Browsing by Author "Olupot-Olupot, Peter"

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    A phase I/II randomized controlled clinical trial to assess the feasibility, safety, and preliminary effectiveness of paracetamol in resolving acute kidney injury in children with severe malaria.
    (Springer Nature, 2026) Paasi, George; Namayanja, Cate; Ongodia, Paul; Okalebo, Charles; Okiror, William; Abongo, Grace; Masifa, George; Amorut, Denis; Muhindo, Rita; Olupot-Olupot, Peter
    Background: Acute kidney injury (AKI) is prevalent among children with severe malaria, contributing to considerable morbidity and mortality. Oxidative stress has been implicated in the pathophysiology of malaria-induced AKI, and paracetamol, with its antioxidant properties, has been proposed as a solution. This phase I/II randomized trial evaluated paracetamol as a potential renoprotective adjunct in children with severe malaria and acute kidney injury. Methods: We conducted a phase I/II open label parallel randomised controlled trial of 40 hospitalised children aged >6month to <12 years with malaria-induced AKI in eastern Uganda. Participants were randomized by a sealed envelope 1:1 to receive either oral paracetamol 20mg/kg 6-hourly for 48 hours or tepid sponging every 30 minutes until fever subsided. Only the assessors of the primary outcome were masked to the intervention. The primary outcome was renal recovery at 48 hours assessed using restricted mean survival time (RMST) in intention to treat population of children according to their randomisation groups. Results: Between 19 September 2021 and 25 August 2023, 250 children with haemoglobinuric severe malaria were screened and the 40 enrolled were randomly assigned paracetamol (n=20) or tepid sponging (n=20). The mean age was 6.54 (2.61) years. The mean time to renal recovery in the paracetamol group was 0.491 hours (95% CI: -9.265 to 10.248; p=0.921) longer than the control group within 48 hours, but this difference was not statistically significant even after adjusting for age and weight: 1.04 hours (95% CI: -8.61-10.70; p=0.832). The safety assessment indicated no significant differences in adverse events and hepatoxicity in either group. Conclusions: Although Paracetamol was safe, it did not significantly improve renal recovery in children with malaria-induced AKI. Further larger studies are needed to explore this role of paracetamol. The trial registration: ISRCTN84974248. Keywords: Acute kidney injury, Paracetamol, Children, Severe malaria, Blackwater fever, Restricted mean survival time, Randomised controlled trial
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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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    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. Ingunn
    Background 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.
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    Antimicrobial stewardship: Knowledge, attitudes and practices of healthcare providers in Eastern Uganda.
    (Research Square, 2025) Alunyo, Patrick Jimmy; Kagoya, Kawala Enid; Virhia, Jennika; Charitonos, Koula; Langdridge, Darren; Biard, Olivier; Banks, Duncan; McMullan, Rachel; Olupot-Olupot, Peter
    Introduction: Antimicrobial resistance (AMR) is a growing global health threat exacerbated by inappropriate antimicrobial prescribing practices. In low- and middle-income countries (LMICs) like Uganda, additional challenges for effective antimicrobial stewardship include limited resources and healthcare infrastructure. This study assessed current antimicrobial prescribing practices and evaluated healthcare providers' knowledge, attitudes, and practices related to antimicrobial stewardship (AMS) in Eastern Uganda. Methods A cross-sectional study was conducted in healthcare facilities across Eastern Uganda. Data were collected through interviewer administered structured questionnaires. Results 240 respondents completed questionnaires from four health facilities in Eastern Uganda. Respondents were 51.5% male, median age 33 years [IQR 28–38] with 6 years of medical experience [IQR 4–10]. Clinical Officers constituted 22.5%, Medical Doctors 11.2%, Nurses 40.8%, Pharmacists 4.5%, and other categories accounted for 20.8%. Adherence to national and international guidelines on antibiotic use was suboptimal with a high frequency of broad-spectrum antibiotic prescriptions. 75.4% of the respondents reported the presence of an antibiotic resistance control program within their healthcare facility. Most respondents (83.3%) reported a designated leader for AMS at the facility while 86.7% indicated that Pharmacists lead the programmes at facilities. 92.5% of respondents confirmed that there is a policy in place to guide the appropriate dosage and duration of antibiotic treatments. Overall, 98.8% of respondents believed AMR a significant concern and 62.1% indicated that high workloads negatively affect AMS practices. Conclusion The study identifies gaps in antimicrobial prescribing in Eastern Uganda, highlighting the need for improved stewardship programs, training, and policy implementation. Keywords: Antimicrobial Resistance, Antimicrobial Stewardship, Prescribing Practices, Healthcare Providers, Uganda
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    Baseline infection prevalence, risk factors and treatment outcomes of visceral leishmaniasis in Northeastern Uganda : a cross-sectional study.
