Mak IR Repository (Makerere University)
Not a member yet
9127 research outputs found
Sort by
Comparison of logistic, log binomial and modified poisson regression models in identifying factors associated with early marital union in Uganda
No full textA dissertation submitted to the Department of Epidemiology and Biostatistics, School of Public Health in Partial fulfillment of the requirements for the award of Master of Biostatistics of Makerere UniversityIntroduction: Early marital union, defined as marriage under the age of 18, affects 33,000 lives globally each day, with 43% of Ugandan women aged 25-49 experiencing it. This study aimed to compare how well ordinary logistic, log-binomial, and modified poison regression models fit the same data in identifying factors associated with early marital unions in Uganda.
Objectives:
To assess the performance of three binary statistical models and use the best model to identify the factors associated with early marital unions in Uganda.
Methodology: Using UDHS-2016 data on a weighted sample of 13,768 ever-married women, the study assessed model performance based on metrics such as AIC, AUC, negative log-likelihood, variance, and Wald chi-square in R-software. The outcome variable was binary, signifying whether a respondent got married before turning eighteen years (coded as 1) or not (coded as 0).
Results:
The logistic model exhibited the lowest AIC, highest AUC, and lowest Log likelihood, while modified Poisson had the smallest variance. Multivariable multilevel logistic regression revealed that women with secondary or higher education had a 63% decreased odds of early marital unions (AOR=0.37, 95% CI: 0.3, 0.4) as compared to those with no formal education. Other associated factors included age at first sex (AOR= 0.05, 95% CI: 0.08, 0.1), internet use (AOR=0.61, 95% CI: 0.5, 0.8), region (AOR= 0.87, 95% CI: 0.8, 1.0), source of drinking water (AOR= 1.22, 95% CI: 1.1, 1.4 & AOR =1.21, 95% CI: 1.0, 1.5), and recent sexual activity (AOR= 1.14, 95% CI: 1.05, 1.24).
Conclusion:
Although logistic regression model was a superior fit, Modified Poisson model provided precise estimates. Early marital unions were significantly reduced among educated women. Recommendations include prioritizing education beyond primary school for girls, promoting responsible internet use, and implementing region-specific interventions addressing socio-cultural and economic factors contributing to early marriages in Uganda
Viability of using Broadband over Power Lines to provide Broadband Internet to rural schools
No full textA dissertation submitted to the graduate school in partial fulfillment for the award of the degree of Master of Science in telecommunication engineering of Makerere University.The Uganda Vision 2040 identifies Information and Communications Technology (ICT) as a tool to spur Uganda’s transformation into a modern and prosperous country. According to NDP III, ICT services across the country are still low due to limited ICT infrastructure footprint and high cost of services. The limited infrastructure footprint is mainly in the last mile section in rural areas. ICT services need to penetrate both urban and rural communities to a level where every citizen anywhere in the country can access them reliably. The last mile section is the most expensive part of an ICT network, therefore having a cheap last mile solution makes roll-out of infrastructure easier and cost of services to end users cheaper. Last mile connectivity through use of Broadband over Power Lines (BPL) technology to every home, takes the ICT transformation to every family, urban or rural. Although electricity has not yet reached every home in Uganda it still has penetrated communities more than fixed Internet infrastructure. This research proposes the use of BPL to provide cheap last mile connectivity to rural areas with special emphasis on rural schools. The low Internet penetration level in Uganda’s rural schools denies many learners access to digital educational opportunities and educational resources. This low Internet penetration means that learners and teachers in most of these schools will not be able to access and use the available online digital educational resources to enhance teaching and learning processes. This has led to digital exclusion in the rural learning environment. BPL is a method of power line communication that allows high-speed data transmission over the public electric power distribution wiring without addition of new cables. BPL can deliver voice, data and video services to many areas that conventional ICT infrastructure cannot reach due to both physical and economic constraints. The advantages of using BPL are wide coverage and cost. However, despite the benefits of
using BPL, there are certain challenges like signal attenuation, bit errors due to impulsive noise and interference caused by BPL to wireless users in the 2 MHz to 30 MHz bands. This research was done in Nakaseke District. It characterized impulsive noise in indoor BPL circuits in selected rural schools, developed an attenuation profile of BPL circuits on low voltage grids connecting selected rural schools and came up with a model to guide on deployment of last mile technologies in rural areas. The research concluded that BPL is a viable option for last mile Internet connectivity to schools under certain conditions
