Mbale Hospital

BACKGROUND:Extraintestinal pathogenic Escherichia coli (ExPEC) are a leading cause of human bloodstream infections (BSIs) in sub-Saharan Africa, yet few studies have characterized African strains implicated in BSI or explored their potential reservoirs. METHODS:We enrolled febrile patients at 2 hospitals in Moshi, Tanzania, 2007-2019, and performed blood cultures. Whole-genome sequencing was conducted on E. coli originating from the bloodstream to characterize sequence types (STs), serotypes, and theoretical coverage of a 9-valent ExPEC polysaccharide conjugate vaccine (ExPEC9V). Separately, we evaluated 601 E. coli whole-genome sequences from humans, animals, and environmental sources in nearby communities. We assessed genetic relatedness between bloodstream and community isolates based on single-nucleotide polymorphisms and allele differences. FINDINGS:Of 3046 participants receiving blood culture, 48 (0.2%) had BSI yielding 48 E. coli isolates. The median (range) age of participants with E. coli BSI was 40.7 (0.3-89.0) years, and 32 (68.1%) were female. We identified 16 STs including ST131 (n = 16, 33.3%), ST73 (n = 10, 20.8%), and ST69 (n = 6, 12.5%) and 19 O groups including O25 (n = 13, 27.1%), O6 (n = 10, 20.3%), O17 (n = 4, 8.3%), and O18 (n = 4, 8.3%). Theoretical coverage for an ExPEC9V was 72.9%. None of the bloodstream and community E. coli pairs were closely related. CONCLUSIONS:We found a high diversity of STs among E. coli human bloodstream isolates in Tanzania. Despite this diversity, we observed that an EXPEC9V in development would provide good coverage. Reservoir-attribution studies at finer spatial and temporal scales may better identify transmission networks and reservoirs of ExPECs.

Background National ICU registries are increasingly being implemented in low- and middle-income countries (LMICs) to support resource mapping, patient care evaluation, and data-driven quality improvement. The Intensive Care Registry of Uganda (ICRU) was launched in 2020 to strengthen critical care services through standardized data collection, benchmarking, and research facilitation. This article describes the implementation of ICRU, its contributions to critical care in Uganda, and lessons learned during operationalization. Methods ICRU was established as a cloud-based registry using standardized nomenclature (SNOMED-CT) to ensure interoperability. Participating ICUs employed dedicated data collectors supported by centralized training, IT assistance, and quality assurance mechanisms. Data were collected across admission, daily care, and discharge domains. Challenges, including staffing constraints, ethical approvals, and internet limitations, were addressed through targeted mitigation strategies. Results Between 2020 and 2024, ICRU expanded from 5 to 11 ICUs, capturing nearly 3,800 consecutive admissions and achieving >95% completeness across 33 core variables. The registry enabled real-time tracking of ICU occupancy and critical resource utilization, supported benchmarking with risk-adjusted outcome measures (including e-TROPIcs), and embedded context-appropriate quality indicators. Registry data have informed national quality improvement initiatives, site-level process monitoring, and have supported observational and interventional studies such as MOTIVATE-ICU and ARISE-Africa. Conclusion ICRU demonstrates the feasibility of implementing a national ICU registry in a low-resource setting. By enabling benchmarking, quality improvement, and research, it provides a scalable model for LMICs seeking to strengthen critical care through data-driven approaches. Future priorities include nationwide expansion, integration with the national Health Management Information System (HMIS), and participation in multinational benchmarking and adaptive trials.

