Mak IR Repository (Makerere University)
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Birth preparedness and complications' readiness among mothers attending the antenatal care clinic at Katakwi General Hospital, Eastern Uganda
No full textDissertation submitted to School of Graduate Studies in partial fulfillment for the award of Master of Medicine in Family Medicine and Community practice of Makerere University.Introduction: Birth preparedness and complications readiness is an essential component of the antenatal care that is intended to reduce delays by the pregnant mothers to access skilled care for birth and related complications. The levels of birth preparedness and complications’ readiness have been noted to be low especially in Sub Saharan Africa and Uganda in particular. No known studies have assessed the levels of practices and the determinants of birth preparedness and complications’ readiness in Katakwi. Objective: To establish the levels and the determinants of BPCR among women attending the antenatal care clinic at Katakwi General Hospital, Eastern Uganda. Methods: This was a health facility based cross-sectional study. Three hundred and seventy-eight (378) pregnant mothers participated in the study. Three hundred and sixty-six (366) questionnaires were considered for analysis while 12 (3.3%)) were dropped due to errors/incompleteness. Results: The level of BPCR was not satisfactory. Mothers who were resident in urban/semi urban areas significantly had lower odds of BPCR. History of miscarriage was also significantly negatively associated with BPCR. More ANC visits were strongly associated with being birth prepared and complications ready. Conclusions. The level of practice of BPCR was low. Factors associated with BPCR were residence, ANC attendance and history of miscarriage. Recommendation: Education for mothers should be enhanced to improve on the practice levels of BPCR. Mothers with history of miscarriages and those resident in urban/semi urban settings should be given more education and counseling support to improve on their perception and practice of BPCR
Predicting suicidality in people living with HIV in Uganda: A machine learning approach
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of a Master of Science Degree in Bioinformatics of Makerere University.Background
Suicidality is a major risk factor for future suicide attempts and completed suicide. People living with HIV (PLWH) are at a higher risk of fatal suicide attempts compared to the general population due to the psychological distress associated with an HIV infection. Timely identification and referral can prevent suicide, but the stigma and discrimination associated with mental illness prevent affected persons from seeking psychiatric treatment. This study applied machine learning (ML) approaches to predict suicidality among PLWH in Uganda.
Materials and Methods
This retrospective case-control study used sociodemographic, psychological, and clinical data of 1126 study participants to predict prevalent and incident suicidality. In addition, suicidality polygenic risk scores (PRS) for a subset of 282 study participants were calculated and incorporated as an additional feature in the model. Model performance was determined using positive predictive value (PPV), sensitivity, specificity, Mathew’s correlation coefficient (MCC), and the area under the receiver operating characteristics curve (AUC).
Results
The best model for predicting suicidality among PLWH was logistic regression (LR) and it predicted prevalent suicidality with a PPV of 0.34, sensitivity of 0.68, specificity of 0.70, and MCC of 0.31. In predicting incident suicidality, model specificity increased to 0.83, but at the cost of reduced sensitivity (0.50), PPV (0.05), and MCC (0.12). Suicidality PRS were statistically significant (p=0.007) but only explained 4.2% of the phenotypic variance between cases and controls. Incorporating PRS as an additional feature resulted in a modest (26.5%) improvement in the model’s PPV.
