Jonathan Nkalubo

Background and Aims: Antimicrobial resistance (AMR) is a global public health threat, especially in developing countries, where limited antimicrobial stewardship programs contribute to inconsistent prescribing practices for Caesarean section (CS) surgical prophylaxis. This study aimed to investigate physicians' knowledge and prescribing practices related to CS surgical antibiotic prophylaxis at Kawempe National Referral Hospital (KNRH) in Uganda. Methods: An anonymous electronic survey was conducted among 200 prescribing healthcare providers, including obstetricians, gynecologists, residents, fellows, medical officers, and interns involved in CS procedures over 4 months in 2021. The survey assessed demographic characteristics, knowledge of AMR, stewardship practices, and adherence to CS antibiotic prophylaxis guidelines. Participation was voluntary and confidential. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27, with a p ‐value < 0.05 considered statistically significant. Results: The most commonly chosen antibiotic was ceftriaxone, followed by metronidazole, either alone or in combination, both of which are not recommended according to World Health Organization (WHO) guidelines for CS prophylaxis. Most antibiotics were administered 15 to 60 min prior to surgery, which is also not in alignment with recommendations. Overall, the study revealed limited compliance with national and international guidelines on antibiotic prescription for CS prophylaxis among healthcare professionals, particularly regarding antibiotic choice, timing of administration, frequency, and dosage. Conclusion: The study reveals major gaps between recommended and actual antimicrobial prophylaxis practices for CS at KNRH. Despite clinicians’ awareness of AMR, systemic barriers such as poor microbiological testing and reliance on peer advice hinder adherence. These findings reflect on the importance of policy development and the implementation of antimicrobial stewardship programs in Uganda to improve prescribing practices among healthcare providers.

Most climate‐resilience health interventions are designed at the global level, with minimal attention to Indigenous communities' needs. The lack of consideration can lead to unintended harm and exacerbate health risks. This study aims to identify the capacities of Indigenous communities that can serve as transformative pathways in safely adopting global climate‐resilient health approaches within Indigenous contexts, ensuring the aims of the Sustainable Development Goals, such as Good Health and Well‐being (SDG3) and Reduced Inequalities (SDG 10). The World Health Organization's climate‐resilient health systems approach was used as a starting point to identify the transformative pathways. We collaborated with the Indigenous Peoples' Observatory Network (IPON) and conducted key informant interviews ( n = 17) with partners who maintain ongoing collaborations with Indigenous communities across 11 countries: Australia, Canada, Fiji, Ghana, India, Kyrgyzstan, Namibia, Peru, South Africa, Sri Lanka, and Uganda. The interview process was guided by two objectives: (i) to identify and examine how transformative pathways contribute to climate‐resilient health systems and (ii) to provide recommendations for strengthening transformative pathways based on key informants' insights. We identified five transformative pathways to support the resilience of health systems to climate change risks: (i) government‐community interactions, (ii) traditional medicine and spiritual beliefs, (iii) experience‐based practices, (iv) community‐based collective actions, and (v) community‐based policies. Based on the key informant interviews, we provide three recommendations to enhance the identified transformative pathways: (i) Indigenous mentorship in knowledge, health education, and research, (ii) identify opportunities to develop an Indigenous inclusive health workforce, and (iii) enhance indigeneity in health policies.

One of the most critical impacts of the COVID-19 pandemic was on food security. Food insecurity increased in many communities, with some showing signs of resilience through autonomously creating community kitchens that enhanced food security and built support networks. These initiatives filled gaps left by government programmes and provided a critical lifeline for vulnerable communities during the pandemic, fostering community solidarity. This paper aims to investigate the experiences and perceptions of community kitchen managers in addressing food insecurity during the COVID-19 pandemic by using a town in South Africa in 2020–2022 as a case study. Using arts-based participatory approaches, researchers interviewed 11 community kitchen managers representing 10 community kitchens in four sessions between June and November 2021. The results showed that a lack of jobs and food insecurity were identified as the main threats, whereas COVID-19 was not even identified as a threat by all of the community kitchen managers. Lacking support from the local government, these initiatives depended on individuals and community-based organisations for backing. However, this support decreased in 2021 and 2022, raising concerns about the sustainability of these efforts.

The spread of COVID-19 in Peru resulted in the declaration of a national health emergency, in which Indigenous peoples were identified as being particularly vulnerable due to their pre-existing poor health indicators and disadvantaged social conditions. The aim of this paper is to examine how the Peruvian government responded to the health and food needs of the Shawi and Ashaninka Indigenous peoples of Peru during the first 18 months of the pandemic (March 2020–August 2021). This study uses both official policy documents and real-world experiences to evaluate policy responses in terms of their immediate impact and their longer-term sustainability and contribution to the improvement of health, well-being and justice for Indigenous communities. Four health and food security responses were evaluated: the Amazon Health Plan and Indigenous Command; food aid; cash aid; and COVID-19 vaccination. We employed the Multidimensional Injustice Framework to analyse the justice implications of the design and implementation of responses. Data collection included 71 interviews with government officials (n = 7), Indigenous leaders (n = 31) and community members (n = 33). The results show how national and regional governments released policies to address the health and food needs of Indigenous peoples directly or indirectly, as part of a broader focus on vulnerable people. However, justice implications were not sufficiently addressed in the design or implementation of the responses. On the distributive dimension, Indigenous communities were prioritized to receive health goods and services, nevertheless, the distribution had shortcomings that impeded their collection and Indigenous food systems and livelihoods were largely overlooked. On the procedural dimension, Indigenous representatives were included to provide culturally sensitive feedback on health interventions, but without funding, and furthermore, the community members had only passive participation. This paper points out the importance of considering and addressing justice implications for more effective and fairer health and food policy responses to current and future health crises.

