Solomon Tsebeni Wafula

Background: Children living with HIV who develop tuberculosis (TB) have higher case fatality and lower treatment success than their HIV-negative peers. Tanzania’s routine surveillance reports pediatric TB-HIV co-infection descriptively, without formal trend testing or modelling of associated factors, leaving the National Tuberculosis and Leprosy Programme without evidence to target HIV testing and TB preventive therapy. We determined the prevalence of TB-HIV co-infection, described its pattern by year, age group, sex and region of registration, and identified associated factors among children aged below 15 years registered with TB in Tanzania. Methods: We conducted a retrospective analysis of Tanzania’s national electronic TB surveillance system (DHIS2-eTL). The analysis included all children aged below 15-years with documented HIV status registered with TB across ten high-burden regions between January 2018 and December 2023. HIV positivity was confirmed at TB registration. We tested the annual trend with the chi-square test for linear trend and estimated adjusted prevalence ratios (aPR) by modified Poisson regression with robust variance. Results: Of 25,449 children registered with TB and having a documented HIV status, 3,667 were HIV-positive (14.4%, 95% CI:14.0–14.8). Prevalence fell in every successive year, from 28.5% (95% CI:26.8–30.2) in 2018 to 8.9% (95% CI:8.1–9.8) in 2023 (χ²₁=719.7, p < 0.001). It rose across age groups, from 9.0% (95% CI:8.5–9.5) below 5 years to 17.7% (95% CI:16.8–18.6) at 5–9 years and 22.6% (95% CI 21.6–23.7) at 10–14 years (χ²₁=684.3, p < 0.001) and did not differ by sex ( p = 0.814). It was highest in Njombe (29.7%) and lowest in Ruvuma (6.7%) ( p < 0.001). In the adjusted model, co-infection was independently associated with age 10–14 years (aPR = 2.40, 95% CI:2.22–2.59), registration in Njombe (aPR = 1.46, 95% CI:1.30–1.64) and relapse TB (aPR = 2.30, 95% CI:1.92–2.76). Conclusions: TB-HIV co-infection affected approximately one-in-seven children notified with TB and declined by two-thirds between 2018 and 2023, but remained concentrated in older children, in previously treated children and in Njombe, Mbeya and Iringa. The NTLP should prioritize repeat HIV testing for all children aged 5 years and above presenting with TB and for all retreatment cases, with geographic intensification in these three regions.

Timely and effective management of suspected paediatric malaria remains critical for reducing mortality in sub-Saharan Africa (SSA). Despite efforts, inequ

Snakebite envenoming is a neglected tropical disease with a disproportionate burden in sub-Saharan Africa, where weak surveillance, limited antivenom availability, and reliance on traditional remedies compound morbidity and mortality. Evidence on how snakebite cases are clinically managed in routine practice in Uganda remains scarce. We conducted a facility-based cross-sectional study with retrospective abstraction of records from four purposively selected health facilities in Gulu and Arua districts of Northern Uganda. Snakebite case records from outpatient, inpatient, paediatric, and intensive-care service points covering the period 2017–2021 were reviewed using a standardised abstraction tool. Descriptive statistics were computed in Stata version 14, with frequencies and proportions for categorical variables and medians with interquartile ranges (IQR) for continuous variables. A total of 227 snakebite case records were analysed, of which 58.6% were female, a median age of 21 years (IQR 13–38), and 31.3% were students. Most bites involved the lower limb (85.9%) and occurred in the second and third quarters of the year (59.9%). Snake species was undocumented in 76.2% of records. Pre-hospital first aid was either undocumented (59.1%) or inappropriate such as applying tourniquets (29.3%) and herbal remedies (8.9%). The dominant clinical manifestations were pain (60.8%), swelling/blisters (58.7%), and fang marks (26.9%), while 18.5% had features suggesting envenomation, of whom only 33.3% received antivenom. Overall, only 15.0% of cases received antivenom, while supportive care predominated (intravenous fluids 68.1%, analgesics 64.2%, antibiotics 53.1%). Coagulation testing was rare (20-minute whole blood clotting test 17.3%; INR 12.0%). Overall, 93.4% of patients recovered, 3.1% died, 0.9% were referred to other healthcare facilities, and the rest (2.6%) had missing information on the outcomes. Snakebite management in Northern Uganda is largely symptomatic, with critical gaps in species identification, syndromic assessment, coagulation testing, antivenom utilisation, and pre-hospital first aid practices. Strengthening health-worker training, improving documentation and surveillance, and community education on appropriate first aid are urgently needed to reduce preventable morbidity and mortality. Author summary: Snakebite envenoming is one of the most neglected of the tropical diseases, and its burden falls heaviest on poor, rural communities in sub-Saharan Africa. In Uganda, we know that many people are bitten each year, but very little is known about what actually happens to them once they reach a health facility. We reviewed the records of 227 people treated for snakebite at four hospitals in the Gulu and Arua areas of Northern Uganda between 2017 and 2021. We found that most of those bitten were young people, students and farmers, usually bitten on the leg. Before reaching hospital, many had received harmful first aid such as tight tourniquets or herbal remedies. In hospital, staff rarely recorded which snake was involved, seldom used the simple bedside blood-clotting test recommended by the World Health Organization, and gave the life-saving antivenom to only a small minority of patients, relying instead on painkillers, fluids and antibiotics. Most patients recovered, but some died. Our findings show where care can be improved — through training, better record-keeping, a reliable supply of antivenom, and community education on safe first aid — to prevent needless death and disability from snakebite.