    (PLOS One, 2025) Sagaki, Patrick; Twa-Twa, Mutwalante Jeremiah; Mulalu, Posiano; Wanume, Benon; Olupot-Olupot, Peter
    Introduction Visceral leishmaniasis (VL) also known as Kala-azar is one of the neglected tropical diseases (NTD) of public health importance. Despite being a disease of a long history, the condition remains poorly studied especially in East Africa. For instance, whereas, the geographical location of the disease is known, there is a stark paucity of data on the burden, risk factors and clinical outcomes of this condition in Northeastern Uganda. Therefore, the disease picture in these settings is incomplete. The overarching aim for this study was to describe pre-elimination prevalence, associated factors and treatment outcomes of VL in Moroto District. Methods We conducted a cross-sectional study in which community cases were identified at baseline. They were followed up at Amudat Hospital Kala-azar Treatment Centre for the treatment outcomes. We used a customized data collection tool to elicit data on demographic characteristics, socio-economic and anthropometry. Data were entered on excel database and exported to Stata software for analyses. Proportions and measures of central tendency were computed. Binary associations were determined using Chi-square statistical test. In addition, variables independently associated with VL were determined via logistic regression analyses. At follow up stage, the outcomes were determined. Results The overall prevalence of VL infection in Moroto district was 5.21% (95%CI: 3.15% - 8.48%) with varying county level prevalence at Matheniko, Tepeth and Mororo at 6.90%, 4.49% and 3.61%; respectively. The common risk factors for VL infection included lack of knowledge of habitat for Sand flies, AOR 5.33 (95%CI: 1.69–16.82). Patients with VL presented with ever, headache, abdominal pain and swelling, coughing, night sweats, diarrhea, fatigue, breathlessness, and nose bleeding. The average hospitalization for VL was 17 days. All the patients who were treated at the hospital cured. Conclusion The prevalence of VL in Moroto district was 5.21% and within elimination threshold. The high-risk factors for VL infection included lack of knowledge about the habitat for Sand flies. The average hospitalization for VL was 17 days.
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    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, Peter
    Background: 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 Africa
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    Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda : a cross-sectional study.
    (BMJ Group, 2025) Jemutai, Julie; Njuguna, Gathoni Rebecca; Laurence, V Yoko; Murunga, Sheila; Ogwang, Caroline; Mwaringa, Shalton; Mwalekwa, Laura; Timbwa, Molline; Paasi, George; Olupot-Olupot, Peter; Juma, Mwanajuma; Thitiri, Johnstone; Ngao, Narshion; Singa, Benson; Mukisa, John; Mupere, Ezekiel; Lancioni, Christina; Sukhtankar, Priya; Tickell, D Kirkby; Uddin, Fakhar Md; Molyneux, Sassy; Walson, L Judd; Vassall, Anna; Berkley, James
    Introduction: Childhood illness and hospitalization result in both direct and indirect costs to families before, during and after admission. We aimed to estimate the catastrophic expenditure during hospitalisation for children with acute illness. Methods: This was a prespecified cross-sectional substudy nested within two prospective studies. Participants were recruited and interviewed from three rural and three urban hospitals in Kenya and Uganda. A costing questionnaire was administered to the caregivers of 731 children hospitalised for acute illness to evaluate direct and indirect costs incurred by caregivers and families. Costs incurred were compared for families with children both with and without complicated severe malnutrition (CSM). Catastrophic out-of-pocket expenditure exceeding 10% and 25% of monthly income was assessed. Results: The median (IQR) total cost during hospitalization per child was US$47 (US$24–US$84), with higher costs for children with CSM, especially during hospitalisation (US$56 (US$26–US$99) vs US$36 (US$20–US$65); p<0.001). During hospitalisation, bed charges followed by food were the main cost drivers. Caregivers reported losing a median of 7 (4–11) days of productive time during a child’s hospitalisation with a mean loss of income of US$10 (SD US$25.6, median US$0 (US$0–US$10)). 92% and 74% of households experienced catastrophic expenditure at thresholds of 10% and 25% of monthly income, respectively. Caregivers reported borrowing, selling property and withdrawing other children from school to cope with costs. Conclusions: Despite intentions of free healthcare services for under 5, families of acutely ill children very commonly faced catastrophic expenditure, especially for children with CSM. Interventions aimed at supporting financial protection, reducing additional healthcare costs, and lowering health service charges may help prevent catastrophic expenditures
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    CLIF-Net : intersection-guided cross-view fusion network for infection detection from cranial ultrasound.
