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Item Prevalance and determinanats of folic acid utilization among women of childbearing age at Mbale regional referral hospital eastern Uganda.(Busitema University, 2026) Okello, DanielBackground: Folic acid supplementation before conception and during early pregnancy is a proven and cost-effective intervention for preventing neural tube defects and improving maternal and neonatal outcomes. Despite national and global recommendations, folic acid utilization among women of childbearing age remains suboptimal in many low-resource settings, including Eastern Uganda. Limited context-specific evidence exists regarding the prevalence and determinants influencing folic acid use among women attending maternal health services at Mbale Regional Referral Hospital. Objective: This study aimed to assess the prevalence and determinants of folic acid utilization among women of childbearing age attending Mbale Regional Referral Hospital in Eastern Uganda. Methods: A cross-sectional study design was conducted at selected mother-care points of Mbale Regional Referral Hospital (Antenatal care (ANC) clinic and Postnatal care Ward (PNC). This was quantitative study involving women aged 18–49 years attending antenatal and postnatal services, selected using a probability sampling approach. Data was collected using structured interviewer-administered questionnaires adapted from validated tools. Quantitative data was analyzed using descriptive statistics and inferential analysis to identify factors associated with folic acid utilization. Results 334 women of childbearing age were recruited in this study and out of these, 70.1% (234/334) reported using folic acid at least once within the previous 12 months. However, only 8.1% of this population of mothers initiated folic acid supplementation before pregnancy or preconception, meanwhile 46.7% commenced supplementation during the first trimester of pregnancy. At bivariate analysis,socio-demographic factors associated with folic acid utilization included age(p=0.049),religion(p<0.001),and occupation(p=0.004).The factors associated with folic acid utilization, included the maternal-related factors like parity(p=<0.001),planned pregnancy(p=0.036),gestational age at first ANC visit(p<0.001),Knowledge of folic acid(p<0.001),decision making regarding folic acid use (p<0.001),perceived need for folic acid supplementation(p<0.001),Knowledge of appropriate timing of folic acid use (p<0.001),and perceived risks of birth defects without folic acid(p<0.001). The health system-related factors included, counselling on folic acid received(p=0.042),availability of folic acid at health facility(p<0.001),partner support(p<0.001),family encouragement(p<0.001),Received information on folic acid(p<0.001),folic acid recommendation by health worker(p<0.001),availability of health workers(p<0.001),ease of obtaining folic acid(p<0.001),cost of access(p<0.001) and the usual source of folic acid(p<0.001). In bivariate logistic regression analysis, women with knowledge about folic acid were nearly thirteen times more likely to utilize folic acid compared to those with less knowledge (COR=12.86; 95% CI: 6.59–25.09; p<0.001).Consequently women who initiated Antenatal visits after 12 weeks were 80% less likely to utilize folic acid than those attending Antenatal before 12weeks (COR=0.20; 95% CI: 0.12–0.33; p<0.001).Participants who had been advised by health workers to take folic acid were eighteen times more likely to utilize folic acid than those who had not received such advice (COR=18.06; 95% CI: 8.02–40.66; p<0.001).Mothers who received information on folic acid had seven-folds higher odds of utilization (COR=7.05; 95% CI: 3.76–13.22; p<0.001). After adjusting for the potential confounders in multivariable logistic regression, three factors remained independently and strongly associated with folic acid utilization. Women who initiated Antenatal care after 12 weeks gestation had significant lower odds of folic acid utilization compared with those booking before 12 weeks (AOR=0.33; 95% CI: 0.18–0.61; p<0.001), indicating a 67% reduction in the odds. Furthermore, women who had been advised by health worker to take folic acid were approximately five times more likely to utilize folic acid than those not advised (AOR=4.67; 95% CI: 1.68–13.01; p=0.003) and women who reported regular intake of folic acid when prescribed were more likely to utilize (AOR=2.48; 95% CI: 1.83–3.35; p<0.001) Conclusion: Folic acid utilization among women of childbearing age attending Mbale Regional Referral Hospital was relatively high during pregnancy, but remained low during the critical preconception period. Early Antenatal attendance, health worker recommendation and adherence to prescribed supplements were independent predictors of folic acid utilization. Therefore, strengthening preconception health education programs, promoting early Antenatal attendance and enhancing health worker counselling and prescription quality practices may significantly improve folic acid utilization and hence contributing to prevention of neural tube defects, with other adverse pregnancy outcomes.Item Factors Influencing Treatment Adherence among TB Patients at Mbale Regional Referral Hospital in Mbale city, Eastern Uganda(Busitema University, 2026) Chebet, Janet KipropBackground: Tuberculosis (TB) remains a major global public health challenge despite being preventable and curable. Poor adherence to TB treatment contributes significantly to treatment failure, relapse, prolonged infectiousness, increased transmission, and the emergence of drug-resistant TB, particularly in low- and middle-income countries such as Uganda. In Eastern Uganda, treatment adherence remains suboptimal despite the implementation of patient-centered TB control interventions. Aim of the Study: The study aimed to determine the prevalence and factors influencing treatment adherence among TB patients attending Mbale Regional Referral Hospital in Mbale City, Eastern Uganda. Methodology: A hospital-based cross-sectional study employing quantitative methods was conducted among 121 TB patients receiving treatment at Mbale Regional Referral Hospital. Participants aged 18 years and above who had been on anti-TB treatment for at least one month were selected using systematic random sampling. Data were collected using a structured interviewer-administered questionnaire programmed in KoBoCollect. The questionnaire captured socio-demographic characteristics, patient-related factors, health system factors, and socio-economic and cultural determinants of treatment adherence. Data were cleaned, coded, and analyzed using Stata statistical software. Descriptive statistics were used to summarize participant characteristics, while bivariable and multivariable analyses were conducted to determine factors associated with treatment adherence. Crude and adjusted prevalence ratios with corresponding 95% confidence intervals were computed, and statistical significance was considered at p-value <0.05. Results: A total of 121 participants were enrolled