1. Background: Despite road safety regulations, “Boda Boda” riders in Uganda continue experiencing frequent road traffic injuries due to unsafe riding behaviours, increasing morbidity and mortality among riders and passengers. Evidence on safe riding practices and associated factors remains limited. This study assessed factors associated with safe riding behaviours among boda-boda riders and passengers in Kampala Central Division. Methods: A cross-sectional survey using a convergent parallel mixed-methods design guided by Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation Model was conducted. Quantitative data were collected from 424 riders using structured questionnaires and analyzed using descriptive statistics and binary logistic regression to determine predictors of safe riding behaviours, with adjusted odds ratios (AORs) reported at p<0.05. Qualitative data were collected simultaneously through in-depth semi-structured interviews with 10 passengers. Thematic analysis and triangulation were used to identify convergences and divergences, providing a comprehensive understanding of safety determinants among riders and passengers. Results: Among 424 riders (mean age 29.56 ± 5.71), 65.1% exhibited unsafe riding behaviors. Bivariate analysis identified education, marital status, religion, willingness to obey traffic regulations, and family encouragement as significant factors. In the adjusted model, secondary (AOR=0.50; 95% CI:0.30–0.85) and post-secondary education (AOR=0.57; 95% CI:0.33–0.98), being married (AOR=0.56; 95% CI:0.34–0.91), Christian religion (AOR=2.98; 95% CI:1.63–5.47), willingness to obey traffic regulations (AOR=0.41; 95% CI:0.24–0.70), union advocacy (AOR=1.76; 95% CI:1.03–3.01), and well-maintained roads (AOR=1.65; 95% CI:1.07–2.55) were significant predictors. Qualitative findings highlighted barriers including helmet lack, over-speeding, traffic regulation disregard, and poor road infrastructure Conclusions: Rider and passenger safety is still low, interdependent, and influenced by multiple factors. Integrated interventions focusing on education, stronger families, religious affiliations, union safety advocacy, and stricter enforcement of traffic regulations are vital for enhancing safety for both riders and passengers. Clinical trial number: not applicable

Climate-related hazards such as floods and droughts disrupt household access to safe water, sanitation, and hygiene (WASH), undermining progress toward the Sustainable Development Goals (SDGs). Evidence on how household characteristics such as housing type, altitude, subjective social status, and disability status shape vulnerability to floods and drought and related risk mitigation in informal settlements remains limited. This study, therefore, assessed the vulnerability to climate impacts on WASH, risk mitigation, and its determinants among households in informal settlements in Eastern Uganda. This cross-sectional study applied nexus thinking and used an adapted questionnaire, informed by the World Health Organisation’s climate vulnerability checklist, to collect data from 589 households in Eastern Uganda. Quantitative data on household characteristics, documented flood and drought impacts, as well as risk mitigation measures, were collected. Robust least squares regression was used to show predictors of climate impact scores as well as risk mitigation scores at 95% confidence level. Results show that 21.4% reported increased susceptibility to waterborne diseases due to contamination from animal faeces and sewage. Vulnerability to flood impacts was higher among households living in temporary housing or with disabled members, but lower among those in higher-altitude areas or with higher subjective socioeconomic status. Higher subjective social status was also linked to reduced drought impacts, whereas temporary housing reduced the capacity to mitigate drought risk. Overall, climate-related hazards compromise WASH in informal settlements, with cascading effects on health, education, food security, gender equality, and poverty reduction. These findings highlight the need to strengthen water governance, promote integrated (nexus) approaches, and build resilient WASH systems through multi-sectoral partnerships to mitigate climate risks in vulnerable communities.

