Scovia Nalugo Mbalinda

Introduction: Stroke is one of the leading causes of disability worldwide, and its prevalence is increasing in low- and middle-income countries (LMIC) like Uganda, presenting nursing care challenges. Simulation-based learning has been used successfully to train nurses in general care in LMIC but has not been applied to training for stroke care. In this study, we aimed to develop a simulation-based stroke care education intervention for nurses involved in care for patients with stroke at a large hospital in southwestern Uganda. Methods: Between February 2024 and March 2025, we used the iterative design to develop an educational intervention for stroke care. We engaged stroke care content experts through in-depth qualitative interviews (n=14), generated content, and developed the first version of the intervention. Transcripts were derived, reviewed and coded to generate themes and categories using inductive content analytic approach. We then tested, analyzed and refined the intervention through three repetitive exposures of the intervention to final year Bachelor of Nursing students (n=20), with improvements after every exposure. That were grouped in teams of 5 students. Results: Qualitative data from content experts revealed three thematic areas of patient care including admission of a stroke patient, care for a stroke patient during their hospital stay and discharge of a stroke patient as key content for consideration during intervention development. This content was integrated into the "Uganda Simulation-Based Nursing Stroke Care intervention”. Post-exposure qualitative interviews with final year Bachelor of Nursing students revealed great satisfaction with the intervention, improved preparedness and ease to assess stroke patients. There were also high teamwork scores and improved clinical skills. To maintain efficiency with stroke care competencies, they preferred at least three exposures to the intervention per year. Conclusion: With diverse stakeholders, we used an iterative approach to develop a context specific, simulation-based stroke educational intervention. Future work will examine the feasibility, acceptability, and effectiveness of this intervention among nurses working with stroke patients and its effect on the patient outcomes.

Introduction: The prevalence of human papillomavirus (HPV) infection and related illnesses is disproportionately high in women and young people living with HIV. Vaccination against high-risk HPV types has the potential to reduce HPV- associated disease burden dramatically. However, HPV vaccine uptake has been variable and suboptimal in most countries, including Uganda, with low levels of both initiation and completion of the HPV doses. The purpose of this research was to identify determinants of HPV vaccine uptake and completion among young girls living with HIV. Methods: A cross-sectional study was conducted among 274 adolescents and young people living with HIV who were selected from an antiretroviral therapy (ART) clinic in a district Hospital ART clinic, Uganda. Data were collected between February and June 2024. The data were collected using a structured questionnaire examining HPV vaccine uptake (initiation and completion). Bivariate and multivariate analyses were conducted to assess factors associated with HPV vaccine uptake using SPSS version 21 software. Results: This study involved 274 participants, with a mean age of 20.3 years ranging from 15-24 years. The proportion who initiated HPV vaccination in this study was 68.2% (187/274), and HPV vaccine dose completion (2 doses and more) was 24.1% (66/274). The uptake of HPV vaccination was significantly associated with age 15 to 19 years (AOR 2.9, 95% CI 1.352-6.1 P = 0.006), having been taught about HPV vaccine and cervical cancer at school (AOR 8.7 95% CI 2.8–24.7, P = < 0.001), living within a distance of less than 5 km from the health facility (AOR 5.9, 95% CI 2.2–16.1, P = < 0.001), and availability of HPV vaccines at the health facility (AOR 5.2, 95% CI 1.9–14.5, P = < 0.001). The completion of HPV vaccination was significantly associated with age 20 to 24 years (AOR 1.9, 95% CI 1.057–3.499, P = 0.032). Conclusion: The initiation and completion of HPV vaccination among HIV- positive girls are both crucial for preventing HPV related diseases and cancers. In this study, the completion rate is very low. Vaccination against human papillomavirus (HPV) must be prioritised in the HIV-positive youth population. The findings suggest a need for targeted policies to improve vaccine uptake among HIV-positive youth, including better education, healthcare provider engagement, and system support for follow-up care. This will guide targeted interventions in achieving the WHO’s target of 90% immunising all adolescent girls by 2030.