Cerebral dominace and side of stroke among patients attending Neuro-Clinics in Uganda: A cross sectional study of Mulago and Kirudu National Referral Hospitals
No full textA research dissertation submitted to the department of anatomy in partial fulfillment of the requirements for the award of Masters of Science in Human Anatomy Makerere University.Introduction: Non-dominant hemispheric strokes have been associated with more severe stroke, longer recovery time and much slower return of functional activity compared to the dominant side. During activity Functional MRI studies have demonstrated increased blood supply to the dominant cerebral hemisphere compared to the non-dominant. Comparatively the dominant cerebral hemisphere is exponentially active in activities of daily life perhaps yielding vascular adaptability, plasticity that could be protective against stroke. Modifying or enhancing non dominant handedness could be used in preventing stroke or reducing its severity. Objectives. To establish the relationship between cerebral dominance (handedness) and side affected by stroke among stroke patients attending Mulago and Kiruddu national referral hospitals in Uganda Methodology: This was a cross sectional study involving 128 stroke patients aged 18years and above attending neuro clinics and wards at Mulago and Kiruddu National Referral Hospitals and had provided written informed consent. Unconscious patients, those with TIAs and stroke resulting from non-vascular causes were excluded from the study. Data sources included researcher assisted questionnaires, modified Edinburgh handedness assessment tool and radiological investigation of brain CT- scan. Data was entered in Excel and exported to STATA for analysis. Odds ratios were used to determine the association between stroke and side affected by stroke. p values <0.005 were considered statistically significant. Results A total of 133 adult patients were enrolled in this study. Out of the 133 participants, 77 participants (57.9%) were females and the mean was 59.9 (S.D 1.29) years. Most of the participants (60.9%) reported no history of routine exercises. Majority of the participants (93.94%) were hypertensive were while only 18.9 were suffering from diabetes mellitus. 124 (93.23%) were right handed/ left cerebral dominant and 9 (6.77%) were left handed/right cerebral dominant. The middle cerebral artery was the most prevalent artery affected by stroke (93.24%). Majority of the participants (74.4%) presented with ischemic stroke. There was a significant association between side of stroke and the non-dominant cerebral hemisphere or handedness (p=0.001). Conclusion Side affected by Stroke is related to the non-dominant side/ cerebral hemisphere in Uganda. Affirmative exercises and activities of daily living for the non-dominant laterality needs to be encouraged in individuals at risk for developing stroke in UgandaNational Institute of Neurological Disorders and Stroke (NINDS) Grant Number R01NS11854
Lubogo's law: the power of adaptive resilience
No full textBookLubogo's Law explores the concept of Adaptive Resilience, which involves developing the capacity to navigate and thrive in the face of constant change and uncertainty. This book will provide readers with practical strategies and mind set shifts to cultivate Adaptive Resilience, enabling them to stay ahead of the curve and turn challenges into opportunities. Book Overview: Lubogo's Law the Power of Adaptive Resilience in Uganda In a rapidly evolving world marked by unforeseen challenges, economic instability, political shifts, and technological revolutions, the ability to adapt and remain resilient has become an essential skill for survival and success. Lubogo's Law: The Power of Adaptive Resilience in Uganda delves deep into this critical life skill, offering readers a comprehensive guide on how to thrive amidst uncertainty and turn adversities into opportunities for growth. At its core, the book explores the concept of Adaptive Resilience, which goes beyond traditional notions of endurance and persistence. Adaptive Resilience is the dynamic capacity to adjust one’s mindset, strategies, and actions to continuously changing circumstances. Unlike conventional resilience that often focuses on bouncing back to a previous state after adversity, Adaptive Resilience emphasizes bouncing forward—adapting to new realities, learning from challenges, and leveraging them as opportunities for growth and innovation
Development of an Application Programming Interface for an Integrated Health Management Information System. A Case Study at CoRSU Hospital
No full textBackground
Health facilities in Uganda have adopted health information systems most of which are disjointed and operate in silos within areas of limited resource settings. Inline to this is delayed provision of complete, accurate and timely patient data across health facilities. This has brought about delay in analysis, retrieval and sharing of data for use in treatment interventions and other related hospital activities.