    (IEEE., 2025) Yu, Mingzhao; Peterson, R. Mallory; Burgoine, Kathy; Harbaugh, Thaddeus; Olupot-Olupot, Peter; Gladstone, Melissa; Hagmann, Cornelia; Cowan, M. Frances; Weeks, Andrew; Morton, U. Sarah; Mulondo, Ronald; Mbabazi-Kabachelor, Edith; Schiff, J. Steven; Monga, Vishal
    This paper addresses the problem of detecting possible serious bacterial infection (pSBI) of infancy, i.e. a clinical presentation consistent with bacterial sepsis in newborn infants using cranial ultrasound (cUS) images. The captured image set for each patient enables multiview imagery: coronal and sagittal, with geometric overlap. To exploit this geometric relation, we develop a new learning framework, called the intersection-guided Cross-view Local and Image-level Fusion Network (CLIF-Net). Our technique employs two distinct convolutional neural network branches to extract features from coronal and sagittal images with newly developed multi-level fusion blocks. Specifically, we leverage the spatial position of these images to locate the intersecting region. We then identify and enhance the semantic features from this region across multiple levels using cross-attention modules, facilitating the acquisition of mutually beneficial and more representative features from both views. The final enhanced features from the two views are then integrated and projected through the image-level fusion layer, outputting pSBI and non-pSBI class probabilities. We contend that our method of exploiting multi-view cUS images enables a first of its kind, robust 3D representation tailored for pSBI detection. When evaluated on a dataset of 302 cUS scans from Mbale Regional Referral Hospital in Uganda, CLIF-Net demonstrates substantially enhanced performance, surpassing the prevailing state-ofthe-art infection detection techniques. Index Terms—Cross-view fusion, deep learning, geometric prior, infection detection, ultrasound.
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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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    Cross-border transmission corridors and diffusion velocities of Ebola-virus in in the Great-lakes basin : a 1976-2025 multilayered phylogeographic analysis.
    (Research Square, 2025) Paasi, George; Okware, Samuel; Olupot-Olupot, Peter
    Background Ebola disease (EBOD) outbreaks are recurrent and highly lethal in the Great-Lakes basin, yet regional scale evolutionary reconstructions are lacking. Objectives To locate the long-term reservoir, quantify cross-border transmission corridors and measure diffusion velocities of EBOD outbreaks across central Africa during 1976–2025. Methods We curated 110 complete Ebola virus genomes from GenBank and BV-BRC, aligned them with MAFFT, and inferred a time-scaled phylogeny in BEAST v1.10.5. A dual-layer Bayesian framework coupled (i) a discrete Bayesian stochastic-search variable-selection (BSSVS) model for country-to-country migration with (ii) a continuous Cauchy relaxed random walk (RRW) for kilometre-scale movement. Posterior trees (300 million states; ESS > 200) were visualised in EvoLaps 2.42; Markov-jump counts, Bayes factors (BF) and branch velocities were extracted. Results Our dual-layer reconstruction shows that Ebola circulation is firmly rooted in north-eastern DRC: 80% of the root posterior density clusters within a 150 km radius of the Yambuku-Ituri-Likati forests axis, identifying this block of lowland rainforest as a persistent enzootic cradle. From that focus, diffusion unfolded in three distinct temporal phases initially as short-range local spread (1976–1987), then as a westward, Congo/Kasai river-mediated wave (1994–2007), and, since 2007, as an east-south-east