Browsing by Author "Musaba, Milton W."

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    Changes in haematological indices among children with sickle cell disease on hydroxyurea treatment for at least 1 year : a cohort study.
    (PLOS One, 2025) Emuli, Stephen; Tegu, Crispus; Oguttu, Faith; Nantale, Ritah; Ochieng, Paul; Paasi, George; Abeso, Julian; Wamulugwa, Joan; Musaba, Milton W.; Namazi, Ruth; Kiguli, Sarah; Mukunya, David
    Background Sickle cell disease is the 12th cause of under-five mortality in Africa, with over 81,000 deaths attributed to sickle cell disease annually. Hydroxyurea is one of the few disease-modifying therapies available for the management of sickle cell disease. This study aimed to assess changes in haematological indices among children who had been initiated on hydroxyurea for at least one year in a non-trial setting at a regional referral hospital in Eastern Uganda. Methods We conducted a cohort study, which included children who attended the sickle cell clinic from 21/Aug/2024 to 30/Oct/2024. Data were analyzed using Stata version 18.0. We conducted a paired sample t-test comparing the haematological indices of children with sickle cell disease at baseline and at least one year later. Results We included 324 children. Nearly half 155/324 (47.8%) of the participants had good monthly adherence to hydroxyurea. The mean haemoglobin level at follow-up increased by 0.77g/dl (p <0.001) from 7.07g/dl (SD 0.10) at baseline to 7.84g/dl (SD 0.09). There was an increase in the mean corpuscular volume [0.97fl (p=0.645)] and mean corpuscular haemoglobin [0.58pg (p=0.120)]. The white blood cell count decreased by 6.17x103/µl (p<0.001) from 20.77x103/µl (SD ± 0.806) at baseline to 14.60x103/µl (SD ± 0.613) at follow-up. The differential white cell counts of neutrophils, lymphocytes, monocytes, and basophils also decreased. Conclusion Hydroxyurea resulted in an increase in mean haemoglobin level and a decrease in absolute and differential white blood cell count. The benefit was more pronounced among children with good adherence to hydroxyurea. We add our voice to calls for continued advocacy for the availability of hydroxyurea for use by children with sickle cell disease in low-resource settings. We also recommend a routine complete blood count to monitor response to treatment and also guide patient management among children with sickle cell disease initiated on hydroxyurea.
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    Continuum of maternity care in Zambia:
    (BMC, 2021) Sserwanja, Quraish; Musaba, Milton W.; Mutisya, Linet M.; Olal, Emmanuel; Mukunya, David
    Background: Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia. Methods: We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. Results: Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces. Conclusion: Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services. Keywords: Continuum of care, Antenatal care, Postnatal care, Childbirth, Utilization, Women and Zambia
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    Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial
    (PLOS One, 2021) Musaba, Milton W.; Wandabwa, Julius N.; Ndeezi, Grace; Weeks, Andrew D.; Mukunya, David; Waako, Paul; Nankabirwa, Victoria; Tulyamuhika Mugabe, Kenneth; Semakula, Daniel; Tumwine, James K.; Barageine, Justus K.
    Introduction Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. Objective To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. Methods We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (>37 weeks’ gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. Intervention A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. Outcome measures Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. Results The median maternal venous lactate was 6.4 (IQR 3.3–12.3) in the intervention and 7.5 (IQR 4.0–15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40–0.51) implying very little if any effect at all. Conclusion The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels.
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    Factors associated with childhood overweight and obesity in Uganda :
    (BMC, 2021) Sserwanja, Quraish; Mutisya, Linet M.; Olal, Emmanuel; Musaba, Milton W.; Mukunya, David
    Background: Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016. Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda. Results: The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3–5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2–4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8–1.5). Mother’s nutritional status, sex of the child, and child’s age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49–59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North. Conclusion: The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age. Keywords: Prevalence, Obesity, Overweight, Children and Uganda
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    “I can no longer give take-home exams”: health professionals educators’ experiences and perceptions regarding the use of artificial intelligence in health professions education in Uganda.