Purpose
The purpose of this study was to develop an API for an integrated health management information system.
Methodology
The study was conducted at CoRSU hospital, and adopted design science research methodology (DSRM). Purposive sampling technique was adopted during selection of interviewees, based on well informed and available staff among doctors, nurses and administrators at CoRSU. Key Informant Interviews (KII) were used for data collection. The study enrolled 7 participants to conduct key informant interviews (KII); 4 were females and 3 were males. All the participants had formal education and majority had between 6-10 years of job experience.
Result
Data management and analysis was based on transcribed verbatim and major themes identified. The identified themes included; systems used at CoRSU hospital, effectiveness of current systems, system challenges, existing solutions and suggested solutions. This guided identification of requirements then the designing and development of the API for an integrated health management information system.
Conclusion
The development of an API integrating a patient management system (PMS) and image management system (IMS) represents an easy-to-use modular component providing for a bridge between the medical imaging solutions and healthcare information networks. This is aimed at providing complete, accurate and timely patient data for improved healthcare service delivery
Diagnostic accuracy of anti-mycobacterial protein 51 antibodies as a biomarker for latent TB infection in asymptomatic HIV positive individuals
No full textA dissertation submitted to the Department of Immunology and Microbiology as partial fulfillment for the award of Master's Degree in Clinical Immunology and Microbiology of Makerere University.Background: Tuberculosis (TB) continues to be a major global public health concern more so in sub-Saharan Africa and Uganda in particular due to inaccessibility to accurate, rapid and reliable diagnostic methods on top of the increased TB drug resistance. Tuberculin Skin Test (TST) and Interferon Gamma Release Assay (IGRA) the currently available diagnostic methods for latent TB still have challenges in regards to low sensitivities and poor predictive values for progression to active disease. The main goal of this investigation was to evaluate the diagnostic utility of anti-MPT51 antibodies as a biomarker for latent TB among asymptomatic HIV positive individuals.
Methods: This was a cross-sectional study. Blood was collected from asymptomatic HIV positive individuals and plasma was obtained from these blood samples. ELISA was done to assess anti MPT51 antibody positivity. To determine diagnostic performance of the anti- MPT51 antibodies versus IGRA, QuantiFERON-TB Gold Plus was performed on the same participants’ blood. Data was recorded in an excel sheet, then exported to SPSS and tables. A 2 by 2 table was used to calculate sensitivity, specificity, positive and negative predictive values of anti -MPT51 antibodies against QuantiFERON-TB Gold Plus at 95% confidence interval. The univariate and multivariate logistic regression analysis was used to determine factors associated with antibody positivity.
Results: Considering QuantiFERON-TB Gold Plus as the gold standard, antibody reactivity to MPT51 revealed sensitivity of 32.6% (95% CI 24.5-40.6), specificity of 56.1% (95% CI 47.6-64.6), positive predictive value of 61.7% (95% CI 53.4-70.1) and negative predictive value of 27.7% (95% CI 20-35.4). Among the factors tested, none was independently associated with an increased risk of antibody reactivity against MPT51.
