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Impact of stigma on the HIV care cascade among older persons living with HIV in sub-Saharan Africa : protocol for a systematic review
No full textThis item can be retrieved directly from the publisher's site at http://doi.org/10.1136/bmjopen-2024-091718Introduction: Data are limited on the impact of stigma (stigma associated with HIV and/or stigma related to old age (ageism) or both) on linkage to the HIV care cascade among older persons (aged 50 years and older) in sub-Saharan Africa (SSA). Studies have documented the prevalence and determinants of HIV testing, antiretroviral therapy (ART) use and viral load suppression among older people in Africa. However, there is a need to conduct a systematic review to synthesise the findings on the impact
of stigma on the HIV care cascade among older people in SSA. The objective of this systematic review is to collate the findings on the impact of stigma on the HIV care cascade among older people aged 50 years and older in SSA. The major research question is: what is the impact of stigma on the HIV care cascade among older persons aged 50 years and older in SSA? Methods and analysis: We will search MEDLINE via PubMed, Web of Science Collection, Academic Search Premier from the EBSCO platform, Cochrane Central, JBI EBP, Global Health, Social Policy and Practice and Health Management Information Consortium for articles published in English from 2000 to June 2024. The search strategy will include variations of the following terms: HIV, HIV cascade, HIV testing, HIV care or linkage to care, retention in care, viral suppression, older persons, stigma, HIV related stigma, age-related stigma, ageism, discrimination and intersectional stigma. In terms of study characteristics, the following will be included: epidemiological studies/observational studies/randomised controlled trials and qualitative studies on the HIV care cascade (i.e, HIV testing, linkage to care, retention and viral suppression). We will restrict eligibility by focusing on the older population (older persons aged 50 years and older living with HIV) in SSA. The planned limits include timing (2000–2024), geographical coverage (SSA), language (English), copyright (open access publications) and age of the population (50 years and older). The primary and secondary outcomes are drawn from the HIV care cascade, including HIV testing, linkage to care, retention in care and adherence to ART. Ethics and dissemination: Ethics approval is not needed since this is a systematic review based on published data. Dissemination will be done by submitting scientific articles to academic peer- reviewed journals. We will also present the results at relevant conferences and meetings
Anti-infective activity, phytochemistry and cytotoxicity of Dalbergia Melanoxylon Guill. & Perr and Ormocarpum Sennoides ssp. Zanzibaricum Brenan & J.B. Gillett
No full textA thesis submitted to the Directorate of Research and Graduate Training for the Award of a Degree of Doctor of Philosophy in Botany of Makerere UniversityInfectious diseases account for 90% of the disease burden worldwide with a significant rampage being felt in developing countries. This is coupled by the widespread antibiotic resistance to available conventional drugs. Infectious agents have been reported to raise the risk of human cancer which is a major cause of mortality worldwide. The aim of this study was to investigate Dalbergia melanoxylon Guill. & Perr and Ormocarpum sennoides subsp. zanzibaricum Brenan & J.B. Gillett as potential anti-infective and anticancer agents. Extraction of root bark of D. melanoxylon was done using CH2Cl2/MeOH (1:1) while O. sennoides subsp. zanzibaricum was extracted using 80% methanol and partionioned to obtain n-hexane, ethylacetate, n-butanol and water extracts. The structures and absolute configuration of the isolated compounds were elucidated by Mass spectrometry, Nuclear magnetic resonance and Electronic circular dichroism spectroscopy. The antibacterial activity of the crude extract and the isolated compounds against Bacillus subtilis and Aliivibrio fischeri was determined in a turbidimetric assay. The pure compounds were subjected to a panel of human pathogenic bacteria (Enterococcus faecalis, Escherichia coli, Mycobacterium vaccae, Staphylococcus aureus, methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa using agar diffusion assay. The crude extracts were tested for antifungal activity against Phytophthora infestans, Botrytis cinerea, and Septoria tritici using turbidimetric assay. The pure compounds were subjected to further antifungal testing against human pathogenic fungi (Sporoidiobolus salmonicolor, Candida albicans and Penicillium chrysogenum) using agar diffusion assay. The crude extracts of O. sennoides