Francis Bajunirwe

Introduction: Maternal mortality remains a major global health concern, disproportionately affecting low- and middle-income countries. Puerperal sepsis remains an important contributor to maternal morbidity and mortality, with caesarean delivery increasing women’s risk of infection. As caesarean deliveries increase, strengthening strategies to prevent puerperal sepsis throughout the continuum of care is increasingly important. Although prevention efforts have focused largely on antenatal and intrapartum care, post-discharge self-care and education remain insufficiently emphasized. Evidence from Mbarara Regional Referral Hospital indicates gaps in women’s knowledge and practices regarding post-caesarean self-care, highlighting the need for effective discharge education to support prevention, early recognition, and timely care-seeking for puerperal sepsis. However, the effectiveness of discharge education depends not only on the information provided but also on healthcare providers’ ability and willingness to deliver it within the available health-system environment. The COM-B framework provides a useful lens for understanding these influences by examining providers’ capability, opportunities within the health system, and motivation to deliver discharge education. Understanding these factors is therefore important for identifying barriers and facilitators that can be addressed to strengthen puerperal sepsis prevention after discharge. The study aimed to explore the facilitators and barriers to the provision of discharge education for puerperal sepsis prevention following caesarean delivery. Methods: This study employed an exploratory qualitative design at Mbarara Regional Referral Hospital. A total of 12 healthcare providers, comprising six senior house officers and six midwives, were purposively selected, provided informed consent, and participated in in-depth interviews. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by systematically coding statements from the transcripts, organizing similar codes into subthemes, and subsequently synthesizing the subthemes into overarching themes. Results: Twelve healthcare providers (six midwives and six senior house officers) participated in the study. Under Capability, knowledge, clinical experience, and awareness of puerperal sepsis and its prevention facilitated discharge education. Opportunity was facilitated by the availability of discharge forms and opportunities to provide education, but barriers included limited post-caesarean-specific information, inconsistent timing and content of instructions, language barriers, inadequate staffing and time, fatigue, limited space and privacy, and gaps in coordination and teamwork. Under Motivation, professional commitment, passion for patient care, and awareness of the consequences of inadequate education facilitated discharge teaching, whereas patient disengagement, heavy workload, and other demotivating factors hindered it. Conclusion: Discharge education for puerperal sepsis prevention following caesarean section was influenced by interacting provider and health-system factors. While providers’ knowledge, experience, commitment, and available resources supported education, workload, staffing constraints, limited privacy and space, language and literacy barriers, inadequate post-caesarean materials, inconsistent timing, and gaps in teamwork constrained its consistent delivery. Strengthening discharge education therefore requires a multi-level approach that addresses both providers’ capability and motivation and the health-system opportunities needed to deliver effective education.

Background: Hypertensive disorders of pregnancy (HDP) are important contributors to maternal and perinatal morbidity and mortality in sub-Saharan Africa. Women’s knowledge of warning signs, risk factors, diagnosis, and prevention may support earlier care-seeking and timely diagnosis, yet data from primary-level antenatal-care settings in Uganda remain limited. We assessed knowledge of HDP and associated factors among antenatal-care attendees in Mbarara City, southwestern Uganda. Methods: We conducted a cross-sectional study among pregnant women attending their third or later antenatal-care visit at six public health facilities in Mbarara City between January and March 2025. Participants were recruited by consecutive sampling. Knowledge was assessed using 41 scored knowledge items covering awareness, disease manifestations, risk factors, diagnosis, management, prevention, complications, and blood-pressure monitoring. Scores were expressed as percentages of correct responses; adequate knowledge was defined as ≥ 60%. Multivariable modified Poisson regression was used to estimate adjusted prevalence ratios. Results: Among 426 antenatal-care attendees, 271 had adequate knowledge, giving a prevalence of 63.6% (95% CI: 58.8– 68.2). Knowledge was highest for timing or frequency of blood-pressure checks (86.2%) and complications (76.1%), but lower for diagnosis (51.4%), timing of occurrence (53.3%), treatment and management (53.4%), and risk factors (56.8%). Adequate knowledge was more prevalent among women with secondary education (aPR=1.34; 95% CI: 1.10– 1.64) or tertiary education (aPR=1.36; 95% CI: 1.04– 1.78), compared with primary education or less; women with five or more pregnancies compared with primigravidas (aPR=1.77; 95% CI: 1.27– 2.48); and women with family history of preeclampsia compared with those without (aPR=1.26; 95% CI: 1.06– 1.50). Conclusions: Approximately two-thirds of antenatal-care attendees had adequate knowledge of HDP, but important gaps remained in diagnosis, timing of occurrence, treatment and management, and risk-factor recognition. Health education during antenatal care should prioritize practical messages for women with lower educational attainment, primigravidas or limited pregnancy experience, and women without a family history of preeclampsia.