    (BMC, 2025) Mukunya, David; Nantale, Ritah; Paungholi, Kennedy; Epuitai, Joshua; Kayemba, Frank; Jemba, Brian; Ajalo, Elizabeth; Afodun, Adam; Musaba, Milton W.; Munabi, Ian G.; Kiguli, Sarah; Mubuuke, A. G.
    Introduction: Artificial intelligence (AI) tools offer immense opportunities and challenges for medical education. However, there is limited information about the use of AI among health professional educators, particularly in low and middle-income countries. We aimed to explore the experiences and perceptions regarding AI use in health professional education. Methods and materials: We collected qualitative data using in-depth interviews with 19 health professional educators. The interviews were audio-recorded and transcribed verbatim. We used Atlas Ti version 9.1 to organise the data. We used Braun and Clarke’s six-step thematic analysis for data analysis. The study was approved by the Busitema University Research and Ethics Committee (BUFHS-2023-79). Results: Three major themes were identified from the data: uptake and use of AI, perceived benefits of AI in health professional education, and concerns regarding AI use. We noted initial reluctance to support AI use, while its use varied from no or infrequent use to frequent use. Health professional educators used AI for various reasons, such as for teaching, student assessment, research, and personal work. AI was perceived to be beneficial in improving the clarity of writing, providing access to individual-tailored information, teaching, learning, and assessment, and research purposes. The barriers to AI use included a lack of institutional policies to guide AI use, limited capacity to afford paid AI versions, and reluctance to use AI. AI was seen to have inherent limitations, which included inaccurate information and a lack of contextual information for resource-limited settings. The fears of AI use included the risk of over-reliance on AI, academic misconduct, examination malpractice, ethical conflicts, and integrity. Conclusion: AI use in health professional education was perceived to have some benefits, amidst concerns that may derail its use in health professional education. The lack of policy and guidelines to govern the use of AI in health professions education underscores the need to develop policies and guidelines that safeguard and promote responsible and ethical use of AI. Keywords Health professional education, Artificial intelligence, Educators, Uganda
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    Incidence and determinants of perinatal mortality among women with obstructed labour in eastern Uganda: a prospective cohort study
    (Springer Nature, 2021) Musaba, Milton W.; Ndeezi, Grace; Barageine, Justus K.; Weeks, Andrew D.; Wandabwa, Julius N.; Mukunya, David; Waako, Paul; Odongkara, Beatrice; Arach, Agnes; Tulya-muhika Mugabe, Kenneth; Kasede Napyo, Agnes; Nankabirwa, Victoria; Tumwine, James K.
    Background: In Uganda, the incidence and determinants of perinatal death in obstructed labour are not well documented. We determined the incidence and determinants of perinatal mortality among women with obstructed labour in Eastern Uganda. Methods: Between July 2018 and September 2019, 584 with obstructed labour were recruited and followed up to the 7th day postnatal. Information on maternal characteristics, obstetric factors and laboratory parameters was collected. Each patient received the standard perioperative care. We used a generalized linear model for the Poisson family, with a log link and robust variance estimation to determine the association between the exposure variables and perinatal death. Results: Of the 623 women diagnosed with obstructed labour, 584 met the eligibility criteria. There were 24 fresh still births (FSB) and 32 early neonatal deaths (ENND) giving an FSB rate of 43.8 (95% CI 28.3–64.4) deaths per 1000 total births; early neonatal death rate of 58.4 (95% CI 40.3–81.4) deaths per 1000 and an overall perinatal mortality rate of 102.2 (95% CI 79.4–130.6) deaths in the first 7 days of life. A mother being referred in active labour adjusted risk ratio of 2.84 (95% CI: 1.35–5.96) and having high blood lactate levels at recruitment adjusted risk ratio 2.71 (95% CI: 1.26–4.24) were the determinants of perinatal deaths. Conclusions: The incidence of perinatal death was four times the regional and national average. Babies to women referred in active labour and those with high maternal blood lactate were more likely to die. Keywords: Obstructed labour, Perinatal death, Determinants, Lactate
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    Predictors of Intrapartum Stillbirths among Women Delivering at Mulago Hospital, Kampala, Uganda
    (PubMed, 2021) Kiondo, Paul; Nakimuli, Annettee; Ononge, Samuel; Wandabwa, Julius N.; Musaba, Milton W.