subsp. zanzibaricum and D. melanoxylon (500 μg/ml) were tested for anthelmintic activity using Caenorhabditis elegans. The cytotoxicity (CC50) of the crude extracts against the human prostate cancer (PC-3) and colon adenocarcinoma (HT-29) was performed using colorimetric cell viability assays. The cytotoxicity assay against HeLa cells was performed on the most promising active pure compound using the methylene blue assay.Phytochemical investigation of root and root bark of O. sennoides subsp. zanzibaricum and D. melanoxylon resulted in the isolation of twenty compounds (1-20), of which seven are new. The root bark of D. melanoxylon yielded six previously undescribed prenylated isoflavanones (1-6), alongside isoflavanoids (7-10), neoflavones (11-13) and alkyl hydroxycinnamates (14). A new biflavonoid, trime-chamaejasmin (15) alongside two known biflavonoids (16-17), bi-4-phenyldihydrocoumarin (18), isoflavan (19), triterpenoid (20) were also isolated from the roots of O. sennoides subsp. zanzibaricum. The crude extracts at 50 and 500 μg/mL exhibited promising antibacterial activity against Bacillus subtilis. Sophoraisoflavanone A (10) caused inhibition against both B. subtilis and Aliivibrio fischeri assays at 99% at 100 µM. Kenusanone H (7) and (3R)-tomentosanol B (9) exhibited promising antibacterial activity against MRSA and M. vaccae showing minimum inhibitory concentrations between 0.8 and 6.2 µg/mL. Both crude extracts showed promising antifungal activity against all phytopathogens at 125 µg/mL. Kenusanone H (7) at 42 µg/mL showed very promising activity against S. tritici (74%) and B. cinerea (99%). At low 0.05 μg/mL, both crude extracts showed no cytotoxic effect against PC-3 and HT-29 cells. Kenusanone H (7) was highly cytotoxic against HeLa cells with CC50 of 1.8 ± 1.4 µg/mL (4.2 µM). The crude extracts of both O. sennoides subsp. zanzibaricum and D. melanoxylon are not toxic in general but show selective antibacterial and antifungal activities. Kenusanone H (7) proved to be a lead drug candidate as an antibacterial, antifungal and cytotoxic compound.DAAD-NAPREC
Structure and lithology-based reservoir characterization of the Lake Edward-George Basin, Western Uganda
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of Master of Science Degree in Petroleum Geosciences, Makerere University.This research was conducted in the Lake Edward-George basin, Albertine Graben. It focused on the structural and lithological analysis aimed at understanding the hydrocarbon reservoir characteristics of the Lake Edward-George basin. The research utilized a combination of seismic datasets and well log interpretation techniques to unravel the geological complexities of the basin. In this research, examination of the basin's geological characteristics, employing a multi-disciplinary approach combining seismic interpretation, well log analysis, and reservoir delineation techniques were undertaken. Structural analysis using the 2D seismic data revealed a dominance of normal faults that strike NE-SW which is evidence of extensional tectonics, alongside compressional features such as reverse faults and positive flower structures. The basin geometry is tilted to the west, indicating typical example of a half graben. Through detailed seismic interpretation and fault mapping, fault networks were delineated. Lithological characterization further enhanced the understanding of the basin's hydrocarbon reservoir characteristics. Utilizing well log data from the Ngaji-1 Well, distinct lithological units comprising sandstone reservoirs intercalated with clay-rich strata, were observed. Advanced petro-physical analysis elucidates the porosity-permeability relationship within these reservoir units, providing insights into fluid flow behavior and reservoir connectivity. The integration of gamma ray, density, neutron, and resistivity logs enabled discerning of the lithological variations and quantification of key reservoir parameters such as volume of shale and total porosity. The study revealed seven (7) reservoir zones encountered in the Ngaji-1 Well with thickness of between 7 m to 28 m. The lowest average effective porosity of the reservoirs range is 15% and the highest average porosity of 37%. The lowest average permeability of the reservoir is 0.2 D as the highest average permeability is 28 D. Reservoir delineation efforts reveal heterogeneous distribution of the potential reservoirs, influenced by faulting and depositional facies changes. By correlating seismic reflections with well log data, detailed subsurface models revealed reservoir compartments. Notably, areas characterized by thicker sedimentary sequences away from the Ngaji-1 Well exhibit better reservoir qualities, emphasizing the importance of localized geological conditions that control reservoir quality