Background: The burden of cancer is escalating in resource‐limited settings like Uganda. However, studies on the unmet needs of family caregivers (FCs) of cancer patients are rare in Africa, despite their importance in guiding supportive care programs and high‐quality patient‐and‐family‐centered care outcomes. Objective: The study aimed to explore the unmet needs of FCs of cancer patients in Uganda and its relationship with mental health status and quality‐of‐life outcomes of FCs. Method: A cross‐sectional descriptive design was used to collect data from 170 FCs in Uganda. The data were collected using the Hospital Anxiety and Depression Scale, the Quality of Life Index‐Cancer Scale, and the Needs Assessment Family Caregiver‐Cancer Scale. Results: FCs exhibited reduced quality of life (mean = 73.55 ± 21.88), anxiety (37.6%), and depressive (20%) symptoms. The lowest scores were in the quality‐of‐life domains of positive adaptation (52.9%) and financial concerns (63.5%). FCs had significant medical, psychosocial, and financial unmet needs. The key medical and psychosocial unmet needs were related to symptom management, medical care, and emotional distress. The quality of life was associated with anxiety, depression, daily activity, finance (all p < 0.01), and psychosocial unmet needs ( p < 0.05). Conclusion: The unmet needs of FCs of cancer patients in Uganda significantly impact their quality of life and mental health. The nurses and other healthcare providers caring for cancer patients must utilize care plans that integrate supportive care programs and interventions to address the unmet needs of FCs to ensure better healthcare system, patient, and caregiver outcomes.

Aims: Dyslipidemia is a major modifiable risk factor for stroke; however, it is poorly understood among patients at risk of stroke in Uganda. This study is aimed at determining the prevalence of dyslipidemia and identifying associated factors among a Ugandan sample at risk for stroke. Methods: This was a hospital based cross‐sectional study conducted across three Ugandan sites. The serum lipid levels were determined following the National Cholesterol Education Program guidelines. Data were analyzed with STATA employing univariable and multivariable logistic regression. Statistical significance was set at p < 0.05. Results: We enrolled 247 study participants with a mean age (SD) of 55.4 (12.0) years. Majority of the participants were female, n = 168 (68%). About 81% ( N = 199) had elevated serum lipid levels. Sixty‐one (24.7%) had elevated levels of total serum cholesterol, whereas half of female participants had abnormally low levels of HDL cholesterol. About a third ( N = 82 and 84, respectively) had elevated serum LDL and triglycerides. Nearly 40% ( N = 98) were obese and 23.5% had a sedentary lifestyle ( N = = 58). Only 20.2% ( N = 50) were receiving lipid lowering drugs. Prior family stroke history and personal history of stroke had lower odds of 58% (AOR = 0.42, 95% CI: 0.20–0.88, p = 0.022); and 64% (AOR = 0.36, 95% CI: 0.17–0.76, p = 0.008), respectively, of having dyslipidemia. Conclusions: Approximately four in five Ugandans at risk of stroke have dyslipidemia. The majority also have low HDL‐c levels. Implementation of systematic screening and provision of statin therapy among those at high risk for stroke is urgently needed to reduce stroke burden in Uganda. Trial Registration: ClinicalTrials.gov identifier: NCT04685408

Background: Neurological disorders remain a challenge in sub-Saharan Africa, with limited expertise and credible research data to guide interventions and disease prevention. Training the next generation of clinical researchers requires a focused and concerted effort to stem the growing neurological disease burden. The US National Institute of Health (NIH) research training funded through the Fogarty International Center (FIC) Global Brain Disorders Research program gave trainees an opportunity to participate in mentored neurology research and training for 1– 2.5 years. We conducted a descriptive cross-sectional study among mentees of 2 FIC research programs to assess the training experience and inform program refinement. Methods: The data were collected via an online questionnaire created using Google Forms. All participants who had participated in the prior brain health research training programs received an online survey form. The form included a brief instruction with review guidance on the methodology to be used in training, and its objectives were provided. We used a descriptive analytical approach where we assessed the perceived interest in medical research, barriers to mentorship, satisfaction with the current mentorship and barriers to the current training program. Results: About half of the trainees are male, and the majority, 62/72, reported that they had participated in research studies before enrolling for their training and few (11.1%) had a research experience of more than 3 years. Overall, 97.2% (70/72) reported that they were interested in conducting medical/neurology research as part of their career as a clinician, with 80.5% indicating that they were very interested. There were no significant differences across the several areas of interest regarding the level of satisfaction based on age groups and gender. Conclusion: Barriers still exist for brain health research training in sub-Saharan Africa (SSA) and efforts to improve more protected time for research, mentorship growth and tailored research training courses are still needed to increase support for young research scientists in SSA.

