Browsing by Author "Olupot-Olupot, Peter"
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Item 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, KathyBackground: 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, AttitudeItem Acceptability of minimal invasive tissue sampling (MITS) for stillbirths in Eastern Uganda(PLOS One, 2025) Chebet, Martin; Burgoine, Kathy; Rujumba, Joseph; Okalany, Regina Akwi Noela; Olupot-Olupot, Peter; Tylleskär, Thorkild; Weeks, D. Andrew; Napyo, Agnes; Mukunya, David; Engebretsen, Marie S. IngunnBackground In sub-Saharan Africa, stillbirth rates remain high. To design effective interventions to reduce stillbirths, accurate determination of their aetiology is important. Conventional autopsy for accurate confirmation of cause is not acceptable or feasible in several societies in sub-Saharan Africa; minimal invasive tissue sampling (MITS), is a recently developed, less invasive alternative. In this study, we explored the acceptability of MITS in the community and among healthcare workers in Uganda to guide the future implementation. Methods A qualitative study was done among community members and healthcare workers in Mbale in Eastern Uganda. We undertook in-depth interviews and focus group discussions in English or local languages. Interviews were audio-recorded, transcribed as necessary prior to formal content analysis. The themes were organised using NVivo software and presented according to Sekhon’s theoretical framework. Results Overall, participants preferred the idea of MITS to conventional autopsy because of the perception that it was fast, maintained the facial appearance and kept the body intact. It was thought that the procedure would improve the detection of the cause of stillbirths, which in turn would help to prevent future stillbirths. It would also resolve conflicts in the community between community members or the women and the healthcare workers about the cause of a stillbirth. It was suggested that some community members may not approve of MITS because of their religious beliefs; the fear that the body parts may be extracted and stolen for witchcraft or organ donation; and a lack of trust in the healthcare system. To implement the procedure, it was suggested that extensive community sensitization should be done, space limitations in healthcare facilities overcome, healthcare workers should be trained and limited human resource should be addressed. Conclusion The implementation of MITS in Mbale, Eastern Uganda, is likely to be acceptable given sufficient training and sensitisation.Item Capacity building in field epidemiology in Sub Saharan Africa : findings from Infectious Disease Field Epidemiology and Biostatistics in Africa (IDEA) Fellowship Program(Taylor & Francis Group, 2025) Alunyo, Patrick Jimmy; Paasi, George; Ario, Riolexus Alex; Olupot-Olupot, PeterBackground: Emerging and re-emerging infectious diseases (EREIDs) remain a major public health threat globally, particularly in sub-Saharan Africa (SSA), where fragile health systems, inadequate infrastructure, and limited workforce training exacerbate vulnerabilities. Uganda, a recognised hotspot for outbreaks, faces increasing risk due to anthropogenic and environmental drivers. To address critical capacity gaps, the Infectious Disease Epidemiology and Biostatistics in Africa (IDEA) Fellowship was launched as Uganda’s first master’s-level programme in infectious disease field epidemiology. Led by Busitema University, in collaboration with national and international partners, the programme was funded through EDCTP-II (CSA2020E). Methods: The IDEA Fellowship combined theoretical instruction with fieldwork and research tailored to national health priorities. Activities included outbreak investigations, disease modelling, and surveillance, supported by Africa CDC, Uganda’s Ministry of Health, and UK institutions. A REDCap-based survey was administered to 202 public health professionals across SSA to assess training needs, skill gaps, and barriers. Data were analysed using descriptive statistics and thematic analysis. Results: The programme trained 15 master‘s-level fellows, strengthening Uganda’s capacity in surveillance, early detection, and outbreak response. Survey results showed that 55.4% of professionals required further training, with skill gaps in zoonotic disease management (64.4%), outbreak preparedness (64.9%), and data management (59.4%). Key barriers included limited diagnostic capacity (73.8%) and weak collaboration (49.5%). Qualitative findings highlighted inconsistent mentorship, restricted data access, and limited funding for fieldwork. Respondents advocated for structured mentorship, longer training durations (≥3–6 months), and hybrid delivery models (42.3%). Conclusion: The IDEA Fellowship demonstrates a scalable model for infectious disease capacity building in SSA. Training African scientists in local