AGABA Bekiita Bosco
Molecular Epidemiological Surveillance of pfhrp2 and pfhrp3 gene deletions in Plasmodium falciparum parasite populations in Uganda

Mr. AGABA Bekiita Bosco investigated the biological and molecular changes in malaria parasites that make them difficult to be detected in malaria infected individuals. Once these parasites evade detection, individuals remain untreated leading to severe disease and risk of mortality. The results provide the first large-scale evidence reporting the presence of pfhrp2/3 gene deletions in P. falciparum parasites in Uganda and demonstrated that gene deletions are not confined but rather spread across regions. Further, the study showed that these parasites emerge independently and sponteneously. The findings inform national guidelines for malaria case management and policy for the introduction and deployment of new malaria diagnotic tests. The study was funded by the NIH-Fogarty Malaria training grant and the WHO collaborating center in Australia. The work was supervised by Prof. Moses R. Kamya, Prof. Chae Seung Lim, Dr. Adoke Yeka and Dr. Samuel Nsobya.

AMONGIN Dinah
Understanding Trends and Trajectories of Repeat Adolescent Birth in Uganda

Ms. AMONGIN Dinah studied the magnitude and explanation for repeat adolescent birth (i.e. a second or higher order live birth before age 20 years, following a first birth before age 18 years) and its later life consequences in Uganda. Her results revealed high repeat adolescent births (over 1 in 2) with slight decline in the 30 years of observation (1988/89-2016) although more women over the years wanted to have this repeat birth later. Results suggest life-long negative socio-economic and reproductive health outcomes among women with repeat adolescent births compared to those without. Further, escalation of the socio-economic distress following first birth, domestic violence, and partner coercion, predisposed adolescent girls to sexual exploitation and unwanted marriages. Interventions should focus on preventing repeat adolescent pregnancy and increasing opportunities for adolescent mothers, with a primary focus on: improving school retention/continuation, strengthening family planning services, and preventing early marriage. This study was funded by Training Health Researchers into Vocational Excellence (THRiVE-2) and was supervised by Assoc. Prof Annettee Nakimuli, Assoc. Prof Lenka Benova, Assoc. Prof Lynn Atuyambe, and Assoc. Prof Claudia Hanson.

KAPAATA ANDAMA Anne
Genotypic And Phenotypic Characterization Of Hiv-1 Transmitted/Founder Viruses And Their Effect On Cytokine Profiles And Disease Progression Among Acutely Infected Ugandans

Ms. KAPAATA ANDAMA Anne looked at Genotypic and Phenotypic Characterization of HIV-1 transmitted/founder viruses and their effect on cytokine profiles and disease progression among acutely infected Ugandans. Subtype analysis of inferred transmitted/founder viruses showed a high transmission rate of inter-subtype recombinants (69%) involving mainly A1/D, while pure subtype D variants accounted for one- third of infections (31%). The signal peptide-C1 region and gp41 transmembrane domain were hotspots for A1/D recombination events. She documented diversity in the functional protein domains across the Gag-Pol region of the HIV virus and identified differences in the Gag-p6 domain that were frequently associated with higher in vitro replication. She also found that HIV-1 subtype D infections had higher concentrations of different cytokines than subtype Ainfections. cytokines IL-12/23p40 and IL-1α were associated with faster CD4+T cell count decline while basic fibroblast growth factor was associated with maintenance of CD4+T cell count above 350cells/microliter. This work was funded by the International AIDS Vaccine initiative and supervised by Prof. Pontiano Kaleebu, Eric Hunter and Moses Joloba and Dr Jesus Salazar Gonzalez.

BAKESIIMA Ritah
Modern contraceptive use among female refugee adolescents in northern Uganda: prevalence, effect of peer counselling, adherence and experiences

Ms. BAKESIIMA Ritah studied modern contraceptive use among female refugee adolescents northern Uganda: the prevalence, effect of peer counselling, adherence, and experiences. She found that the use of modern contraceptives among sexually active adolescents was very low with less than 10% using a method, and yet they wanted to delay child birth. This highlights a high unmet need of contraceptives in this population. She also found that peer counselling had a positive effect on acceptance of modern contraceptives; participants who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling. The commonest reasons for non-acceptance of a method were partner prohibition and fear of side effects. She recommends that refugee adolescents, together with their partners, are further sensitized of the dangers of teenage pregnancy, and the benefits of contraception in preventing teenage pregnancy and associated complications. This research was funded by SIDA and supervised by Assoc. Prof Elin Larsson, Dr. Jolly Beyeza-Kashesya, Prof. Kristina Gemzell-Danielsson, Dr. Amanda Cleeve, and Dr. Rose Chalo Nabirye.