advance toward Lakes Albert and Edward that underpins recent Ugandan outbreaks. Cross-border movement is dominated by the Lake-Albert corridor: Bayes factors of 32.1 for DRC to Uganda and 26.4 for Uganda to DRC, together with a median 13.4 Markov-jump events, account for three-quarters of all international transitions in the posterior; by contrast, only a single westward leap reaches the Gabon/Cameroon littoral (BF = 6.4). Continuous-model vectors yield a mean radial expansion of 7.9 km year⁻¹ (95% HPD: 5.4–10.6 km year⁻¹), yet the distribution’s heavy tail reveals rare founder events that cover more than 150 km in a single transmission chain. Conclusions A single Yambuku-Ituri-Likati forest axis hearth has seeded all documented EBOD outbreaks, with transmission funnelling chiefly through informal Lake-Albert crossings. Sentinel surveillance in this area, corridor-focused border health teams, and pre-emptive vaccine positioning along the Ituri-Lakes corridor could blunt future outbreaks. Keywords: Ebola virus, Zaire ebolavirus, phylodynamics, phylogeography, Bayesian stochastic search variable selection, continuous diffusion, cross-border transmission, Great Lakes region, Democratic Republic of the Congo (DRC), Uganda
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    Effect of nutritional supplementation with lipid-based therapeutic food on body composition of non-severely malnourished African children aged 6–59 months hospitalized with severe pneumonia
    (Oxford University Press, 2025) Nalwanga, Damalie; Musiime, Victor; Kiguli, Sarah; Olupot-Olupot, Peter; Alaroker, Florence; Opoka, Robert; Tagoola, Abner; Mnjala, Hellen; Mogaka, Christabel; Nabawanuka, Eva; Giallongo, Elisa; Karamagi, Charles; Briend, Andr’e; Maitland, Kathryn
    Pneumonia remains an important cause of morbidity and mortality among children in low- and middle-income countries. Poor outcomes are associated with undernutrition. Nutritional supplementation may be beneficial. We examined the effect of supplementation with lipid-based ready-to-use therapeutic food (RUTF) on the body composition of children with severe pneumonia. Non-severely malnourished children (6–59 months) with severe pneumonia enrolled into the Children’s Oxygen Administration Strategies and Nutrition trial in Uganda and Kenya and randomized to receive a diet supplemented with RUTF (500 Kcal/day) for 56 days versus usual diet alone (control) were included. We assessed arm anthropometry and bioimpedance analysis at admission and days 28, 90, and 180 of follow-up. We used mixed effects linear regression to compare body composition between groups. We included 737 participants (369 in intervention; 368 in control group). The median age was 16 months (IQR; 9, 26), and 58.1% were male. Overall, baseline mean arm fat area (AFA), arm muscle area and arm muscle circumference were 5.8 ± 1.8 cm2, 11.6 ± 2.3 cm2, and 12.3 ± 1.2 cm2, respectively. The mean fat mass and fat-free mass calculated in 116 participants were 5.5 ± 1.5 kg and 5.5 ± 1.5 kg, respectively. There were modest increases in most body composition parameters. RUTF significantly increased AFA at days 28 and 90 but not at day 180 (P-value ¼ .03, .02, and .99, respectively). RUTF did not change other body composition parameters. Despite initial increases in AFA, RUTF did not change the body composition of children with severe pneumonia. KEYWORDS: bio-impedance analysis; body composition; children; fat-free-mass fat-mass; malnutrition; pneumonia; ready-to-use therapeutic food
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    Epidemiological dynamics of influenza B virus across multiple seasons in Kenya and Uganda inferred from sequence data, 2010–2021.
