Mulago National Specialised Hospital, also known as Mulago National Referral Hospital, is a component of Mulago Hospital Complex, the teaching facility of Makerere University College of Health Sciences. It is the largest public hospital in Uganda.
Genome-wide association studies (GWAS) have identified over 200 genetic risk loci for breast cancer, yet the target genes in these loci remain largely unknown. To address this knowledge gap, we conducted a series of multi-ancestry transcriptome-wide association studies (TWAS) to discover potential breast cancer susceptibility genes. We developed and validated ancestry-specific genetic models to predict levels of gene expression, alternative splicing, and 3' UTR alternative polyadenylation, using genomic and transcriptomic data from normal breast tissue samples of 652 females of African, Asian, or European ancestry. These models were then applied to GWAS data of 178,534 breast cancer cases and 248,300 controls from these ancestry groups for association analyses. We identified 290 genes associated with breast cancer risk, including 103 previously unreported in TWAS and 46 located at least 500Kb away from any previously identified risk variants. Among them, 39 genes exhibited distinct associations with breast cancer risk by estrogen receptor status. The identified genes were enriched in pathways related to homologous recombination, apoptosis, p53, PI3K/AKT/mTOR, estrogen, and IL-2/STAT5 signaling. Single-cell RNA sequencing and in vitro experiment data provided additional functional evidence for 169 genes. Our study uncovered large numbers of candidate breast cancer susceptibility genes and contributed valuable insights into the genetics and biology of this common cancer.
BACKGROUND:In many low- and middle-income countries, expanding access to cancer services has been a major priority. Yet, patient outcomes increasingly depend not only on whether services exist but on how care is organized, documented, and coordinated within overstretched systems. ASCO's Quality Oncology Practice Initiative (QOPI) has shown that structured quality measurement is feasible in resource-limited settings (RLSs), but less attention has been given to how such frameworks can be sustained without adding pressure to already burdened clinical teams. OBJECTIVE:To describe how the ASCO QOPI Resource-Limited Setting (RLS) track, implemented through a lean, stepwise approach, can generate real and sustained institutional improvements in a resource-constrained oncology setting in sub-Saharan Africa. METHODS:Drawing on implementation experience across African oncology programs, this analysis applies a lean lens. Lean is used here as an approach that focuses on simplifying processes, reducing unnecessary steps, and introducing changes in stages. The analysis examines how QOPI RLS was introduced in a stepwise fashion and integrated into routine care. The three-tier structure is analyzed as a sequencing strategy that stabilizes core processes before expanding measurement to more complex domains. Operational examples illustrate how QOPI evolved from a documentation exercise into an embedded governance tool. RESULTS:A staged and lean-informed implementation transformed QOPI from a reporting framework into an organizing system for care delivery. Initial focus on essential processes such as documentation and treatment planning established a reliable baseline. Subsequent expansion made previously hidden gaps in safety, coordination, and continuity of care visible, allowing targeted improvements without overloading clinical workflows. Over time, quality activities became embedded within routine practice, supporting more consistent delivery of systemic therapies and strengthening institutional capability. As systems matured, these processes also created a foundation for more complex functions, including coordination across the patient pathway and readiness for clinical trial implementation. CONCLUSION:Structured, stepwise quality approaches can strengthen oncology care in RLSs by improving the reliability of core processes. This offers a practical pathway for applying global standards and improving day-to-day care across diverse health systems.
Bright IDEAS is a problem-solving skills intervention designed to aid caregivers of children with cancer. While this paradigm has been well-studied in high-income settings, the feasibility and utility of this intervention in low-resource settings has been largely unexplored. This pilot study examined whether Bright IDEAS was perceived as workable, usable, and useful by professionals in Uganda caring for patients and caregivers within pediatric oncology settings. A single-arm pilot feasibility study design was utilized in this study. Participants included 24 Ugandan health and psychosocial professionals trained in the Bright IDEAS model. Quantitative data was obtained from 14 participants, using a post-training survey of usability, feasibility, comfort, practicality, and perceived utility on a 5-point Likert scale (1 = Poor to 5 = Excellent). Open-ended items assessed barriers, enablers, and experiences of implementation. Descriptive statistics and thematic content analysis were conducted. Respondents rated both overall feasibility and usability highly (M = 4.3, SD = 0.6). They reported comfort in teaching caregivers about the intervention (M = 4.1) and reported Bright IDEAS strategies were easy for caregivers to understand (M = 4.4). The major qualitative themes were perceived empowerment of caregivers, strengthened problem-solving skills, and enhanced therapeutic engagement. Relevant challenges included lack of support from institutions, time constraints, and inadequate resources. Bright IDEAS was widely believed to be valuable for Ugandan professionals and the study demonstrated strong perceived impact on caregiver coping and communication. These results support additional contextual refinement and robust testing of Bright IDEAS in Ugandan oncology and psychosocial care contexts.
Precision medicine in gastric cancer management involves accurate diagnosis, accurate staging, minimally invasive surgery for early disease, and targeted therapies or immunomodulation for advanced disease. The current approach to the management of gastric cancer relies on the tumor-node and metastasis (TNM) classification, which has been shown to have limitations. Molecular and genetic diagnoses are accurate and available, but expensive. The modified Laurén classification has been proposed and is based on the tumor location, tumor histology, and clinical course. This classification relates well to patient prognosis and could offer an accessible option for achieving individualised care in gastric cancer management. To map the evidence on the patterns of gastric cancer by histopathological subtype and topographical subsite in Sub-Saharan Africa (SSA). Primary studies on gastric cancer, particularly adenocarcinoma, published between 2003 and 2024 in Sub-Saharan Africa were eligible. PubMed, Web of Science, and Google Scholar were searched using a predetermined strategy. Reports not in English, inaccessible abstracts/full texts, and those outside Sub-Saharan Africa were excluded. Data were charted using a pretested Google Form to capture publication year, author, country, study design, population size, sex, age, histological subtype, and topographical subsite. Descriptive analysis was employed for synthesis. After screening 214 studies, the databases yielded 20 studies that were included in the analysis from nine SSA countries. Most of the studies were retrospective in nature. The intestinal histopathological subtype and the non-cardia topographical subsite were the most predominant. Two studies evaluated the association of Helicobacter pylori with the histopathological subtypes. Three studies evaluated early-onset gastric cancer with a predominance of the intestinal histopathological subtype. Although the reviewed studies encompassed diverse regions within SSA, the lack of prospective designs and the concentration of data from only a few countries limit broader applicability. Interestingly, early-onset gastric cancer in these studies predominantly exhibited the intestinal subtype—contrasting with the diffuse subtype commonly reported in Asian and Western studies. These findings highlight the need for regionally representative, prospective research to better scrutinize gastric cancer subtypes, subsites, and epidemiological patterns across the continent.
While urban refugee youth face HIV vulnerabilities spanning socio-ecological levels, knowledge gaps persist in HIV prevention outcomes. We conducted a baseline analysis of a cohort enrolled in Tushirikiane-4-Uthabiti, an intervention focused on HIV testing practices among urban refugee youth aged 16–24 in Kampala, Uganda (N = 330). Using regression models, we examined the societal, community, and interpersonal factors associated with condom use self-efficacy [CUSE], consistent condom use, HIV self-testing [HIVST] kit access, and recent HIV testing. Most participants were women (53.3