in the study, of whom 43 (35.5%) were adherent to TB treatment while 78 (64.5%) were non-adherent, indicating a low prevalence of treatment adherence. Most participants were aged 35 years and above (55.4%), and the study population was almost equally distributed by sex. At bivariable analysis, level of education, herbal medicine use, availability of TB medicines, transport challenges, and stigma or discrimination were significantly associated with treatment adherence. In multivariable analysis, participants involved in other occupations were significantly less likely to adhere to treatment compared to business persons (APR=0.56, 95% CI: 0.34–0.92, p=0.022). Herbal medicine users were also less likely to adhere to treatment compared to non-users (APR=0.51, 95% CI: 0.27–0.96, p=0.038). Similarly, participants who experienced stigma or discrimination had significantly lower adherence to treatment compared to those who did not experience stigma (APR=0.31, 95% CI: 0.17–0.57, p<0.001). Conclusion: The prevalence of treatment adherence among TB patients attending Mbale Regional Referral Hospital was low. Herbal medicine use, stigma or discrimination, and occupation were significant factors associated with treatment adherence among the study participants. Recommendation: Healthcare providers and hospital management should strengthen adherence counselling, patient follow-up, and psychosocial support programs to improve TB treatment adherence. Community sensitization initiatives should also be enhanced to reduce stigma and discourage the use of herbal medicine during TB treatment.Item The prevalence of depression and it's association with risky behaviors among secondary school adoloscents in Mbale district, Uganda.(Busitema University, 2026-08-03) Masaba, MurishidiBackground: Adolescent mental health is a growing public health concern globally with depression being one of the leading causes of disability among young people. In Uganda, especially in Mbale District, adolescents in secondary schools face multiple challenges such as academic pressure, poverty, peer influence, unstable home environments, and limited access to mental-health service. These stressors increase vulnerability to depression and related behavioral problems. At the same time, risky behavior like substance use, unsafe sexual activity, violence and absenteeism are common in schools. Studies show that adolescents experiencing depression are more likely to engage in such behaviors due to emotional distress, poor judgement and lack of coping skills. Despite this, there is limited local evidence linking depression and risk-taking among adolescents in Mbale, highlighting the need for more focused research and school-based mental health programs. Methods: A cross-sectional descriptive study was employed to develop both qualitative and quantitative methods of data collection. It will be purely a secondary school-based study on different school going adolescents in Mbale district. Data will be collected basing on questionnaires given to different secondary school students in secondary schools in Mbale district and data completeness will be checked before carrying out complete analysis using a check list. Results: A total of 308 secondary school adolescents participated in the study. The prevalence of depression was 8.17% (25/308). Most participants (85.39%) had no depressive symptoms, while 6.17%, 5.19%, and 3.25% had mild, moderate, and moderately severe depression, respectively. Common risky behaviors reported included engagement in sexual activity (42.2%), viewing or sharing explicit content (32.8%), bullying or being bullied (41.6%), skipping school (34.1%), and exposure to friends who use drugs (26.0%). At bivariate analysis, depression was significantly associated with age, residence, class level, and experiencing a major life event. In multivariable analysis, adolescents aged 18–19 years were more likely to experience depression compared to those aged 13–17 years (AOR=20.33, 95% CI: 2.39–173.08, p=0.006), while experiencing a major life event increased the likelihood of depression threefold (AOR=3.00, p=0.017). Although risky behaviors were more common among depressed adolescents, the association was not statistically significant after adjustment for confounding factors. Conclusion: The study concluded that depression affected 8.17% of secondary school adolescents in Mbale District, with most students showing no clinically significant symptoms. However, a notable proportion experienced mild to moderately severe depression. Common risky behaviors included sexual risk-taking, bullying, school absenteeism, physical fights, and substance use. Older adolescents (18–19 years) and those who had experienced major life events were more likely to be depressed. Although risky behaviors were more common among depressed adolescents, the association was not statistically significant after adjusting for confounders. Overall, the findings highlight that depression remains an important mental health concern among adolescents, emphasizing the need for early identification and targeted school-based interventions.Item Influence of women's empowerment on modern contraceptive use among women of reproductive age Mbale regional referral hospital.(Busitema University, 2026-07-30) Ituluntu, DenisIntroduction Women’s empowerment refers to the process of increasing women’s and girls’ capacity to make strategic life choices, gain control over resources, and challenge unequal power relations. Women’s participation in decision-making and equitable access to social and economic opportunities remain limited in many low-and middle-income countries. Evidence shows that only 28% of women of reproductive age in low–income countries use contraception. This persistent gap in women’s empowerment contributes to low utilization of modern contraceptives. This study aimed to determine the influence of women’s empowerment on the use of modern contraceptives among women of reproductive age attending Mbale Regional Referral Hospital. Methods This study was an analytical cross-sectional study conducted among women aged 15-49 years who attended the family planning unit at Mbale Regional Referral Hospital. A total of 326 participants was calculated using Leslie Kish’s formula. A consecutive sampling technique was used, and data were collected using a structured questionnaire. Results The proportion of women currently using modern contraception was 51.07%. The majority of the respondents were 18 - 35 years old. Injectable was the most commonly used method. Autonomy in sexual activities and decision-making was significantly associated with modern contraception (AOR = 2.75(1.32 – 5.77), P = 0.007 Conclusion Women with greater autonomy in sexual activities and participation in decision-making are more likely to use modern contraception. Educational attainment and economic participation alone may be insufficient to increase modern contraceptive use. Keywords: Autonomy in sexual activities. Educational attainment. Mbale Regional Referral Hospital. Modern contraception and women’s empowerment.Item Factors associated with therapeutic Inertia in treatment of hyperglycaemia in patients with type two diabetes at Mbale regional referral hospital.