Conclusion: These results indicate that antibody reactivity against MPT51 could be a marker for M. tb infection in HIV positive individuals prior to the development of disease. If validated by larger studies with prospectively collected samples, these findings could lead to the development of screening tests identifying those M. tb-infected HIV positive individuals that are at risk for developing disease, which in turn could lead to early therapeutic interventions.MITHU, Case Western Reserve University
Characterizing change in cough frequency and associated factors among patients with pulmonary tuberculosis using HYFE App in Kampala- Uganda
No full textDissertation submitted to the School of Medicine, Clinical Epidemiology unit in partial fulfillment of the requirement for the Award of Masters of Science in Clinical Epidemiology and Biostatistics of Makerere University.Background: The most important means of pulmonary tuberculosis transmission is cough, which invariably results from an inflammatory reaction to pulmonary mycobacterial infection. A noticeable decrease in coughing is presumptively assumed as an indicative sign to adequate response to TB therapy and this lowers risks of increased transmission. Determining cough frequency is important in assessing severity of disease, evaluating infectiousness, and predicting patient outcomes. The study aimed to characterize change in cough frequency and associated factors among patients with confirmed pulmonary tuberculosis using Hyfe application which identifies the explosive sounds that might be coughs. Then these sounds are analyzed and, once confirmed as coughs, they are recorded on dashboard. Methods: A longitudinal retrospective study was conducted with both descriptive and analytical components among 100 participants’ from R2D2-Study that recruited over 120 newly diagnosed pulmonary tuberculosis (PTB) patients whose coughs were recorded using the Hyfe Application between Sept 2021 and Dec 2022 at Mulago national referral hospital and Kisenyi health center IV study sites. An abstraction tool was used in data collection. Time effect analysis was done and observed changes with effect of time on cough frequency were identified. Using R ‘glmmTMB’ package analysis, a random coefficient poisson mixed-effects model with robust standard errors was used to determine independent predictors of cough frequency.Results: The majority of the participants were aged 18-39 (71%, n=71) years with more than half being male (55%, n=51). There was a 90% reduction in the rate of coughs at day 14 compared to day1. BMI-underweight (IRR=0.32, 95% CI 0.13-0.92), BMI-overweight (IRR=0.07, 95% CI 0.01-0.39), interaction between time and diabetes (IRR=0.66, 95% CI 0.45-0.97), and sex interaction with BMI-overweight (IRR=3.68, 95% CI 1.36-9.98) were found to be associated with cough frequency. Conclusion: The significant reduction in cough rates over time highlights the potential improvement of the body's immune response since the participants were on treatment, hence reduce inflammation and cough symptoms. Key associations (BMI, Sex*BMI-overweight and Time*Diabetes) with cough frequency emphasize the importance of considering these factors in clinical management and health educating the public about how key associations influence cough frequency, highlighting the need to maintain a healthy weight and manage diabetes properly.R2D2-Study staff
Expenditure management in Uganda Broadcasting Corporation (UBC)
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of the degree of Master of Business Administration of Makerere University.This work had three specific objectives namely, assessing the effectiveness of expenditure management in UBC, identifying the challenges of expenditure management, and to propose mechanisms for improving expenditure management. The study employed cross sectional research design and as such, data were collected once without repeat. A quantitative approach employing questionnaires to collect data was employed. A total of 269 questionnaires were dispatched and a response rate of 91.8% was realised. SPSS system was used to aid the analysis. The results show that expenditure management in UBC was ineffective. The said state of affairs was mainly demonstrated by the poor scores in such aspects as, poor estimation of expenses with accuracy, poor projecting expenses per job/project, the variation between the actual and the projected expenses, and how UBC performance in expenditure management as compared with related institutions. In respect to the challenges, it was noted that UBC faced challenges including, wastage, poor services, acts of negligence, ethical lapses, and weak control system. Finally, in terms of the mechanisms that can be employed to promote expenditure management, UBC ought to; employ new smart expense management system, hire competent employees, and offer incentives to employees of the departments that perform well in terms of expense management
Cerebrospinal fluid mononuclear cell profiling among patients with HIV associated cryptococcal meningitis: Immunological predictors of early mortality and 1 year survival
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment for the award of Master of Medicine in Internal Medicine of Makerere University.Introduction: Despite the introduction of new treatment strategies for the induction phase of HIV-associated cryptococcal meningitis (CM), the 2-week mortality continues to be unacceptably high and at 1 year more than half are reported dead. The strategic framework for ending CM deaths set a goal of reducing deaths from CM by 90% by 2030. Examining host-pathogen interactions to identify cellular biomarkers in patients at high risk of death after diagnosis of CM could lay the foundation for interventions to reduce mortality from HIV-associated CM and lay the groundwork for future therapeutic targets and treatment strategies.