    (BMC Infectious Diseases, 2025) Nyarango, K. Brenda; Owuor, Collins D.; Isoe, Everlyne; Mutunga, Martin; Cheruiyot, Robinson; Katama, N. Esther; Makori, Timothy; Lambisia, Arnold; Nyiro, Joyce; Githinji, George; Kiguli, Sarah; Olupot-Olupot, Peter; Maitland, Kathryn; Agoti, N. Charles
    Background: Influenza B virus (IBV) contributes significantly to morbidity and mortality during Influenza seasons annually. However, IBV genomic surveillance occurs unevenly across the globe, particularly within the African region, obscuring its epidemiology. This study aims to elucidate the epidemiological dynamics of IBV in Kenya and Uganda between 2010 and 2022. Methods: In this study, 83 near complete IBV genomes circulating in Kenya and Uganda between 2010 and 2022 were generated through Oxford Nanopore Technologies sequencing (ONT). Publicly available IBV datasets were incorporated to evaluate the public context of these genomes. Further evolutionary dynamics analysis investigated the antigenic mutation, reassortment and glycosylation patterns of IBVs circulating in Kenya and Uganda within this period. Results: Alternating IBV lineage predominance and clade turnover was observed consistent with global patterns. No B/Yamagata strains were detected at the study sites after 2019. Multiple B/Victoria clade/subclades (V1A, V1A.3, V1A.3a, V1A.3a.2) and B/Yamagata clades (Y2 and Y3) were identified with no inter-lineage reassortments observed. Over time, the clades/subclades appeared to diversify through the accumulation of amino acid changes along the hemagglutinin (HA) segment backbone, especially within the known antigenic sites. Local outbreak strains appeared to be putatively introduced from both within and outside Africa. Conclusions: The congruence of local and global strains in circulating lineages and amino acid changes suggests potential effectiveness of vaccines recommended for the Northern and Southern Hemispheres in East Africa. Keywords: IBV, B/Victoria, B/Yamagata
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    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, Benon
    Ecological 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 reuse
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    Feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing intervention among men in two Ugandan fishing communities, 2022.
    (BMC, 2025) Matovu, KB Joseph; Namwama, Aisha Twahiri; Kemigisha, Linda; Taasi, Geoffrey; Nakabugo, Jennipher; Wandabwa, Julius; Bogart, M. Laura; Fakier, Nuraan; Wanyenze, K. Rhoda; Olupot-Olupot, Peter; Musinguzi, Joshua; Serwadda, David
    Background: Social network-based interventions can improve uptake of health interventions. However, limited evidence exists on their feasibility and acceptability in fishing community settings. We assessed the feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing (HIVST) intervention among men in Uganda. Methods: The PEer-led HIVST intervention for MEN (PEST4MEN) is a pilot intervention conducted among men in Kalangala and Buvuma districts. Baseline data were collected in July 2022 and follow-up data in September 2022. The intervention was implemented through 22 trained lay men (“peer-leaders”) who received training in HIVST use and distribution processes and requested to refer at least 20 male members from their social networks for study eligibility screening. To be eligible, men had to be aged 15 years or older with unknown or HIV-negative status. After the baseline interview, men were requested to pick two oral fluid-based HIVST kits from their peer-leaders. The intervention was deemed feasible if peer-leaders gave-out >80% of the kits and acceptable if>80% of the kits’ recipients used them to self-test for HIV. At the follow-up interview, newly diagnosed HIV-positive men were asked if they had linked to HIV care. Data were descriptively analyzed using STATA version 16.0. Results: Of 475 screened men, 400 (84.2%) met the eligibility criteria and completed the baseline interview. Of these, 56.7% (n=227) were engaged in fishing or fishing-related activities. At follow-up, 361 men (90.2%) were interviewed; 98.3% (n=355) received at least one kit from their peer-leaders. Nearly all (99.1%, n=352) kits’ recipients used them to self-test for HIV. Of the 352 HIV self-testers, 51 men (14.5%) had reactive (positive) HIV self-test results. Nearly onethird of the HIV self-tested men (31.4%, n=16) were first-time HIV-positive testers. Of these, 87.5% (n=14) went for confirmatory HIV testing, 50.0% (n=7) were confirmed as HIV-positive and 71.4% (n=5) were linked to HIV care. Conclusion: Our peer-led HIVST intervention was feasible and acceptable and identified newly diagnosed HIVpositive men who were linked to HIV care. However, while these results are promising, we recommend additional research in a randomized controlled trial prior to the eventual roll-out of this intervention. Trial registration ClinicalTrials.Gov: NCT05685498 (retrospectively registered on January 17, 2023). Keywords Peer-led, HIVST, Men, Fishing communities, Uganda
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    Hematologic, immunologic and outcome characteristics of severe acute respiratory syndrome 2 (SARS-COV-2) among people living with HIV in eastern Uganda : a retrospective study.
