Browsing by Author "Okello, Francis"

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    Acceptability of immediate CPAP for preterm infants in the delivery room to mothers, caregivers and healthcare workers in a low-resource setting: a qualitative study
    (BMC Pediatrics, 2025) Napyo, Agnes; Nakiyemba, Alice; Muduwa, Martha; Ssenkusu, M. John; Okello, Francis; Hagmann, Cornelia; Namuyonga, Judith; Hewitt-Smith, Adam; Loe, Kate; Abongo, Grace; Amorut, Denis; Wandabwa, Julius; Olupot-Olupot, Peter; Burgoine, Kathy
    Background: Preterm birth is the leading cause of childhood mortality, with respiratory distress syndrome as the predominant aetiology. Initiating continuous positive airways pressure (CPAP) immediately after birth may reduce CPAP failure, the need for ventilation, and surfactant use. In low-resource settings, without ventilation or surfactant, immediate CPAP could significantly reduce preterm mortality. We explored the experiences, perceptions, and acceptability of immediate CPAP among parents, caregivers, and healthcare workers in a Ugandan hospital. Methods: This qualitative study (April 2023–April 2024) was nested in a pilot randomised controlled trial of immediate delivery room CPAP for very low birthweight infants (VLBW, <1500 g) at a government hospital in Uganda. Data were collected through 12 key informant interviews and focus group discussions with 36 healthcare workers, and 37 parents and caregivers of enrolled infants. We applied deductive framework analysis using the Theoretical Framework of Acceptability (TFA) and coded transcripts using Nvivo 12. Results: Regarding affective attitude, healthcare workers, mothers and caregivers expressed positive feelings towards immediate CPAP. For perceived effectiveness, healthcare workers described immediate CPAP as a prophylactic intervention that reduces the severity of complications and shortens hospital stays, while mothers and caregivers believed it expands the infant’s lungs and increases chances of survival. Concerning burden, healthcare workers highlighted that successful implementation depends on a committed neonatal team, multidisciplinary team collaboration, adequate staffing, active maternal involvement, and the availability of sufficient CPAP machines. Opportunity costs were evident where limited staffing forced healthcare workers to choose between prioritising the mother or the infant. Under ethicality, cultural beliefs, religious views, and fear were identified as influential factors in decision making around immediate CPAP. Regarding intervention coherence, healthcare workers, mothers, and caregivers demonstrated a good understanding of the purpose and process of immediate CPAP. Finally, self-efficacy was linked to the availability of adequate staff, training, and necessary equipment to confidently engage in the intervention. Conclusions Immediate CPAP was found to be acceptable among healthcare workers and mothers/caregivers. Successful implementation requires adequate staff training, comprehensive health education, adequate human resources, and sufficient availability of CPAP machines. Trial registration Study is registered on Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Keywords Preterm, Very low birthweight, VLBW, Africa, Neonatal, CPAP, Respiratory distress syndrome, Low-resource setting, Acceptability, Barriers, Facilitators, Attitude
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    Community perspectives regarding preparedness, response and prevention of ebola virus disease amidst COVID-19 pandemic, an exploratory descriptive qualitative study using a community engagement approach in Mbale City.