Development of solar thermal energy storage technology for off-grid cooking applications
No full textA thesis submitted to the Directorate of Research and Graduate Training and School of Physical Sciences for the award of the degree of Doctor of Philosophy of Science in Physics of Makerere UniversityThis study presents the design and development of a solar photovoltaic (PV) cooker integrated with an energy storage system (TES). Thermic AXCL heat transfer oil and rock pebbles were used as sensible energy storage materials. Two types of TES systems were developed: a single-tank TES system with an internal cooker, and a dual-tank TES with an external cooker. A heating funnel in the form of a Y-shape was integrated into each design to charge a small volume of heat transfer oil. A cooking unit sits on top of the heating funnel. A 1.8 kW solar PV array was used to generate and supply DC electricity through an MPPT load controller to the DC/AC resistive heating element. During charging, the oil at the top of the funnel attains higher temperatures in a short time, allowing for immediate cooking. The funnel barrier height and oil flow rate can be regulated to vary the temperature at which hot oil overflows into the tank. The hot oil expands and overflows into the TES tank while cold oil enters the funnel from the bottom to be heated. The system is based on self-circulation without mixing cold and hot oil. No pumps are required. It was observed that the funnel system was able to charge the oil to an average temperature of 200 oC in less than 1 hour. The single tank and dual tank can store energy up to 2.5 kWh and 9.0 kWh respectively suitable for cooking. Cooking can be done during the charging and discharge process. Several cooking tests were demonstrated using the systems; 10 L of water boiled in 25 minutes consuming 0.986 kWh of energy; 3 kg of rice boiled in 1 hour consuming 0.556 kWh. In addition, 1.26 kWh of energy was used for boiling and simmering 3 kg of beans within 2-3 hours. A charging efficiency of 71.9 % was obtained for the single tank and 57.4 % for the dual tank system. Cooking efficiency of about 75.0 % and 59.4 % were obtained during charging and discharge cycles respectively. A low-cost Arduino data logger for temperature and power logging was able to record data automatically as a stand-alone device useful for field deployment. The systems are easy to operate and highly scalable for indoor households and institutional solar cooking with a lot of potential to reduce the use of woodfuels.Norwegian Agency for Development (NORAD) -NORHED-II: Through Energy Technology Network Project Makerere Universit
Contextualising international digital health terminology standards for semantic interoperability of Uganda's Health Information Systems
No full textA thesis submitted to the Directorate of Research and Graduate Training in partial fulfilment of the award of the Degree of Doctor of Philosophy of Makerere University.Background: Semantic interoperability is defined as the ability of information systems to interpret exchanged linguistic information in meaningful and consistent ways using medical terminologies and nomenclatures. Although international digital health terminology standards exist to facilitate semantic interoperability, these standards are generic; therefore, they may not adequately address the unique needs of Uganda’s health system. Yet, there is no documented process for using the standards in national health information systems. Aim: This research aimed to develop a process for contextualising international digital health terminology standards to support the semantic interoperability of Uganda’s health information systems. Methodology: The research study adopted the pragmatic information systems research philosophy and various methods, including descriptive cross-sectional, qualitative case study, socio-technical walkthrough and design science, to answer the research questions. Study respondents were purposively sampled. Data were collected by reviewing documents, conducting surveys, key informant interviews and workshops, and analysed using descriptive statistics and thematic analysis. Findings: The research findings indicate scanty implementation of the international digital health terminology standards in Uganda’s health information systems; this is attributed to limited expertise in digital health terminology standardisation, a deficit of human resources trained in terminologies and unmatched national terminologies to international digital health terminologies. Accordingly, requirements were derived to guide the development of the contextualisation process of the international digital health terminology standards. The derived contextualisation process entails six phases: assessing the national health information system context, extracting data elements in the national health information system, mapping existing national data elements to international terminologies, identifying and coding unmatched data elements, validating the contextualised terminologies, and digitising the validated terminologies. Conclusion: This research demonstrates how Uganda can contextualise the international digital health terminology standards to address the semantic interoperability challenges of health information systems. The study recommends developing terminology services and vocabulary interfaces for Uganda’s health information systems, as well as implementing contextual terminology standards
