Mak IR Repository (Makerere University)
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The informed consent process for emergency surgery at public and private hospital surgical emergency units in the urban Ugandan setting
No full textA thesis submitted to the Directorate of Research and Graduate Training (DRGT) in fulfilment for the award of the Degree of Doctor of Philosophy (PhD) of Makerere University.Introduction: Informed consent is a process that can have challenges when required for emergency surgery, because the patient might not have the capacity to consent, and consent may be obtained from the next of kin, or surrogate decision-makers. The key stakeholders in the informed consent process for patients undergoing emergency surgery are the patient, the next of kin or surrogate decision–makers, and the emergency staff. This study hoped to contribute to a better and more nuanced understanding of how patients and their next of kin engage with the informed consent process in cases where emergency surgery is required. The study was conducted in the emergency units of one urban public, and one urban private not-for-profit hospital, to assess the knowledge and perspectives of the patients, their next of kin, and the emergency staff, towards the informed consent process for emergency surgery. Methods: We used a descriptive cross-sectional study design, combining quantitative and qualitative methods. We conducted a quantitative survey of 380 patients and their next of kin (210 from the public hospital, and 170 from the private hospital). Qualitatively, we conducted 39 in-depth interviews of patients, and the next of kin of patients who had undergone emergency surgery, 17 key informant interviews of emergency staff involved in the informed consent process, and direct observation of emergency staff during the informed consent process at these 2 units. Results: From the survey, 79.7% of patients did not have the risks of the surgery communicated to them, 87.6% were not given alternative options, and 57.4% had no opportunity to ask questions. There were 7 themes from the in-depth interviews of the patients, and the next of kin. These were attitudes and experiences regarding the informed consent process, decision-making in the informed consent process, disclosure, knowledge, and communication of the informed consent process, emergency staff role in the informed consent process, resources affecting the consent process, challenges encountered during the consent process, and recommendations to improve the informed consent process. Six themes studied for the key informant interviews of emergency staff were; knowledge and perspectives on informed consent; processes, procedures, and practices regarding informed consent; communication strategies for informed consent; ethical considerations; benefits of informed consent; and challenges of emergency informed consent. Direct observation of emergency staff showed that consent was conducted in a noisy environment, greeting of patients, disclosure of risks, and assessment of understanding were poorly done at both institutions. Conclusions: Risks and benefits should be disclosed to the patient in simple language, and patients should be given an opportunity to ask questions, to improve understanding and decision-making during the consent process. A communitarian approach, combined with shared decision-making between the doctor and the patient and NOK, should be used during the consent process. Emergency staff at both institutions need procedure-specific consent documents, which capture the information that is given to the patient and institutional guidelines and policies on consent for incapacitated patients, who have no surrogates
Response of groundnut varieties and commercial rhizobia bio-fertilizers in two locations of Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirements for the award of a Degree of Master of Science in Soil Science of Makerere UniversityRhizobia bio-fertilizer inoculation is an environmentally-friendly and cheaper option for smallholder farmers to improve legume productivity and soil fertility. However, there may be variations in legume variety response to inoculation. Therefore, on-station field experiments were conducted in two locations of Uganda to determine response of groundnut varieties to bio-fertilizers. The experiments were arranged in split plots under randomized complete block design with four varieties of groundnut as main treatments and inoculation and no inoculation as sub-treatments. The results showed that inoculation of groundnut with the Mak-Bio-Fixer and Biosoil Nitro+ significantly (P<0.001) increased the number of effective nodules and shoot N at 45 days after plating in all the tested varieties with the exception of the Red Beauty variety. The grain yield response ranged from 0 to 37% with the Serenut 5R giving the highest grain yield response of 358 kg ha-1 (37%) when inoculated with Biosoil Nitro+ followed by Serenut 2T that gave the grain yield response of 314 kg ha-1 (31%) when inoculated with the Mak-Bio-Fixer. From this study, there was low abundance of native Bradyrhizobia in Tororo and and MUARIK soils and Serenut 5R and Serenut 2T positively responded to inoculation with better responses recorded in Tororo than in MUARIK and also better responses were recorded with the Nitro BioSoil Nitro+ than the Mak-bio-fixer. It is therefore recommended to inoculate groundnut with the Mak-Bio-Fixer and Biosoil Nitro+ commercial bio-fertilizers in Uganda