    (Research Square, 2024) Kagoya, Enid Kawala; Nsubuga, Allan G.; Ewing, Helen; Atuhairwe, Irene; Ijangolet, Esther; Otim, Eric; Ronald, Kibuuka; Jesca, Atugonza; Okello, Francis; Nakattudde, Prossy; Nyangoma, Faith; Namara, Racheal; Nakabaale, Mark; Nakawuka, Betty; Nakawuki, Ashley; Kizito, Prisca; Waako, Paul; Wandabwa, Julius; Makoko, Tonny Brian; Musaba, Milton; Ahaisibwe, Bonaventure; Barugahare, Banson
    Background: Ebola virus disease (EVD) is a rare and deadly infectious hemorrhagic fever disease. Four of the 6 known Ebola virus species can cause human disease. Since 1976, EVD outbreaks have been recorded sporadically in East, Central, and West Africa. Uganda has experienced 6 documented outbreaks of EVD since 2000 that can be attributed to 3 species of Ebola viruses (Zaire, Sudan, and Bundibugyo). Despite substantial advances in clinical management, the case fatality ratio for EVD remains high, reaching more than 60% for the Zaire Ebola virus in 2018–2020. Methods. The study followed a descriptive qualitative study design. Data were collected using an interviewer-administered questionnaire with both closed and open-ended questions. Data were analysed using ATLAS Pro. Results: Our results illustrate the lack of health education in the community among the different categories of people and this comes from an emic perspective. We identified 4 high-level themes and 19 subthemes, (1) Knowledge of Ebola Virus Disease, (2) Prevention of EVD in the community, (3) Preparedness for Ebola Virus Disease, and (4) Community response to Ebola Virus Disease and the final thematic area (4) which included giving first aid, using traditional medicines, and approaching a health facility among others. Conclusions: With all the available information about the previous outbreaks in Uganda, it is surprising that less effort was made this time round to take local sensibilities and culture into account among other social factors contributing to the poor practices of masses toward the EVD, preparedness, prevention, and response. Keywords: Ebola Virus Disease, Preparedness, Response and Prevention, Community Engagement
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    Congenital cytomegalovirus in eastern Uganda : prevalence and outcomes.
    (BMC Pediatrics, 2025) Okalany, Regina Akwi Noela; Engebretsen, Marie S. Ingunn; Mukunya, David; Chebet, Martin; Okello, Francis; Weeks, D. Andrew; Mwanda, Edrin; Muhindo, Rita; Bisso, Fred; Tylleskär, Thorkild; Olupot-Olupot, Peter; Burgoine, Kathy
    Background: Cytomegalovirus (CMV) infection poses risks to both maternal and neonatal health, however there are limited comprehensive data on congenital CMV in low-resource settings where the virus is widespread, particularly among women of reproductive age. Our research in eastern Uganda aimed to assess the prevalence of congenital CMV and outcomes among infants to inform public health policies and interventions in similar settings, addressing a significant gap in current knowledge. Methods: We conducted a descriptive study, nested within the BabyGel Trial, across Mbale and Budaka districts in eastern Uganda, between May 2023 and January 2024. Infants underwent saliva sampling within the first week of life, which was validated through urine polymerase chain reaction testing within the first 21 days of life. At three months of age, a cranial ultrasound examination, neurological examination, developmental evaluation, and audiological assessment were conducted for all infants diagnosed with congenital CMV infection. Statistical analyses were performed using Stata 17.0. Results: Congenital CMV infection was found in 5 out of 1,265 newborns tested, indicating a prevalence of 0.4% (95% CI: 0.16 to 0.96). Of these 5 infected infants, two experienced febrile illness at birth and required hospitalisation within the first week of life, and three had findings on ultrasound examination consistent with congenital cytomegalovirus during the neonatal period. Audiologic follow-up until three months of age revealed that three infants had failed unilateral and bilateral hearing screening. Neurodevelopment assessments using the Malawi Development Assessment Tool fell within optimal ranges for all 5 infants; however, when evaluated using the Hammersmith Infant Neurological Examination, four infants scored below optimal levels. Conclusion: Our community-based study revealed a low prevalence of congenital CMV infection. Further longitudinal multi-site research is needed to assess the generalisability of these findings. Also, long-term follow-up of children is crucial to understanding the outcomes and sequelae of infected infants to inform prevention strategies, targeted interventions and scalable screening frameworks in resource-limited settings. Keywords: Cytomegalovirus, Congenital, Prevalence, Neurodevelopment, Hearing, Low-resource setting, Uganda
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    Coping mechanisms for students with mental disorders : an exploratory qualitative study at Busitema University’s Mbale and Busia campuses.