    Background: Over the last decade, Uganda has registered a significant improvement in the utilization of maternity care services. Unfortunately, this has not resulted in a significant and commensurate improvement in the maternal and child health (MCH) indicators. More than half of all the stillbirths (54 per 1,000 deliveries) occur in the peripartum period. Understanding the predictors of preventable stillbirths (SB) will inform the formulation of strategies to reduce this preventable loss of newborns in the intrapartum period. The objective of this study was to determine the predictors of intrapartum stillbirth among women delivering at Mulago National Referral and Teaching Hospital in Central Uganda. Methods: This was an unmatched case-control study conducted at Mulago Hospital from October 29, 2018 to October 30, 2019. A total of 474 women were included in the analysis: 158 as cases with an intrapartum stillbirth and 316 as controls without an intrapartum stillbirth. Bivariable and multivariable logistic regression was done to determine the predictors of intrapartum stillbirth. Results: The predictors of intrapartum stillbirth were history of being referred from lower health units to Mulago hospital (aOR 2.5, 95% CI:1.5-4.5); maternal age 35 years or more (aOR 2.9, 95% CI:1.01-8.4); antepartum hemorrhage (aOR 8.5, 95% CI:2.4-30.7); malpresentation (aOR 6.29; 95% CI:2.39-16.1); prolonged/obstructed labor (aOR 6.2; 95% CI:2.39-16.1); and cesarean delivery (aOR 7.6; 95% CI:3.2-13.7). Conclusion and Global Health Implications: Referral to hospital, maternal age 35 years and above, obstetric complication during labor, and cesarean delivery were predictors of intrapartum stillbirth in women delivering at Mulago hospital. Timely referral and improving access to quality intrapartum obstetric care have the potential to reduce the incidence of intrapartum SB in our community. Key words: • Stillbirths • Intrapartum • Predictors • Maternal Health • Child Health • Child Death • MCH • Case-Control • Uganda • Africa
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    Utilisation of ChatGPT and other Artificial Intelligence tools among medical faculty in Uganda : a cross-sectional study.
    (MedEdPublish, 2025) Mukunya, David; Nantale, Ritah; Kayemba, Frank; Ajalo, Elizabeth; Pangholi, Kennedy; Babuya, Jonathan; Akuu, Suzan Langoya; Namiiro, Amelia Margaret; Tweheyo, Ronald; Ekak, Steven; Nakitto, Brenda; Nantongo, Kirsten; Mpagi, Joseph Luwaga; Musaba, Milton W.; Oguttu, Faith; Kuteesa, Job; Mubuuke, Aloysius Gonzaga; Munabi, Ian Guyton; Kiguli, Sarah
    Background ChatGPT is a large language model that uses deep learning techniques to generate human-like texts. ChatGPT has the potential to revolutionize medical education as it acts as an interactive virtual tutor and personalized learning assistant. We assessed the use of ChatGPT and other Artificial Intelligence (AI) tools among medical faculty in Uganda. Methods We conducted a descriptive cross-sectional study among medical faculty at four public universities in Uganda from November to December 2023. Participants were recruited consecutively. We used a semi-structured questionnaire to collect data on participants’ sociodemographics and the use of AI tools such as ChatGPT. Our outcome variable was the use of ChatGPT and other AI tools. Data were analyzed in Stata version 17.0. Results We recruited 224 medical faculty, majority [75% (167/224)] were male. The median age (interquartile range) was 41 years (34–50). Almost all medical faculty [90% (202/224)] had ever heard of AI tools such as ChatGPT. Over 63% (120/224) of faculty had ever used AI tools. The most commonly used AI tools were ChatGPT (56.3%) and Quill Bot (7.1%). Fifty-six faculty use AI tools