contexts promotes relevance, retention, and cost-effectiveness. Regional expansion, cross-sector collaboration, and systemic investment are essential for sustainable epidemic preparedness and global health security. Keywords: field epidemiology, capacity building, infectious disease training, Sub-Saharan AfricaItem Factors associated with willingness to use ecological sanitation toilets in Katine sub county Soroti district Uganda: a cross sectional study(Springer Nature, 2025) Ikiring, Osako Betty; Okia, David; Okolimong, Charles; Alunyo, Patrick Jimmy; Katuramu, Richard; Khainza, Tabitha Annet; Mukunya, David; Matovu, K. B. Joseph; Musoke, David; Olupot-Olupot, Peter; Wanume, BenonEcological sanitation (EcoSan) toilets provide a sustainable approach to waste management by converting human excreta into usable agricultural inputs. Despite their environmental and health benefits, uptake remains low in many settings. This study investigated the proportion of community members in Katine sub-county, Soroti district, Eastern Uganda, who had ever used EcoSan toilets, their willingness to use them, and the factors associated with this willingness. A cross-sectional survey was conducted among 395 residents using structured questionnaires. Descriptive statistics estimated the proportions of prior use and willingness to use EcoSan toilets. Multivariable logistic regression was used to identify factors independently associated with willingness. Analyses were conducted in Stata 18, and results are presented in tables and figures. Only 18.5% (73/395) of respondents had used EcoSan toilets, and 13.7% (54/395) expressed willingness to use them. In multivariable analysis, key factors negatively associated with willingness included awareness of Ecosan toilets (adjusted odds ratio [AOR] 0.06, 95% CI 0.02–0.16; p<0.0001), willingness to use sanitized fecal matter (AOR 0.06, 95% CI 0.02–0.17; p<0.0001), and perceived ease of use (AOR 0.16, 95% CI 0.05–0.48; p=0.001). Adoption of EcoSan toilets remains low in this setting, primarily due to limited awareness, cultural reservations, and usability concerns. Community sensitisation, culturally appropriate messaging, and user centered toilet design are essential to improving uptake in similar rural environments. Keywords Ecological sanitation, Willingness, Rural sanitation, Uganda, Waste reuseItem Hydroxyurea pharmacokinetics in children with sickle cell anemia across different global populations(PubMed Central, 2025) Power-Hays, Alexandra; McElhinney, E. Kathryn; Williams, N. Thomas; Mochamah, George; Olupot-Olupot, Peter; Paasi, George; Reid, E. Marvin; Rankine-Mullings, E. Angela; Opoka, O. Robert; John, C. Chandy; McGann, T. Patrick; Quinn, T. Charles; Punt, C. Nieko; Smart, R. Luke; Latham, S. Teresa; Vinks, A. Alexander; Ware, E. RussellHydroxyurea provides effective disease-modifying treatment for people with sickle cell anemia (SCA), especially when escalated to maximum tolerated dose (MTD), which has wide interpatient dosing variability due to pharmacokinetic (PK) differences. Whether hydroxyurea PK parameters differ among children with SCA in different global regions is unknown. We compared hydroxyurea PK parameters among children with SCA from 5 clinical trials: HUSTLE (United States), TREAT (United States), NOHARM (Uganda), REACH (Uganda and Kenya), and EXTEND (Jamaica). Key hydroxyurea PK parameters were determined using HdxSim, a validated hydroxyurea PK software program. The results were compared across regions by analysis of variance. PK profiles from 451 children with SCA (146 from the United States, 265 from Africa, and 40 from the Caribbean) were included. Children from Africa had slightly lower volumes of distribution, but absorption rate and clearance were similar across regions. The PK-recommended doses to achieve MTD were statistically different but clinically similar across the United States (26.6 ± 5.9 mg/kg per day), Africa (27.6 ± 6.5 mg/kg per day), and the Caribbean (25.2 ± 4.7 mg/kg per day) (P = .04). In multivariable regression, younger age and increased reticulocyte counts were associated with higher PK-recommended doses. Hydroxyurea PK parameters in children with SCA differ minimally across global populations, predicting clinically similar doses to achieve MTD. Individualized hydroxyurea dosing based on a PKpopulation model derived from US children with SCA can be used broadly to maximize the benefits of this critical medication in other global populations. These trials were registered at www.ClinicalTrials.gov as #NCT00305175 (HUSTLE), #NCT02286154 (TREAT), #NCT01976416 (NOHARM), #NCT01966731 (REACH), and #NCT02556099 (EXTEND).Item Incidence and predictors of Sudan ebolavirus transmission among contacts in Uganda in 2022 : a retrospective cohort study(BMC Public Health, 2025) Mulongo, Muhamed; Matovu, K. B. Joseph; Lubaale, A. M. Yovani; Olupot-Olupot, PeterBackground: Ebola