    (PLOS One, 2025) Kagoya, Enid Kawala; Mpagi, Joseph; Waako, Paul; Muhwezi, Martha R. L.; Namaganda, Agnes; Nsubuga, Allan G.; Atala, Christine Etoko; Okello, Francis; Okibure, Ambrose; Kibuuka, Ronald; Wandera, Ernest; Ndamanywa, Kalisiti; Kirabira, Joseph
    In recent years, Ugandan universities have faced a rising incidence of mental health issues among students, with prevalence rates of mental disorders reaching up to 60% among undergraduates. These challenges significantly impact both academic performance and social interactions. This study aimed to investigate the coping mechanisms among students with mental disorders at Busitema University. We conducted 42 key informant interviews with students diagnosed with mental disorders, as determined by the Mini International Neuropsychiatric Interview. Interviews were guided by a structured protocol developed by the research team, and all participants provided informed consent. The interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. This approach was chosen for its efficiency and directness. Nvivo software facilitated the coding and organization of themes. The study identified several coping strategies used by students at the two Busitema University campuses. Five main themes emerged: Alcohol and Substance Use, Use of Sedatives, Social and Personal Initiatives, Seeking Counseling Services, Withdrawal and Confrontation, and Faith Healing. Various subthemes were also noted, including substance use, withdrawal, confrontations, witchcraft, participation in co-curricular activities, abortions, and seeking psychosocial support. These findings are detailed in Table 2. Addressing the mental health challenges faced by university students requires a thorough understanding of their coping strategies. While some strategies are self-developed, others involve university-led interventions. It is crucial to reinforce effective coping mechanisms and address detrimental ones to improve students’ mental health outcomes. Mental disorders, coping strategies, university students, Uganda
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    Designing a lighting system that is controlled by a remote and uses a low voltage using locally available materials.
    (Busitema University, 2026) Okello, Francis
    The aim of this study was to design a lighting system that is controlled by a remote and uses a low voltage as low as 5 Volts. In this study, a lighting system that is controlled by a remote was designed using a sensor, resistors, USB socket, remote and LED lamp beads. The band width of the lighting system was measured and found to decrease with increase in distance. These results suggest that the remote would be effective if it is used at a nearby distance with no obstacle.
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    Exploring barriers and facilitators of preceptorship in undergraduate health professions education : insights from a qualitative needs assessment among preceptors in Eastern Uganda.
    (BMC, 2025) Wani, Solomon; Nantale, Ritah; Atuhairwe, Irene; Makoko, Brian Tonny; Okello, Francis; Waako, Paul; Twineamatsiko, Andrew; Agaba, Brian; Nyalihama, Alain; Kibuule, Dan; Kagoya, Enid Kawala
    Background: Clinical preceptorship plays a critical role in bridging theoretical knowledge and practical skills for health professions students. In resource-constrained settings like Eastern Uganda, understanding what facilitates effective preceptorship is essential for improving clinical education outcomes. This study explores the barriers and facilitators to preceptorship among clinical preceptors and faculty at Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital. Methods: We conducted 15 in-depth interviews with clinical preceptors, including faculty and clinical staff from Busitema University, Mbale College of Health Sciences, and Mbale Regional Referral Hospital. Participants were purposively selected based on experience, education level, medical care, and leadership roles. We conducted the interviews between May 2024 and June 2024, audio-recorded, were transcribed verbatim, and thematically analyzed using Atlas.ti version 9. Results: Three key facilitators and six barriers to preceptorship emerged from the analysis. The facilitators included: support from Seed Global Health through donations of medical tools, equipment, and healthcare worker training; strong commitment and willingness among health workers at Mbale Regional Referral Hospital to teach students; and, support from faculty and postgraduate students at Busitema University. Barriers were: high numbers of students in clinical settings; poor communication and coordination between academic institutions and clinical sites; limited preceptorship skills and knowledge among clinical preceptors; shortages of faculty preceptors; insufficient time for clinical rotations; and inadequate models and equipment for simulation-based teaching. To address these challenges, preceptors recommended better coordination and student orientation, phased placement in smaller groups, training and refresher courses to strengthen preceptorship capacity, increased faculty presence in wards, and provision of essential medical equipment. Conclusion: Effective preceptorship in resource-limited settings depends on leveraging facilitators while addressing persistent barriers. External partnerships, staff commitment, and faculty support are valuable enablers, but their impact is undermined by overcrowding, poor coordination, and resource shortages. Actionable strategies such as structured communication between training institutions and hospitals, phased student placement, targeted preceptor training, and investments in teaching equipment can mitigate barriers and reinforce facilitators. Strengthening these systems is vital for sustaining high-quality clinical education in Uganda and similar contexts. Keywords: Preceptorship, Barriers, Facilitators, Medical education, Uganda
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    Postnatal cytomegalovirus infection and its effect on hearing and neurodevelopmental outcomes among infants aged 3–10 months : a cohort study in Eastern Uganda.