Climate change is increasingly affecting both health and the systems required to deliver care, particularly in low-resource settings. In response, Uganda developed its Health National Adaptation Plan (H-NAP) 2025–2030 to guide climate change adaptation in the health sector. However, limited analytical attention has been paid to how low-resource countries are developing and institutionalising health adaptation planning, what enables these processes, and what constraints shape early implementation. This paper examines the development and early implementation of Uganda’s H-NAP using a qualitative insider policy and process case study approach. The analysis draws on policy and planning documents generated during and around the H-NAP process, including the H-NAP itself, the national Climate Change Health Vulnerability and Adaptation Assessment (VAA), and related strategic and technical materials. Guided by a climate-resilient health systems lens, the paper explores how the H-NAP emerged, how it was developed, how it frames resilience within the health sector, and what lessons its early institutionalisation offers for low-resource settings. The findings show that Uganda’s H-NAP emerged through a sequenced process of agenda setting, evidence generation, stakeholder engagement, iterative drafting, and institutional validation. The national VAA was central in reframing climate change as a health systems issue by documenting risks to facilities, service continuity, preparedness, utilities, and vulnerable populations. The H-NAP was subsequently developed as a systems-oriented adaptation instrument addressing leadership and governance, workforce development, evidence systems, integrated risk monitoring and early warning, infrastructure and supply chains, environmental determinants of health, emergency preparedness, financing, and climate-informed programming. The Ugandan case suggests that health adaptation planning can be strengthened by country-specific evidence, strategic leadership by Ministry of Health (MOH), and broad-based multisectoral engagement through consultations, technical review, and validation; however, implementation remains constrained by financing gaps, limited institutional ownership, coordination challenges, and the difficulty of translating national policy into sub-national action. Uganda’s H-NAP therefore demonstrates that the value of H-NAPs depends on whether they move beyond paper commitments through sustained financing, institutional coordination, technical capacity, and effective sub-national implementation. Importantly, it shows that Uganda should be understood not as a model to be adopted/emulated mechanically, but as a case that offers transferable lessons for other low-resource settings.

We assessed baseline C-reactive protein (CRP) and procalcitonin levels in asymptomatic individuals from malaria-endemic West Africa. C-reactive protein remained unaffected by Plasmodium falciparum parasitemia, while procalcitonin (PCT) was more frequently detectable among malaria-positive individuals. These findings support that CRP thresholds remain valid and highlight the need to explore parasite density–PCT associations.

Despite being critical for improving student nutrition, there is limited evidence of food safety practices among food vendors around university settings. This cross-sectional study assessed food safety practices and associated factors among 322 food handlers using a modified Poisson regression model. We found out that 53.1% (171/326) of the food vendors exhibited poor food safety practices. Food handlers with a tertiary education (PR = 0.47, 95% CI: 0.34-0.98) and those having a valid food handlers license (PR = 0.47, 95% CI: 0.37 -0.61) were less likely to exhibit poor food safety practices. Food handlers working in a food establishment with adequate wholesome water (PR = 1.74, 95% CI: 1.16 - 2.60), agreeing that it is safe to leave food out of the refrigerator for more than 2 h (PR = 1.37, 95% CI 1.07-1.77) and disagreeing to a food handler using the same towel to clean various places (PR = 1.60, 95% CI: 1.14 - 2.23) predicted poor food safety practices. Factors associated with poor food safety practices included low levels of formal education, working in unlicensed food premises, and limited access to safe drinking water. There is an urgent need for comprehensive food safety training programs and stricter enforcement of food safety regulations in educational settings to improve food-handling practices.