Objectives: To compare the cerebrospinal fluid (CSF) cellular phenotype and activation among CM patients who died within two weeks, and to describe the changes in CSF characteristics and immune profile from baseline to 1 year after CM diagnosis and treatment among survivors.
Methods: This was a prospective cohort study nested within a parent study with a nested case-control study. In the case-control study, the CSF cellular immune profile associated with early mortality was determined. Thawed CSF cell pellets and supernatant were processed and analyzed to determine the immunophenotype and activation of CSF T lymphocytes (CD4+, CD8+), monocytes (CD+14), and natural killer cells (CD56+) using polychromatic flow cytometry and quantitative CSF cryptococcal antigen (CrAg) titer using CrAg lateral flow assay respectively. Statistical analysis was performed using Mann Whitney U test, logistical regression and Wilcoxon signed rank sum test where appropriate with a P value <0.05 being considered as significant.
Results: Sixty CSF samples from 39 participants were used in this study. At CM diagnosis, participants who died within 2 weeks significantly had low absolute CSF CD8+ T cell and CD14+ monocyte counts, increased expression of PD-1 on all CSF mononuclear cells i.e., CD8+ and CD4+ T cells, CD14+ monocytes, and CD56+ natural killer cells at the time of CM diagnosis compared to survivors. Likewise, the CSF CD14+ monocytes among those who died expressed less HLA-DR+ and more CD163+ compared to those who survived beyond 2 weeks. There was a significant improvement in the CSF opening pressure, protein, lactate, and glucose among the CM survivors at 1 year compared to CM diagnosis. We also noted a significant reduction in the median CSF CrAg titer from 1:2560 at baseline to 1:5 at 1 year (p <0.0001). The median reduction in CSF CrAg dilutions was 8.0 (IQR= 5.0-9.0) with 8 of 21 participants (38.1%) having a negative CSF CrAg test at 1 year. Similarly, there was a significant reduction in the HLA-DR+ on CD4+ and CD8+ T lymphocytes, CD163+ expression on CD14+ monocytes, and CD57+ expression on NK cells at 1 year compared to baseline among CM survivors.
Conclusion: In addition to the known clinical risk factors, a low CD8+T cell count, abundance of alternatively activated macrophages and immune exhaustion of CSF mononuclear cells may contribute to the early mortality seen among patients with CM. There is a need for adjunctive immune therapy in addition to the current standard of care among CM patients with poor CSF immunological profile. After 1 year of CM treatment, 62% of participants still had a positive CSF CrAg and the CSF mononuclear cells that had previously been activated returned to a deactivated state. More studies are needed to explore the mechanisms as to why some CM patients have their CSF CrAg convert at 1 year and others do not.National institute of neurological disorders and stroke under the Improving diagnostics and neurocognitive outcomes in HIV/AIDS related meningitis study. Project number 5R01NS086312-0
Analysis of capital adequacy in commercial banks: a case study of Guaranty Trust Bank Uganda Limited
No full textA research report submitted to the College of Business and Management Sciences in partial fulfillment of the requirements for the award of a degree of Master of Business Administration of Makerere UniversityThis study analyzed capital adequacy in Guaranty Trust Bank (GTBank) Uganda, which transitioned to a credit institution by the end of the 2023/2024 financial year. It focused on three objectives: (1) evaluating GTBank’s capital adequacy ratio before and after the transition, (2) assessing the effectiveness of its capital management practices in complying with evolving regulations, and (3) examining challenges and opportunities in maintaining capital adequacy during the transition.