(Busitema University, 2026-07-30) Mulomi, IvanBackground: Therapeutic inertia (TI) remains a critical systemic failure in achieving optimal glycaemic control globally, particularly within resource-constrained settings. At Mbale Regional Referral Hospital (MRRH) in Eastern Uganda, a substantial proportion of patients with Type 2 Diabetes Mellitus (T2DM) present with persistently elevated blood glucose levels despite routine clinical appointments, though localized operational drivers of this gap remain inadequately categorized. Objective: To determine the prevalence of therapeutic inertia and establish the patient-related, behavioral, and structural health-system factors associated with the management of hyperglycaemia among T2DM patients receiving care at MRRH. Methods and Materials: A facility-based, cross-sectional analytical study was conducted among n = 421 adult T2DM patients sampled from the outpatient diabetes clinic as well as medical and surgical wards at MRRH. Quantitative data were gathered utilizing structured interviewer-administered questionnaires alongside extensive clinical record audits. Glycaemic control was classified via Fasting Blood Sugar (FBS) thresholds. Data processing and statistical computations were executed using Stata 17.0, utilizing descriptive statistics and bivariate Chi-square (chi^2) analysis to identify significant parameters (p < 0.05). Results: The cohort exhibited a mean age of 45.15, 12.61 years, with a female majority (65.08%) and high prevalence of non-formal employment (91.65%). Uncontrolled hyperglycaemia (FBS > 7.0 mmol/L) was documented in 44.42% (n = 187) of participants. The overall prevalence of therapeutic inertia was critically elevated at 93.58%, where 175 out of 187 metabolically unmitigated patients received no pharmacological up-titration or agent additions. Bivariate analysis revealed no statistically significant associations between poor glycaemic control and socio-demographic indicators, hospital distance, or annual clinic attendance rates (p > 0.05). Conversely, uncontrolled hyperglycaemia was significantly tied to composite behavioral non-adherence (p = 0.002), especially when driven by multi-layered barriers including forgetfulness, drug side effects, and stock-outs (66.67% uncontrolled) or fear of hypoglycemia (100% uncontrolled). Systemic institutional bottlenecks were highly pervasive: 72.45% experienced outpatient waiting times exceeding 2 hours, 66.67% lacked self-monitoring access, and hospital pharmacy anti-diabetic drug supplies were fully stable in only 45.61% of cases. Conclusion: Therapeutic inertia is highly endemic at MRRH, affecting nearly 94% of poorly managed T2DM cases. Notably, this care gap is not driven by client absenteeism or demographic disparities, as 93.82% of patients comply perfectly with monthly follow-up schedules. Instead, it is perpetuated by a clinical environment favoring passive tracking over active clinical management. Resolving this clinical inertia requires moving beyond patient blame to implement structural institutional changes: embedding point-of-care diagnostic infrastructure, deploying standardized algorithmic intensification protocols, optimizing outpatient workflows to combat prolonged wait times, and securing an uninterrupted pharmacy supply chain.Item Knowledge, attitudes and perceptions of mothers regarding post-abortion care at Mbale regional referral hospital, Uganda(Busitema University, 2026) Ibanda, Enoch FortunateBackground: Post-abortion care (PAC) is an essential intervention for reducing maternal morbidity and mortality associated with unsafe abortion. Despite the availability of PAC services in Eastern Uganda, utilization remains suboptimal, partly due to knowledge gaps, negative attitudes, and unfavorable perceptions towards these services. This study assessed the knowledge, attitudes, perceptions, and factors influencing perceptions regarding post-abortion care among mothers attending Mbale Regional Referral Hospital (MRRH), Uganda. Methods: A quantitative cross-sectional study was conducted among 287 mothers attending Mbale Regional Referral Hospital. Data were collected using a structured interviewer-administered questionnaire and analyzed using Stata version 16. Descriptive statistics were used to summarize the characteristics of respondents and levels of knowledge, attitudes, and perceptions. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with women's perceptions regarding post-abortion care services. Adjusted odds ratios (AORs) with 95% confidence intervals were reported, and statistical significance was considered at p < 0.05. Results: Of the 287 respondents, 78.1% demonstrated adequate knowledge regarding post-abortion care services, while 70.7% had positive attitudes towards post-abortion care services. However, only 19.5% exhibited positive perceptions regarding the accessibility, quality, and acceptability of post-abortion care services. During multivariate analysis, place of residence was identified as the only independent predictor of perception. Women residing in peri-urban areas had significantly lower odds of having positive perceptions compared to women residing in urban areas (AOR = 0.37, 95% CI: 0.16–0.82, p = 0.014). Conclusion: Although mothers demonstrated relatively high levels of knowledge and positive attitudes towards post-abortion care services, unfavorable perceptions regarding accessibility, quality, and acceptability remained prevalent. Strengthening counseling services, improving privacy and confidentiality, and addressing geographical and health-system barriers may improve women's perceptions and enhance utilization of post-abortion care services in Eastern Uganda.Item Prevalance and factors associated with receiving afamily planning method that clients do not prefer at Mbale regional referral hospital.(Busitema University, 2026-07-29) Nabbanja AnnetBack ground. Family planning enables individuals and couples to attain their desired number of children also control the spacing between the births. Ensuring that clients receive their preferred contraceptive method is a foundation of quality family planning services, as preference alignment ensure client satisfaction, adherence to family planning and overall reproductive health outcomes .Despite this, evidence shows that many women globally and within Uganda commonly receive methods they do not prefer due to biases, stockouts, partner opposition and personal or cultural barriers. However, limited data exist on the prevalence and determinants of receiving non-preferred family planning methods at facility level in Eastern Uganda, particularly at Mbale Regional Referral Hospital. Aim of the study. This study aimed to determine the prevalence of women who do not receive their preferred contraceptive method and to identify factors associated with non-preferred family planning use at MRRH. Methods. A descriptive cross-sectional study was conducted among 327 women of