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Adult patients with cancer in Uganda : validation of the tool, health-related quality of life, and patient experiences
No full textA thesis submitted to the Directorate of Research and Graduate Training in fulfillment of the requirements for the award of the Doctor of Philosophy Degree of Makerere University.Background: This study aimed to assess the validity and reliability of the Luganda version of the tool used to measure health-related quality of life (HRQoL), specifically the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The study sought to investigate the prevalence of poor HRQoL concerning clinical and sociodemographic characteristics and to describe the experiences of adult cancer patients undergoing treatment at a specialized cancer facility in Uganda. Methods: A sequential explanatory multi-method study was conducted at the Uganda Cancer Institute among adult patients with various types and stages of cancer. Clinical and sociodemographic information was collected using study-specific items and patients' medical records. Sub-study 1: Tool validation evaluated the reliability and validity (including construct, known group, and criterion validity) of the Luganda and English versions of the EORTC QLQ-C30 instrument. Sub-study 2: This sub-study investigated the prevalence of and factors associated with poor health-related quality of life (HRQoL). It used predetermined validated clinical thresholds to identify patients with poor HRQoL and conducted a multivariable logistic regression analysis to determine the associated factors. Sub-study 3: This sub-study described the experiences of adult men and women receiving
treatment at a specialized cancer facility, utilizing reflexive thematic analysis. Main results: Sub-study 1. Construct validity, CFA yielded good fit indices (RMSEA = 0.08, SRMR = 0.05, and CFI = 0.93). Known-groups validity was supported by statistically significant better HRQoL among patients with early-stage compared to those in late-stage. Criterion validity: positive correlations between the Karnofsky Performance Scale and the Physical Function (0.75 - 0.76) and Global quality of life (0.59 - 0.72) for Luganda and English versions, respectively. Cognitive function did not reach acceptable Cronbach’s alpha values (Luganda α = 0.66, English α = 0.50). Sub-study 2: (68%−87%) reported functional impairment and symptoms of pain (80%) and fatigue (63%). Increasing age, no formal education, unemployment, being an inpatient, diagnosed with cervical cancer or leukemia were factors associated with poor HRQoL. Sub-study 3: Organization of care, personal challenges, mental suffering, and satisfaction with care were the themes generated. Conclusion: The validated Luganda and English versions of the EORTC QLQ- C30 appear to be a valid and reliable instrument recommended for assessing HRQOL in adult Ugandans with cancer. Most patients reported poor functioning and a significant burden of symptoms, including pain and fatigue, that warrant concern. The prevalence of poor health-related quality of life (HRQoL) is especially noticeable among older adults, those without formal education, and those who are unemployed. Furthermore, being an inpatient and having a cancer diagnosis are both linked to a lower quality of life related to health. Patients also described their penurious experiences of care, including inadequate infrastructure and resources (food, staff, and drugs), delays in accessing care, the poor health system, and high treatment costs as well as stigma, abandonment, isolation, and emotional distress. This situation calls for policymakers'’ interventions including a need to adapt and adopt the cancer pain management clinical guidelines in the Ugandan context, development of a psychosocial oncology center, and training of health professionals Policymakers are urged to update the budget for cancer care to improve the infrastructural challenges and ensure adequate resources, decentralize cancer care for easier access, and to create awareness about cancer and its treatment to reduce stigma.Uganda Cancer Institute/African Development Bank (AfDB
Prevalence and associated factors of erectile dysfunction among men attending the urology clinic at Mulago Hospital: a cross-sectional study
No full textA dissertation submitted to the department of surgery in partial fulfillment of the requirements for the award of the Degree of Master of Medicine in Surgery at Makerere University.Background: Erectile dysfunction (ED) is a significant public health concern affecting men’s quality of life and relationships. Despite its global burden, epidemiological data on ED in Uganda, particularly among men seeking care at specialized clinics, remains limited. This study was aimed at determining the prevalence and associated factors of ED among men attending the urology clinic at Mulago National Referral Hospital (Mulago Hospital). General objective: To determine the prevalence and factors associated with erectile dysfunction among men attending the urology clinic of Mulago Hospital
