CI - (1.2, 17.5)] and babies born with Apgar score less than 7 [AOR 0.02, 95% CI - (0.005, 0.1)]. Thess factors were significantly associated with perinatal mortality at multivariable analysis. However, occupation [AOR 0.2,95% CI - (0.1, 0.8)], was protective. Conclusion and recommendations: Newborn infections and Apgar score < 7 were the significant factors associated with perinatal mortality in Mbale regional referral hospital. Attending the recommended ANC visits, delivering in established health facilities, being employed and producing babies with Apgar score >7, reduced perinatal mortality. Dissertation

Patient satisfaction with nursing care at medical and surgical wards of Mbale regional referral hospital

Sat, 01 Jan 2022 00:00:00 GMT

Patient satisfaction with nursing care at medical and surgical wards of Mbale regional referral hospital Namunyala, Emmanuel The majority of studies from developing countries show that patient satisfaction with nursing care is below average. That means that more than half of the patients are dissatisfied, despite the fact that satisfaction is directly related to better health outcomes. In Uganda, overall patient satisfaction with health care delivery is still extremely low (25% in 2018). Patient satisfaction with nursing care remains unresolved in Uganda. If interventions are to be developed to improve overall patient satisfaction, assessments in different health-care capacities may be necessary to identify gaps. As a result, patient satisfaction with nursing care outcomes from this study could be extremely beneficial in this endeavor. Objectives: 1) To assess the level of patients’ satisfaction with nursing care provided in the medical and surgical wards of Mbale RRH. 2) To determine factors that may affect patients’ satisfaction with nursing care. Methods The study was done from November to December of 202 at Mbale Regional Referral Hospital using a cross-sectional study design. Simple random sampling technique was employed to recruit 213 sampled study participants. A data collection tool with patients’ descriptive characteristics and the Newcastle Satisfaction with Nursing Scale (NSNS)was utilized. Stata version 15 was used to analyze the data, which was presented in tables and graphs. To identify factors associated with patient satisfaction with nursing care, bivariable and multivariable logistic regressions were computed. The significance and strength of the association was declared using P-values < 0.05 with (CI) of 95% Result A total of 213 patients participated. Participants average age was 40.7 (SD, 14.7, min=18 and max=77) years. The mean score the patients obtained from the Satisfaction with Nursing Care Scale (NSNS) was 67.413±16.1 (min=30.263 and max=94.737) on 0-100scale.After dichotomizing satisfaction into ‘satisfied’ and ‘not satisfied’ using the mean satisfaction score as the cut off, 50.23% (n=107) of the study participants were satisfied with the care provided by nurses. Patients were more satisfied with the amount of time nurses spent with them (2.88±0.88)and there always being a nurse around if they needed one (2.83±0.84). Patients were least satisfied with the amount of privacy nurses gave them (2.48±1.07) and how nurses listened to their worries and concerns (2.57±1.06). Regarding the factors affecting the satisfaction, patients aged below 45 and those with higher levels of education where least satisfied whereas patients who were admitted to a surgical ward, who had a chronic condition, and those who had spent more than 10 days on the ward were more satisfied than their counterparts. Conclusion In this study, the level of patient satisfaction with nursing care was average. It shows that the care needs of hospitalized patients are yet not satisfied to some extent. These findings may motivate hospital administrators, authorities, and nurses to pay more attention to patients' distinct characteristics, concerns, and anxieties, as well as maintaining patient privacy when providing care. Improving personnel to minimize workload, improving ward architecture and providing privacy screens, and scheduling refresher trainings will all help to improve the quality of care offered and hence increase patient satisfaction. Dissertation

Feasibility, acceptability and experiences of intrapartum fetal monitoring by caregivers using the Moyo device at Mbale regional referral hospital:

Sat, 01 Nov 2025 00:00:00 GMT

Feasibility, acceptability and experiences of intrapartum fetal monitoring by caregivers using the Moyo device at Mbale regional referral hospital: Nakawuki, Ashley Winfred Background: Intrapartum fetal heart rate monitoring (FHRM) is essential for identifying fetal distress and preventing asphyxia-related complications. However, inadequate FHRM due to staffing shortages is a critical issue in low-resource settings such as Uganda, where intrapartumrelated neonatal deaths are high. The Moyo device, a portable fetal heart rate (FHR) monitor, reduced perinatal morbidity and mortality in a recently conducted trial in Mbale. However, its potential remains underutilized due to a high patient-to-midwife ratio. Recent evidence suggests that task-sharing FHRM with caregivers may address poor fetal monitoring practices, enabling non-clinical individuals to support the timely identification of fetal distress. Objective: This study assessed the feasibility, acceptability, and caregivers' experiences with intrapartum FHRM using the Moyo device at Mbale Regional Referral Hospital (MRRH), Eastern Uganda. Methods: A pilot quasi-experimental study design was used employing a sequential explanatory mixed-methods approach at MRRH. Caregivers of labouring women were consecutively enrolled, trained, and guided to monitor FHR every 30 minutes using the Moyo device. Feasibility was defined as achieving a mean monitoring interval within 30 ± 5 minutes, while acceptability was assessed using a five-point Likert scale converted into percentage scores and categorized using Bloom’s criteria. Experiences of caregivers who used the Moyo were explored through structured, in-depth interviews. Quantitative data were analysed using Stata version 17, and qualitative data were analysed thematically using Atlas. ti. Results: A total of 75 caregivers participated, with a median age of 32 years (IQR: 25–42). Most were female (n=70, 93.3%) and had primary-level education (n=35, 46.7%). The majority of participants (n=74, 98.7%) were able to use the Moyo device to check and document FHR, with 65 (86.7%) reporting no technical issues. However, only 34.7% (n=26) of caregivers were able to monitor FHR at 30-minute intervals, and 65.3% (n=49) of readings within 60 minutes. The median number of FHR recordings was 3 (IQR: 1–10), and the mean duration of the active stage of labour was 10.9 ± 9.7 hours. Feasibility was higher among caretakers who were first or second-degree relatives (61.5%; p = 0.037). The majority of the caregivers (n=70, 93.3%) found FHRM using the Moyo device acceptable. Caregivers reported positive experiences with the Moyo device, driven by curiosity, reassurance about fetal safety, and a desire to learn. Conclusion: Intrapartum FHRM by caregivers using the Moyo device was highly acceptable, and most caregivers correctly used the device. However, adherence to the recommended 30-minute monitoring interval remained low. Similar initiatives involving caregivers should prioritize practical support systems like reminders and workflow integration to enable timely recordings and improve adherence to recommended FHR monitoring. Dissertation