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    A time series analysis of the climate-related determinants of malaria in Buikwe District, Central Uganda : a data science approach
    (Makerere University, 2026) Nakuya, Niona Kasekende
    Introduction: Climate change affects public health, with malaria being one of the most climate-sensitive diseases. Despite numerous control interventions, Buikwe District continues to experience high malaria morbidity, and the influence of local climatic factors on transmission remains insufficiently understood. This study aimed to analyze the temporal relationships between key environmental variables and malaria trends in Buikwe District from 2015 to 2024 and to forecast future malaria patterns using a time-series modelling approach. Methods: A retrospective longitudinal study design was used, drawing on DHIS2 malaria data and ERA5-Land climate data for temperature, precipitation, and humidity, from which heat index was derived. All monthly data were included using a census approach. Analysis in R 4.4.3 involved descriptive statistics, LOESS-based seasonal decomposition, Spearman’s correlation, Augmented Dickey-Fuller tests, Granger causality, and ARIMAX modelling for forecasting. Results: Analysis revealed strong seasonal patterns in the heat index with consistent annual cycles and a rising long-term trend between 2022 and 2024, suggesting increasing heat exposure likely linked to climate change. Temperature showed a statistically significant moderate negative correlation with malaria incidence (ρ = -0.25, p = 0.006), while precipitation and relative humidity had non-significant associations. Granger causality analysis confirmed that all three environmental variables significantly predicted malaria cases. Temperature exhibited the strongest effect, with both lagged (F = 9.81, p < 0.001) and immediate (χ² = 27.92, p < 0.001) impacts. Precipitation (F = 3.94, p = 0.009) and relative humidity (F = 3.15, p = 0.025) also demonstrated predictive power. The ARIMAX(1,0,1) model identified temperature as a significant negative predictor (-142,677.10) and humidity as a significant positive predictor (53,270.62) of malaria incidence. The model achieved good performance, with a low Mean Absolute Scaled Error (MASE = 0.613) and no significant residual autocorrelation (Ljung-Box p = 0.318). Forecasts for 2025 projected fluctuating malaria incidence following seasonal climatic patterns, highlighting periods of potential increased transmission risk driven by temperature and humidity variations. Conclusion: This study demonstrates that climatic factors—especially temperature—significantly influence malaria incidence in Buikwe District. The ARIMAX model successfully captured temporal patterns and forecasted malaria trends, highlighting the value of integrating climate data into surveillance systems. Strengthening climate-informed early warning systems, entomological monitoring, and predictive modelling, alongside collaboration between health, meteorological, and research institutions, is essential for implementing targeted interventions and building effective climate-responsive malaria control strategies.
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    Maternal Health Services for Adolescent Urban Refugees in Urban Settings in Uganda; Access, Utilization and Health Facility Readiness.
    (Makerere University, 2026) Nakisita, Olivia.
    Background; Uganda hosts an estimated 1.7 million refugees, 12.5% of these live in urban areas mainly in Kampala city. Uganda is implementing an integrated healthcare model where both refugees and host population utilize the same health care services. Yet, in Kampala, adolescents generally find it hard to access maternal health services because of difficulty in reaching the facility, lack of financial support, discrimination and disrespect by health workers, and lack of privacy. Whereas there are several studies on maternal health among the general population, little is known on what is the level of access and utilization of maternal health services among urban refugee adolescents in Kampala? and what is the readiness of the government health facilities to offer maternal health services to this population? The study investigated access, utilization, and the readiness of the government health facilities to offer maternal health services to urban refugee adolescents in Kampala, Uganda.Methods; This was an explanatory sequential mixed methods study conducted between November 2023 and August 2024 in Kampala Uganda. Quantitative and qualitative methods of data collection were used. The qualitative component explained the findings from the quantitative component of the study. First, validation of the tool that measured access to antenatal and delivery services adapted from (Hoseini-Esfidarjani et al., 2021) was undertaken. This came first to allow measurement of access using a validated tool. Second, a quantitative study, which was the biggest part of the study, was conducted to assess access and utilization of antenatal and delivery care services among 637 urban refugees who became pregnant aged 10 -19 years. A semi-structured questionnaire uploaded in ODK software was used and analysis was conducted using STATA version 17. Uni-variate, bi-variate and multivariate analyses were performed. Third, a facility-based cross-sectional study was conducted to assess health facility readiness in all the six government lower level III & IV health facilities in Kampala City, Uganda. Data were collected using a health facility checklist that was adapted from African Youth Alliance, Path Finder and WHO. Finally, a qualitative study was conducted to assess the readiness of health workers to offer maternal health services to refugee adolescents among 12 health workers from the six government health centers using an in-depth interview guide. This component of the study explained the findings from the first, second and third component of the study that were qualitative focused on the access and utilization of maternal health services by adolescents and the readiness of the facilities. Interviews were audio recorded and transcribed verbatim. Qualitative data were analysed using thematic and content analysis and findings are presented in themes and supported with typical quotes. The results from the quantitative and the qualitative study were integrated during reporting. Findings highlighting the level and correlates of access and utilization of antenatal and delivery care services were presented first, then readiness of the government health facilites