BAYIGGA Lois
Role of Vaginal Microbiome in Host Susceptibility of HIV Infection in Pregnant Ugandan Women: Inflammatory Response and Epithelial Barrier Integrity

Mr. BAYIGGA Lois investigated the virginal microbial diversity and its immune-modulatory effects on host susceptibility to HIV among pregnant women in Uganda. In the results, the vaginal microbiome of pregnant women in the cross-sectional study was categorised into four distinct cervicotypes. In conclusion, African women had a more diverse vaginal microbiome relative to women in the America and Europe as observed in the literature. This work was supervised by Prof. Damalie Nakanjako, Dr. David Patrict Kateete, Dr. Musa Sekikubo and Prof. Deborah Anderson.

MIJUMBI Deve Rhona
Rapid Response Services to Support Policymaking in Uganda

Ms. MIJUMBI Deve Rhona evaluated the rapid response mechanisms aimed at providing evidence for policymaking in Uganda, including their feasibility and establishment, their uptake amongst the users along with these users’ experiences with them. She was able to determine and confirm the feasibility of an RRS in Uganda and map the establishment, growth, and evolution of the service. She was also able to document the important factors that led to the establishment of the service, then used this information to develop a theoretical framework combining the structural and temporal components of the development of an RRS and the factors important at each stage. She also established the important factors that influence the uptake of the RRS amongst its actual and potential users and also explored the users’ experience with the rapid response (RR) briefs produced by the RRS and used her findings to improve these briefs. The findings from this work are important to enable the use of evidence for decision-making at different levels of governance globally, especially in complex situations where time is barred. The work was funded by the International Development Research Center’s International Research Chairs Initiative and supervised by Prof. Nelson Sewankambo, Prof. John Lavis, and Dr. Andrew Oxman.

MUKURU Moses
An analysis of evolutions in maternal health policies and implementation adaptations in Uganda during the MDG period (2000-2015)

Mr. MUKURU Moses analysed Uganda’s maternal health policies introduced during the fifteen years of the Millennium Development Goals (MDG period) to understand policy failure. This followed the persistence of high preventable maternal mortality, which closed at a Maternal Mortality Ratio (MMR) of 368 deaths per 100,000 live births in 2015 below the target of 131 deaths per 100,000 live births. While most studies explain the failure to achieve maternal health policy targets from epidemiological, interventional and health systems perspectives, this study examined how elite interests underpinning maternal health policies, policy design and implementation influenced maternal health policy failure in Uganda. The study found that the failure to achieve policy targets and persistence of high maternal mortality despite introducing fourteen policy shifts emanated from a complex interplay of factors at the policy formulation, design and implementation levels. Policy elites developed policies which mainly served their selfish political and economic interests while paying limited attention to the goal of reducing maternal mortality. The policy instruments introduced were incoherent, inconsistent and incomprehensive to cover all the causes of maternal mortality rendering the policies ineffective in design. Consequently, maternal health policies could not be fully operationalised at the frontline to support timely response to all the emergencies that cause maternal death. The study was funded by DAAD, the Alliance for Health Policy and Systems Research, Switzerland, through the University of Cape Town, South Africa, the “Support Policy Engagements for Evidence informed (SPEED)” and was supervised by Professor Freddie Ssengooba and Dr Suzanne Kiwanuka.

