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ItemComparing performance of generalized linear mixed model and generalized estimating equations in modelling under-five mortality : a case study of Iganga-Mayuge Districts Uganda(Makerere University, 2023)Introduction: Reduction of childhood mortality is a global health priority and an indicator of child survival. Over 5 million in 2021 children under five years died every day from preventable and curable diseases which is undesirable. Between 1990 and 2020, the global mortality rate for children under five years declined by 61 per cent, from 93 deaths per 1,000 live births to 37 deaths per 1,000 live births. Over the last three decades, under-five mortality has steadily been declining in Uganda. Between 1990 and 2020, the rate declined by more than 70%, from 183 to 43.3 deaths per 1,000 live births. This study aimed at determining the association between the predictor variables and under-five mortality rates in the Iganga and Mayuge districts. Methods: Data from Iganga-Mayuge Health and Demographic Surveillance Site (IMHDSS) of 2010 to 2015 collected on women of reproductive age (13 to 49 years) were used. The outcome was death before the fifth birthday and the independent variables were gender, place of residence, birth order, mother’s age, education, wealth index, marital status, place of delivery, attend antenatal care, occupation and year. Village was used as a random effect. For descriptive analysis, proportions were used. Means and standard deviation were used for continuous variables. The explanatory variables were checked for multicollinearity to ensure validity for further analysis. AIC and QIC were used for model selection. Data management and analysis was done using excel and STATA 18. Results: Between 2010 and 2015, 2011 had the highest number of under-five deaths. Mothers from both the rural and Peri_urban areas had an average of one child. The odds of dying before the age of five reduced among the children whose mothers were cohabiting and those whose highest level of education was below primary. Being male, residing in the rural areas and children whose mothers were teenagers increased the odds of dying before the age of five. Conclusion: The choice between these methods should be guided by the underlying data structure, assumptions, research objectives, and the practical significance of the differences observed. Interventions like healthcare access could improve maternal and child healthcare services, enhance education, thus improving future research, guide policy development aimed at improving overall child well-being and reduce under-five mortality in Iganga and Mayuge districts.
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ItemPrevalence and factors associated with malaria in households following scale up of integrated community case management of malaria in Kiruhura District, Western Uganda(Makerere University, 2025)Background: Malaria remains a major public health challenge in sub-Saharan Africa, with a disproportionate burden in rural Uganda. Despite national adoption of integrated community case management implemented through Village Health Teams to improve early diagnosis and treatment, several districts continue to report high malaria burden. This study assessed malaria prevalence and examined household-level factors associated with malaria risk following scale-up of integrated community case management in Kiruhura District, western Uganda. Methods: mixed-methods cross-sectional study was conducted among 327 households registered under integrated community case management between September 2022 and August 2023. Quantitative data were collected using structured questionnaires and analyzed to estimate malaria prevalence and associated factors. Bivariate and multivariable logistic regression analyses identified factors independently associated with malaria, with results reported as odds ratios and 95 percent confidence intervals. Qualitative data were collected through key informant interviews and Focus Group Discussions involving 15 purposively selected stakeholders and analyzed thematically to explore experiences with integrated community case management implementation. Results: A total of 327 households were surveyed across Kiruhura District under the ICCM intervention, achieving a response rate of 98.4%. The majority of households were located in rural areas, with a mean household size of seven individuals. Overall, 410 malaria episodes were reported, corresponding to a prevalence of 26.7% among residents of ICCM-supported households, while 10.1% of households experienced at least one malaria episode during the reference period. Children under five years accounted for 74.8% of reported cases, indicating a disproportionate burden of malaria in this age group. In multivariable analysis, the presence of vegetation near households was associated with increased malaria risk (AOR = 1.17; 95% CI: 1.02–1.34). Conversely, use of long-lasting insecticide-treated nets (AOR = 0.66; 95% CI: 0.48–0.91) and seeking care from public health facilities (AOR = 0.74; 95% CI: 0.66–0.83) were independently protective. Conclusion: Malaria remains highly prevalent in ICCM supported households in Kiruhura District. Efforts to reduce household malaria burden could focus on strengthening the supply chain for ICCM commodities, improving VHT support and motivation and enhancing community education on effective malaria prevention practices, such as the proper use of LLINs.
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ItemCervical cancer screening utilisation among female health workers at Mulago National Referral Hospital.(Makerere university., 2025-01-28)Background: Cervical cancer is a leading cause of cancer-related mortality among women and is largely preventable through screening. However, uptake remains low in Uganda, including among female health workers who are expected to model preventive health behaviors. Objectives: To assess utilization of cervical cancer screening services and associated factors among female health workers at Mulago National Referral Hospital. Methods: A cross-sectional quantitative study design and case study qualitative designs were conducted at Mulago National Referral Hospital. Quantitative data were collected from 264 female health workers and analyzed using descriptive statistics, chi-square tests, and modified Poisson regression. Qualitative data were collected through 7 key informant interviews and 16 in-depth interviews and analyzed thematically. Results: The study included 264 female health workers with a mean age of 38.6 years (SD ± 9.4). Most participants had diploma or bachelor’s level education and the majority had at least one child. Overall, 96 participants (36.4%; 95% CI: 30.6–42.5%) had ever undergone cervical cancer screening. Screening utilization was significantly higher among women aged 50 years and above (aPR = 1.71; 95% CI: 1.08–2.72), those with easy access to screening services (aPR = 1.90; 95% CI: 1.15–3.12), and those who received provider recommendations (aPR = 1.46; 95% CI: 1.08–1.98). Participants with lower educational attainment and those who were nulliparous or primiparous were less likely to have been screened. Qualitative findings addressed the study objectives by explaining barriers and facilitators to screening utilization: knowledge gaps, fear, heavy workload, inadequate privacy, and discomfort with peer examiners limited uptake, while peer encouragement, institutional support, provider recommendation, and motivation to lead by example facilitated screening. Conclusion: Cervical cancer screening utilization among female health workers at Mulago National Referral Hospital was suboptimal and influenced by sociodemographic, reproductive, and institutional factors. Qualitative findings provided contextual explanations for observed quantitative associations. Addressing both individual and workplace-level barriers is critical to improving screening uptake among health workers.