Community participation and disaster management: a case study of droughts & floods in Bardhere District-Somalia
No full textA dissertation submitted to the Directorate of Graduate Training for the award of Masters of Public Administration and Management of Makerere UniversityThis study, titled "community participation and disaster management: A case study of Droughts & Floods in Bardhere District-Somalia," aims to explore the critical role of community engagement in managing climate-induced disasters, particularly droughts and floods. Guided by four specific objectives, the research investigates the community's perceptions regarding their involvement in disaster management efforts, examines the state's capacity to respond to these disasters in the face of climate change, assesses the role of other actors such as NGOs, and evaluates the coping mechanisms adopted by the local population in response to these challenges. The study employs Disaster Theory and Emergency Management Theory to frame the analysis, offering insights into how communities, governments, and other stakeholders interact in the context of disaster preparedness and response. Primary data was gathered through interviews with key informants, including community members, government officials, and NGO representatives, to capture a comprehensive understanding of the disaster management landscape in Bardhere District. Thematic analysis was employed to interpret the data, allowing for an in-depth exploration of the key themes emerging from the study. Findings reveal a complex interplay between community participation and institutional capacity, with limited state resources and a lack of comprehensive planning posing significant challenges to effective disaster management. NGOs and other non-state actors were found to play a crucial role in filling gaps left by the state, while the community's coping mechanisms, although innovative, remain strained under the increasing frequency and intensity of climate-related disasters. The study underscores the need for enhanced collaboration between communities, governments, and NGOs to develop more resilient disaster management strategies in the region
Severity of post - operative knee stiffness and associated factors after surgical fixation of knee osseous injuries among adults at Mulago National Referral Hospital
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfillment of the requirement for the award of a Master's Degree in Orthopaedic Surgery of Makerere University.Background: Knee stiffness following surgical fixation of knee osseous injuries is a common and potential complication of surgery and rehabilitation with a global incidence of 4% to 38%. Even with the currently recommended surgical fixation techniques of these injuries, it was noted that patients develop varying degrees of stiffness.
Main objective: To establish the severity of post – operative knee stiffness and associated factors after surgical fixation of knee osseous injuries among adults at Mulago national referral hospital.
Methods: A period cross sectional study was done between September 2024 and January 2025, among adults with knee osseous injuries managed by surgical fixation. A total of 115 participants were enrolled into the study and consecutive sampling was used to recruit the participants. Descriptive statistics was done and then Bivariate and multivariate ordinal logistic regression model analyses were conducted, with STATA version 15 to identify the factors associated with severity of POKS.
Results: 90 (78.3%) out 115 patients had varying severity of POKS. 25.2% had extreme POKS, 28.7% had severe POKS, 19.1% had moderate POKS and 5.2% had mild POKS. 15 patients had extension limitation, 39 patients had flexion limitation and 36 patients had combined extension and flexion limitation. After controlling for other factors, non-adherence to physiotherapy (cOR = 0.28, 95% CI 0.16 – 0.49), cigarette use (cOR = 3.49, 95% CI 1.29 – 10.92) and surgical fixation done greater than 2 weeks post-injury (cOR = 1.35, 95% CI 1.02 – 7.76) were significantly associated with the severity of POKS, with P – values less than 0.05.
