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ItemPrevalence, patterns and factors associated with ocular findings among adolescents living with HIV at the Baylor College of Medicine Mulago.(Makerere University, 2025)Introduction Human Immunodeficiency Virus (HIV) is a major cause of morbidity and mortality worldwide. In 2021, 38.4 million people were living with HIV/AIDS globally, including 1.71 million adolescents. Despite the understanding that HIV can impact various organs, including the eyes and cause blindness, few studies have been conducted to describe the prevalence, patterns, and factors associated with ocular findings of HIV in adolescents, particularly in Africa and specifically in Uganda. General objective: To determine the prevalence, patterns, and factors associated with ocular findings among adolescents living with HIV at the Baylor College of Medicine Mulago. Methods: This was a cross-sectional study conducted at the Baylor College of Medicine in Mulago. Adolescents aged 10-19 were recruited consecutively. Data were collected on the history, clinical examination, and ocular findings using an interviewer-administered, pre-tested questionnaire and entered into EpiData 4.2, which was then exported to STATA 15 for analysis. Descriptive statistics were presented as means and standard deviations (SD), frequencies, and proportions. Factors associated with the outcome were assessed using a modified Poisson regression model to obtain prevalence ratios, along with their corresponding P-values and 95% confidence intervals. Results: A total of 341 adolescents with HIV were recruited. Most participants were females 179 (52.5%), aged 15-19 years 198 (58.1%). The prevalence of at least one abnormal ocular finding in HIV was 17%, (n=57). In this study, most of the abnormal ocular findings were found on the conjunctiva (n=41, 72%) and optic disc (9, 17%). Other ocular findings included abnormal retinal findings (n=3, 0%) patients and maculopathies (n=3, 5%) patients among others. Adolescents who had a high viral load were 53% less likely (PR=0.47; p=0.049) to have ocular findings than those with a suppressed viral load. Conclusion and recommendations: In this study, the prevalence of ocular findings was 17%. We recommend that the adolescents should continue adhering to their treatment and care. Since our study found ocular findings in states of low viremia and normal CD4 which is contrary to what has been found in previous studies, we recommend another study, probably a longitudinal study on a larger sample size to further establish the association of the viral load with ocular findings.
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ItemOutcomes and factors affecting survival of children diagnosed with Burkitt’s lymphoma in Lacor Hospital(Makerere University, 2025)Background: Burkitt’s lymphoma (BL) is the most common childhood cancer in Uganda with a prevalence of 28%. The incidence of BL has been reported to be even much higher in northern Uganda than elsewhere in Africa. Lacor Hospital has an oncology unit that treats BL and other solid tumors. The overall survival rate of the most common childhood cancer and the factors affecting it are unknown among the affected children living in the most endemic region in Africa. Objective: To determine the 5-year clinical outcomes and factors associated with survival of children with BL that received care from St. Mary’s Hospital Lacor. Method: This was a retrospective cohort study involving chart review for children diagnosed with Burkitt’s Lymphoma from January 2015 to December 2020 at St. Mary’s hospital Lacor. Relevant data was extracted and analyzed. Kaplan-Meier survival curves were used to estimate 5-year survival. Cox regression analysis was used to assess the prognostic factors and presented as hazard ratios with their 95% confidence interval at both bivariate and multivariate levels. Results: The five-year survival rate among children with known outcomes was 34.1%. Most patients (79.7%) presented with advanced-stage disease (Stage III or IV). Significant predictors of improved survival included higher baseline hemoglobin levels (median 11.0 g/dL vs. 9.0 g/dL), higher absolute lymphocyte counts (median 3.0 vs. 2.0 x10⁹/L), achieving clinical remission, and completing more chemotherapy cycles (median 6 vs. 2). Treatment abandonment was reported in 12.3% and loss to follow-up in 24.8% of cases. Regional disparities were noted, with higher adherence in West Nile and Karamoja compared to Eastern Uganda. Underweight status was nearly universal (97.3%), and HIV status was unknown (78%) of participants, limiting conclusions about its prognostic role. Conclusion: Survival of pediatric BL in Lacor Hospital is far below global statistics. Chemotherapy delivery was feasible though late-stage presentation, undernutrition, and high attrition rates severely limited survival outcomes. Early diagnosis, nutritional support, improved treatment adherence, and robust follow-up systems are urgently needed to improve survival in this vulnerable population. KEY WORDS: Burkitt’s lymphoma, pediatric cancer, Uganda, survival outcomes, treatment adherence, low-resource settings, chemotherapy, St. Mary’s Hospital Lacor.