    (medRxiv, 2025) Otaala, Timothy; Opito, Ronald; Mugisha, Kenneth; Oryokot, Bonniface; Bakashaba, Baker; Esabu, Moses; Nbidde, Nabadda Susan; Watmon, Benedicto; Etolu, Wilson; Lubaale, Yovani Moses; Olupot-Olupot, Peter
    Introduction: Globally People Living with HIV (PLWHIV) are prone to severe opportunistic infections with Coronavirus disease of 2019 (COVID-19) inclusive. Dual infection of HIV and COVID-19 could complicate the clinical outcomes of these patients. This study sought to determine hematologic, immunologic, virologic and outcome characteristics of people with HIV and COVID-19 co-infections in two Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. Methods: A retrospective review of medical records of PLHIV and contracted COVID-19 virus was conducted in two large regional referral hospitals in Eastern Uganda using a data abstraction tool. Data was captured using Kobo collect toolbox, downloaded in Microsoft Excel and analyzed using STATA version 15.0. Descriptive statistics was reported as frequencies and proportions, while contingency and comparisons were done at the bivariate level analysis. The penalized logistic regression was conducted at multivariate level to establish the factors associated with COVID-19 severity among PLHIV. Results: A total of 100 patient records had 38%(n=38) of individuals aged 40-50 years and 62%(n=62) females. Most patients (6 in 10) were peasants with 79%(n=79) having low-income levels. Other than HIV, 3 out of 10 patients had comorbidities. Also, 30 had haematological records, of which 9 (30%) had leucocytosis and 3, leucopoenia. Further, 67% had immunologic records, of which 22 (33%) had CD4 counts <200 cells/mm3. Only 22% of patients had viral load results, of which 8 (36) were unsuppressed. Nineteen percent (19/100) patients had severe COVID19 and 14% (14/100) died. Socio-demographic factors significantly associated with severe COVID-19 outcomes were being male (P=0.026) and having other comorbidities (P<0.001). Conclusion: A significant proportion of PLHIV co-infected with COVID-19 had abnormal hematological and virological status possibly due to varying socio-demographic characteristics. Clinical outcomes of HIV and COVID-19 co-infection may therefore vary depending on an interplay between host factors, viral factors, and comorbidities. Keywords: HIV and COVID-19 co-infection, Hematologic, immunologic, and outcome characteristics
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    High-resolution ecological niche maps identify population-density hot-spots for Ebola disease spillover in Uganda.
    (Research Square, 2025) Paasi, George; Okware, Samuel; Olupot-Olupot, Peter
    Background Uganda experiences recurrent Ebola disease (EBOD) outbreaks, but the only available risk maps pool virus species and resolve five-kilometre grids insufficient for district-level preparedness. Therefore, this study aimed to generate one-kilometre, species-resolved MaxEnt risk surfaces for Uganda (2000–2024) and quantify the population living in predicted spill-over hotspots. Methods We compiled 71 laboratory-confirmed spill-over localities for Sudan, Bundibugyo and imported Zaire ebolaviruses and paired them with eleven minimally collinear environmental and anthropogenic predictors. Species-specific MaxEnt models were tuned with ENMeval (feature classes = L, Q, H; β = 0.5- 3.0) and evaluated by four-fold spatial block cross-validation. A 10% training-presence threshold converted continuous suitability to binary maps; the union surface was stratified into four risk tiers. WorldPop 2023 provided population counts. Results Models showed excellent discrimination: the pooled model achieved a spatially validated AUC of 0.927, while species-specific AUCs ranged from 0.961 to 0.999. Human population density dominated permutation importance (median 77%), followed by precipitation seasonality (7%) and bat-roost probability (8%). Tier 1 pixels (highrisk, cloglog ≥ 0.65) occupied only 58 % of Uganda’s land but contained 13.7 million residents (9 % of the national population), clustering along the Kampala-Hoima corridor and the Albertine Rift escarpment. All 15 historical outbreak epicentres fell within 8 km of Tier 1 or Tier 2 pixels. An alternative checkerboard partition raised mean AUC by Δ = +0.006 and preserved identical tier rankings, confirming robustness. Conclusions One-kilometre, species-resolved MaxEnt maps pinpoint compact geographic targets where intensified One-Health surveillance, GeneXpert diagnostics and future vaccine rings could most effectively curb EBOD emergence in Uganda.
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    Hydroxyurea - Pragmatic Reduction in Mortality and Economic burden (H-PRIME): A 2x2x2 factorial randomized open-label trial investigating practical approaches to the treatment of sickle cell disease at four sites in Eastern Uganda.