    (PLOS One, 2025) Okalany, Regina Akwi Noela; Mukunya, David; Olupot-Olupot, Peter; Chebet, Martin; Okello, Francis; Weeks, D. Andrew; Bisso, Fred; Tylleska¨r, Thorkild; Burgoine, Kathy; Engebretsen, Marie Stadskleiv Ingunn
    Background Hearing impairment and neurodevelopmental disorders pose a significant global health burden in children. The link between postnatal cytomegalovirus (CMV) infection and these outcomes remains unclear. This study explored the association of postnatal CMV infection with hearing and neurodevelopmental outcomes in term infants aged 3 to 10 months. Methods This was a cohort sub-study within the BabyGel cluster randomised trial in Eastern Uganda. From 1265 term infants screened for CMV, 219 were negative at birth but positive at 3 months, and were age-matched with 219 CMV-negative controls. CMV status was determined by PCR screening of saliva samples, with positive results confirmed using urine samples (Chai Open qPCR, Santa Clara, CA). From the established cohort, 424 infants were successfully followed up between 3 to 10 months of age. Clinical assessments included neurodevelopmental evaluation using the Malawi Developmental Assessment Tool, the Hammersmith Infant Neurological Examination, and hearing screening using Otoacoustic Emission testing (Otoport Lite, Otodynamics Limited). Statistical analyses were performed using descriptive statistics, chisquare tests and log binomial regression models with Stata 18. Results Of the 424 infants included in the study, 206 were postnatal CMV-infected and 218 were uninfected. Neurodevelopmental assessments indicated no differences between postnatalCMV-infected infants and uninfected groups (ARR 0.88, 95% CI [0.67, 1.15], p = 0.346). Hearing screening revealed a 1.99-fold increased risk of a positive result for postnatal CMVinfected infants compared to uninfected infants (67/106 vs. 39/106, 95% CI [1.27, 3.12], p = 0.003). Conclusion Postnatal CMV infection was associated with more positive hearing screenings, though no significant differences in neurodevelopmental outcomes were observed in early infancy. Exploration into the feasibility of incorporating hearing and CMV screening into routine care will play a vital role in early identification and intervention, improving the management of both hearing and CMV-related conditions in resource-limited settings
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    Term stillbirths in Eastern Uganda: a community-based prospective cohort study
    (Taylor & Francis Group, 2025) Chebet, Martin; Olupot-Olupot, Peter; Weeks, D Andrew; Engebretsen, Marie S Ingunn; Okalany, Regina Akwi Noela; Okello, Francis; Tylleskär, Thorkild; Burgoine, Kathy; Mukunya, David
    Background: Every year, 1.9 million stillbirths occur worldwide, of whom 1.5 million occur in sub-Saharan Africa (SSA) and Southeast Asia. Objectives: This study aims to determine the incidence and risk factors and to describe underlying causes for term stillbirths in Eastern Uganda. Methods: This was a cohort study of pregnant women enrolled at 34 weeks of gestation or more and followed to birth between January 2021 and January 2024. Enrolment and follow-up were done in the community by trained midwives. Using structured questionnaires, details of maternal health, pregnancy and birth were captured. Results: We enrolled 6101 participants and analysed 5496 for incidence of term stillbirth and 5296 for risk factors. Of the participants, 4913/5296 (92.8%) were between 14 and 35 years, and 4456/5296 (84.1%) had a health facility birth. There were 101 term stillbirths (61 were intrapartum and 40 antepartum). The incidence of term stillbirth was 18.4 per 1000 births (95% CI 14.8 to 22.9). The most common underlying causes of stillbirth were prolonged or obstructed labour 32/101 (31.7%) and malaria 20/101 (19.8%). The factors associated with term stillbirths were caesarean birth (aRR 3.3; 95% CI 2.00 to 5.4), intimate partner violence (aRR 1.8; 95% CI 1.1 to 2.8) and maternal age above 35 years (aRR 2.2; 95% CI 1.2 to 3.9). Conclusion: Eastern Uganda has a high rate of term stillbirths with more than half occurring during labour. Efforts are needed to improve the quality of birth care and to prevent intimate partner violence.