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ItemProbable depression, its correlates and coping mechanisms among adults exposed to floods in Ntoroko District, Uganda(Makerere University, 2026)Background: Flooding is one of the most frequent natural disasters contributing to both direct and indirect effects on human health globally. Anthropogenic climate change has contributed to intensified hydrological cycle characteristics, in a nature sufficient to alter the strength and geographical distribution of extreme climate-related weather events. At least 90% of these extremes are weather-water-related exacerbated by increasing intensity of heavy rainfall. In East Africa, rural Ugandan populations experienced floods resulting from the heavy rains of the March-April-May (MAM), and September-October-November-December (SOND) 2024 rainfall seasons. The focus of studies on health consequences of these floods in this region of Sub-Saharan Africa (SSA) has often been directed towards other health outcomes, and less frequently on mental health. Study aim: To determine the prevalence of depressive disorders and their correlates among adults who were exposed to the SOND floods in Ntoroko, Uganda, and determine the different coping mechanisms utilized by these adults post-flood. Methods: A cross-sectional study was conducted to collect data from 360 participants following the extreme flood event of SOND 2024 in Ntoroko. The Patient Health Questionnaire-9 (PHQ-9) tool, General Anxiety Disorder-7 (GAD-7) scale, Perceived Stress Scale (PSS) and Oslo Social Support Scale-3 (OSSS3)were incorporated in a semi-structured online questionnaire to screen for probable depression and its correlates. Total scores on each tool/scale were determined for each participant. These scores were used to report on probable depression status, anxiety, perceived stress and social support. Other measures were used to determine and report on exposure and coping mechanisms. Analysis was performed using methods of descriptive statistics and other methods such as Poisson regression, then presented in summaries such as mean, prevalence ratio (PR), and tabular/graphic selections. Results: The study achieved a 93.51% response rate. Male participants accounted for 56.4% (n=203) of the study. The prevalence of probable depression was 64.7% with most participants experiencing moderate severity (106; 29.4%). Male participants recorded a higher occurrence of probable depression (121; 33.6%) compared to females (112; 31.1%). The correlates of probable depression included anxiety status (p<0.001) (PR= 0.550 95% CI [0.457-0.663] ) and social support level (p=0.033) (Low; PR=1.704 95% CI [1.140-2.548], Moderate; PR= 1.567 95% CI [1.043-2.354]). The final predictive model for depressive status included other variables despite them showing non-significant associations with depression status; sex, age, marital status, primary source of income, flood level, flood impact, former location, community leaders support, flooring material and stress severity. Conclusions: The study found a high prevalence of probable depression as compared to Uganda’s pooled prevalence of 30.2% from a systematic review, moderate severity being the most common. The correlates of probable depression included anxiety status and social support level even though the final predictive model for probable depression status included sex, age, marital status, primary source of income, flood level, flood impact, former location, community leaders support, flooring material and stress severity. The participants suggested needing more coping-focused aid from the government. This study gave recommendations including prioritizing early warning systems, mental health screening, psychosocial first aid, and community-led social support.
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ItemEvaluating the effectiveness of seasonal malaria chemoprevention in reducing under-five malaria incidence in Karamoja, Uganda using generalised linear mixed models(Makerere University, 2026-02-04)Background: Malaria remains a major public health challenge in Uganda, particularly among children under five years. Seasonal Malaria Chemoprevention (SMC) is a recommended intervention to reduce malaria incidence in high-transmission areas. This study assessed the effectiveness of SMC in reducing malaria incidence among children under five in the Karamoja region using DHIS2 data. Methods: A retrospective analysis was conducted using malaria case data from the District Health Information Software 2 (DHIS2) for children under five. Temporal and spatial trends were analyzed to identify peak transmission periods and high-burden districts. The effectiveness of SMC was evaluated using Generalized Linear Mixed Models (GLMMs), adjusting for relevant covariates. Results: Malaria incidence exhibited clear seasonal peaks during the rainy months, with considerable variation across districts. Some districts consistently reported higher malaria burden than others. GLMM analysis indicated that SMC significantly reduced malaria incidence among children under five. Additionally, female neonates (0–28 days) were found to have higher malaria incidence compared to older children, highlighting a vulnerable subgroup. Conclusion: SMC is effective in reducing malaria incidence among children under five in the Karamoja region. Malaria transmission varies temporally and spatially, emphasizing the need for targeted, location-specific interventions. Early-life preventive measures should be strengthened for neonates, and SMC delivery should be aligned with seasonal transmission peaks to maximize impact.