reproductive age (15-49 years) attending family planning services at Mbale Regional Referral hospital. Continuous sampling was used to recruit participants. Data was collected using structured questionnaires and analyzed using STATA version 17. Logistic regression analysis was performed to identify factors associated with receiving a non-preferred family planning method. Results. Of the 327 participants, 109 (33.350 did not receive their preferred family planning method. Conclusion. This study found that 33.3% of women attending family planning services at Mbale Regional Referral Hospital did not receive their preferred family planning method. The study further established that occupation, provider recommendation of another method, respect for the client preference, and the ability to freely choose a preferred family planning method were independently associated with receiving a preferred family planning method. Women whose preferences were respected and those who reported being able to choose freely their method of choice were significantly more likely to receive their desired contraceptive method. Provider recommendation of alternative methods was associated with reduced likelihood of receiving the preferred method. Improving provider-client interactions and reducing provider influence n contraceptive decision-making may help ensure that women receive methods that align with their reproductive intentions and preferences.Item Quality of life in patients with diabetic foot ulcers seeking healthcare at Mbale regional referral hospital.(Busitema University, 2026-07-27) Nabakiibi, LinetBackground: Diabetic foot ulcers (DFUs) are among the most debilitating complications of diabetes mellitus and are associated with chronic pain, disability, prolonged hospitalization, lower limb amputation, and reduced quality of life (QoL). Despite the increasing burden of DFUs in Uganda, there is limited evidence on the quality of life of affected patients and the factors influencing it. This study assessed the quality of life and associated factors among patients with diabetic foot ulcers seeking healthcare at Mbale Regional Referral Hospital (MRRH). Methods: A hospital-based cross-sectional analytical study was conducted among 160 patients with diabetic foot ulcers receiving care at MRRH. Participants were recruited using consecutive sampling. Data were collected using a structured interviewer-administered questionnaire and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument. Data were entered, cleaned, and analyzed using STATA version 17. Descriptive statistics were used to summarize participant characteristics and quality of life scores. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with quality of life. Statistical significance was considered at p < 0.05. Results: The mean age of participants was 55.6 ± 13.3 years, and 59.4% were male. The overall mean quality of life score was 2.46 ± 0.55. Among the WHOQOL-BREF domains, the environmental domain recorded the highest mean score (2.53 ± 0.67), while the physical domain had the lowest mean score (2.40 ± 0.59). Overall, 83.1% of participants had poor quality of life, while only 16.9% had good quality of life. Multivariable logistic regression showed that female gender (AOR = 0.12, 95% CI: 0.02–0.65, p = 0.014), ulcer severity (AOR = 0.28, 95% CI: 0.08–0.99, p = 0.049), availability of prescribed medications (AOR = 21.33, 95% CI: 2.03–224.06, p = 0.011), availability of wound dressing materials (AOR = 0.15, 95% CI: 0.03–0.76, p = 0.022), financial ability to meet daily needs (AOR = 0.06, 95% CI: 0.006–0.53, p = 0.012), access to information regarding diabetic foot ulcer care (AOR = 0.17, 95% CI: 0.05–0.57, p = 0.004), and satisfaction with access to health services (AOR = 0.02, 95% CI: 0.002–0.21, p = 0.001) were significant predictors of quality of life. Conclusion: The majority of patients with diabetic foot ulcers attending Mbale Regional Referral Hospital experienced poor quality of life across physical, psychological, social, and environmental domains. Quality of life was significantly influenced by ulcer severity, availability of medications and wound care supplies, financial capacity, access to information, and access to health services. Strengthening diabetic foot care programs, ensuring the availability of essential supplies, improving patient education, and reducing financial barriers to care may improve quality of life among patients living with diabetic foot ulcers.Item Knowledge and Perception Regarding Intermittent Preventive Treatment Measures Against Malaria among Pregnant Women Attending Antenatal Care at Mbale Regional Referral Hospital(Busitema University, 2026) Ssebwato, George WilliamBackground Malaria remains a major public health problem and is one of the leading causes of morbidity and mortality among pregnant women and their unborn babies in Uganda. Intermittent Preventive Treatment in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) is a key intervention recommended by the World Health Organization to prevent malaria-related complications such as maternal anemia, low birth weight, stillbirth, and neonatal mortality. Despite its proven effectiveness and availability, the uptake of IPTp-SP remains suboptimal in many settings. Knowledge and perception of pregnant women towards IPTp-SP play a significant role in influencing its utilization. This study assessed the knowledge and perception regarding IPTp-SP among pregnant women attending antenatal care at Mbale Regional Referral Hospital. Objectives To assess the level of knowledge and perception regarding IPTp-SP among pregnant women attending antenatal care at Mbale Regional Referral Hospital and to identify factors associated with knowledge and perception of IPTp-SP. Methods A descriptive cross-sectional study was conducted among 423 pregnant women attending antenatal care at Mbale Regional Referral Hospital. Participants were selected using consecutive sampling. Data were collected using a structured interviewer-administered questionnaire and entered into Stata/SE 15.1 for analysis. Descriptive statistics including frequencies, percentages, means, and standard deviations were used to summarize the data. Knowledge was categorized as good or poor based on a score of 70% and above. Those who scored 70% and above had good knowledge while those who scored below 70% had poor knowledge. Perception was assessed using a five-point Likert scale, and the overall perception was categorized based on the mean score. Chi-square tests and logistic regression analyses were performed to determine factors associated with knowledge and perception. Statistical significance was considered at p < 0.05. Results Among the 423 pregnant women interviewed, the majority demonstrated good knowledge regarding IPTp-SP. Most participants demonstrated poor knowledge about the correct timing, dosage, and administration of IPTp-SP despite being aware of its existence and benefits. The overall mean perception score was 3.14, indicating a generally positive perception towards IPTp-SP. Most respondents agreed that