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    The association between malaria parasite geometrical mean and clinical spectrum of severe disease in a high-transmission setting in eastern Uganda : a cross-sectional study.
    (Wiley, 2025) Egiru, Isaiah Eregu Emma; Namayanja, Cate; Paasi, George; Okiror, William; Ongodia, Paul; Okalebo, Benard Charles; Muhindo, Rita; Abongo, Grace; Oguttu, Faith; Okibure, Ambrose; Okello, Francis; Tegu, Crispus; Mukunya, David; Chebet, Martin; Olupot-Olupot, Peter
    Background: Malaria burden remains significant, especially in high-transmission settings. While some data show an association between severe malaria and high-malaria parasite geometrical mean (GM), few data describe this phenomenon in malaria hightransmission settings. We described the malaria parasite GM and clinical spectrum of severe malaria in Eastern Uganda to advance understanding of its implications on disease severity and patient outcomes. Methods: We conducted a cross-sectional study in Mbale Regional Referral Hospital (MRRH), Eastern Uganda. Children admitted with severe malaria confirmed by microscopy with ages between 2 months and 12 years were enrolled in the study from September 21, 2021, to September 21, 2022. Data were collected on patient sociodemographics, clinical symptoms and signs, laboratory parameters, treatment details, and outcomes. From the blood samples collected at the bedside, blood films/smears were made. The malaria parasite count was obtained from the patients’ smears by counting the malaria parasites against 200 white blood cells (WBCs). The GMs of malaria were obtained after the logarithmic transformation of the parasite counts. Data were analyzed using Stata 15, and significant associations were reported at p values of 0.05 at 95% confidence intervals. Results: A total of 376 children with a mean age of 4.65 years were recruited, of whom 57.71% (217/376) were male. Children under 5 years constituted 61.7% (232/376). The common clinical manifestations were prostration 76.9% (289/376), jaundice 55.6% (209/376), severe anemia 48.4% (182/377), and hemoglobinuria 46.5% (175/376). The overall malaria parasite GM was 12,238.42 parasites/microliter (95% CI: 9166.72–16,339.43). The highest GM of 197,000 parasites/microliter (95% CI:40,817.64–946,368) and the lowest of 8938.185 parasites/microliter (95% CI: 5932.8–13,466.01) were observed in shock and severe anemia, respectively. Inpatient mortality was 3.4%. Conclusion: In malaria high-transmission settings of Eastern Uganda, patients with severe malaria had low parasite GMs similar to those in uncomplicated malaria. Thus, malaria parasite GM should not be relied upon to determine disease severity in these settings.
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    The resurgence of blackwater fever among children in sub-Saharan Africa : a scoping review.