Methods: A cross-sectional study was conducted over three months, enrolling 384 men aged 35–60 years at the urology clinic. Data on sociodemographic characteristics, clinical history, and lifestyle factors were collected using a structured questionnaire. The Sexual Health Inventory for Men (SHIM) was used to assess ED severity. Logistic regression analysis was performed to identify factors associated with ED. Results: The prevalence of ED was 65.3% (95% CI: 60.3–69.9). Multivariate analysis showed showed significant associations between ED and age (AOR 1.023; P-value 0.05, 95% CI: 1.000–1.054), chronic alcohol use (AOR 2.690; Pvalue 0.00, 95% CI: 1.565–4.625), urethral strictures (AOR 3.874; Pvalue 0.01, 95% CI: 1.44–10.392), and lower urinary tract symptoms (AOR 2.094; Pvalue 0.01, 95% CI: 1.250–3.505). Conclusion: ED is highly prevalent among men attending urology clinic of mulago hospital. These findings highlight the need for routine ED screening, early intervention, and public health strategies to address modifiable risk factors. Keywords: Erectile dysfunction, Prevalence, associated factor
Techno-economic evaluation of probable hydrogen production technologies for iron ore reduction
No full textA dissertation submitted in partial fulfillment of the requirements for the award of a Degree of Master of Science in Mechanical Engineering of Makerere University.The annual global production of crude steel is expected to reach 2.4 billion tons by 2040, with 73% of the process employing the blast furnace and basic oxygen converter route which emits large amounts of CO2. A potential solution is to use H2 as a reducing agent. A systematic literature review conducted identified H2 production technologies including, Alkaline electrolysis (AE), proton exchange membrane (PEM), solid oxide (SOE), anion exchange membrane (AEM) electrolyses, thermolysis, photolysis, bio photolysis, photo fermentation, dark fermentation, pyrolysis, gasification, combustion, liquefication, steam methane reforming (SMR), partial oxidation (PO), auto thermal reforming (ATR), and ammonia reforming (AR). NASA's technology readiness level (TRL) scale ranking revealed SMR, AE, and PEM processes were the most mature, with TRLs of 8-9 (SMR) and 6-7 (AE and PEM). Schematic diagrams were developed using Aspen Plus®V10 software for plant output of 20 kgH2/hr. An economic analysis showed that PEM offered the lowest levelized cost of H2 (LCOH) at 4.53/kg and SMR at $2.81/kg. Furthermore, the sensitivity analysis showed that; PEM responds well to variations in material feed, operating temperature, and pressure. AE exhibited better stability across temperature changes. PEM proved the most promising due to less design complexity and the lowest LCOH
Predictors of mortality among severe traumatic brain injury patients admitted at Mulago Hospital. A retrospective cross-sectional study
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment for the award of Master of Medicine in Surgery Degree of Makerere University.Introduction
Severe traumatic brain injury (STBI) contributes significantly to death and disability especially
in low and middle income countries. However, little is known about the mortality rate and its
predictors among these patients in Uganda. Therefore, the study aimed to assess mortality rate
and its predictors among patients with STBI admitted at Mulago national referral Hospital.
Methods.Record review of patients’ charts was performed for selected patients who presented with severe TBI between January 2022 to December 2022 at Mulago national referral Hospital, Uganda. In-hospital management and mortality were recorded. Severe head injury was defined as a Glasgow Coma Scale (GCS) score of 8 and below. Results. A total of 325 patient files were reviewed of which, 245 (75.4%) were male. Median age of the
participants was 29 years. 37.5% were boda boda riders while 20.9% were alcohol users. Road
traffic accidents (76.3%) was the main cause of TBI. 44.3% of the participants were admitted
to High Dependence Unit (HDU), 23.4% to Intensive Care Unit (ICU) and 32.3% to the general
ward. Proportion of mortality of the participants with severe TBI was 35.4%. The predictors of
mortality for patients with severe TBI in this study were; admission GCS (RR=0.73, P<0.01,
95%CI=0.64-0.82), pupil size and reactivity (RR=1.31, P=0.01 95%CI=1.11-1.52) and
destination ward of the patient on admission (RR=1.49, P=0.04, 95%CI=1.31-1.59).