Techno-economic analysis of a hybrid solar thermal-biogas powered dryer for fruit dehydration
No full textA dissertation submitted to Directorate of Research and Graduate training in partial fulfillment of the requirements for the award of Master of Science Degree in Renewable Energy of Makerere UniversityThe global population as of 2024 stands at 8.2 billion and is projected to rise according to the United Nation, these pose sustainability challenges, particularly in food supply. Reducing postharvest losses, which account for about a third of food waste, is crucial, especially in developing countries, to meet future food demands without straining natural resources. This study aimed at determining the techno-economic viability of drying fruits using a hybrid solar thermal-biogas powered drying system. The objective is to; Develop and simulate a hybrid solar thermal-biogas powered tray/cabinet dryer to address intermittency and continuity, the work involved use of SolidWorks in model development and simulation. The design of experiment was done using Box Behnken under the response surface methodology found within design expert software. The parameters, which were optimized were air velocity at 2 m/s, material thickness at 7.5 mm, temperature at 60 °C and moisture content at 10.5 %. The prototype was built and tested. The findings showed continuity in drying was supported resulting into shorter residence time in comparison to open sun drying, moisture drive out from the sample was better in hybrid resulting into a loss of 78.3 % by weight compared to conventional open sun drying at 42.3 % for the same duration. The economic analysis was limited to key parameters which included ROI, NPV and a simple payback period, the result was very promising at 68.0 %, UGX 1,156,463/= and 1.47 years respectively for the hybrid dryer as compared to open sun drying with ROI of 28.0 %, NPV of UGX 5,602/= and 3.57 years. The sensitivity analysis revealed that the hybrid system’s economic performance is sensitive to changes in revenue and operating costs. A 10–20% decrease in revenue or a 10% increase in operating costs extended the payback period and reduced both ROI and NPV emphasizing the importance of maintaining stable revenues and controlling costs to sustain the system’s economic viability. The hybrid drying system shows potential as an efficient, costeffective solution for drying processes. While promising, sustaining its economic benefits requires managing costs and revenue. Further research is needed to test diverse crops, conditions, and industrial scalabilit
Developing a predictive model to improve post-partum haemorrhage risk classification among pregnant women in Kampala District using machine learning
No full textA dissertation submitted to the School of Public Health in partial fulfillment of the requirements for the award of
a Master of Health Informatics Degree of Makerere UniversityBackground: Postpartum haemorrhage (PPH) remains one of the leading preventable causes of maternal mortality in Uganda, particularly affecting young mothers. Early identification and intervention are crucial to reduce its impact. However, current screening methods often rely on expensive laboratory tests and require skilled healthcare workers, who may not always be readily available.
Objective: This study developed a predictive model for PPH risk classification among pregnant women in the Kampala district using supervised machine learning.
Methods: PPH risk factors and the presence dataset of pregnant mothers above the age of 18 who attended antenatal services and delivered at Naguru National Referral Hospital in Uganda were extracted from electronic patient medical records. Four supervised machine learning algorithms, including decision tree, random forest, support vector machine, and k-nearest neighbours, were applied to analyse the data. Each algorithm's performance was evaluated through hyperparameter optimization and 10-fold cross-validation, followed by a comparative analysis based on accuracy, sensitivity, specificity, and area under the ROC curve. The best-performing algorithm was then utilized to build a web application.
Results: The random forest algorithm outperformed support vector machines, k-nearest neighbours, and decision trees, achieving an accuracy of 88.7%, a precision of 83.8%, a recall of 94.8%, an F1 score of 88.9%, a sensitivity of 94.8%, a specificity of 88.7%, and an Area Under the Receiver Operating Characteristic Curve (ROC-AUC) of 94.3%. A web application was developed to allow health workers to select relevant risk factors and predict the likelihood of PPH using the prediction model. This method accurately predicted the presence or absence of PPH in pregnant women without the need for laboratory tests, kits, or devices, and provided real-time results.