Background Metabolic syndrome (MetS) is a growing public health burden associated with increased cardiovascular morbidity and mortality, particularly among patients with hypertension (HTN). Comprehensive cardiometabolic risk profiling, including estimation of 10-year cardiovascular (CVD) risk, provides an estimate of overall cardiovascular risk. However, data on MetS and cardiovascular risk profiles among HTN patients in Uganda are limited. Understanding the prevalence, associated factors, and cardiovascular risk profile is critical for designing preventive and management strategies. Objective To determine the prevalence and factors associated with MetS and to describe the 10-year cardiovascular risk profile among patients with HTN attending the Chronic Care Clinic at Mbale Regional Referral Hospital in Eastern Uganda. Methods A cross-sectional study that involved 384 patients with HTN was conducted between December 2024 and April 2025, using a structured questionnaire modified from the WHO STEPwise instrument®. Physical measurements and laboratory investigations were systematically collected. MetS was defined using the harmonized 2009 criteria. Ten-year CVD risk was estimated using three published algorithms: QRISK3, the ASCVD Pooled Cohort Equation, and the Framingham Risk Score. Data were summarized as proportions, means, and standard deviations. Adjusted prevalence ratios (APR) and their 95% confidence intervals (CI) were calculated using modified Poisson regression. Results Of 384 participants, 74.5% (286/384) had MetS. Independent factors associated with MetS were female sex (APR 1.44; 95% CI 1.25–1.66; p < 0.001) and increasing age (APR 1.004 per year; 95% CI 1.001–1.008; p = 0.027). Central obesity (81.3%), low HDL-C (59.4%), and hypertriglyceridemia (44.5%) were the most prevalent components. The proportion of participants classified as high 10‑year cardiovascular risk was 17.8% by QRISK3, 19.6% by ASCVD, and 43.8% by Framingham. Conclusion MetS was highly prevalent in this hypertensive population and was associated with female sex and increasing age. A substantial proportion of participants were classified as having elevated 10-year cardiovascular risk. Routine assessment and management of MetS components in HTN clinics is warranted for early risk stratification and intervention.

Abstract Background Vasectomy remains one of the most underutilized contraceptive methods in Uganda, with a prevalence of only 0.2% despite its safety, effectiveness, and potential contribution to fertility reduction. Understanding the factors influencing awareness, knowledge, and attitudes toward vasectomy acceptance is crucial for developing effective promotion strategies in the Ugandan context. Methods A cross-sectional study was conducted among 617 men aged 20-60 years, selected through simple random sampling of participants attending Kapchorwa General Hospital. Data were collected using a structured questionnaire. Results Knowledge scores showed a negative association with age (β = -0.044, p < 0.001) and varied significantly by marital status, with married participants demonstrating higher knowledge than single (β = -0.624, p < 0.001) and widowed (β = -0.950, p < 0.001) individuals. Counterintuitively, higher knowledge was associated with more negative attitudes (β = -1.729, p < 0.001). Age demonstrated the strongest negative effect on attitudes (β = -0.249, p < 0.001), and 99.9% of participants believed contraception is primarily women’s responsibility. Behavioral data revealed that 75.0% desired more children, with 51.2% preferring a family size of 3-4 as the ideal. Conclusion The study shows a disconnect between knowledge, attitudes, and behaviors regarding vasectomy. While general awareness is high, deep-seated misconceptions, cultural norms around masculinity and contraceptive responsibility, and fertility preferences present significant barriers to acceptance.

Background Timely review of very high-risk mothers by an obstetrician within one hour of admission is very important in enabling fast decision making for emergency intervention. Any delays in review of high-risk obstetric patient such as hypertensive disorders, obstructed labour or haemorrhages increase maternal morbidity and mortality. Globally, more than 260,000 mothers die from pregnancy related causes with sub-Saharan Africa being contributing 70%. To reduce this mortality, the ministry of health of Uganda encourages urgent assessment of all high-risk pregnant mothers. This study assessed the proportion and factors associated with specialist review within one hour of very high-risk obstetric mothers at Mbale Regional Referral Hospital. Methods A retrospective quantitative study was conducted from June to October 2025 at a tertiary Hospital in Easter Uganda. Systematic sampling was used to select files of mothers triaged as very high (red category). The minimum calculated sample size was 427, but 454 eligible files were analysed to improve precision. Social demographics obstetric characteristics and timing of specialist review ere extracted. Data were entered into excel and analysed using STATA. Descriptive statistics summarized proportions and modified Poisson regression identified factors associated with timely review at 95% CI and p<005. Results The proportion of very high-risk mothers reviewed within one hour was 33.9 % (95% CI:29.7%-38.4%). In multivariable analysis, foetal heart monitoring conducted once was independently associated with lower likelihood of timely review (aPR=0.575,95% CI:0.334-0.988; p=0.045). No other variables showed significant association. Conclusion Only one-third of very high-risk mothers received specialist review within one hour below national recommendations. Strengthening obstetric triage and specialist availability is essential to improving emergency obstetric care ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the Busitema University Research Ethics Committee, reference number BUFHS-2026-691, and administrative clearance was obtained from the Mbale Regional Referral Hospital. The study was done according to the Declaration of Helsinki. As this was a retrospective review of routinely collected medical records, the Research Ethics Committee waived the requirement for informed consent. Patient identifiers were not collected, and all data were anonymised to ensure confidentiality. Patient codes were used instead of their real names to protect participants' identities. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the paper and its supporting information files.