Fredrick Makumbi

Self-care is a modern name for a very old concept. Long before formal health systems existed, people managed their own health using herbal remedies, traditional practices, and knowledge passed down...

Several systematic reviews have been published on psychosocial care interventions (PCIs) in cancer care. However, there are limited systematic reviews and meta-analyses (SRMA) on the effectiveness of PCIs in cancer care for adults patients in low- and-middle income countries (LMICs). This study aimed at synthesizing the available evidence on the effectiveness of PCI in improving the quality of life (QoL) of adult cancer patients in LMICs. We registered the protocol with PROSPERO (ID: CRD4202342156) before conducting this SRMA. Studies published between 2002 and 2023 were searched from MEDLINE, Web of Science, EmBASE and APA PsycINFO. We followed the standard guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results of the pooled studies were analysed using MedCalc version 10.10 statistical software. Twenty-six intervention studies were included in this SRMA. The Eastern Mediterranean WHO region had the highest number of studies and Africa region had the least. Most studies utilised Cognitive Behavioural therapy-related interventions (38%, n = 10 studies), while Family systems therapy 4% (n = 1) was the least utilised. From the subgroup analyses of the means and standard deviations of domains of QoL in the pooled primary studies, the respective standardized mean differences indicated that the PCIs had a significant positive effect on the physical (0.972: p = 0.002), social (0.884: p = 0.005) and psychological (0.590: p = 0.03) domains of QoL of adult cancer patients. However, some PCIs did not improve the QoL of study participants. Generally, PCIs effectively improved most domains of the QoL of adult cancer patients. However, more research is needed for PCIs that had a negative effect on some domains of the QoL of cancer patients. Lastly, there is need for LMICs to prioritise resources to strengthen the integration of psychosocial care interventions in cancer care to meet the different QoL sub-domains of patients with cancer.

Background: In Uganda, 22% of all women of reproductive age have an unmet need for family planning services. Access to contraceptive services, especially long-term reversible contraceptives such as implants, remains a challenge. The number of trained health providers is also not sufficient to address the needs for contraception. The Uganda Ministry of Health implemented a community-based implant provision pilot project where community health extension workers (CHEWs) were trained and accredited to insert implants at community level. Objective: This study aims to evaluate the implementation and acceptability of stakeholders toward task shifting the provision of family planning implants to CHEWs in Uganda. Methods: The evaluation will use a cross-sectional design using both quantitative and qualitative methods. The quantitative component will use a noninferiority design, whereas the qualitative component will use a descriptive approach. The noninferiority design involves a comparison of the competence of the currently authorized cadre to offer the service to the proposed cadre (CHEWs). Compared with a randomized controlled trial, the noninferiority design is more appropriate for this evaluation because the CHEWs and the authorized cadre are not comparable in terms of level of training and competencies. The authorized cadre has gone through formal training, which is not comparable with the training the CHEWs have received, and so the comparison is such that the competencies of the CHEWs are noninferior or at most equal to the competencies of the authorized cadre. Quantitative data will be collected among 92 CHEWs and 92 qualified health workers using performance assessment checklists and practice-based questionnaires that were developed based on the training manuals. Competency will be measured on a continuous scale and summarized as mean (SD) scores. Qualitative data will be collected through key informant interviews (n=23), in-depth interviews (n=24), and focus group discussions (n=18). Qualitative data will be analyzed using thematic analysis following the framework method for the analysis of qualitative data using ATLAS.ti (version 9). Results: Preliminary findings indicate improved confidence and capacity of community health workers to provide implants despite challenges such as poor waste disposal, record keeping, and data management. By August 2025, training of research assistants had been concluded, and data collection had started. We anticipate that the data collection will be completed by the end of October 2025, the data analysis will be completed by November 2025, and the final results will be published by December 2026. Conclusions: This pilot will generate contextual information that can be used to improve access to family planning services at the community level.