Conclusion.The proportion of deaths among patients with severe TBI was high. The predictors proposed by this study for this mortality were GCS less than 8, pupillary size and reactivity and final ward (disposition). Severe TBI in a resource-limited setting remains a major challenge and
affects mainly young males. Key words: Severe Traumatic brain injury, Mortality rate, predictors. Mulago National Referral hospital
Risk factors associated with cervical cancer diagnosis among women living with HIV: a modified poisson regression analysis
No full textA dissertation submitted to the Directorate of Research and Graduate Training for the award of the Degree of Master of Statistics of Makerere UniversityCervical cancer is a leading cancer among women, with approximately 570,000 new cases and 311,000 deaths annually. Women living with HIV face a sixfold higher risk of developing cervical cancer than those without HIV. However, the specific risk factors in this population remain underexplored in Uganda. The main objective was to examine factors associated with cervical cancer among women living with HIV in Kampala, Uganda. Secondary data of 307 records at the Centre registry on cervical cancer among women living with HIV, screened for cervical cancer between 1st January 2021 to 31st July 2022 were retrieved. A modified Poisson regression model was fitted to examine factors associated with cervical cancer among women living with HIV in Kampala, Uganda. The findings are reported as adjusted Risk Ratios (aRR) with the 95% Confidence Intervals (CI). The overall positivity rate for cervical cancer in this study was 11.4%. The results indicate that women living with HIV who had multiple sexual partners had a significantly higher likelihood of testing positive for cervical cancer (aRR = 1.03; 95% CI: 1.01 - 1.15) compared to those with one or no sexual partner. Similarly, women with a history of STIs other than HIV had an increased risk (aRR = 1.07; 95% CI: 1.01 - 1.13) compared to those without such a history. Notably, an interaction between multiple sexual partners and history of STIs other than HIV revealed that women with both risk factors had an even higher likelihood of screening positive (aRR = 1.16; 95% CI: 1.06 - 1.28), suggesting a compounded risk. Conversely, the risk of cervical cancer was significantly lower among women with a history of contraceptive use (aRR = 0.91; 95% CI: 0.85 - 0.98) and those with a CD4 count of at least 200 cells/mm³ (aRR = 0.92; 95% CI: 0.87 - 0.98) compared to their respective counterparts. This study underscores the role of behavioral and clinical factors in cervical cancer risk among women living with HIV in Uganda. Raising awareness about risky sexual behaviors, such as having multiple sexual partners, is essential. Integrating safe sex education and routine STI screening into HIV/AIDS care services is recommended. Future studies with larger sample sizes are needed to enhance statistical power and reliability. Additionally, further research should explore the interaction between HIV/AIDS, CD4 count, and different contraceptive methods in relation to cervical cancer risk
Bat ecology and social epidemiology of filoviruses in Uganda
No full textA thesis submitted to the Directorate of Research and Graduate Training for the award of the Degree of Doctor of Philosophy of Makerere University.Introduction: Filoviruses pose significant threats to both human and animal populations in Africa, particularly in Uganda, which ranks among the most affected by Ebola and Marburg virus outbreaks. These viruses are closely linked to bats, especially those in the Pteropodidae family. The 2022 outbreak of Sudan virus (Orthoebolavirus sudanense) in Uganda, reported 164 cases and 55 confirmed deaths before containment which underscores the ongoing risk of pathogen outbreak and spillover in the region.