Conclusion: The study demonstrated the potential of a machine learning application can be deployed as a web-based tool for predicting PPH among pregnant mothers in the Uganda population. It is recommended that health workers adopt this tool, as it has the potential to significantly support efforts to improve health outcomes and save lives in low-income settings
Patterns and trends of indigenous salt-making technology at Kibiro Salt Gardens in Southwestern Uganda, 1894-1997
No full textA thesis submitted to the Directorate of Research and Graduate Training in partial fulfilment to the requirements for the award of a Degree of Doctor of Philosophy (Field of History) of Makerere UniversityThe study asks why the Kibiro salt-making technology that consists of indigenous knowledge, tools, skills, techniques, processes, and spiritual aspects like taboos, customs, rituals, myths and language continues to endure amidst new and modern technologies. Kibiro is located in Bunyoro, western Uganda. Despite the British colonialists’ attack and occupation of Kibiro salt gardens in 1894 and their efforts to disrupt the indigenous salt-making and subsequent technological development over the 20th century, the people of Kibiro continued to practice their salt-making. The study ended in 1997 not because indigenous technology ceased to be used in the place but because in 1997, Kibiro salt gardens were recognised as one of the unique villages which have sustained its people on Indigenous technologies for centuries. It was listed on the UNESCO World Heritage Tentative List. The following questions guided the study: What role did Kibiro salt play in the growth and expansion of the Bunyoro Kitara kingdom? What did the salt-making process involve? and, what explains the survival of the indigenous technology in this area? Ethnographies and diaries of early Europeans who visited Bunyoro and Kibiro, particularly during the nineteenth and early twentieth century, and archival and oral sources, were used. The study argues that the indigenous technology survived and continues to survive because of the common belief in Nyasimba and the region's geography. The study revealed that the people of Kibiro regard the practice as god-given because they traced it to their ancestral god, Nyasimba Nyamuhanga. Both perennialism and liberal feminism theories informed this study. The study contributes to the historiography of the Bunyoro Kitara Empire and how the Kibiro salt contributed to state building in western Uganda. Furthermore, it contributes to scholarship on divine power, environment and centrality of women in state building in Uganda
Institutional mechanisms for enhancing the uptake and use of doctoral research outputs from Makerere University
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 Doctor of Philosophy in Educational Management of Makerere UniversityIncreasing emphasis is currently put on doctoral education as a source of capacity for innovation and socio-economic development worldwide. The purpose of doctoral research has been re-expressed and expanded in terms of not just its academic value, but its wider societal value. As such universities have an obligation to enhance the uptake and use of doctoral research outputs. I was impelled by concerns about the low uptake and use of research outputs and innovations produced by staff and students at Makerere University. I examined the institutional mechanisms for enhancing the uptake and use of doctoral research outputs at Makerere University in regard to the climate for research use, research production, linking research to action and research evaluation using the Research Knowledge Infrastructure framework developed by Ellen et al. (2011) as the analytical lens. I subscribe to the interpretivist world view, as such, I used the qualitative single case study research design. I collected data through interviewing and documents review. I purposively selected 10 doctoral program coordinators, three managers of research and graduate training, and 13 PhD students. I reviewed seven institutional documents pertaining to graduate training in Makerere University; two plans, three policies, one framework, and one guideline. I used thematic data analysis to make sense of the data. The findings reveal that Makerere University aspires to enhance and promote the uptake and use of research outputs and innovations generated by staff and students as one of the key drivers of becoming a researchled university. But, institutional mechanisms for enhancing the uptake and use of doctoral research outputs beyond the scientific community were inadequate. The climate for use of doctoral research outputs was unsupportive, doctoral research production was purely academic, doctoral research outputs were not developed in collaborative contexts limiting the proactive dissemination of research outputs to potential users, there were no clear mechanisms for linking doctoral research to action, and doctoral research evaluation was narrow and purely academic. I conclude that the current institutional policies, frameworks, guidelines, structures, processes and practices of doctoral education are not supportive to enhance the uptake and use of doctoral research outputs. As such, uptake and use of doctoral research outputs at Makerere University was dismal. I recommend that the University should establish and integrate support mechanisms in doctoral research training to enhance the uptake and use of doctoral research outputs beyond the scientific community
Effectiveness of strategies used to increase uptake of community-based health insurance by the Uganda Protestant Medical Bureau