disease (EBOD) is a highly lethal zoonotic viral hemorrhagic fever that is responsible for 41 outbreaks globally. Ebola transmission is a key driver of the magnitude and complexity of outbreaks, yet incidence rate during outbreaks is not fully studied. This study aimed to determine the incidence and predictors of Sudan Ebolavirus transmission during the 2022 outbreak in Uganda. Methods: We conducted a retrospective cohort study leveraging surveillance records for individuals identified as contacts, and collected between September and December 2022 during the Sudan Ebolavirus Disease (SUVD) outbreak in Uganda. Data were extracted and analyzed via Stata/SE 15. This analysis involved calculating incidence rates and assessing predictors of Ebola transmission through appropriate multivariable regression models, and controlling for potential confounders like sex, age, health worker, and place of contact. The study protocol was approved by the Busitema University Research Ethics Committee (BUFHS-2023-145). Individual informed consent was waived, and all the data were anonymized. Results: 3140 contacts were included in the study, with 50.6% being female and a mean age of 24 years. The incidence rate of SUVD was 1.6 cases per 1,000 person-days of follow-up. Kaplan Meier survival function showed that the risk for being diagnosed with SUVD extended beyond 21 days, up to the 28th day post exposure. The incidence of SUVD in secondary transmission settings was 1.8 times higher than that in primary transmission settings (IRR=1.81, 95% CI=1.202–2.735; P<0.001). After controlling for sex, age, health worker, and place of contact, the significant predictors of SUVD transmission were high-risk contact status (aHR=2.5, 95% CI: 1.68–3.72; P<0.001) and male sex in secondary transmission settings (aHR=2.14, 95% CI=1.15–4.01; P=0.02). Conclusions: This study revealed a high incidence of Ebola among contacts, with cases emerging beyond the standard 21-day follow-up period. The incidence was notably higher in secondary transmission settings, with high-risk contacts and males being particularly vulnerable. These findings suggest the need to revise contact tracing protocols (extend beyond 21 days), and prioritize follow-up on the basis of risk stratification. Further research is warranted to explore sex-related differences in secondary transmission dynamics. Keywords: Ebola transmission incidence, Predictors, Uganda, Sudan Ebola virusItem Plasma folate dynamics in Plasmodium falciparum-infected African children treated with artemisinin combination therapy and single low-dose primaquine or placebo(BMC, 2025) Ajayi, Seun; Onyamboko, A. Marie; Olupot-Olupot, Peter; Ayuen, S Dhol; Chimjinda, Natenapa; Taya, Chiraporn; Williams, N Thomas; Uyoga, Sophie; Maitland, Kathryn; Fanello, Caterina; Day, P J Nicholas; Mukaka, Mavuto; Taylor, R J WalterBackground: Adding single low-dose (0.25 mg/kg) primaquine (SLDPQ) to block Plasmodium falciparum transmission is now a WHO recommendation. Whether SLDPQ increases haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) patients, leading to increased folate demand and impaired haemoglobin (Hb) recovery is unknown. This study sought to answer this question. Methods: This randomized, placebo-controlled trial measured serial plasma folate concentrations [Day (D) 0, 3, 7 and 28] in falciparum-infected Ugandan and Congolese children (6 months to 11 years), treated with age-dosed SLDPQ/placebo and artemether-lumefantrine/dihydroartemisinin-piperaquine. Genotyping defined G6PD (G6PD c.202T allele) status. Multiple linear and non-linear, mixed effects, cubic spline regression were fitted to identify factors significantly associated with plasma folate at baseline and over time, respectively. Results: 408 children (3 had missing D0 values) had ≥ 1 plasma folate value. Of these, 66 (16.2%) were G6PD-deficient, 51 (12.5%) heterozygous females, 283 normal and 8 unknown. Mean baseline folate concentrations were 10.83 [standard deviation (SD) 3.58, SLDPQ] vs 10.92 (SD 4.54, placebo) ng/ml, associated independently with baseline Hb [estimate: 0.52 ng/ml (95% CI: 0.26 to 0.79, p = 0.0001)] and baseline parasitaemia [estimate: - 0.18 ng/ml (- 0.32 to - 0.05, p = 0.007)]. For all patients, mean plasma folate concentration paralleled mean haemoglobin concentration with an initial mean fall of 1.65 ng/ml (p < 0.0001 vs. baseline), followed by a sustained rise achieving a mean D28 concentration of 11.04 (SD 4.45) ng/ml. Over time, only age (p = 0.0001), male sex (p = 0.017) and baseline parasitaemia (p = 0.029) were significantly associated with a reduced plasma folate. Conclusion: SLDPQ and G6PD status did not compromise posttreatment plasma folate concentrations in young children with acute uncomplicated falciparum malaria, providing additional evidence of SLDPQ safety and supporting its use without G6PD testing. Trial registration: The trial is registered, reference number ISRCTN11594437. Keywords: Folate; Glucose-6-phosphate dehydrogenase; Malaria; Single low-dose primaquineItem Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study.