This is coupled with the prevailing traditional knowledge and systems with varying norms and beliefs that increase the bat-human interaction. The social epidemiological and ecological role of bats living in locales such as caves remains complex and largely unknown. Therefore, this study aimed to assess the relationship aspects of bat ecology and social epidemiology of filoviruses in central and western, Uganda. Materials and Methods: The study utilized a mixed methods approach to comprehensively assess bat ecology and social epidemiology of filoviruses in Uganda. This study utilized various methods including systematic review, quantitative surveys, participatory epidemiology, qualitative methods; focus group discussion (FGDs), key informant interviews (KIIs), and in-depth interviews (IDIs), bat fecal sample collection, respective laboratory-based techniques and mathematical modeling. The investigation consisted of five sub-studies each representing a study objective: Study 1: This was a systematic review adhering to PRISMA-P guidelines, examining relevant studies regarding bat ecological and behavioural factors as well as human actions that increase susceptibility to bat-borne pathogens. Data from published articles in different databases and grey literature were qualitatively analyzed, with key findings processed for reflexive thematic analysis in Excel to create themes. The themes generated were combined with Z-scores in R software for statistical analysis to create a Principal Component Analysis (PCA), cluster dendrogram and Pearson correlation for the variables within each theme. Study 2: To achieve this, the study utilized a mixed-methods approach involving surveys (n = 384) and FGDs with participants residing near bat caves in Bundibugyo district (western Uganda). Quantitively, the study assessed the knowledge aspects, perception and risk factors associated with bat
exposure among persons living near bat roosting sites and analysed using descriptive statistics. Proportional piling through ranking was done using 10 FGDs (6–8 participants for each group) to explore community perceptions of activities associated with bat exposure and risk of bat-borne disease transmission. Study 3: This study was carried out in western Uganda i.e. Mubende and Kassanda districts which were known to have had Ebola cases. Qualitative data was collected through FGDs; n=4, IDIs; n=12,
KIIs; n=12, and participatory landscape mapping to explore perceived drivers of the Ebola virus disease outbreak in the study areas. Thematic analysis using a deductive approach guided by social ecological model and epidemiological model in NVivo 12
pro software. Study 4: This study aimed to investigate the presence of filoviruses and characteristics of Kasokero (Masaka district, central region) and python caves (Rubirizi district, western region). To achieve this, 115 environmental bat fecal swab samples
were collected and analysed using nested Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Additionally, the ecological characteristics were assessed through observation checklists. Study 5: This study developed and analyzed a stochastic model considering the bat-human-environment interface to assess the impacts on disease outbreak extinction and persistence. Using a multitype branching process, the model assessed transmission dynamics involving bats, humans, and environmental
contamination. Parameters were based on existing data, incorporating bat excretions and human exposure behaviors. Numerical simulations of both deterministic and stochastic models depicted a major outbreak and persistence of the virus. Results: Study 1: Five key themes i.e. pathogen spillover from bats to humans, anthropogenic influences, pathways to spillover, seasonal and climate variability, and drivers of bat abundance and viral dynamics were identified related to bat and human leading to pathogen spillover. Among these, influence of anthropogenic activities and seasonal changes had a more significant role on transmission dynamics. The PCA highlighted strong correlations between bat abundance, viral dynamics, and environmental factors. Study 2: In total, 214/384 respondents (55.7%) had a history of bat exposure. Increased exposure to bats was associated with being male (OR = 1.6; 95% CI: 1.0, 2.4), staying in urban areas (OR=1.9; 95% CI: 1.2, 3.1), hunting (OR = 10.9; 95% CI: 1.4 to 87.6), and positive perception to bat guano being safe as fertiliser (OR= 2.5; 95% CI: 1.0, 5.9) and hunting was ranked as the major risk factor. Based on the provided data, the adjusted odds ratio of 0.7 for the good measures (95%CI: 0.4, 1.1), suggests a potential protective effect on the risk of bat exposure. Study 3: Five themes were identified as perceived drivers of Ebola virus outbreaks: (1) Individual factors (knowledge of EVD and fear from deaths of suspected cases); (2) Interpersonal factors (ecological, anthropogenic, environmental, and cultural sources of spillover); (3) Community impact (economic