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 University.The study investigated the effectiveness of strategies the Uganda Protestant Medical Bureau uses to increase uptake of community-based health insurance in Uganda. It was premised on three objectives, which are: assessing the effectiveness of community awareness campaigns in increasing uptake community-based health insurance at Uganda protestant medical bureau, assessing the effectiveness of partnerships with local healthcare providers by the bureau has increased uptake of community-based health insurance, and analyzing the effectiveness of offering subsidized premiums to increase accessibility and participation among low-income populations in community-based health insurance. The study used an evaluative research design with a quantitative study approach, collecting quantitative data from 98 savers of Uganda Protestant Medical Bureau through a survey. Data was analyzed using Statistical Package for the Social Sciences, Version 27. The findings from the study reveal varying degrees of effectiveness in the strategies used to increase uptake of community-based health insurance at the Uganda Protestant Medical Bureau. Community awareness campaigns have had a moderate impact, effectively educating the public about community-based health insurance benefits (mean = 3.55, SD = 1.219) but struggling with providing clear information (mean = 2.51, SD = 1.133) and building trust in the program (mean = 2.44, SD = 1.236). Partnerships with local healthcare providers have had mixed results, improving the quality of care (mean = 3.44, SD = 1.277) but less effective in enhancing accessibility (mean = 2.46, SD = 1.203) or timely service delivery (mean = 2.49, SD = 1.302). These partnerships have strengthened trust (mean = 3.36, SD = 1.195) and contributed to higher enrollment (mean = 3.59, SD = 1.250), yet their role in improving health outcomes (mean = 3.57, SD = 1.268) and ensuring long-term sustainability (mean = 2.83, SD = 1.334) remains a challenge. However, subsidized premiums have positively contributed to the financial sustainability of the health insurance program (mean = 4.01, SD = 1.239). Therefore, the study recommends simplifying communication using visual aids and local languages to improve clarity and reach. It also suggests launching targeted campaigns to address misconceptions and building trust through community involvement, especially by engaging local leaders. Additionally, the study calls for enhancing healthcare accessibility, improving timely service delivery, and strengthening collaborations for the long-term sustainability of the Community Based Health Insurance program while expanding subsidy programs and introducing flexible payment options to serve low-income populations better
Using an integrated electronic document management system to support the central registry function of public institutions (EDCR): a case of Ministry of Finance, Planning and Economic Development
No full textA Project Report Submitted to College of Computing and Information Sciences in partial fulfillment of the requirements for theaAward of the Degree of Master of Science in Information Systems of Makerere UniversityElectronic Document Management Systems (EDMS) have been identified globally as one of the key development strategies in the management of records in all public institutions in Uganda (NRCA, 2017). In Uganda today, the Government has made an initiative in adoption of EDMS in some public institutions to ensure that employees could access and collaborate on documents without being limited by physical location. However, many public institutions in Uganda still rely on outdated, manual methods, making it difficult to quickly find, track, share and securely handle documents which often leads to delays in service delivery. To address these issues, this study aims to develop an integrated electronic document management system for supporting operations in the Central Registry function of public institutions (EDCR), using Uganda’s MoFPED as a case study. In order to achieve the said objective, a preliminary investigation of the existing system was undertaken in MoPS and MoICT to gain deep in sight of the current document management practices and challenges faced by the Central Registry in public institutions in Uganda. Subsequently, a survey was done through the use of questionnaires to determine the requirements for an effective EDCR. The data collected was analyzed through content analysis and statistical package for social sciences (SPSS) software. The System was designed using visual studio code integrated development environment specifically; PHP for backend programming, while bootstrap, CSS and JavaScript for front end coding. The system was tested and validated to realize the objectives of the study.
Overall, the EDCR helped to simplify management of documents through document tracking and retrieval in real time for all stakeholders not limited to those within the MDA. This addressed the delays and difficulties in document tracking experienced with the existing system. In addition, the EDCR supported an integrated approach to document management by enabling the sharing of documents across different MDAs hence facilitating better collaboration
Prevalence, risk factors and socio -economic effects of human and bovine brucellosis in post conflict northern 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 UniversityBrucellosis is a zoonotic disease with worldwide impact on both animal production and public health. Human brucellosis is closely associated with the disease occurrence in animals, and it is endemic in many developing countries, including Uganda. Effective brucellosis control is significantly impacted by the knowledge, attitudes and practices of key stakeholders, including the community, policy makers medical and veterinary workers. This underscores the importance of having data on the magnitude and risk factors, as well as information on the social and economic impact of the disease, which in turn requires an efficient indicative method. In view of this, a cross-sectional study was conducted from March 2014 to February 2015 covering seventeen selected health facilities in four purposively chosen districts of Apac, Gulu, Lira and Pader in post-conflict northern Uganda. The overall objective of this study was to establish the state of occurrence and the social economic dynamics of brucellosis in post-conflict-northern Uganda. The specific objectives were firstly to determine the knowledge, attitudes, and practices of the community, medical and veterinary workers regarding brucellosis in post-conflict northern Uganda. Secondly to estimate the seroprevalence of brucellosis in prolonged fever patients and to identify modifiable risk factors for the infection in humans. Thirdly to estimate the seroprevalence and risk factors for bovine brucellosis