Conclusion
We developed an explainable ML model for predicting suicidality using sociodemographic, psychosocial, and clinical data. This model can be refined and incorporated into Electronic Medical Records (EMR) to support routine suicidality screening. Suicidality PRS improves the PPV of the prediction model and with increasing availability, they will play an increasingly significant role in disease risk prediction
HIV-1 drug resistance among adults on integrase inhibitors with virologic failure at Medical Research Council, Uganda: Prevalence, associated factors and diagnostic accuracy of next generation sequencing
No full textDissertation submitted to the School of Medicine, Clinical Epidemiology Unit in partial fulfillment of the requirements for the award of Master of Science in Clinical Epidemiology and Biostatistics of Makerere universityEmerging evidence suggests a high rate of drug resistance (DR) associated with integrase strand transfer inhibitors (INSTIs) in developed countries, though there is limited information on DR during INSTI treatment in Uganda. With the increased use of INSTIs as first-line treatment, monitoring for DR using next-generation sequencing (NGS) has become essential. NGS can detect lower-frequency variants that may be missed by traditional Sanger sequencing (SS). This study assessed the diagnostic accuracy of NGS, prevalence and factors associated to DR among 175 adults living with HIV in Uganda who experienced virologic failure (VF) on INSTIs. Utilized the Illumina MiSeq platform in comparison to sanger, data were analyzed using stata v.18 and used logistic regression model at 5% level of significance. The study demonstrated that NGS achieved an overall accuracy of 100% in detecting major mutations. NGS identified INSTI DRMs in 4% (95% CI: 1.6– 8.0%) of adults at a ≥20% threshold and was able to detect both high and low-abundance variants. However, no variable was significantly associated to presence of DRMs. The study emphasizes the need for DR testing before antiretroviral therapy (ART) initiation due to the increasing use of INSTIs. It advocates for healthcare providers to adopt more sensitive diagnostic methods like NGS, and tailor antiretroviral therapies based on detailed resistance profiles to effectively manage and prevent drug-resistant HIV strains
Critical success factors, dynamic capabilities, and operational excellence for the pharmaceutical manufacturing industry in Uganda
No full textThis dissertation is submitted to the Directorate of Graduate Research and Training in partial fulfillment of the requirements for the Award of Master of Business Administration of Makerere University.This research study investigated the critical success factors, dynamic capabilities, and operational excellence within the pharmaceutical manufacturing industry in Uganda, focusing on the Greater Kampala area as a case study. This study employed a descriptive correlational research design with a sample of 248 employees from five licensed pharmaceutical manufacturing organizations in Uganda. Both qualitative and quantitative data collection methods were utilized, including self-administered questionnaires and interviews. The collected data were analyzed using SPSS (version 25).
The key findings of this study reveal that the critical success factors for the pharmaceutical manufacturing industry in Uganda include production management, financial management, and marketing management. The dynamic capabilities specific to this industry include managing opportunities, value innovation, and transformation. The operational excellence indicators include quality, cost, and time.
There is a significantly moderate positive correlation between critical success factors (r = .301**, p < .05; B = 0.786, p = 0.00) as a global variable, its constructs of financial management (B = 0.475, P = 0.001), production management (B = 0.613, p = 0,00), marketing management (B = 0.586, p = 0.000) and operational excellence. Also, a significantly moderate positive relationship exists between dynamic capabilities and operational excellence (r = .431**, p < .05) in Uganda’s pharmaceutical manufacturing sector. Moreover, the mediating effect of dynamic capabilities (β = 0.177, bootSE = 0.047, CI [0.95, 0.280]) on the relationship between critical success factors and operational excellence is significant, implying enhanced potential synergy.