for research writing, 37 for summarizing information, 28 for proofreading work, and 28 for setting exams or assignments. Forty faculty use AI tools for nonacademic purposes like recreation and learning new skills. Faculty older than 50 years were 40% less likely to use AI tools compared to those aged 24 to 35 years (Adjusted Prevalence Ratio (aPR):0.60; 95% Confidence Interval (CI): [0.45, 0.80]). Conclusion The use of ChatGPT and other AI tools was high among medical faculty in Uganda. Older faculty (>50 years) were less likely to use AI tools compared to younger faculty. Training on AI use in education, formal policies, and guidelines are needed to adequately prepare medical faculty for the integration of AI in medical education. Keywords ChatGPT, medical faculty, Bing, Bard, Uganda, generative AI, medical education
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    Widespread use of ChatGPT and other Artificial Intelligence tools among medical students in Uganda : a cross-sectional study.
    (PLOS One, 2025) Ajalo, Elizabeth; Mukunya, David; Nantale, Ritah; Kayemba, Frank; Pangholi, Kennedy; Babuya, Jonathan; Akuu, Suzan Langoya; Namiiro, Amelia Margaret; Nsubuga, Yakobo Baddokwaya; Mpagi, Joseph Luwaga; Musaba, Milton W.; Oguttu, Faith; Kuteesa, Job; Mubuuke, Aloysius Gonzaga; Munabi, Ian Guyton; Kiguli, Sarah
    Background Chat Generative Pre-trained Transformer (ChatGPT) is a 175-billion-parameter natural language processing model that uses deep learning algorithms trained on vast amounts of data to generate human-like texts such as essays. Consequently, it has introduced new challenges and threats to medical education. We assessed the use of ChatGPT and other AI tools among medical students in Uganda. Methods We conducted a descriptive cross-sectional study among medical students at four public universities in Uganda from 1st November 2023 to 20th December 2023. Participants were recruited by stratified random sampling. We used a semi-structured questionnaire to collect data on participants’ socio-demographics and use of AI tools such as ChatGPT. Our outcome variable was use of AI tools. Data were analyzed descriptively in Stata version 17.0. We conducted a modified Poisson regression to explore the association between use of AI tools and various exposures. Results A total of 564 students participated. Almost all (93%) had heard about AI tools and more than two-thirds (75.7%) had ever used AI tools. Regarding the AI tools used, majority (72.2%) had ever used ChatGPT, followed by SnapChat AI (14.9%), Bing AI (11.5%), and Bard AI (6.9%). Most students use AI tools to complete assignments (55.5%), preparing for tutorials (39.9%), preparing for exams (34.8%) and research writing (24.8%). Students also reported the use of AI tools for nonacademic purposes including emotional support, recreation, and spiritual growth. Older students were 31% less likely to use AI tools compared to younger ones (Adjusted Prevalence Ratio (aPR):0.69; 95% CI: [0.62, 0.76]). Students at Makerere University were 66% more likely to use AI tools compared to students in Gulu University (aPR:1.66; 95% CI:[1.64, 1.69]). Conclusion The use of ChatGPT and other AI tools was widespread among medical students in Uganda. AI tools were used for both academic and non-academic purposes. Younger students were more likely to use AI tools compared to older students. There is a need to promote AI literacy in institutions to empower older students with essential skills for the digital age. Further, educators should assume students are using AI and adjust their way of teaching and setting exams to suit this new reality. Our research adds further evidence to existing voices calling for regulatory frameworks for AI in medical education.