(Elsevier Ltd., 2025) Opolot, Godfrey; Olupot-Olupot, Peter; Okware, Samuel; Izudi, JonathanRationale: People with human immunodeficiency virus (PWH) have an increased risk of multidrug-resistant TB (MDR-TB) compared to those without HIV. Objective: To investigate the risk factors for MDR-TB among PWH in rural eastern Uganda. Methods: We conducted a nested case–control study at Soroti Regional Referral Hospital in rural eastern Uganda. TB records from January 2017 to May 2024 were retrospectively reviewed to identify all PWH. MDR-TB was defined as resistance to at least both Isoniazid and Rifampicin following GeneXpert Mycobacterium TB and Rifampicin assay and culture-based drug-susceptible testing. Cases were PWH with MDR-TB, while controls were a random sample of PWH without MDR-TB, in a 1:3 ratio. Multivariable binary logistic regression was used to identify factors independently associated with being a case rather than a control. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. Results: We included 37 cases and 111 controls, and found retreatment TB was associated with being a case rather than a control (aOR 6.97; 95% CI 2.65–19.46). Male sex (aOR: 1.59; 95% CI: 0.67–3.93), clinically diagnosed pulmonary TB (aOR: 0.38; 95% CI: 0.10–1.23) or extrapulmonary TB (aOR: 0.37; 95% CI: 0.05–1.62), and recent anti-retroviral therapy initiation (aOR: 2.07; 95% CI: 0.83–5.28) were insignificantly associated with being a case. Conclusion: This study showed that retreatment TB is associated with a higher likelihood of MDR-TB among PWH in a referral hospital in rural eastern Uganda. These findings underscore the need for intensified drug resistance surveillance and adherence support among PWH with prior TB treatment. Keywords: Multi-drug resistant tuberculosis, Human Immunodeficiency Virus, Previously treated tuberculosis, Retreatment TB, UgandaItem 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, DavidBackground: 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.Item The Impact of Diagnostic Delays and Timeliness of Response on Ebola Disease outbreak-level case-fatality Ratios in Uganda (2000–2023) : a Rapid Systematic Review and meta-analysis(Springer, 2025) Paasi, George; Okware, Sam; Olupot-Olupot, PeterBackground: Uganda has experienced seven laboratory-confirmed Ebola virus disease (EBOD) outbreaks from 2000 to 2022, with reported case‐fatality ratios (CFRs) varying widely. The influence of diagnostic and response delays on outbreak‐level mortality has not been systematically assessed. We conducted a rapid systematic review and meta-analysis to quantify the effect of diagnostic and response delays on outbreak-level mortality. Methods: We registered the review on OSF and adhered to PRISMA-2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, WHO Global Index Medicus, and grey literature through 30 April 2025. Eligible reports described laboratory-confirmed human EBOD in Uganda (2000–2022) and reported case counts, deaths, or quantitative timeliness metrics. Outbreak-level CFRs were meta-analyzed using random-effects models with Freeman–Tukey transformation (metafor package in R). Mixed-effects meta-regression assessed the association between continuous delay metrics and transformed CFR. Results: Fifteen reports met inclusion criteria, spanning 741 confirmed cases and 358 deaths. The pooled CFR was 45.4% (95% CI: 26.2%–65.2%; I² = 87.8%) across seven outbreaks. By species, Sudan ebolavirus outbreaks (n = 5) had a CFR of 44.6% (95% CI: 33.7%–55.6%), Bundibugyo ebolavirus (n = 1) 24.8% (95% CI: 18.2%–32.1%), and Zaire ebolavirus (n = 1) 100% (95% CI: 61.2%–100.0%). In meta-regression, each additional day from first case report to specimen collection was associated with a significant increase in CFR (β = 0.142 on the transformed scale; p = 0.025; R² = 62%), translating to an approximate absolute increase of 3.8% points in CFR per day at a baseline risk of 45%. Conversely, longer delays from symptom onset in the index case to national outbreak declaration were linked to a slight decrease in CFR (β = − 0.00765; p = 0.047). Conclusions Uganda’s EBOD outbreaks exhibit high and variable mortality, with diagnostic delays substantially amplifying case-fatality. Rapid specimen collection and prompt public health responses are critical to reducing EBOD mortality. Strengthening laboratory networks and accelerating declaration protocols should be central to future outbreak preparedness in Uganda and similar contexts. Keywords: Ebola virus disease • Case-fatality ratio • Uganda • Diagnostic timeliness • Outbreak response • Sudan ebolavirus (SUDV) • Bundibugyo ebolavirus (BDBV) • Zaire ebolavirus (EBOV) • Systematic review and meta‐analysis.