The study recommends that Uganda’s pharmaceutical manufacturing industry prioritize production management by optimizing and streamlining its production processes. Pharmaceutical manufacturing companies should also focus on capturing, analyzing, and understanding market data to produce differentiated, low-cost, high-quality products. The focus should be on strategic investments and cost optimizations to improve financial performance. Moreover, pharmaceutical manufacturing companies should prioritize the potential synergy of coupling critical success factors with dynamic capabilities to drive operational excellence in Uganda’s dynamic pharmaceutical manufacturing industry
Incidence and immediate outcomes of in-hospital cardiac arrest in Healthcare institutions on the Mulago hill
No full textA dissertation submitted to the directorate of research and graduate training in partial fulfillment of the requirements for the award of the degree of Master of Medicine in Anesthesia and Critical Care of Makerere UniversityBackground: In-hospital cardiac arrest (IHCA) is an acute event that can occur to any hospitalized patient. It is associated with high morbidity and mortality and constitutes a significant healthcare burden worldwide. Despite advances in the understanding of its causes and management, outcomes of IHCA remain poor. Traditionally, IHCA has been viewed as a condition with such poor outcomes that resuscitation may not even be warranted. Most of the literature on IHCA is from developed countries. Data on IHCA in Uganda dates back to nearly a decade ago. Method: This prospective observational study recruited 385 inpatients who suffered a cardiac arrest from any of the four tertiary healthcare institutions on the Mulago Hill over 3 months. Approval was sought from the School of Medicine Research & Ethics Committee (SOMREC) and hospital Research & Ethics Committees. Pretested questionnaires were used for data collection. An exit interview with study unit heads was used to assess hospital systems for the prevention and management of IHCA. Data analysis was done using Stata software. Data was reported as frequencies, means (±SD), and medians (±IQR) and presented in tables, figures, charts, and graphs. Results: The incidence of IHCA was 19.7 per 1000 admissions with most (N = 242, 62.9%) of the cardiac arrest occurring in the general patient admission wards. All the cardiac arrests in this study were witnessed. A significant majority (N = 315, 81.8%) of the participants received cardiopulmonary resuscitation (CPR) and there was a return of spontaneous circulation (ROSC) in 85 (27.0%) of the participants following the index cardiac arrest. Of the participants who got ROSC, 61 (71.8%) were alive at 24 hours post the index cardiac arrest. However, the overall 24-hour mortality from this study was 84.2%. Conclusion: There is a high incidence of IHCA in our setting. Many of the victims receive CPR but the 24-hour outcome is still poor
Outcomes of birth asphyxia and associated factors among newborns
No full textA research dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of Master of Nursing (Midwifery and Women’s Health) Degree of Makerere University.Birth asphyxia is a serious clinical problem that is associated with life-threatening complication like Hypoxic Ischemic Encephalopathy (HIE). Hypoxic Ischemic Encephalopathy carries high case fatality rates ranging between 10–60%, with 25% of survivors getting an adverse long-term neurodevelopment outcome. In Uganda, birth asphyxia has been the leading cause of neonatal deaths over the past three years at an average of 48% with the Bugisu region having the highest neonatal death rates of 55.6% as compared to the other 14 regions of the country. Despite the above, data are scarce regarding the immediate outcomes and associated factors in most developing countries, including Uganda. Therefore, this study aimed to describe the immediate outcomes of birth asphyxia and determine the factors associated with adverse outcomes among newborns admitted to the Special Care Unit (SCU) at Mbale Regional Referral Hospital (MRRH) during the first 24 hours of life.
Methodology: A longitudinal prospective study was conducted on 286 newborns/mother pairs with birth asphyxia in the first 24 hours of birth admitted to SCU MRRH. We used a consecutive Sampling method to recruit our study participants and data were collected using a structured questionnaire, mother’s maternity records, pulse oximetry, Thomson scoring sheet, and participants records were used to measure the outcome variables. The data were analyzed using STATA version 15. Bivariate analysis by cross-tabulation using a Chi-square test was used to determine the existence of the association of the maternal social demographic and newborn characteristics with HIE. A binary logistic regression model was performed at a multivariable level reporting odds ratios of 95% confidence intervals. The factors with an adjusted Odds ratio of greater than one and a P-value of < 0.05 were considered statistically significant. Results: The incidence of HIE was 70.3% at admission, 45.1% at 12 hours, and 24.6% at 24 hours (AOR 5.1, CI 1.8-15.0, P<0.003) respectively. A total of 4.6% died at admission, 4.4%in 12 hours and 1.2% in 24 hours. Accordingly, HIE, deaths were significantly associated with a referral from lower health facilities (AOR 4.2, CI 1.7-10.0, P<0.001), meconium-stained liquor (AOR 2.2, CI 1.2-4.1, P<0.014) and newborns who were resuscitated at 95% CI . Conclusion: The burden of Hypoxic Ischemic Encephalopathy and mortality was high among newborns with BA in our study and a majority had HIE at admission and decreased over time. We found a significant association between HIE and meconium-stained amniotic fluid, newborns referred from peripheral facilities, newborns resuscitated using a bag and mask, and those delayed to breastfeed. It is important to pay close attention to these factors while managing a laboring mother and newborns as this may alter the course and modify the risk of HIE. It is imperative, therefore to optimize the response to emergencies as this may succeed in minimizing the incidence of HIE. Keywords: birth asphyxia, hypoxic ischemic encephalopathy, newborn and factors