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.

Kidney disease affects 850 million people worldwide, with Sub-Saharan Africa bearing a significant burden. People living with HIV (PWH) are at increased risk due to nephrotoxicity of antiretroviral therapy (ART), in part due to widespread use of tenofovir disoproxil fumarate. In response, Uganda recommends routine kidney disease screening by doing a serum creatinine test at ART initiation. However, the extent of adherence to these guidelines remains poorly understood. We extracted clinical data for adults initiating ART between 2017 and 2024 at three large-volume HIV clinics in Uganda. To determine if kidney disease screening rates had increased appropriately over time, we divided the observation period into three eras as per national guidelines: (1) Test and Treat (2017–2019), that recommended screening only PWH and diabetes or hypertension; (2) DTG rollout/COVID-19 (2020–2022); and (3) creatinine-for-all (2023–2024), recommending screening everyone initiating ART. Logistic regression models were fit to identify correlates of renal screening. Of the 17,485 participants, only 22.4% (3,909/17,485) were screened for kidney disease at ART initiation. Screening was more common at the urban site (54.2%) compared to rural sites (10.0%). At rural sites, screening declined over time and individuals were 83% less likely to be screened in the creatinine-for-all era compared to the baseline era (aOR 0.17, 95% CI: 0.13–0.22) while it increased at urban site (aOR 9.27, 95% CI: 7.37–11.66). Male sex (aOR 1.37, 95% CI: 1.20–1.57), older age (≥45 years), hypertension, and non–TDF-based ART regimens were associated with higher screening odds at rural sites. Diabetes, opportunistic infections, and TDF use were not significantly associated with screening likelihood at any site. Kidney disease screening for PWH at ART initiation remains poor in Uganda, even when using a single creatinine test, particularly in rural clinics, highlighting critical challenges in translating national guidelines into practice. Future research should focus on understanding multilevel barriers to screening and evaluating strategies to improve guideline uptake.

Advanced HIV disease (AHD) at first diagnosis remains a significant barrier to HIV epidemic control. We evaluated whether health facility-based or communit

Background Serum cortisol is often elevated in postpartum mothers, but data on its prevalence and associated factors remain limited in many settings. The current study aimed at examining the factors associated with elevated serum cortisol levels among postpartum mothers in Mbarara district, rural southwestern Uganda. Methods We conducted a facility based cross sectional study among mothers between 6 weeks and 6 months after childbirth. Using consecutive sampling, mothers were enrolled from postnatal clinics of two health facilities, Mbarara Regional Referral Hospital and Bwizibwera Health Center IV, a county level health facility in rural southwestern Uganda. The blood cortisol levels were measured using a chemiluminescence with the use of a standard, commercially available competitive immunoassay (Diagnostic Products Corp. Nichols Institute Diagnostics, San Juan Capistrano, CA). Postpartum depression (PPD) was diagnosed using the Mini-International Neuropsychiatric Interview (MINI) version 7.0.2, based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria. Results We enrolled 309 postpartum mothers, and the prevalence of elevated serum cortisol levels was 26.2% (95% CI 22.0–31.4). Elevated serum cortisol levels were significantly associated with PPD (AOR = 2.9, 95% CI 1.6–5.3, p < 0.001), health facility level attended by the mother (AOR = 3.8, 95% CI 1.9–7.6, p = 0.001), pre-diabetes (AOR = 2.5, 95% CI 1.3–5.0, p = 0.008) and diabetes mellitus status (AOR = 4.0, 95% CI 1.8–8.9, p = 0.001), and decreased involvement in physical activity (AOR = 0.3, 95% CI 0.1–0.7, p = 0.002). Conclusion In this study of elevated serum cortisol levels was significantly associated with postpartum depression, attending a rural healthcare facility, having pre-diabetes or diabetes mellitus status, and reduced physical activity. These findings underscore the need for targeted holistic interventions addressing both physical and mental health challenges in postpartum women.