    (Wellcome Open Research, 2025) Olupot-Olupot, Peter; Amorut, Denis; Ongodia, Paul; Okalebo, B. Charles; Abeso, Julian; Aloroker, Florence; Asio, Sarah; Odiit, Amos; Kiyaga, Charles; Muhindo, Rita; Uyoga, Sophie; Mochamah, George; Muyinda, Asad; Abongo, Grace; Nyutu, Gideon; Mogaka, Christabel; Maitland, Kathryn; Walker, Sarah Ann; Gibb, Diana; Connon, Roisin; George, Elizabeth; Ware, E Russell; Williams, N. Thomas
    Background Sickle cell disease is the most common and severe genetic disease in humans worldwide. The majority of those affected are born in subSaharan Africa, where resources to diagnose and manage them are often limited. Fresh approaches to the pragmatic management of children with sickle cell disease in Africa that improve both morbidity and mortality are urgently needed. Methods Hydroxyurea - Pragmatic Reduction in Mortality and Economic burden (H-PRIME) is a 2 × 2 × 2 factorial randomized open-label trial that is investigating three separate interventions. Eighteen hundred children aged 1-10 years attending sickle cell clinics at one of four sites in Eastern Uganda are being randomized to: (1) hydroxyurea administered at a low dose (10 mg/kg/day) versus high dose (25mg/kg/day), prescribed pragmatically through a weight-band-based approach and with clinically, rather than laboratory-guided monitoring; (2) enhanced malaria prophylaxis with weekly doses of dihydroartemisinin-piperaquine versus monthly doses of sulfadoxinepyrimethamine (standard of care); and (3) enhanced antibacterial prophylaxis with daily cotrimoxazole throughout life versus twice daily penicillin until the age of 5 years (standard of care). All children will be followed up for 48 months after the date on which the first child was randomized. The primary endpoint for the hydroxyurea randomization will be mortality, for the antimalarial random will be malaria-associated hospital admission, and for the antimicrobial randomization will be all-cause hospital admission. Secondary outcomes will include the incidence of sickle-specific complications, receipt of blood transfusions, hemoglobin and fetal hemoglobin concentrations, and economic costs and benefits of the three interventions. Conclusions The first participant was recruited for the trial on January 16, 2024. In total, 1487 of the 1800 target children were recruited by February 17, 2025. H-PRIME will efficiently answer three important pragmatic questions regarding the management of children with sickle cell disease in Africa. Keywords sickle cell disease, hydroxyurea, malaria, bacterial infections, Uganda
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    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. Russell
    Hydroxyurea 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).
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    Hydroxyurea therapy for children with sickle cell anemia in Sub-Saharan Africa : rationale and design of the REACH trial.
    (Wiley Online Library, 2015) McGann, Patrick T; Tshilolo, leon; Santos, Brigida; Tomlinson, George A; Stuber, Susan; Latham, Teresa; Aygun, Banu; Obaro, Stephen K; Olupot-Olupot, Peter; Williams, Thomas N; Odame, Isaac; Ware, Russell E
    Background: Sickle cell anemia (SCA) is an inherited hematological disorder that causes a large but neglected global health burden, particularly in Africa. Hydroxyurea represents the only available disease-modifying therapy for SCA, and has proven safety and efficacy in high-resource countries. In sub-Saharan Africa, there is minimal use of hydroxyurea, due to lack of data, absence of evidence-based guidelines, and inexperience among healthcare providers. Procedure: A partnership was established between investigators in North America and sub-Saharan Africa, to develop a prospective multicenter research protocol designed to provide data on the safety, feasibility, and benefits of hydroxyurea for children with SCA. Results: The Realizing Effectiveness Across Continents with Hydroxyurea (REACH, ClinicalTrials.gov NCT01966731) trial is a prospective, phase I/II open-label dose escalation study of hydroxyurea that will treat a total of 600 children age 1–10 years with SCA: 150 at each of four different clinical sites within sub-Saharan Africa (Angola, Democratic Republic of Congo, Kenya, and Uganda). The primary study endpoint will be severe hematological toxicities that occur during the fixed-dose treatment phase. REACH has an adaptive statistical design that allows for careful assessment of toxicities to accurately identify a safe hydroxyurea dose. Conclusions: REACH will provide data that address critical gaps in knowledge for the treatment of SCA in sub-Saharan Africa. Keywords: Africa; hydroxyurea; sickle cell anemia
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    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, Peter
    Background: 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 virus