Effectiveness of video in agricultural extension training : the case of ZOA piggery extension video in Arua district
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of the Degree of Master of Science in Agricultural Extension Education of Makerere University.This study explored the effectiveness of video-based extension to complement face-to-face extension and identify ways of improving it. The effectiveness of video-based extension in reducing the knowledge gap was assessed based on both sex and their levels of education. The objectives were: to determine the perception of piggery farmers towards the quality of the video in the pig extension video (PEV) group and to compare the level of knowledge gained on pig production management practices in the PEV with the face-to-face extension (FFE) group. A quasi-experimental pre-test and post-test design with two non-equivalent groups was used to assess the effectiveness of pig video-based extension (PEV) and face-to-face extension (FFE). Data were collected from 66 respondents using questionnaires. Quantitative data were analysed using SPSS version 20 for descriptive statistics of percentages, frequencies, and means. The results showed that video-based extension has a positive influence on farmers' perception. Knowledge gain in terms of the percentage of correct responses to knowledge-based questions was high with an average of 53% for the respondents in the PEV group versus an average score of 23% for the FFE group. The male respondents had a slightly higher percentage of correct responses than the female respondents for most of the test items before and after the pig video exposure. Respondents with secondary education levels and above had a slightly higher percentage of correct responses before and after video-based extension training than the respondents with primary education levels for most of the test questions. There was an improvement in correct responses for most of the test questions after extension exposure, regardless of sex and education level. Incorporating gender and education analysis into the development and promotion of agricultural training videos acknowledges the diverse needs and capacities of the target audience, thereby enhancing the overall effectiveness and impact of the training program. It was concluded that pig video-based extension was effective for influencing positive attitudes and knowledge gain of farmers if used in agricultural extension. Therefore, the video-based extension should be integrated into the dominant face-to-face extension as an effective agricultural extension approach to address the limited extension-agent-to-farmers ratio challenges
Investigating the effects of land use and land cover changes and BMPS scenarios on water balance and sediment yield of the Nakivubo channel micro-catchment in Uganda
No full textA thesis submitted to the Directorate of Research and Graduate Training in partial fulfilments for the award of the degree of Master of Science in Agricultural Engineering of Makerere UniversityThe increasing demand for freshwater resources due to the growing population requires information on the effects of land use and land cover (LULC) changes on blue and green water resources. This study aimed at investigating the effects of LULC changes and BMPs scenarios on water balance and sediment yield in the Nakivubo micro-catchment of the inner Murchison Bay catchment in Uganda. LULC change analysis between 2005 and 2040 was done by ArcGIS software and the cellular automata Markov model. The Soil and Water Assessment Tool (SWAT) was used to simulate the components of the water balance equation. Results showed that between 2005 and 2040, built-up land and water bodies increased by 1,010 Ha and 60 Ha respectively. Bare land, wetland, and agricultural land declined from 343 Ha to 322 Ha, 85 ha to 7Ha and 1864 Ha to 657 Ha respectively in the same period. Model performance evaluation produced R2 of 0.74, NSE of 0.72 and PBIAS of -0.05 for calibration and R2 of 0.68, NSE of 0.75 and PBIAS of 2.35 for validation. Water flows in 2005 and 2040 were 1096.5 mm and 1278.9 mm respectively, whereas Evapotranspiration plus soil moisture flows were 2482.5 mm and 2522.5 mm in the same period respectively. Surface runoff increased from 207.6 mm to 698.1 mm between 2005 and 2040 and total sediment loading from 5.8 ton ha-1 year-1 to 12.4 ton ha-1 year-1 between 2005 and 2040. Catchment management scenarios reduced sediment load and surface runoff by 79% and 68% respectively. Therefore, the information on the effects of LULC changes and BMPs application on the water balance and sediment yield will be used in global and national water planning and management of water resources for a sustainable catchment
Prevalence and factors associated with premarital sickle cell screening among couples at the different religious institutions in Kampala District: a cross-sectional study.