Background: People diagnosed with advanced HIV disease (AHD) are at high risk of increased mortality even after starting antiretroviral therapy (ART). We assessed AHD prevalence, clinical outcomes, and risk of mortality among children and adolescents living with HIV (CALHIV) in western Uganda. Methods: We abstracted routinely-collected data of CALHIV aged 0-19 years from HIV clinic electronic medical records in 48 high-volume health facilities in two regions of western Uganda (Fort Portal and Hoima). Data for clients who initiated ART during January 2016—July 2023 were analysed. AHD was defined as a CD4 cell count <200 cells/μL, or WHO stage 3 or 4, or any child younger than five years of age living with HIV who had been on ART for more than 12 months and virally non-suppressed (≥1,000 copies). We used descriptive statistics (i.e., frequencies and percentages) to summarise prevalence and treatment outcomes. Kaplan-Meier curves were used to estimate overall survival and median time to death; log-rank tests were used to compare survival functions. A gamma-shared frailty model was used to determine factors associated with the rate of mortality. Effect measures were summarized using adjusted hazard ratios (aHRs) and their 95% confidence intervals (95%CI). Results: A total of 5,143 CALHIV, including 3,067 (59.6%) females, with a median (interquartile range [IQR]) age of 10 (9) years were assessed. The overall prevalence of AHD was 18.2% (932/5,143) and varied by age—68.4% (0-4 years), 12.6% (5-9 years), 13.2% (10-14 years), and 7.7% (15-19 years). Just over half of the CALHIV diagnosed with AHD were active in care (51.5% [480/932]), about a quarter (26.4% [264/932]) had transferred out, 13.8% (129/932) were lost to follow-up, and 8.3% (77/932) had died. Survival was significantly higher in CALHIV who were not malnourished compared to those with malnutrition (p=0.001). Overall mortality rate among CALHIV with AHD was 3.41 (95% CI: 2.72-4.28) per 1,000 person-years and pronounced among those who had been on ART for three months or less (22.5; 95%CI: 17.0-29.8) compared to those above six months (0.8.2; 95%CI: 0.49 - 1.37). Conclusion: Prevalence of AHD in CALHIV in western Uganda was within range compared to published adult-based studies. Risk of death differed by nutrition status and was high among those on ART three months or less. Early screening and management of malnutrition, as well as early ART initiation and adherence initiatives, might improve outcomes and reduce AHD-related mortality among CALHIV.

Background: It is important to understand time-to-pregnancy expectations and when women begin to worry or seek help for fertility-related concerns, particularly in sub-Saharan Africa, where infertility is highly stigmatized and there is considerable pressure to conceive quickly. Yet our understanding of this topic is informed by a small body of literature often involving selective clinic-based samples of those receiving infertility care. This study aims to better understand Ugandan women’s expected time-to-pregnancy and their anticipated emotional and behavioral responses to time spent trying as well as its alignment with the 12-month clinical threshold for infertility. Methods: We use population-based cross-sectional data of women aged 15–49 in Uganda ( n = 4227), limiting our analytic sample to women who had ever had sex ( n = 3741). Our outcomes of interest were time-to-pregnancy expectations and related worry and help-seeking. We operationalized time-to-pregnancy expectations as a continuous measure, in months, and worry and help-seeking as binary measures, with a 12-month and a 12- and 24-month cut-off, respectively. We fit multivariable Tobit and logistic regression models to identify sociodemographic factors associated with time-to-pregnancy expectations and related worry and help-seeking. Results: Half of women think it typically takes less than one month to conceive. The majority anticipated that they would begin to worry (82.4%) and seek help (77.3%) before reaching the 12-month clinical threshold for infertility. Women with children, with perceived difficulties conceiving, and with longer time-to-pregnancy expectations had decreased odds of worrying or seeking help before 12 months. Over 10% of women anticipated that they would seek help after 24 months of trying, with those who had longer time-to-pregnancy expectations having increased odds of seeking help after 24 months of trying. Time-to-pregnancy expectations, worry, and help-seeking were highly normative, with 27–36% of the variability in these outcomes explained by the woman’s geographic community. Conclusion: Our study suggests that the clinical threshold for infertility may not align with individuals’ expectations and concerns related to delayed childbearing in Uganda. More education about conception and suggested care-seeking timelines, along with early psychosocial support, could help women navigate fertility concerns, especially in cultures where delayed pregnancy leads to stigma and social consequences.

Background: Understanding the association between digital payment services and health worker outcomes is critical to improving public health outcomes and optimising health workforce efficiency. This study examined the link between digital payment systems and health campaign workers’ perceived satisfaction, motivation and performance in Nigeria. Methods: A national survey was conducted among 821 polio immunisation workers who participated in campaigns. A structured electronic questionnaire which had sections on sociodemographic characteristics and digital payments was used to elicit information from participants. Campaign workers’ self-reported satisfaction, motivation and performance were assessed using standardised tools for examining these outcomes. Linear mixed model regression analysis was used to examine the factors associated with health worker’s motivation, satisfaction and performance. Predictors of these outcomes during periods of cash and digital payment methods were assessed, with statistical significance set at the 5% level. Results: This cross-sectional study included 821 health campaign workers in Nigeria, with a mean age of 37.13 years (SD=11.06). Regarding digitised payments, mean scores across all constructs were generally high: general motivation (16.34±2.58; maximum=20), job satisfaction (20.33±3.16; max=25), intrinsic job satisfaction (12.87±1.62; max=15), organisational commitment (16.99±1.96; max=20), conscientiousness (15.68±1.71; max=20), timeliness and attendance (13.35±1.55; max=15) and perceived performance (20.54±2.97; max=25). Overall, the combined motivation, satisfaction and performance score was higher among workers paid via digital methods compared with those paid in cash (104.14±9.34 vs 68.43±50.75). In multivariable linear regression, being female (β=1.83; 95% CI=0.28 to 3.38) and the ability to use the internet (β=1.87; 95% CI=0.02 to 3.72) were significant independent predictors of higher overall scores. Conclusion: Digital payment methods were associated with higher health workers’ perceived job satisfaction, motivation and performance. Public health stakeholders need to promote the use of digital payments to maximise their positive influence on health workers.