loss and lack of government support for survivors); (4) Organizational challenges (delayed lab results, inadequate reporting systems, and poor surveillance); and (5) Policy recommendations (One Health approach and ongoing public sensitization). Study 4: The study compared Kasokero and Python Caves, both home to fruit bats (Rousettus aegyptiacus). Python cave, with its larger colony size and water sources, supports greater bat populations. Kasokero cave features cultural practices at its entrance. No active viral shedding was revealed at the time of sampling despite the presence of large bat colonies. Despite verified RNA quality, the findings indicate a maximum filovirus prevalence of less than 0.02 at a 95% confidence level. Study 5: Through a multitype branching process approximation, it was demonstrated that both bats and humans can significantly increase the likelihood of disease outbreaks persisting. Managing environmental contamination alone is inadequate for controlling viral transmission without addressing infected hosts. The findings emphasize the need for a One Health approach, involving collaboration across public health, veterinary, wildlife, and environmental sectors, applicable to Marburg virus control. Conclusion: This thesis investigated the complex interactions between bats, humans, and the environment in Uganda regarding filovirus transmission. Through five studies, it highlights that spillover risks driven by human activities, viral dynamics, ecological and environmental factors, cultural norms, and seasonal changes along with bat exposure from hunting, gender roles, and geographical location, are crucial to transmission dynamics. The findings highlight that spillover is not solely due to ecological and environmental factors but is intensified by human behavior and socio-
cultural practices, such as hunting, farming, and bat consumption, which increase bat-human interactions and amplify transmission. Understanding the ecology of bats alongside the associated social epidemiological dynamics is important for designing filovirus preparedness plans as well as heightening prevention and control of related outbreaks.NORAD and the CIDIMOH project under the NORHED II progra
Assessment of Library and Information Services at Uganda National Roads Authority
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 Science in Information Science of Makerere University.The study assessed the Library and Information Services Provision at the UNRA Library with the aim of identifying the services provide challenges faced so as to improve Library and Information Services provision at the Library. The objectives of the study were to: 1) establish the range of information resources available in the UNRA Library, 2) identify library and information services provided by the UNRA Library, 3) establish challenges hindering UNRA library in delivering library and information services and 4) suggest strategies for improving Library and Information services by the UNRA Library. The study emphasized the importance of efficient library service provision for improving organizational performance. The study used a case study research design to maintain focus on identifying viable strategies for improving UNRA library services. The study adopted interviews, questionnaires, observation and document review methods to collect data from 45 participants. Participants were chosen from UNRA headquarters through random and purposive sampling. The findings of the study revealed that the UNRA Library has a range of information resources and users were found to occasionally utilize the resources offered by the UNRA library, such as standards and specifications, books and reports, policy papers, journals and periodicals, government publications and online databases, for various tasks. The key Library and Information services included orientation services, circulation services, current awareness services, indexing and knowledge management services, reference and research assistance services, selective dissemination of information, document delivery and interlibrary loans. The major challenges identified included limited resources, insufficient e-resources, limited specialized content on UNRA operations and lack of awareness among UNRA staff as well as lack of library management policy. The study concludes that while the UNRA Library provides basic services, significant gaps remain in specialized services, resource currency, accessibility and awareness. The lack of prioritization for services for persons with disabilities is a critical oversight. Addressing these shortcomings is essential for enhancing the library’s role in supporting UNRA's mission and goals. It is recommended that UNRA Library should address budget constraints to ensure regular updating and acquisition of current resources, prioritize services for persons with disabilities by ensuring the physical infrastructure is fully accessible, including ramps and elevators and invest in retooling staff with training in key subject areas relevant to UNRA, such as road construction, promoting awareness of the Library services to the staff is also critical