No full textA dissertation submitted to Makerere University College of Health Sciences in partial fulfillment of the requirements for the award of a Degree of Masters of Science in Clinical epidemiology and biostatistics.Introduction: Premarital screening provides an opportunity for intending couples to know their phenotype or genotype and be aware of the risk of having children with genetic diseases like sickle cell disease (SCD) and adopt rational preventive measures.
Objectives of the study: To determine the prevalence and factors associated with premarital sickle cell screening (PMSCS) among couples at the different religious institutions in Kampala district.
Methods: A cross-sectional study was conducted that comprised 246 couples (492 participants) at the different religious institutions in Kampala district. The religious institutions were selected from each of Uganda's 6 main domains, including Anglican, Catholic, Muslim, Adventist, Orthodox and Pentecostal. Questionnaires were used to collect the data from the couples. The data was entered into the Epidata manager and exported to STATA for further analysis. The outcome of interest was testing together for sickle cell trait (SCT) denoted with a “Yes” or “No”. Logistic regression was used to analyze the data and to assess the association of the independent variables with PMSCS while adjusting for clustering at religion and place of worship.
Results: PMSCS prevalence among couples at different religious institutions was 14.6% (95% CI 7.3 - 26.4). Having been in marriage counselling sessions for more than 3 months (aOR - 3.8, 95% CI 2.3 – 6.3) and assumed the cost of SCD test below 50000shs (aOR - 3.3, 95% CI 1.4 – 7.6) and above 50000shs (aOR – 2.0, 95% CI 0.8 – 2.3) were significantly associated with PMSCS among couples at the different religious institutions in Kampala district.
Conclusion: The PMSCS prevalence was found in only about one in every 7 couples which is low compared to what the Ministry of Health (MoH) encourages of every couple screening before marriage. The more time couples spent in marriage counseling sessions and the lower cost of the SCT test were positively associated with PMSCS. The National Disease Control Department under MoH should work hand in hand with different religious institutions to integrate sickle cell screening (SCS) services earlier in couples before they can plan on marriage
Financial performance, firm specific factors and dividend policies: a case of firms listed on Uganda securities exchange
No full textA dissertation submitted to the College of Business and Management Sciences in partial fulfillment of the requirements for the award of Degree of Master of Business Administration of Makerere UniversityThe purpose of this study is to investigate the impact of firm financial performance and firm specific factors to dividend policy on companies listed on the Uganda Securities Exchange from 2017 to 2021. The study was guided by two objectives; to establish the relationship between financial performance and dividend policies and to evaluate the moderating role of the firm specific factors on the relationship between financial performance and dividend policies. Purposive sampling was utilized, and there are 16 companies represented in the sample. Purposive sampling was used to pick the samples, and those that satisfied the requirements were sixteen firms that were consistently featured in USE (not delisted and relisted) between 2017 and 2021. Profitability, Liquidity, and Leverage were used as proxies for financial performance. Likewise, the Dividend Payout Ratio and Dividend Yield served as a proxies for dividend policy. In this quantitative research, the panel data regression approach was applied and the formulated hypotheses were tested using t-statistics in order to evaluate partial regression coefficients. F-statistics were also analyzed in order to examine feasibility of research models with a level of significance of 5%. A classical assumption test, which contains the normality test, multi-collinearity test, heteroscedasticity test, and autocorrelation test, was conducted. The analysis results reveal that the Profitability has significant influence on dividend policy ratios whereas financial leverage and liquidity have a positive but non-significant influence on dividend policy. Additionally, firm specific factors were found to have a significant moderating effect between financial performance and dividend policy. These results suggest that the company's liquidity position and leverage are not taken into consideration when deciding how much dividends to distribute to investors or when establishing the dividend polic