IPTp-SP is important for preventing malaria during pregnancy and improving maternal and fetal health outcomes. Education level, attitude of health workers, and clarity of explanations provided during antenatal care were the major factors independently associated with knowledge regarding IPTp-SP. Conclusion The study found that pregnant women attending antenatal care at Mbale Regional Referral Hospital generally had good knowledge and a positive perception towards IPTp-SP. However, knowledge gaps and misconceptions still existed among some women, which could affect optimal utilization of the intervention. Recommendations The Ministry of Health and health facilities should strengthen health education programs on IPTp-SP during antenatal care visits. Health workers should provide consistent information on the benefits, timing, and recommended doses of IPTp-SP. Community sensitization programs should also be enhanced to improve awareness and address misconceptions about malaria prevention during pregnancy. Further studies should explore barriers to the actual uptake and completion of recommended IPTp-SP doses among pregnant women. Keywords: Intermittent preventive therapy in pregnancy, Sulfadoxine/pyrimethamine, Malaria in pregnancyItem Prevalence and factors associated with anxiety during clinical practice among nursing students at Mbale Regional referral hospital.(Busitema University, 2026-07-24) Nakato Betty NakigoziBackground: Anxiety is one of the mental health concerns among nursing students. They experience varying levels of anxiety during their clinical training. Elevated levels of anxiety among nursing students negatively affect their academics, learning and overall well-being. Social-demographic factors and clinical stressors affect levels of anxiety during clinical practice among nursing students. There is limited data on the prevalence and factors associated with anxiety during clinical practice among nursing students in Uganda. Objectives: The aim of this study was to determine the prevalence and factors associated with clinical practice anxiety among nursing students at MRRH. Methods: A cross sectional study was carried out among 320 nursing students having their clinical placement at MRRH. Data were collected electronically using a researcher administered questionnaire. Anxiety was assessed using the Beck Anxiety Inventory (BAI). Clinical stressors were assessed using the adapted KEZKAK questionnaire. Socio-demographic data were also captured. The data were exported to STATA for analysis. Descriptive statistics were used to determine the prevalence of anxiety. Bivariate and modified Poisson regression analyses were used to identify factors associated with anxiety. Results: A total of 320 nursing students participated in the study. The prevalence of clinically significant anxiety (BAI ≥ 8) was 666.6%. Mild anxiety was observed among 23.3% of participants, moderate anxiety among 18.4%, and severe anxiety among 24.3%. Male students were less likely to experience clinically significant anxiety compared to female students (aRR = 0.61,95%CI: 0.50-0.74). Nursing students who reported lack of competence were more likely to experience anxiety (aRR = 1.34, 95% CI: 1.09-1.65), while interpersonal relationship stressors were also associated with anxiety (aRR = 1.18, 95% CI: 1.00-1.38). Conclusion: Anxiety during clinical practice was common among nursing students on placement at MRRH. These findings highlight the need for psychological support and better supervision during clinical placements.Item Prevalence and factors associated with less than 24-hour stay at the hospital among postpartum mothers in Mbale regional referral hospital.(Busitema University, 2026) Mulinde, RamadhanBackground: A substantial proportion of mothers are discharged from health facilities earlier than the recommended 24- hour postpartum stay, increasing the risk of undetected postpartum complications. The 24- hour stay is considered a critical period for monitoring the mother and newborn allowing for timely identification and management of immediate postpartum complications as recommended by the World Health Organization and Uganda Ministry of Health. Objective: This study aimed at determining the prevalence and identify factors associated with less than 24-hour hospital stay, among women delivering at MRRH Methods: A cross-sectional analytical study was conducted among women who delivered vaginally at in postnatal ward of MRRH. The sample size used was 383. Data on maternal demographics, obstetric history, maternal and neonatal outcomes was collected. Logistic regression analyses (both crude and adjusted) was used to assess associations between potential determinants of less than 24-hour stay. Results: In the study, the prevalence of less than 24- hour stay was 82.8%. The study found significant association between less than 24- hour stay and complications after delivery (AOR=6.76,95%CI: 3.05-15.0, p<0.001), receipt of treatment while in the ward (AOR=3.88, 95%CI: 1.87-8.03, p<0.001), availability of food and water (AOR=0.15,95%CI: 0.04-0.48, p=0.002) and health worker-initiated discharge(AOR=0.25, 95% CI: 0.104-0.617, p=0.002) Conclusion: At MRRH, the less than 24- hour stay is significantly associated with postpartum complications, receipt of treatment while in the ward, availability of food and water and health worker- initiated discharge. These findings call for interventions aimed at improving ward support services and enforcing adherence to standardized discharge protocols to increase compliance with the recommended 24-hour postpartum stay. Keywords: hospital stay, 24 hours, postpartum mothers.Item Caregivers’ perspectives on malaria vaccine uptake for children under five at Mbale regional referral hospital.(Busitema University, 2026) Chemos, JustineBackground: Malaria accounts for 76% of global under-five malaria deaths, with Uganda recording ~16 deaths daily, ten of which are children under five. The R21/Matrix-M vaccine was integrated into Uganda's routine immunization schedule in April 2025 across 105 high-transmission districts at 6, 7, 8 and 18 months. Despite free provision, post-introduction coverage attrition is well documented: Cameroon reported dose-one coverage of 31.2% and dose-three coverage of 17.7% one year after rollout. Local evidence on caregivers' perspectives at Mbale Regional Referral Hospital (MRRH), a center serving 4.6 million people in Eastern Uganda, was absent, constraining contextually appropriate intervention design. Methods: A descriptive qualitative design was conducted at the Young Child Clinic, MRRH, Uganda. Purposive sampling recruited 16 participants: 12 mothers of children under five attending immunization services and 4 nursing/midwifery staff. In-depth interviews were conducted in English and local languages, audio-recorded and transcribed verbatim. Thematic analysis following Braun and Clarke's (2006) framework was applied, with data saturation guiding sample size. Ethical approval was obtained from the Busitema University Faculty of Health Sciences Research and Ethics Committee (BUFHS-REC). Results: Five themes emerged. First, caregivers had a foundational awareness of the vaccine's protective purpose, yet knowledge of the dosing schedule was limited and health worker training was inconsistent. Second, experiences with uptake were largely positive, though vaccination decisions were often conditioned on spousal approval and financial control, while long waiting times were a recurring frustration. Third, barriers operated across multiple levels: transport costs, geographic distance, fear of side effects, community myths about infertility and population control, vaccine stockouts and inadequate staffing. Fourth, key facilitators included parental responsibility reinforced by direct exposure to malaria morbidity, trust in health workers, family social support and free vaccine provision. Fifth, participants recommended multi-channel community awareness campaigns using radio and VHTs, staffing augmentation, satellite outreach immunization points, sustained vaccine supply chain management and structured refresher training for health workers. Conclusion and recommendation: Malaria vaccine uptake at MRRH is shaped by a complex interplay of knowledge gaps, community misconceptions, gendered decision-making, logistical barriers and health system constraints. The Ministry of Health should implement targeted, multi-channel communication that leverages radio, VHTs, and peer-educator networks to correct misconceptions. Health facility managers should augment immunization staffing and extend service hours, while the National Medical Stores must maintain buffer stocks to prevent stockouts. Health workers require structured hands-on refresher training beyond CMEs, and immunization programs should institutionalize male partner engagement to address gendered access barriers, thereby optimizing vaccine completion among children under five in high-burden settings. Keywords: Malaria vaccine, caregivers' perspectives, vaccine uptake, children under five, barriers, facilitators, Uganda, qualitative study, Mbale Regional Referral HospitalItem Factors affecting the uptake of modern postpartum family planning among postpartum mothers in Mbale regional referral hospital.(Busitema University, 2026) Mwebembezi, StephenIntroduction Postpartum Family Planning is the use of technological advances designed to enable couples to have sexual intercourse at any mutually desired time with reduced risks of getting pregnant within 6 weeks after birth. In Uganda, low modern post-partum family planning (PPFP) uptake is a great challenge, at only 28%, with Eastern Uganda having only 34% of mothers using modern PPFP methods. This low uptake is possibly due to limited information regarding mothers’ perspectives on factors affecting their PPFP use, which makes it hard to provide appropriate interventions. This study was aimed at exploring the factors affecting the uptake of modern PPFP among postpartum mothers in MRRH Study aim To assess the factors affecting the uptake of modern postpartum family planning among postpartum mothers in MRRH. This bridged the information gap and helped in providing data that can be used to make informed decisions for possible intervention. Methods This study employed a qualitative descriptive design to explore factors affecting uptake of modern postpartum family planning among postpartum mothers. Data was collected from the Postnatal Care (PNC) unit and the Young Child Clinic (YCC) of Mbale Regional Referral Hospital (MRRH), Mbale city in Eastern Uganda. The study involved all postpartum women (15-49years) receiving PNC services at MRRH and those who had given birth in the last 6 weeks seeking YCC services at MRRH. A purposive sampling technique was used to obtain the study participants Results This study involved 22 participants. Five themes were constructed, which included: Doomed contraceptive outcomes, Partner and Family Influence, Sociocultural and Personal Factors, Family Planning Knowledge, and Health Service Factors. The findings demonstrate that PPFP uptake is influenced by a complex interaction of health-related, sociocultural, interpersonal, knowledge-related, and health system factors. Conclusion The findings indicate that improving PPFP uptake requires comprehensive interventions addressing both demand-side factors, which include knowledge, attitudes, beliefs, and social influences and also supply-side factors, like quality, accessibility, availability, and responsiveness of family planning services. Keywords: Postpartum, Modern, Family planning, Mbale Regional Referral HospitalItem Factors affecting the uptake of modern postpartum family planning among postpartum mothers in Mbale regional referral hospital.(Busitema University, 2026) Mwebembezi, StephenIntroduction Postpartum Family Planning is the use of technological advances designed to enable couples to have sexual intercourse at any mutually desired time with reduced risks of getting pregnant within 6 weeks after birth. In Uganda, low modern post-partum family planning (PPFP) uptake is a great challenge, at only 28%, with Eastern Uganda having only 34% of mothers using modern PPFP methods. This low uptake is possibly due to limited information regarding mothers’ perspectives on factors affecting their PPFP use, which makes it hard to provide appropriate interventions. This study was aimed at exploring the factors affecting the uptake of modern PPFP among postpartum mothers in MRRH Study aim To assess the factors affecting the uptake of modern postpartum family planning among postpartum mothers in MRRH. This bridged the information gap and helped in providing data that can be used to make informed decisions for possible intervention. Methods This study employed a qualitative descriptive design to explore factors affecting uptake of modern postpartum family planning among postpartum mothers. Data was collected from the Postnatal Care (PNC) unit and the Young Child Clinic (YCC) of Mbale Regional Referral Hospital (MRRH), Mbale city in Eastern Uganda. The study involved all postpartum women (15-49years) receiving PNC services at MRRH and those who had given birth in the last 6 weeks seeking YCC services at MRRH. A purposive sampling technique was used to obtain the study participants Results This study involved 22 participants. Five themes were constructed, which included: Doomed contraceptive outcomes, Partner and Family Influence, Sociocultural and Personal Factors, Family Planning Knowledge, and Health Service Factors. The findings demonstrate that PPFP uptake is influenced by a complex interaction of health-related, sociocultural, interpersonal, knowledge-related, and health system factors. Conclusion The findings indicate that improving PPFP uptake requires comprehensive interventions addressing both demand-side factors, which include knowledge, attitudes, beliefs, and social influences and also supply-side factors, like quality, accessibility, availability, and responsiveness of family planning services. Keywords: Postpartum, Modern, Family planning, Mbale Regional Referral HospitalItem Prevalence and factors associated with the use of ANC services in first trimester among public health facilities in Mbale city.