to offer adolescent friendly maternal health services and later the qualitative findings were presented to explain how they offer the services, why the utilization and access was at that level, the challenges they face and the reccomendations to improve access and utilization .Results; This study reflected consistently high levels of perceived access of antenatal and delivery care services among the adolescent urban refugees with the overall perceived access score having a median of 4.0 (IQR 3.9–4.4). The correlates of access to antenatal care services were age, marital status and distance to the facility. Utilisation of antenatal care services was sub-optimal with less than half (41.5%) of the participants attending antenatal care within the first trimester and only 12.2% attending eight or more antenatal care visits recommended by WHO. Utilisation of health facility deliveries was high at 98.3% with 81.6% delivering at public health facilities. The utilization of ANC and delivery services among adolescent refugee mothers in Kampala was influenced by age, marital status, distance to health facilities, and type of facility attended. The readiness of all the six lower-level health facilities in Kampala city to offer general adolescent friendly services was high at 92.5%. The readiness of the health providers to offer adolescent friendly services was 77.7%. The readiness of the facilities to offer antenatal care was higher at 87.2% compared to delivery services 65.8%. Factors that significantly affected readiness include untrained non-provider staff 33.3% (95% CI: 4.3, 77.7), not having essential medicines and supplies 16.6% (95% CI: 0.4, 64.1) and not having essential equipment 33.3% (95% CI 4.3, 77.7) for antenatal and delivery care. The qualitative study revealed that the health workers felt sympathy for the adolescent urban refugees and were willing to offer services to them. They reported that peer educators and village health teams or community health workers enabled them to provide the services. However, health workers had inadequate knowledge about adolescent friendly services and they faced challenges like language barrier, lack of essential drugs, supplies and equipment. The health workers recommended training of healthcare workers, separate space for antenatal care and delivery for adolescents and young people, translators for refugees, and improvement in the availability of essential drugs, supplies and equipment. Conclusions; Perceived access to antenatal and delivery care services among the adolescent urban refugees is high. Utilization of ANC by urban refugee adolescents is sub-optimal, but high for delivery services. The readiness of the lower-level government health facilities to provide general adolescent-friendly services was high. However, the readiness to provide antenatal and delivery care services to refugee adolescents was sub-optimal. Health workers in government lower-level facilities are willing to provide maternal health services to adolescent urban refugees. However, they face several challenges including inadequate knowledge about adolescent friendly services, language barrier and inadequate supplies that limit their readiness to offer the services. There is therefore need for targeted interventions that include community outreaches and home visits to encourage adolescent refugees to utilize antenatal care and delivery care services optimally. There is also an urgent need to improve the readiness of health facilities and health workers to offer adolescent friendly maternal health services to urban refugee adolescents. This research provides a validated tool to measure perceived access to antenatal and delivery care services in similar settings. It provides evidence on the access and utilization of antenatal and delivery care services by urban refugee adolescents and the readinees of the health facilities and health workers to offer maternal health services to adolescent refugees
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    Prevalence and factors associated with exclusive breast milk feeding among preterm infants at Kawempe Referral Hospital, Uganda
    (Makerere University, 2025) Chikula, Rhoda
    Background: Exclusive breastfeeding is recommended for all infants, including preterm babies, during the first six months. However, at Kawempe National Referral Hospital, only about 60% of preterm infants are exclusively breastfed, below the global target of 70% by 2030. This gap increases the risk of adverse outcomes such as necrotizing enterocolitis and neonatal death. Identifying the factors associated with exclusive breastfeeding is essential for targeted interventions. Objective: To assess the prevalence and factors associated with exclusive breast milk feeding among preterm infants at Kawempe National Referral Hospital. Methods: A cross-sectional mixed-methods study was conducted among 352 mother and their infants, selected consecutively during routine visits. Quantitative data were collected using structured questionnaires, while qualitative data were collected through in-depth interviews with 10 purposively selected caregivers. Modified Poisson regression was used to determine associations, and thematic analysis was conducted for qualitative data. Results: The prevalence of exclusive breastfeeding among preterm infants was 59.4%. Positive predictors included maternal age 25–34 years (APR: 1.08; 95% CI: 1.00–1.16; P=0.048). healthcare worker support (APR: 1.11; 95% CI: 1.04–1.23; P=0.007), early initiation of breastfeeding (APR: 1.17; 95% CI: 1.06–1.30; P=0.002), emotional support (APR: 1.10; 95% CI: 1.02–1.19; P=0.010), belief in breast milk superiority (APR: 1.13; 95% CI: 1.03–1.24; P=0.010), being married (APR: 1.08; 95% CI: 1.00–1.16 ;P=0.043), and moderate to late gestational age (APR: 1.09; 95% CI: 1.00–1.21; P=0.047). Conversely, difficulty with breast milk expression (APR: 0.87; 95% CI: 0.80–0.94; P=0.000) and receiving breastfeeding counseling during antenatal visits (APR: 0.93; 95% CI: 0.87–0.99; P=0.024) were negatively associated. Qualitative themes emphasized the role of breastfeeding knowledge, prior experience of EBF, milk expression, family support, and health system assistance. Conclusion and recommendations: Exclusive breastfeeding among preterm infants remains below recommended levels. Strategies to strengthen family involvement, particularly father engagement, and enforce baby-friendly hospital policies are critical to improving breastfeeding outcomes. Keywords: Exclusive breast milk feeding, Preterm infant, Breast milk expression.