A mixed-methods approach was used, combining quantitative and qualitative data. The sample size consisted of 40 purposively selected respondents, including GTBank management, regulators, and department heads. Data were collected through questionnaires and interviews, with quantitative data analyzed using SPSS and qualitative data interpreted through narrative techniques. The study ensured validity via peer review and reliability through methodological triangulation.
Findings revealed that GTBank’s capital adequacy ratio improved significantly post-transition, driven by enhanced capital management strategies and stronger regulatory compliance. However, challenges such as macroeconomic fluctuations, rising compliance costs, liquidity constraints, and increased regulatory burdens hindered the bank's ability to maintain capital adequacy while pursuing growth. The study also identified opportunities for improved risk mitigation and access to capital markets, although GTBank's conservative approach may limit growth potential.
Key recommendations include improving GTBank’s capital management, enhancing collaboration with the Bank of Uganda, engaging investors on capital adequacy issues, and conducting future research on comparative capital adequacy practices. The study emphasizes the importance of effective capital management and regulatory adherence in ensuring the financial stability of banks like GTBank.
A mixed-methods approach was adopted, involving quantitative and qualitative approach, employing a descriptive research design to delve into the multifaceted dimensions of capital adequacy in commercial banks. The study employed a sample size of 40 respondents purposively selected, including executive and senior management team, financial controllers, regulators from Bank of Uganda, branch heads, members from the audit, risk, compliance and credit departments of GTBank. Data collection methods included closed-ended questionnaires and semi-structured interviews. Quantitative data were analyzed using SPSS (v20-64bit), applying descriptive statistics to assess the capital adequacy ratio and compliance management practices. Qualitative data were analyzed using Polkinghorne’s (1995) two-tier approach, incorporating narrative analysis and analysis of narrative techniques, to interpret interview responses and complement the quantitative findings. The validity of the findings was ensured through peer review, while reliability was achieved via methodological triangulation.
The study findings indicate that GTBank's CAR showed a significant improvement post-transition, reflecting enhanced capital management strategies and stronger alignment with regulatory requirements. Stakeholders reported greater confidence in the bank's financial health due to these advancements. Despite these improvements, the transition presented significant challenges including, macroeconomic fluctuations and rising compliance costs, liquidity constraints and increased regulatory burdens which strained the bank's ability to maintain adequate capital levels while pursuing growth opportunities. Additionally, the research highlighted that GTBank's conservative approach to capital management, while ensuring regulatory compliance, may limit aggressive growth strategies. Opportunities identified during the transition include enhanced risk mitigation strategies and the potential for better access to capital markets.
Recommendations highlight the need for GTBank management to improve capital management and risk assessment, while the Bank of Uganda should provide clear guidelines and foster collaboration. Investors should engage with management on capital adequacy, and researchers should conduct longitudinal studies and comparative analyses. The banking sector should advocate for standardization, innovate, and monitor economic conditions for effective capital management. The research recommends future research should compare capital adequacy practices across banks, conduct longitudinal studies on GTBank's capital trends, explore stakeholder views, assess macroeconomic and regulatory impacts, and examine the role of technology in enhancing capital management.
Conclusively, this research underscores the critical importance of effective capital management and regulatory adherence in sustaining financial stability for commercial banks like GTBank. The insights gained provide valuable recommendations for refining capital adequacy practices, ensuring that GTBank not only meets current regulatory standards but also capitalizes on growth opportunities in a competitive banking environment