Objective: Establishing the prevalence of epilepsy in Uganda is crucial to inform interventions and public policy. We conducted a nationwide survey to determine epilepsy prevalence. Methods: From January 2019 to July 2022, a door‐to‐door survey was conducted across all four regions of Uganda, targeting a nationally representative sample of households. Trained field teams identified and interviewed heads of households to obtain demographic information, and three household members were randomly selected for epilepsy screening. A two‐part survey, adapted from a validated standardized epilepsy questionnaire in low‐ and middle‐income countries, was used for screening. To ensure the accuracy of the prevalence estimates, a subset of screened individuals underwent clinical validation by a qualified neurologist. Epilepsy was defined per the International League Against Epilepsy (ILAE) criteria. We employed Monte Carlo simulation to extrapolate prevalence estimates. Results: We identified and screened 35 055 participants (53.5% female). The ages ranged from 1 month to 108 years, with a mean age of 20.7 years. The overall crude epilepsy prevalence was estimated at 16.9 per 1000 persons, with an age‐ and sex‐adjusted prevalence rate of 17.8 per 1000. The differences in sex‐specific prevalence rates were not statistically significant. The highest age‐specific prevalence rate of 25.0 per 1000 occurred in the 20‐ to 39 ‐year age group. There was a substantial variation in epilepsy prevalence across the various regions, with the highest prevalence recorded in the eastern region and the lowest in the northern region. Significance: Our study underscores the high epilepsy burden in Uganda, particularly among adults, and reveals age, gender, and geographical variation likely arising from disparities in the underlying determinants. Identification of these factors is crucial for addressing treatment gaps and reducing epilepsy prevalence.

Background Depressed skull fractures (DSFs) are features of traumatic brain injury (TBI), frequently associated with intracranial damage and long-term functional impairments. The neurological outcomes of the perioperative management are yet to be evaluated. This study aimed to assess the effect of surgical timing and perioperative clinical radiological factors on functional outcomes in DSFs. Methods This prospective cohort study enrolled 205 patients with DSFs at a tertiary neurosurgical center in Uganda. Patients underwent surgical management, with the primary exposure variable being surgical timing (≤ 48 h vs. >48 h). Functional outcomes at six months were assessed using the Glasgow Outcome Scale-Extended (GOSE), categorized into favorable (GOSE 5–8) and unfavorable (GOSE 1–4). Multivariate regression models were used to identify functional outcome predictors. Results The median-age was 24 years (IQR = 15–31), 89.5% were male, and 49.73% were assault victims. Approximately 73.1% had an admission GCS > 13. The frontal bone was most commonly involved (46.2%). Early surgical intervention (≤ 48 h) significantly reduced the risk of surgical site infections (SSIs) (p = 0.01) and shortened hospital stays. However, surgical timing had no significant association with functional outcomes {adjusted risk ratio (ARR): 0.95; 95%CI: 0.35–2.61; p = 0.92}. Several perioperative factors were strongly linked to unfavorable outcomes, including ASA class 3 (ARR: 5.09, 95%CI: 2.11–12.2; p < 0.01), compound DSFs (ARR: 3.18; 95%CI: 1.70–5.96; p < 0.01), and midline shift ≥ 5 mm (ARR: 2.84; 95%CI: 1.50–5.39; p < 0.01). Conclusions Early surgery of DSFs reduces the infection rates and hospital length of stay; however, it does not significantly impact the 6-months functional outcomes. The outcomes are instead influenced significantly by clinical radiological perioperative factors such as the ASA classification, compound type, midline shift ≥ 5 mm, and others. We advocate for an aggressive treatment for increased ICP to improve the outcomes, and an early surgical intervention for infection reduction.

This study evaluates the contraceptive empowerment subscale of the Women's and Girls’ Empowerment in Sexual and Reproductive Health (WGE‐SRH) index across seven sub‐Saharan African countries. Using structural equation modeling and logistic regression among population‐based samples of women aged 15–49, we find evidence that the abbreviated eight‐item subscale is a reliable measure of contraceptive empowerment (Cronbach's alpha range: 0.67–0.78), significantly associated with women's involvement in the decision to use contraception. Results show geographic variability, with the highest overall contraceptive empowerment in Kenya (mean = 4.26, range: 1–5) and lowest in Uganda (mean = 3.67), reflecting diverse fertility trends, contraceptive norms, and gendered power dynamics. The subscale's two‐dimensional structure—distinguishing existence and exercise of choice—proves effective, with existence of choice being a stronger correlate of involvement in contraceptive use decisions than exercise in most settings. Despite some challenges, such as variable factor loadings, the subscale shows acceptable internal consistency and construct validity. This research underscores the need for multidimensional measures of reproductive empowerment to capture this nuanced process.