Introduction: The increasing burden of cancer in resource-limited settings like Uganda puts pressure on healthcare systems and leaves many patients’ needs unmet. These unmet needs impact service uptake, perceptions of care, and health outcomes. However, the extent and effect of unmet care needs on patients’ health outcomes remain poorly characterised. Methods: A cross-sectional study involved 170 adult cancer patients at the Uganda Cancer Institute (UCI). Participants filled out validated instruments such as the Hospital Anxiety and Depression scale (HADS), the EORTC QLQ-30 (Quality of life scale) and the Supportive Care Needs Survey (SCNS-SF34). Descriptive statistics, correlation and regression analyses examined the relationship between unmet needs and health outcomes. Results: Nearly half (45.9%) of participants reported clinically significant anxiety symptoms, while 35.9% had depressive symptoms. The highest unmet needs were in physical/daily living (mean = 73.59 ± 20.26), psychological (51.77 ± 18.24), and health system/information domains (38.96 ± 19.59). Poor quality of life was observed in role (18.14 ± 27.01) and social functioning (9.41 ± 18.48). Fatigue (β = 0.23, p < 0.01) and anxiety (β = 0.20, p < 0.01) were the strongest predictors of overall unmet needs. Conclusion: Cancer patients in Uganda experience substantial unmet needs, particularly in physical, psychological, and informational support, which are strongly linked to worse mental health and quality of life. To improve patient outcomes, integrated interventions targeting symptom management, psychosocial support, and health system strengthening are urgently needed.

Background: Among low and middle-income countries, especially in Sub-Saharan Africa, the stroke burden is severe, with increasing trends in stroke incidence, prevalence, and mortality. Aims: This 6-month, prospective randomized controlled trial (RCT) compared a novel stroke risk reduction approach (TargetEd manAgeMent Intervention (TEAM)) vs. Enhanced Treatment as Usual (ETAU) in 247 Ugandans at risk for stroke. Methods: Participants, enrolled across 3 Ugandan sites, were adults with high stroke risk. The primary outcome was a change in systolic blood pressure (SBP) from baseline to 6-month follow-up. Secondary outcomes included changes from baseline to 6 months on diastolic BP (DBP), serum lipids, glycosylated hemoglobin (HbA1c), self-efficacy and stress. Results: The mean sample age was 55.4 (±SD = 12.0) with majority being women (n = 168, 68%). In addition to hypertension, the most common risk factors were hyperlipidemia (n = 199, 80.6%) and obesity (n = 98, 39.7%). Overall mean SBP and DBP at baseline were 143.0 (SD = 19.8, range 94.5–206) and 89.3 (SD = 14.0, range 61–136) respectively. In TEAM, SBP significantly improved from 145.7 (±21.5) at baseline to137.4 (±18.1) at 6-months vs. change from 141.9 (±18.4) to 141.1 (±21.9) for ETAU (p = 0.031). There were similar reductions in DBP favoring TEAM (p = .012). Compared to ETAU, TEAM showed improved physical activity (p = .017), self-efficacy (p < .001) and stress (p = .014). Conclusions: There is a need for effective and practical approaches to reduce stroke burden in Sub-Saharan Africa. Inclusion of the TEAM approach in primary care seems to be a pragmatic and effective way to potentially reduce stroke burden in Uganda. Trial registration: ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.