Conclusion: In this study, most participants presented with the extreme and severe forms of severity of POKS. The independent predictors of POKS severity included non-adherence to physiotherapy, surgical fixation performed more than 2 weeks post-injury, and cigarette use
Predictive role of neurofilament light protein in neurological and mental health outcomes following non-severe trauma among adults: A prospective cohort study at Mulago National Referral Hospital
No full textINTRODUCTION- Traumatic Brain Injury (TBI) is a major risk for neurological and neuropsychological disorders. Neuroaxonal damage is a major determinant of outcomes of TBI, and Neurofilament Light chain protein (NfL), a product of this damage, has the potential of enhancing patient stratification, monitoring and prediction of outcomes.
METHODS- A total of 176 consenting participants, who met the inclusion criteria, were enrolled in the study and blood obtained to measure serum NfL levels. Data was gathered using a questionnaire and chart abstraction form. Patients were followed for three months post-enrollment to assess neurologic recovery via the Glasgow Outcome Score Extended (GOSE), depression using the Patient Health Questionnaire (PHQ-9), and Post-Traumatic Stress Disorder (PTSD) through a standard checklist. Univariate analysis, bivariate analysis and multivariate analysis were done.
RESULTS: Significant predictors of GCS included time to hospital post-trauma, neurological deficits, and distance from Kampala. Patients with elevated NfL levels had a 10% to 20% higher likelihood of presenting with a moderate pre and post resuscitation GCS (P=0.9 and P=0.6) respectively. 134 patients were followed up, 38 (28%) had unfavorable neurological outcomes. Significant predictors for Unfavorable outcomes- arrival time to hospital, motor neurological deficits and surgery. Multivariate analysis, none of the patient’s characteristic predicted unfavourable outcomes. Prevalence of PTSD was 13%, and those with elevated NfL levels were 7% more likely to develop PTSD. Patients with moderate GCS were twice as likely to have PTSD (P=0.05). Multivariate analysis, none of the patient’s characteristics predicted the risk of developing PTSD. Prevalence of depression was 33%, those with high NfL levels were twice as likely to develop depression (p=0.03). Significant variables included- arrival time hospital, moderate pre & post resuscitation GCS, surgery, poor progress at discharge and poor recent memory increased risk for depression. Multivariate analysis, none of the patient’s characteristics significantly predicted the risk of developing depression.
CONCLUSIONS- The study found no association in NfL levels among patients with mild and moderate GCS scores at admission, nor in the neurological and mental health outcomes three months post injury. Recommendation- larger studies with diverse populations to clarify NfL's role in neurological and mental outcomes after non-severe TBI.Makerere University Brain Health Foundatio
Photo-catalytic degradation of microplastics in wastewater using Metal Modified Titanium (IV) oxide catalysts
No full textA thesis submitted to the School of Physical Sciences, College of Natural Sciences for the award of the Degree of Doctor of Philosophy in Chemistry of Makerere UniversityMicroplastics (MPs) are increasingly recognized as emerging environmental pollutants due to their ubiquitous distribution, persistence, and potential impacts on ecosystems and human health. These particles, resulting from the breakdown of larger plastic materials, are small enough to be ingested by organisms, often being mistaken for food. In addition to their physical presence, MPs act as vectors for other pollutants such as heavy metals and persistent organic pollutants, which can bioaccumulate and transfer through the food chain. Although wastewater treatment plants (WWTPs) serve as barriers to MPs entering aquatic ecosystems, they are not specifically designed for MP removal and can therefore serve as point sources of MP pollution in receiving water bodies. This study assessed a novel approach to MP remediation by employing metal-modified Titanium (IV) oxide (TiO₂) nanophotocatalysts activated under visible light. High-density polyethylene (HDPE) and polyethylene terephthalate (PET) microplastics were used