(Busitema University, 2026) Gemagaine, DanielBackground: Early initiation of ANC within the first trimester optimizes maternal and perinatal outcomes because it allows timely detection, prevention, and management of pregnancy-related complications. In Uganda, only a small proportion of pregnant women initiated ANC within the first trimester, with Eastern Uganda, persistently reporting the lowest rates as compared to other regions. Study aim. This study aimed to determine the prevalence of first trimester ANC use and the factors associated with its utilization among pregnant women attending public health facilities in Mbale City. Methods: A facility-based cross-sectional study was conducted among pregnant women attending Mbale Regional Referral Hospital (MRRH), Namatala HCIV and Namakwekwe HCIII in Mbale City. A total of 355 participants were recruited using a multi stage sampling technique. Data was collected using an interviewer-administered questionnaire and analyzed using Stata. Descriptive statistics and multivariable logistic regression were performed to identify predictors of first trimester ANC use. Results: The prevalence of first trimester antenatal care (ANC) use was 42%. Women who were occupied with home activities were more likely to initiate ANC beyond the first trimester (AOR=1.47, 95% CI: 1.10–1.96, p=0.009). Women who reported negative experiences during (AOR=4.88, 95% CI: 1.24–19.18, p=0.023). Additionally, women who did not receive partner transport or financial support had higher odds of delayed ANC initiation compared to those who received support (AOR=10.06, 95% CI: 1.14–88.53, p=0.037). Conclusions: The prevalence of first trimester ANC use was 42%, indicating that timely ANC initiation remained below recommended levels. Strengthening male partner involvement, improving client experiences during ANC visits and addressing barriers related to domestic responsibilities may improve timely utilization of ANC.Item Assessing womens preference for labour companionship and associated factors among women attending the postnatal clinic in Mbale regional referral hospital.(Busitema University., 2026) Ayesiga, ShallonBackground: Labour companionship is having a trusted person provide emotional, physical, and informational support during childbirth. The World Health Organisation recommends that every woman be allowed a companion of choice during labour and childbirth as an essential component of respectful maternity care. However, little is known about women's preferences for labour companionship and the factors influencing these preferences in Uganda, including at Mbale Regional Referral Hospital (MRRH). Objective: To determine women’s preference for labour companionship and associated factors among women attending the postnatal clinic in MRRH. Methods: A descriptive cross-sectional study was conducted among women attending the postnatal clinic at MRRH. Data on sociodemographic characteristics, obstetric factors, health-system factors, and women's preference for labour companionship was collected using an online structured questionnaire. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with preference for labour companionship. Results: Overall, 68.0% of mothers preferred labour companionship during childbirth. Females were the most preferred companions. Preference was significantly associated with above 35 years (AOR = 0.02; p < 0.001), secondary education (AOR = 2.01; p = 0.034), lack of encouragement by health workers (AOR = 0.41; p = 0.007), multiparity (AOR = 0.04; p = 0.002), and ANC attendance of five or more visits (AOR = 1.85; p = 0.048). Conclusion: Preference for labour companionship was high among women attending MRRH. Strengthening antenatal education and encouraging health workers to support labour companionship may improve the implementation of respectful maternity careItem Enablers and barriers of diploma nurses in upgrading to degree in Mbale city.(Busitema University, 2026) Etap, LydiaBackground: Degree nursing education is increasingly recognized in the report as important for strengthening clinical competence, professional credibility and career advancement; however, diploma nurses in Mbale City may face socioeconomic and institutional constraints that limit their ability to upgrade. Aim of the study: The study explored the enablers and barriers influencing diploma nurses from upgrading from diploma to degree level in Mbale regional referral hospital (MRRH) and Busitema University in Mbale City. Methodology: Using a descriptive qualitative design, the study purposively selected 26 registered nurses,16 from Mbale Regional Referral Hospital, of the 16, 3(18.8%) and already upgraded to degree and 10 upgrading nurses from Busitema University Faculty of Health Sciences. Data were collected through semi-structured in-depth interviews and analyzed thematically to identify recurrent patterns in participants’ experiences of upgrading to a degree. Results: Participants were 30–59 years old, and 32–49 years was the predominant age category (20/26, 76.9%). Most were female (21, 80.8%) and married (23, 88.5%). Education levels were diploma 23 (88.5%), bachelor’s degree 2 (7.7%) and postgraduate diploma 1 (3.8%). Employment titles were predominantly Assistant Nursing Officer 22 (84.6%), Work experience in current job title ranged from one year to 30 years, and 19 participants (73.1%) had at least five years’ service as registered nurses. Two theme were constructed (1) the barriers to upgrading, (2) enablers of upgrading. Key enablers included promotion and salary expectations, knowledge expansion and professional growth whereas major barriers were financial constraint such as tuition costs and school fees for children, workload and lack of study leave limited institutional support, delayed promotion after graduation and lack of flexible degree program options. Conclusion: Upgrading was valued as a route to enhanced competence and career advancement, but its uptake was constrained by intersecting financial, domestic and intuitional barriers. Without targeted system and policy support, motivation alone is unlikely to sustained academic progression among diploma nurses in MRRH and Busitema University in Mbale City.Item Knowledge, attitude, and perception on dual protection utilization among women of (15-49 Years) accessing modern contraceptives at Mbale regional referral hospital.