Introduction: The second wave of COVID-19 greatly affected the health care and education systems in Uganda, due to the infection itself and the lockdowns instituted. Double masking has been suggested as a safe alternative to double-layered masks, where the quality of the latter may not be guaranteed. This study aimed to determine patterns of double mask use among undergraduate medical students at Makerere University, Uganda. Methods: We conducted a descriptive cross-sectional study using an online questionnaire. All students enrolled at the College of Health Sciences; Makerere University received the link to this questionnaire to participate. Logistic regression analysis was used to assess factors associated with double mask use. Results: A total of 348 participants were enrolled. The majority (61.8%) were male; the median age was 23 (range: 32) years. Up to 10.3%, 42%, and 4.3% reported past COVID-19 positive test, history of COVID-19 symptoms, and having comorbidities, respectively. Up to 40.8% had been vaccinated against COVID-19. More than half (68.7%) believed double masking was superior to single masking for COVID-19 IPC, but only 20.5% reported double masking. Participants with a past COVID-19 positive test [aOR: 2.5; 95% CI: 1.1– 5.8, p = 0.026] and participants who believed double masks had a superior protective advantage [aOR: 20; 95% CI: 4.9– 86.2, p < 0.001] were more likely to double mask. Lack of trust in the quality of masks (46.5%) was the most frequent motivation for double masking, while excessive sweating (68.4%), high cost of masks (66.4%), and difficulty in breathing (66.1%) were the major barriers. Conclusion: Very few medical students practice double masking to prevent COVID-19. Coupled with inconsistencies in the availability of the recommended four-layered masks in Uganda and increased exposure in lecture rooms and clinical rotations, medical students may be at risk of contracting COVID-19.

Introduction: Globally, the HIV burden continues to rise among young people despite the discovery of ART. This study assessed demographic and psycho-social factors among young people associated with readiness to be initiated on ART. Methods: A quantitative cross-sectional study was conducted among newly diagnosed HIV positive young people aged 15-24 years at 4 HIV clinics at Mulago Hospital. Readiness was measured as a self-report by the individual to the question,“How ready do you feel to start ART? Results: Of the 231 young people enrolled, the mean age (SD) was 20.7years (+/-2.8) and most were female (66.2%). Majority were very ready (53.3%) and very motivated (51.1%) to start ART. Higher treatment readiness was associated with being female (95% CI [5.62, 8.31], p=0.003), thinking that ART cures HIV (95% CI [0.43, 0.86], p=0.005), history of having unprotected sex (95% CI [0.79, 0.87], p=<0.001), anticipating negative HIV results (95% CI [0.26, 0.88], p=0.017), internalized stigma (95% CI [0.83, 0.98], p=0.018) and knowledge of positive ART effects for others (95% CI [0.84, 0.93], p=<0.001). Conclusions: Understanding the underlying factors associated with ART readiness among young people can inform strategiesto support and increase individuals’ readiness to initiate ART and early engagement in care. Keywords: Antiretroviral therapy Readiness; Young people; Sub-Saharan Africa.

Introduction: To practice adequate Infection Prevention and Control (IPC) measures, health professional students need to have adequate knowledge of IPC. In this study, we assessed the knowledge of health professional students at Makerere University College of Health Sciences on Infection Prevention and Control. Methods: We conducted a cross-sectional online survey among health professional students studying at Makerere University College of Health Sciences located in Kampala, Uganda. An adapted questionnaire was used to measure knowledge on Infection Prevention and Control among students. Results: A total of 202 health professional students were included in the study. The mean age was 24.43 years. Majority were male 63.37% (n = 128), from the school of medicine 70.79% (n = 143) and used one source of information for IPC 49.50% (n = 100). Being in year three (Adjusted coefficient, 6.08; 95% CI, 2.04–10.13; p-value = 0.003), year four (Adjusted coefficient, 10.87; 95% CI, 6.91–14.84; p < 0.001) and year five (Adjusted coefficient, 8.61; 95% CI, 4.45–12.78; p < 0.001) were associated with a higher mean in total percentage score of knowledge on IPC compared to being in year one. Conclusion: IPC knowledge was good among health professional students in Makerere University although more emphasis is needed to improve on their IPC knowledge in various sections like hand hygiene. Infection Prevention and Control courses can be taught to these students starting from their first year of university education.