as model polymers to optimize degradation conditions, which were subsequently applied to environmental MP samples. The photocatalysts were synthesized using the sol-gel method with vanadium (V), cobalt (Co), and molybdenum (Mo) as modifying metal ions, a combination not extensively studied in MP degradation research. Characterization of the materials was performed using X-ray diffraction (XRD) for crystal structure, scanning electron microscopy (SEM) for morphology, and UV- Vis spectrophotometry for optical properties. Metal modification with V, Co, and Mo resulted in complete transformation of TiO₂ to the anatase phase and narrowing of the band gap from 3.2 eV to 2.7 eV, enhancing its activity under visible light. Degradation was found to be pH-dependent: acidic conditions favored HDPE degradation, while neutral to alkaline conditions enhanced PET breakdown. Fourier-transform infrared spectroscopy (FTIR) revealed formation of carbonyl (C=O) and hydroxyl (OH) groups, indicating oxidative degradation. Visual observations under an optical microscope showed yellowing, cracking, and surface deformation of the MPs. An increase in chemical oxygen demand (COD) to
230.0 mg/L in treated samples confirmed the disintegration of MPs into smaller organic compounds. Significant mass reductions were observed after 200 hours of exposure, with environmental MP samples showing 83.0 to 91.7% degradation depending on the photocatalyst used. These results demonstrate the novel potential of visible-light-driven, metal-modified TiO₂ photocatalysis as an effective method for MP degradation in wastewater. The findings suggest that this method could be incorporated into existing WWTPs as an additional treatment step to enhance the removal of MPs from wastewater.European Union-Intra African Water Resource Mobility
Network (AWaRMN) Progra
Maternal near miss at Kawempe National Referral Hospital: risk factors and immediate perinatal outcomes
No full textA dissertation submitted to the Directorate of Research and Graduate Training in partial fulfilment of the requirements for the award of Master of Medicine Degree in Obstetrics and Gynaecology of Makerere University.Introduction: The maternal near misses (MNM) are used as a proxy for, and exceeds maternal deaths by upto 20 times, yet studying them is more advantageous at improving the quality of maternal and perinatal care. They have, however, received less attention, especially in Uganda, with a high MNM incidence of 40 per 1000 live births and maternal mortality ratio of 189 per 100,000 live births. Different previous MNM case definitions have had challenges, therefore, this study assessed risk factors and immediate perinatal outcomes among MNM at Kawempe National Referral Hospital, Uganda, using a more sensitive MNM case definition, suitable for low-income settings.
Methods: A facility-based unmatched case–control study was conducted on 252 women (84 cases and 168 controls) from January to March 2025. The study was approved by the Makerere University School of Medicine Research and Ethics Committee. Data were collected using pretested interviewer-administered questionnaires on cases and controls at hospital discharge. Statistical analyses, including bivariate and multivariable logistic regression (P5km from a health facility were significant risk factors for MNM. Whereas being aware of danger signs in pregnancy significantly decreased the risks of MNM by 96% (aOR:0.04, 95 %CI:0.007-0.245, P value<0.001). Significantly higher proportions of cases than controls had adverse immediate perinatal outcomes such as fresh still births (cases: 27.9% Vs controls: 0.6%), macerated still births (cases: 8.8 % Vs controls:1.8%), low birth weight (cases: 37.3 % Vs controls: 8.3 %), Apgar score <7 at 5 minutes (cases: 29.0% Vs controls: 1.9 %), admission to NICU (cases: 53.5 % Vs controls: 14.6 %). Conclusion: Grand-multiparity, the occurrence of obstetric danger signs, limited awareness of these danger signs, and a longer distance from a health facility were significant risk factors for maternal near miss, who eventually have adverse immediate perinatal outcomes. Emphasizing antenatal care attendance, community sensitization on the obstetric risks of grand multiparity, and improving access to health facilities are recommended to reduce maternal near-misses