(Busitema University, 2026) Nakaweesa, ElizabethIntroduction Despite the availability of modern contraceptives in Mbale Regional Referral Hospital and the critical need to prevent the dual risks of unintended pregnancy and Sexually Transmitted Diseases, there appeared to be a gap in the use of dual protection methods among women aged 15-49 years. For instance, in July, the total number of women who chose condoms as their choice of contraception was 3 out of 220 mothers (1.36%). In August, it was only 2 of 98 mothers (2.22%), and in September, 1 of 88 (1.13%) out of all the mothers who accessed modern contraceptive services. While this group of women has took a proactive step by accessing highly effective modern contraceptives such as implants, injectables, and intrauterine devices to prevent pregnancy, there was still limited use of dual protection among women in Mbale Regional Referral Hospital. Study objective It was to explore the Knowledge, Attitude and Perception about dual protection utilization among women of 15-49 Years accessing modern contraceptives at Mbale Regional Referral Hospital. Study aims The study aimed to assess the Knowledge, Attitude, and Perceptions. This helped increase protection against both unwanted pregnancies and STIs. It also helped to inform targeted interventions to improve the utilization of dual protection at Mbale Regional Referral Hospital. Research methods We employed a descriptive cross-sectional study design, and data were collected from the Mbale Regional Referral Hospital family planning clinic among women aged 15 to 49 years accessing modern contraceptives. A consecutive sampling method was used to recruit participants for the study, and a sample size of 312 participants was determined using the Kish-Leslie formula. Univariate, bivariate using chai squares and multivariable analysis using logistic regression were used for data analysis using Stata version 15. Results Knowledge was generally high, with a percentage of 73.31%(n=228), attitudes were generally favorable, with 62.70% (n=195) women who possessed positive attitudes towards dual protection; however, perceptions were largely poor, with 52.90%(n=164). Despite the high knowledge and positive attitudes, more than half of the study population demonstrated a poor perception of dual protection. The main predictors were prior targeted awareness, stable relationship dynamics and internalized positive attitudes. However, age, education among others had no effect on the final analysis. Conclusion The study demonstrated that achieving high knowledge outcomes (73.31) %and favorable attitudes (62.70) % was not yet supportive enough for productive reproductive health. The ultimate factor restricting dual protection utilization is a high prevalence of poor personal perceptions (52.90) % regarding sexual satisfaction, side effects, and partner dynamics. Dual protection is not driven by the women’s age, marriage, or general school education. It is entirely dependent on whether she had direct institutional contact with health care services, prior targeted awareness, stable relationship dynamics, and internalized positive attitudes that give women self-efficacy to negotiate barrier methods with her partner. Family planning, Dual Protection, Modern Contraceptives, Mbale Regional Referral, Hospital, Knowledge, Attitude and PerceptionItem Determinants of Repeat Abortion among Patients Seeking Post Abortion Care Services in Eastern Uganda(Busitema University, 2026) Mudimi, VictorMaternal mortality remains a global health concern, with Uganda recording a maternal mortality ratio of 189 per 100,000 deliveries, which is above the Sustainable Development target of less than 70. Unsafe abortion contributes greatly to this burden, which accounts for approximately 6-8% maternal mortality in the country. Moreover, repeat abortion (RA) is one of the persistent challenges for healthcare systems worldwide and addressing it remains a significant challenge that requires a targeted approach. Uganda has abortion related severe morbidity, near-miss, and mortality ratios of 2063, 938 and 23 per 100, 000 live births, respectively. Repeat abortion is a public health challenge that needs to be investigated. Despite the existence of this problem, there is a dearth of literature regarding the prevalence and determinants of repeat abortion in Uganda, especially in the eastern region. Materials and methods. The study employed a non-matched case-control study design in three selected health facilities in eastern Uganda. A total sample size of 366 study participants (122 cases and 244 controls) was recruited. Controls were recruited by simple random sampling, and the cases by a consecutive sampling technique. Data were entered into MS Excel 2010 and cleaned for missing values, outliers, and inconsistencies. Coded data were then exported to Stata version 15 for analysis. Descriptive statistics, including means, percentages, frequencies, and standard deviations, were used to summarize participant characteristics. Associations between categorical variables were tested using the chi-square test, while an independent t-test was used for continuous variables. Multivariable logistic regression was performed to identify predictors of the outcome while controlling for confounders. Statistical significance was set at p<0.05 with 95% confidence intervals reported. Results of the 366 participants, 33.3% (122/366) were cases (“repeat abortion”) while 66.7% (244/366) were controls (“index abortion”). The mean age of cases was 27years while that of controls was 24 years. The majority of the controls reported unplanned pregnancy, 68.4% compared to 56.6% for the cases. Notably, whereas 72.9% of the controls had early sexual debut, 67.2% among the cases did so. Additionally, there was low utilization of modern contraceptives across the board, with only 27.1% of the cases, 36.5% for the controls. The study found statistically significant associations between advanced maternal age and higher odds of repeat abortion (AOR: 9.42 95%CI: 1.82-48.67, p=0.007) with 30-34 years older women most affected. Symptoms preceding current abortion specifically malaria and urinary tract infections were significantly associated with repeat abortion (AOR: 3.2, 95%CI (1.81-6.01), p<0.001), Women who had a short interpregnancy interval had higher odds of repeat abortion compared to those who had the recommended or long interpregnancy interval (AOR: 0.32, 95%CI 0.18-0,57, p<0.001). Moreover, women whose preceding pregnancy ended in a stillbirth had substantially higher odds of suffering a repeat abortion, unlike those who had a live birth (AOR: 0.23, 95%CI 0.13-0.39, p<0.001), Unwillingness to use a modern contraceptive as part of the post-abortion care package was significantly associated with repeat abortion(AOR: 0.65 95%CI 0.51-0.82, p<0.001). No significant associations were observed with contraceptive use, having more than one partner, and a history of child abuse. In eastern Uganda, efforts to tackle repeat abortion should aim to target mothers of older mothers, encourage postpartum and post abortion modern contraceptives to prolong interpregnancy interval. In addition, early antenatal care attendance and screening for infections such as malaria, urinary tract infections and asymptomatic bacteriuria should be encouraged and emphasized.Item Patients pay price as nursing care deteriorates.(New Vision, 2018-01-04) Amamukirori, BettyThe clock strikes midday as I enter Mulago National Referral Hospital's casualty ward. I am here to see a friend. Working in one of the wards. As l pass by the emergency room a faint cry for help stop me. "Munyambe (help me)". Shouts a man from the VIP latrines opposite the room.