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ItemLevel of non-utilisation and barriers to initiation of hydroxyurea among children with sickle cell disease attending Mulago Sickle Cell Cinic, Kampala, Uganda(Makerere University, 2025)Background: Sickle cell disease (SCD) is an inherited blood disorder characterized by anemia, severe pain, and other vaso-occlusive complications with over 300,000 individuals born each year with the disorder in sub-Saharan Africa. Hydroxyurea (HU) could improve the health-related quality of life of these persons, however, challenges to adoption and adherence persist. There are limited studies on the level of non utilization and barriers to initiation of HU in Uganda. This study aimed to determine the proportion of children with sickle cell anemia (SCA) not utilizing HU and to describe the barriers to initiation of HU among children with SCA attending Mulago hospital sickle cell clinic, Uganda Methods: A sequentially explanatory mixed methods study was conducted among 356 children aged 9 months to 17 years. data was collected using interviewer administered questionnaires and in-depth interviews with the care takers of the children. Quantitative data analysis included determining prevalence of HU non utilization using frequencies and percentages and logistic regression analysis to determine the factors associated with HU non utilization. Thematic analysis approach with the help of Atlas ti 9 was used to analyze qualitative data. Results: A total of 356 child-adult (caretaker) pairs were recruited. The average age of the children recruited in the study was 8.35 years (SD 4.79, IQR=7, skewness +0.967). The proportion of not utilizing HU was established to be 79/356 (22.2%) and was significantly associated with child‘s age (AOR=4.46, P<0.001), household monthly income (AOR=2.398 P=0.012) and previous hospitalization history (AOR=1.97, P=0.006). the major barriers to HU initiation were frequent stockouts, hydroxyurea not being readily available at local pharmacies, perceived lack of benefits of hydroxyurea, poor support from the children‘s fathers, use of herbal medication and lack of well written displayed guidelines. Conclusion and recommendations: The level of non-utilization of HU among children with SCA attending Mulago Hospital Sickle Cell Clinic, Uganda is high at 22.2% with frequent stockouts of hydroxyurea from the sickle cell clinic, HU not being readily available at local pharmacies, additional pill burden and denial of parents, perceived lack of benefits of hydroxyurea, poor support from the children‘s fathers, use of herbal medication and lack of well written displayed guidelines were the barriers identified. There is an urgent need for programmers and policymakers to ensure continuous availability of HU at the sickle cell clinics, continuous and timely training, and display of SOPs. Keywords: hydroxyurea, sickle cell disease, non-utilization, barriers, sickle cell anemia.
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ItemRepeat malaria test positivity among symptomatic children with an initial negative test at Bombo General Military Hospital, Luwero District, Uganda(Makerere University, 2025)Background: Prompt malaria diagnosis is recommended by WHO for all patients with suspected malaria before receiving treatment. Rapid diagnostic tests (mRDT) and malaria microscopy are used, microscopy being the gold standard. Missed malaria diagnosis increases the risk of severe malaria, hospitalization and death. Missed malaria diagnosis on single testing can be due to type of mRDTs, low parasite densities, incorrect use of mRDTs, inadequate experience and skill of the microscopist. Repeat testing showed reduced missed malaria diagnosis by Centers of Disease Control (CDC) and Clinical and Laboratory Standard institute. WHO guidelines and Uganda malaria policy lack guidance on repeat testing hence need for the study. Study Objective: To determine the frequency and factors associated with missed malaria diagnosis on single malaria testing among symptomatic children attending Bombo General Military Hospital. Methods: Prospective longitudinal study. Symptomatic children for malaria 3months – 17years were enrolled after written imformed consent from caregivers and assent from older children at General Military Hospital, Bombo from June - December ,2024. Blood was obtained by a finger prick and parallel testing with both Pan-RDT and a thick smear microscopy was done. Those that tested Positive were given antimalarials. Repeat testing was done at 24, 48 and 72 hours for the negative cases until found positive, or remained negative at 72 hours. Participants were also investigated for other causes of the symptoms and treated accordingly. Caregivers would come back when a child became sicker or for follow up testing. Transport was refunded and compensation fee was given. Participants’ characteristics and independent variables were obtained by semi structured questionnaire. Data analysis was done with STATA 17. Frequency of missed diagnosis was reported as a proportion of those found positive on subsequent tests at 24,48 and 72 hours following an initial negative test for malaria divided