Introduction: Simulation-based education (SBE) improves skills and knowledge among health professionals. Stroke nursing necessitates swift decision-making, elevated levels of clinical competence, and interdisciplinary collaboration. SBE improves these competencies but encounters implementation challenges. The objective of this study was to explore the barriers and facilitators of SBE implementation for stroke care for nurses at a referral hospital in Uganda. Methods: From March to July 2024, a descriptive qualitative study was carried out at Mbarara Regional Referral Hospital and Mbarara University of Science and Technology using focus group discussions (FGDs), and key-informant interviews (KIIs). The FGDs were carried out with nursing students. The KIIs participants included purposively selected nurses, nurse educators, and other health care providers involved in stroke care and bedside teaching. The study was guided by the Consolidated Framework for Implementation Research (CFIR) and used deductive thematic analysis to identify barriers and facilitators for simulation-based stroke education (SBSE). Results: We conducted 4 FGDs, and 12 KIIs. The FGDs participants’ mean age was 24 years and 36 years for other participants in KIIs. The barriers to SBSE included anticipated high cost for simulation methods, the anticipated high costs to translate lessons learned to real hospital setting, resistance to change from established routines. The high patient-to-nurse ratios and lack of stroke-specific structured training are also barriers. The facilitators included strong institutional administrative support for simulation methodology, availability of training facilities at the simulation center, and prior exposure to simulation methodologies. Conclusion: Strong administrative support exists for SBSE. However, for successful implementation, there is a need to address the resource limitations, address anticipated resistance to change, and foster a culture of continuous learning and improvement within healthcare institutions. Future interventions should strategically address identified barriers while leveraging facilitators can enhance the success of SBSE stroke nursing care in resource-limited settings.

Hypertension is common among older adults and negatively affects cognitive function. Available data on this association is mostly from resource-rich settings and has been understudied in resource-limited settings especially rural areas where the majority of older persons live. We examined the association between hypertension and cognitive impairment in older persons in Kole, a rural district in Uganda, and examined whether sex modifies the association. We conducted a community-based cross-sectional study among older persons aged ≥ 60 years in rural northern Uganda, using a multi-stage sampling approach. The primary exposure was hypertension measured by systolic (≥ 140 mmHg) or diastolic blood pressure (≥ 90 mmHg), or being on anti-hypertensive medication. The dichotomous outcome was cognitive impairment determined by Montreal Cognitive Assessment scores < 26. We used the modified Poisson regression with robust standard errors for the analysis, applying a 5% significance level. We studied 420 participants and found 288 (68.6%) had hypertension while 213 (50.7%) had some cognitive impairment. The overall mean age was 68.4 ± 7.2 years, the mean systolic blood pressure was 138.1 ± 23.1 mmHg while diastolic blood pressure was 85.4 ± 11.9 mmHg, and the mean MOCA score was 17.6 ± 7.2. Hypertension was associated with cognitive impairment (adjusted prevalence risk [aPR] 1.26, 95% CI 1.01–1.57), with 4–5 people in the household (aPR 0.80, 95% CI 0.64–0.99), no smoking history (aPR 0.57, 95% CI 0.43–0.76), and dissatisfaction with one’s health (aPR 1.68, 95% CI 1.27–2.21) and satisfaction with the ability to perform usual domestic duties (aPR 0.74, 95% CI 0.55–0.99) being associated. In a sex-stratified analysis, men with hypertension were more likely to experience cognitive impairment (aPR 2.13, 95% CI 1.33–3.40), compared to those with normal blood pressure but there was no significant association among women (aPR 0.97, 95% CI 0.96–1.24). Older persons with hypertension were more likely to experience cognitive impairment than those without. In a sex stratied analysis, this observation persists among men but disappears among women. Our results suggest a need to raise awareness and consider regular blood pressure measurement and control in older adults. We recommend longitudinal studies to examine temporality and suggest blood pressure interventions to prevent cognitive impairment in older age.