Evaluation of information systems and services in Mengo Hospital, Uganda
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 Information Science of Makerere UniversityThe rapid advancement of health information technologies has significantly transformed healthcare operations globally. This study evaluates the adoption and utilization of Health Information Systems (HIS) at Mengo Hospital, Uganda, to assess their effectiveness in improving healthcare delivery. A mixed-methods approach was adopted, integrating both quantitative and qualitative research methods. Data collection involved structured questionnaires administered to 67 system users, semi-structured interviews with 10 IT staff, and document reviews. The findings reveal that Mengo Hospital has integrated various information systems, including the Outpatient Service System, Laboratory Management System (LMS), Clinic Master, and Counselling Information System. These systems support patient records, appointment scheduling, laboratory procedures, and billing. However, some departments, such as pharmacy and radiology, have underutilized systems, indicating gaps in integration and user adoption. The study found that HIS adoption was moderate, with 54% of respondents actively using the systems, though usability challenges persist. Qualitative findings highlighted the need for system updates and user-friendly interfaces. Staff training on HIS utilization was also found to be inadequate, contributing to underutilization, especially among non-technical personnel. The study recommended comprehensive staff training programs, system integration across departments, and policy reforms to enhance system maintenance, periodic updates, and patient data security. These improvements will optimize HIS adoption, leading to better healthcare outcomes and overall system sustainability
A.I. and the African woman
No full textA bookAI and the African Woman: Pioneering Economic Empowerment for a Brighter Future" is a groundbreaking exploration of the transformative power of artificial intelligence (AI) in reshaping the lives of Africa’s most marginalized women. Authored by Zion Margaret Lubogo and Agatha Lubogo, this visionary work challenges traditional narratives, positioning AI not as a privilege of the elite but as a force of empowerment capable of dismantling poverty and driving sustainable development. At its core, the book weaves compelling stories of resilience with cutting-edge technological insights. It highlights real-world applications of AI, from mobile-based microcredit systems that extend financial services to unbanked women, to predictive agricultural models optimizing harvests and minimizing risks for small-scale farmers. In healthcare, AI-driven maternal health innovations are showcased as life-saving tools in areas with scarce medical resources, while personalized education technologies are breaking down literacy barriers and creating new learning pathways tailored to the unique needs of women and girls. This book goes beyond technology; it delves into the ethical, cultural, and societal implications of AI adoption. It poses profound questions about inclusivity, governance, and the potential risks of deepening inequality if AI is not deployed responsibly. The authors offer actionable recommendations for policymakers, educators, technology developers, and financial institutions, advocating for a collaborative approach to AI that places humanity and equality at the center. "AI and the African Woman" is a call to action—a beacon of possibility for a future where every woman, regardless of her socioeconomic background, can harness technology to build a life of dignity, independence, and opportunity. Rich in research, captivating in narrative, and profound in its vision, this book is an essential read for anyone committed to a more inclusive, equitable, and empowered Africa
Biochars for the removal of toxic gaseous contaminants: state-of-the-art and future directions
No full textBook Chapter 19. In Gwenzi W. (Editor). Biochar for Environmental Remediation Principles, Applications, and Prospects. Published by Elsevier. ISBN: 978-0-323-99889-5.Toxic gaseous contaminants comprised of various harmful gases emitted into the atmosphere have emerged as a key environmental and public health concern. Gaseous contaminants can broadly be categorized into inorganic and organic contaminants. The inorganic contaminants include nitrogen oxides (NOx), sulfur dioxide (SO2), toxic heavy metals (Pb, Cr, Hg), carbon monoxide (CO), carbon dioxide (CO2), and ammonia emissions. Organic contaminants, on the other hand, include volatile organic compounds (VOCs), poly organic pollutants (POPs), polycyclic aromatic hydrocarbons (PAHs), odorous compounds, dioxins, and furans. Thus, polluted air contains an unacceptable concentration of the above-mentioned contaminants