by all children found negative after the initial test. Kaplan Meier curve was used to determine the probability of remaining malaria negative or probability of being misdiagnosed for malaria over time. Cox regression was used to analyse factors associated with missed malaria diagnosis. Results: The participants were mean age 6.67years (5.62) and 160 (54.2 %) were male. Of the 295 participants recruited into the study, 7 were lost to follow-up and 63 (21.9%) of the remaining 288 had missed malaria diagnosis and 225 had no missed malaria diagnosis. For x every 100 persons observed, there was a 7.12% chance of a misdiagnosis per day which equated to 71.2 misdiagnoses per 1,000 person-days. The decline in the probability of remaining correctly diagnosed over time was steepest between 24 and 48 hours, highlighting this window as particularly critical for repeat testing. Factors associated with missed malaria diagnosis were high monthly household income that reduced the risk of misdiagnosis (AHR = 0.490, 95% CI: 0.249 – 0.967, p-value = 0.040) and Other presenting symptoms other than fever such as cough, flue, diarrhoea, vomiting, abdominal pain and others (AHR = 1.583, 95%CI: 1.2741 – 1.9668, p-value < 0.001) that indicated 58.3% increased risk of misdiagnosis. Conclusion and Recommendations: There is substantial incidence of repeat malaria positivity following an initial negative test. The incidence rate of 7% observed translates to a significant risk of misdiagnosis in clinical practice. The probability of remaining malaria-negative declined sharply within the first 48 hours. Diagnostic delays affected children with non-specific symptoms and children from high income showed reduced risk of misdiagnosis. Therefore, reliance on a single test is insufficient in high-burden settings. This study highlights the need for policy and practice changes to improve malaria diagnosis in high-transmission settings through mandating repeat testing in National guidelines with high clinical Suspicion, subsidized diagnostics and treatment for low-income households and integrating malaria testing into broader febrile illness management to ensure comprehensive care for children with co-infections thus improving malaria diagnosis and treatment outcomes for children with malaria in Uganda.
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ItemIndications of imaging and challenges of adherence to imaging guidelines in children with urological conditions: A retrospective cross-sectional multi-centre study(Makerere University, 2025)Introduction Urological conditions in children in Uganda are diverse and they include congenital anomalies, trauma, tumors and urinary tract infections. Amongst these conditions, congenital conditions are the commonest i.e. cryporchidims and hypospadius. These conditions often require imaging for accurate diagnosis, treatment planning, and follow-up. However, establishing appropriate imaging recommendations for children presents challenges due to the need to balance diagnostic accuracy while minimizing radiation exposure and also avoiding unnecessary costs of the imaging. From clinical observations it has been shown that many clinicians make inappropriate imaging recommendations for children with urological conditions due to a number of reasons. There is paucity of data in uganda regarding the use of imaging guidelines and the challenges that clinicians face while trying to adhere to these imaging guidelines. Objective To determine the indications for imaging and the challenges of adherence to imaging guidelines in children with urological conditions at MNRH and St.Francis Nsambya Hospital. Method A retrospective cross-sectional study was conducted at MNRH and St.Francis Nsambya hospital. A review of 424 imaging request forms of children with urological conditions was conducted and 60 clinicians were subjected to pre-structured self administered questionnaires. Results The study enrolled 424 patients. The most common indications for imaging was cryptorchidism 17.45%(74), inguinal scrotal hernia 15.57%(66), UTI 12.03%(51), acute scrotum(orchitis, torsion) 12.03%(51). The overall degree of adherence was moderate at 66.51% (CI 0.619-0.709). However in some specific conditions the degree of non-adherence was high i.e. cryptorchidism 98%(73), trauma 90.91%(10) and PUV 85.19%(23).The commonest challenges of adhering to imaging guidelines were cost related issues 70%(42), lack of access to appropriate imaging modalities 55%(33), limited awareness or familiarity with the guidelines 38.33%(23) and the absence of local guidelines 35%(21). Conclusion The overall adherence to imaging guideline in children with urological conditions is moderate 66.5%(282). However there is a significant gap in the degree of adherence to some specific conditions like cryptorchidism and trauma with non-adherence rates as high as 98%(73) and 90.9%(10) respectively. This could be as a result of lack of knowledge of the imaging guidelines. The most common challenges faced by clinicians while adhering to imaging guidelines include cost limitations, limited access to imaging resources, insufficient awareness of guidelines and lack of local guidelines