    (Research Square, 2025) Paasi, George; Namazi, Ruth; Malaika, Nancy; Namayanja, Cate; Ongodia, Paul; Okalebo, Benard Charles; Amorut, Denis; Asiimwe, Glorias; Okello, Francis; Mukunya, David; Munabi, Guyton Ian; Kiguli, Sarah; Idro, Richard; Olupot-Olupot, Peter
    Background: Blackwater fever (BWF), a life-threatening complication of Plasmodium falciparum malaria, has reemerged as a significant health concern among children in sub-Saharan Africa (SSA). Characterized by acute intravascular hemolysis, hemoglobinuria, and severe anemia, BWF necessitates urgent medical intervention. Despite its clinical severity, data on its burden, risk factors, and management remain fragmented. Therefore, this scoping review aimed to systematically map the existing literature on BWF in SSA, focusing on its epidemiology, clinical presentation, risk factors, management strategies, and outcomes among children in SSA. Methods: Following the Arksey and O’Malley framework, a comprehensive search was conducted across six databases (PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, web of science) and grey literature sources including preprint servers, conference proceedings, theses, dissertations, WHO reports and clinical trials registries (PACTR, clinicaltrials.gov). Studies published from inception to December 2024 were included. Data were extracted and synthesized narratively, with findings categorized thematically by epidemiology, clinical features, risk factors, management, and outcomes. Results: BWF was geographical clustered in East and Central Africa, particularly Uganda (53.8%) and the DRC (26.9%). Prevalence ranged from 4.4% to 52.7%, with higher incidence during rainy seasons. MBL2 AA polymorphisms, elevated IgG1 and quinine exposure (aOR 50.19-57.33) were significant contributors while G6PD deficiency (G6PDd) had conflicting associations. Clinical hallmarks were dark urine (100% of cases), jaundice (22.7-100%), and severe anemia (23.7-77%) aligning with the “hemolytic triad” reported in BWF. Acute kidney injury (AKI) (16.2-90.6% of cases) and recurrent episodes (50-68% readmission rates) exacerbated morbidity. Diagnosis relied on clinical criteria, with limited laboratory confirmation, while management emphasized artemisinin-based therapies and supportive care. Delays in blood transfusions and renal replacement therapy contributed to poor outcomes. Conclusion: BWF resurgence in SSA highlights critical gaps in diagnostics, equitable care, and adherence to artemisinin-based treatments. Targeted surveillance during malaria peaks, standardized diagnostic protocols, and improved access to supportive therapies are urgently needed to mitigate BWF-associated mortality and morbidity in high-burden regions.
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    Watching over life : practices and meanings of postpartum vital signs monitoring in eastern Uganda.
    (medRxiv, 2025) Babuya, Jonathan; Kayemba, Frank; Waiswa, Sinani; Nsubuga, Allan G.; Ewing, Helen; Atuhairwe, Irene; Ijangolet, Esther; Otim, Eric; Ronald, Kibuuka; Jesca, Atugonza; Okello, Francis; Nakattudde, Prossy; Nyangoma, Faith; Nakawuka, Betty; Kabahinda, Nichola; Kamwesigye, Assen; Apoya, Jill; Waako, Paul; Wandabwa, Julius; Musaba, Milton; Bonaventure, Ahaisibwe; Aeby, Tod; Nandutu, Sarah; Mugabe, Kenneth; Pangholi, Kennedy; Nahurira, Doreck; Agaba, Brian; Mbwali, Immaculate; Bahati, Johnson; Kagoya, Enid Kawala
    Introduction Postnatal deaths account for about one-third of maternal mortality in Low- and middle-income countries (LMICs). Nearly half occur within the first 24 hours and are preventable through continuous inpatient monitoring. This study assessed maternal mortality within the first 24 postnatal hours; and the current postpartum monitoring practices, including the availability of monitoring charts and the frequency of vital sign assessments in eastern Uganda. Methods This cross-sectional study reviewed the medical records of all postpartum women admitted at Mbale Regional Referral Hospital, Eastern Uganda, between August 2022 and February 2023. A semi-structured data extraction form was used. The outcome variable was postpartum monitoring; categorized as "No" for women with no vital signs monitored and "Yes" for those with at least one vital sign monitored. Descriptive analysis was performed using Stata Version 17.0, and Poisson regression was employed to explore the association between various factors and postpartum monitoring. Results Medical records of 2,717 postpartum mothers were reviewed. The median (interquartile range) age was 25(20-30) years. A minority (34%; 910/2717) of mothers had vital sign observation charts in their medical records and very few (4%; 110/2717) had a fluid balance chart. About 49 24% (651/2717) of mothers had at least one vital sign recorded. Blood pressure was the most (16.8%; 456/2717) recorded vital sign followed by pulse rate (13.6%; 369/2717). Respiratory rate and temperature were the least monitored vital signs with 1.2% and 1.1% records respectively. Mothers who delivered by C-section had a 151% higher prevalence of postpartum monitoring compared to those who had a vaginal delivery (aPR: 2.51; 95% CI: 2.19–2.89). Maternal mortality rate on the first postpartum day was 8.8 per 1000, with postpartum hemorrhage accounting for 61%. Conclusion Postpartum vital signs monitoring was low. LMICs need to devise means of automating the monitoring process.