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    Prevalence and factors associated with minimum dietary diversity among infants and young children aged 6-23 months in Kyangwali Refugee Settlement, Kikuube District, Uganda
    (Makerere University, 2026) Fidow, Amina Mohamud
    Background: Minimum Dietary Diversity is a key indicator of adequate complementary feeding and optimal nutrition among children aged 6–23 months, essential for growth, development, and long-term health. In humanitarian settings such as refugee settlements, achieving MDD remains a major challenge due to socioeconomic constraints, limited food access, and weakened health and nutrition systems. Evidence on dietary diversity among refugee children in Uganda remains limited, necessitating context-specific assessment to inform targeted interventions. Objective: To determine the prevalence of minimum dietary diversity and associated factors among children aged 6–23 months in Kyangwali Refugee Settlement, Uganda. Methods: A community-based mixed-methods cross-sectional study was conducted among 273 caregivers of children aged 6–23 months and selected by using simple random sampling. Quantitative data were collected using a structured questionnaire incorporating a 24-hour dietary recall, while qualitative data were obtained through five focus group discussions with caregivers. Quantitative data were analyzed using STATA version 18. Descriptive statistics summarized participant characteristics, and multivariable logistic regression was used to identify factors associated with meeting the criteria for MDD. Qualitative data were analyzed thematically using Atlas.ti. Results: The prevalence of minimum dietary diversity among children aged 6–23 months was 4.8%. Meeting MDD was more commonly observed among children whose mothers had tertiary or university education (AOR: 1.91; 95% CI: 1.52–2.31) and among those whose caregivers had media exposure (AOR: 1.86; 95% CI: 1.39–2.90). Conversely, children of unemployed or self-employed mothers were less likely to meet MDD (AOR: 0.28; 95% CI: 0.11–0.44), as were children from larger households (AOR: 0.17; 95% CI: 0.05–0.38) and those born to unmarried mothers (AOR: 0.96; 95% CI: 0.28–0.98). Qualitative findings highlighted economic hardship, limited food availability, large family size, withdrawal of humanitarian food assistance, and inadequate household support as major barriers to achieving dietary diversity, despite caregivers’ general awareness of recommended feeding practices. Conclusion: Minimum dietary diversity among children aged 6–23 months in Kyangwali Refugee Settlement was very low. Maternal education, employment status, media exposure, marital status, and household family size were associated with dietary diversity. Interventions that strengthen maternal education, improve livelihood opportunities, enhance access to nutrition information, and reinforce food security and humanitarian support are essential to improve child feeding practices in refugee settings. Keywords: Minimum dietary diversity, Complementary feeding, Refugee children, Child nutrition, Uganda
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    Compliance with Tuberculosis Infection prevention and control and its associated factors among Health workers of greater Jinja, Uganda.
    (Makerere University., 2026-01-12) Katusiime, Clare.
    Introduction: Tuberculosis (TB) remains a significant public health challenge, particularly in resource-limited settings. Effective TB Infection Prevention and Control (TB-IPC) measures are crucial for reducing transmission within healthcare facilities. This study examined compliance with tuberculosis infection prevention and control and its associated factors among health workers in greater Jinja Uganda.Methodology: A mixed-methods approach was used. Quantitative data were collected in a health facility survey using a structured questionnaire and an observational check list administered to health workers. Qualitative data were gathered through key informant interviews. Univariate and multivariate analysis was done using modified Poisson regression using Stata. Thematic analysis was conducted for qualitative data.Results: Overall, 438 participated in this study. More than half (58.5%) of the participants were females, with mean age of 34.5 years and SD of 9.4 years. Observed TBIPC compliance among HCWs was 84.5%. The prevalence of compliance was higher if the HCWS were Muslims (APR = 1.15, 95% CI: 1.05-1.38), had work experience of 5 or more years (APR = 1.08, 95% CI: 1.01-1.17), TBIPC materials were available (APR = 1.12, 95% CI: 1.04-1.39), TBIPC monitoring and supervision was conducted (APR = 2.09, 95% CI: 1.40-3.13), and HCWs were aware of TBIPC guidelines (APR = 1.81, 95% CI: 1.33-2.46). The qualitative data provided divergent themes such as funding and resource shortages, infrastructural, cultural and belief as barriers, and governance and leadership, supportive and innovative environment, and adequate skilled HCWs as facilitators of TBIPC compliance in the Greater Jinja.Conclusion: Effective TB-IPC compliance requires addressing both systemic and individual-level factors. Key recommendations include improving resource availability, enhancing training and supervision, as well as addressing cultural and behavioural barriers.