in cattle kept in households where individual diagnosed with the disease live. Fourthly to examine the social and economic significance of brucellosis in post-conflict northern Uganda. Fifthly to evaluate the diagnostic accuracy of the commonly used serological tests against Polymerase Chain Reaction as a reference test. A total of 251 community members, 59 medical and 29 veterinary workers participated in the study. A pretested structured questionnaire was used to collect data on knowledge, attitude, practices, risk factors, social and economic effects of Brucellosis. Human and bovine sera from 251 subjects and 311 cows respectively was analyzed for brucellosis using indirect Enzyme Linked Immunosorbent Assay. Data was analyzed using SPSS (SPSS Inc. Chicago, USA Version 16.0). Categorical variables were presented as proportions. The effect of sociodemographic data was assessed using Chi-square test and Odds Ratio at 95% confidence level. The burden of Brucellosis on people’s health was determined by calculating disability-adjusted life years (DALYs). To evaluate the accuracy of serological tests, Epitools online statistical software (https://epitools.ausvet.com.au/) was employed to analyze diagnostic parameters including Sensitivity, Specificity, (McNemer X2, Kappa and Accuracy of the study serological tests against Polymerase Chain Reaction as a reference test for diagnosing human brucellosis. Regarding Brucellosis control and eradication most study participants had positive attitude but low levels of knowledge and inadequate practices. Education level was associated with knowledge and practices among community participants. Seroprevalence of human brucellosis was estimated at 18.7% (n=251). Rearing livestock (p < 0.005) and consumption of unpasteurised milk (p= 0.023) were factors associated with human brucellosis. Animal level bovine brucellosis was estimated at 19.3% (n=311) and the DALY calculations estimated a loss of 0.65 years of full healthy life years. An individual infected with brucellosis was likely to spend 244.40 USD was lost annually per household with a brucellosis seropositive herd (due to milk reduction and infertility). There was no significant difference between Brucellosis seroprevalence results estimated by the modified Rose Bengal Plate Test (McNemer X2, p= 0.343) and Polymerase Chain Reaction a reference test. High education level increases knowledge and improves practices regarding brucellosis prevention and control. The positive attitude provides an opportunity to stimulate formulation of effective policies for implementing low-cost methods to enhance drives for controlling animal bovine brucellosis with a resultant impact of reducing human brucellosis. The social and economic effects of brucellosis is significant and calls for collaborative efforts between relevant sectors, to monitor and mitigate the impacts of the disease
An examination of the nexus between politics and the right to court bail in Uganda
No full textA dissertation submitted for the award of the Degree of Master of Laws (LL.M) of Makerere UniversityThis study examines the relationship between politics and the right to bail in Uganda with particular reference to criminal defendants that have a political relationship with incumbent power. The study analyzes international, regional and domestic legal materials as well as primary data on related aspects of politics and bail. Participants drawn from the JLOS, politics and civil society were interviewed during the months of October and November 2022, and May 2023. The study findings indicate that the international and regional norms on pretrial rights provide an enabling framework within which criminal suspects in Uganda can claim their pretrial rights, including the right to bail. The domestic framework, however, only guarantees the right to apply for bail, the grant of bail itself being the discretional province of the courts. Unfortunately, this discretion has in politically charged cases been exploited to the detriment of criminal suspects. Over the last two decades, the government has used bail as a weapon against the people it perceives to represent a political threat. This it does by framing unresolved political conflicts as political questions in order that the courts may not adjudicate over them, or as security questions in order that they be subjected to military mechanisms. The imposing nature of the Executive over the Judiciary has meant that some political detainees are denied bail and kept in indefinite pretrial detention. The scheme of denying opponents bail is perfected in the Court Martial, where the time for release on bail is a matter of politics rather than military law. The controversial Bail Guidelines 2022 were issued against this politico-judicial backdrop. Although the Guidelines introduce some novel features, they are largely a replica, and often degradation, of preexisting provisions on bail. From the foregoing findings, the study concludes, briefly, that: (i) the political and security questions underlying bail controversies are a function of the political power contests between the ruling elite and the opposition; (ii) the ruling elite deliberately escalate political conflicts in order to justify the use of military force and exert political control over bail; (iii) judicial independence is greatly compromised in cases involving political opponents of the regime, thanks to the subordinate status of the Judiciary against the executive in reality if not in law; (iv) the Bail Guidelines limit rather than enhance the powers of magistrates and the applicants’ access to bail; and (v) effective implementation of the Bail Guidelines will require some changes in the substantive law on bail. The study makes a number of policy recommendations. These include, briefly, that the Bail Guidelines be revised to harmonize with existing provisions of the MCA and TIA; the law enabling the Chief Justice to issue directives and guidelines should spell out the procedure for doing so, which should be participatory; multi-stakeholder deliberations should be promoted under the JLOS on all important matters of law in order to protect the sanctity of judicial decisions from raw politics; The study also makes a number of more general recommendations