MUSABA Milton
Obstructed labour in Eastern Uganda: risk factors, electrolyte derangements, and effect of bicarbonate on obstetric outcomes

Dr. MUSABA Milton studied the risk factors, electrolyte derangements, and effect of bicarbonate on obstetric outcomes among women with Obstructed labour (OL). Failure of a woman to give birth normally is called OL. It is often associated with poor outcomes for both the mother and baby, if the intervention (surgical) is not timely. In Uganda, one in five maternal deaths and two in five perinatal deaths are attributed to OL. The risk factors were being a first-time mother, using herbal medicines, and being referred in labour. While being married, having a delivery plan, and an educated partner were protective. Perioperatively, multiple electrolyte derangements were common. Perinatal death was four times higher than the national average, and the predictors were being referred and having a high maternal blood lactate level. Sodium bicarbonate infusion had no significant beneficial or harmful effect. Developing birth and complication readiness plans may help to minimize delays and multiple referrals in case of an emergency. To minimize the effects of metabolic and electrolyte derangements in OL, healthcare providers need to ensure that these patients are well rehydrated especially during transfer to a higher facility. This study was funded by NORHED/NORAD and was supervised by Prof. Grace Ndeezi, Prof. Julius N. Wandabwa, Dr. Justus K. Barageine, and Prof. Andrew D. Weeks

NAMAZZI Gertrude
Burden and risk factors for child developmental disability among infants in Busoga region, in Uganda

Dr. NAMAZZI Gertrude investigated the burden and risk factors for child developmental disability among infants in Busoga region, in Uganda. The study revealed a high burden of child developmental disability at population level and among preterm babies. The caretakers of children with developmental disability expressed emotional stress and an impoverishing experience with limited support from the community and the health system. The key risk factors included: birth asphyxia, malnutrition, newborn infections, and a mother having more than three children. The study findings indicate the need to improve the quality of care during delivery and the postnatal period to prevent birth asphyxia, neonatal infections and malnutrition so as to curb the burden of child developmental disability. In addition, parents should limit the number of children to those they are able to nurture and care for adequately. The study recommends to government to improve the health facility readiness to respond to caretakers’ needs and the needs of children with developmental disability so as to empower families, while respecting their beliefs, to cope with adversity. The study was funded by SIDA and was supervised by Prof. James Tumwine, Assoc. Prof. Peter Waiswa and Assoc. Prof. Helena.

NANKYA Mutyoba Eron Joan
Hepatitis B. Among Ugandan pregnant women: Studies on Epidemiology, knowledge, perceptions and behavioural intentions

Ms. NANKYA Mutyoba Eron Joan investigated the epidemiology, knowledge, perceptions and behavioural intentions associated with Hepatitis B among Ugandan pregnant women. The study was conducted among pregnant women attending routine Antenatal Care in public health facilities in Kampala, Wakiso and Arua Districts. In the results, the overall prevalence of Hepatitis B. Virus infection was 6.1%. Pregnant women in Uganda have a high burden of the virus with significant regional differences, low knowledge and inaccurate perceptions of the virus. This study was funded by SIDA and was supervised by Assoc Prof. Ponsiano Ocama, Asoc Prof. Fredrick Makumbi and Assoc Prof. Lynn Atuyambe.

ODEI OBENG-AMOAKO Gloria Adobea
Retrospective analysis of concurrently wasted and stunted children 6-59 months in the outpatient therapeutic feeding programme in Karamoja: burden, characteristics, detection, response to treatment and outcomes

Ms. ODEI Obeng-Amoako Gloria Adobea examined the burden, characteristics and detection of concurrently wasted and stunted among children under 5 years, and their response to treatment and outcomes in the outpatient therapeutic feeding programme in Karamoja. She found that 5% of children under-5 years in Karamoja were wasted and stunted concurrently. Concurrent wasting and stunting was common among children younger than 3 years and particularly males. She identified optimal weight for age z-score (WAZ) and mid upper arm circumference (MUAC) thresholds for detecting children with concurrent wasting and stunting. Nearly half (49%) of children with severe acute malnutrition receiving outpatient therapeutic care were concurrently wasted and stunted and had lower recovery rate. The study will inform decision-making on integrated wasting and stunting prevention and treatment policy and programme. This study was funded by Carnegie Corporation of New York through RUFORUM, UNICEF Uganda; and African Union and European Union-Intra-ACP Mobility Partnering for Health Professionals Training in African Universities (P4HPT) and supervised by Assoc. Prof Charles A. S. Karamagi and Dr. Henry Wamani.

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