Background: Sickle cell disease (SCD) is the most common inherited blood disorder worldwide. In Uganda, fifth in global prevalence, about 40,000 children are born with SCD annually. Newborn screening (NBS) enables early diagnosis and reduces mortality. Despite Uganda adopting universal NBS policies, little is known about factors affecting implementation in isolated areas. This study examined barriers and facilitators to NBS for SCD in Kalangala District, an island district in Lake Victoria, Uganda. Objectives: This study investigates challenges and facilitators to Uganda Ministry of Health’s (MoH’s) call for universal NBS in a low‑resource area and describes parent perspectives of NBS. Methods: We conducted a mixed‑methods study with surveys (N = 271) and in‑depth interviews (N = 32) with parents of children under two years old about Kalanglala Health Center IV’s NBS program and their attitudes toward it. Data from surveys, in‑depth interviews, and KHCIV’s annual NBS data assessed NBS capacity. Statistical analysis was conducted in RStudio and Excel; qualitative analysis was conducted in NVivo. Findings: Among 271 participants, 83.8% had heard of SCD, but only 51.5% knew it is an inherited blood disorder. Most (61.6%) were unaware of the NBS at Kalangala Health Center IV, yet 81.5% would recommend screening. Most (51.3%) saw the first two days after birth as the best screening time. Of 455 records, SCD prevalence was 2.4%, higher than the national 0.7%. Qualitative findings highlighted limited knowledge, stigma, transportation, cost, and mistrust as barriers, while facilitators included trust in healthcare workers, positive screening experiences, and integration into community outreach. Conclusions: Universal NBS for SCD is feasible in remote areas like Kalangala District, but barriers such as educational, geographic, financial, and health system issues threaten sustainability. Integrating SCD education into antenatal and immunization services, initiating community outreaches, and improving access to specialized care are key to nationwide scale‑up.
The diagnosis of communicable and noncommunicable diseases cannot be made without radiology/imaging and pathology and laboratory medicine (PALM) services. These diagnostic services are often an under‑recognized vital component of health care systems. Supply chain challenges and limited human resource capacity and capability are major impediments to delivering accurate, timely, and comprehensive diagnostic services in low‑income and lower‑middle‑income countries (LMICs) in sub‑Saharan Africa (SSA) and other low‑resource regions. This viewpoint provides a current assessment of these supply chain and human resource challenges and addresses possible solutions. Chronic underfunding, lack of transparency, and an over‑dependence on inadequate or obsolete methods of supply chain management at all levels are common in many low‑resource regions. Furthermore, overdependence on high‑income countries for basic diagnostic supplies jeopardizes diagnostic and health care services. Resource limitations impede attaining laboratory accreditation and certification. The scarcity of training programs at all levels of laboratory medicine and pathology as well as imaging and the serious problem of brain drain to high‑income countries are major problems in many, if not all LMICs. Training in supply chain management is generally vastly underdeveloped in many low‑resource countries. Diagnostic services in rural and remote low‑resource settings are often very limited. Stakeholder engagement and the adoption of needs‑based solutions to gaps in supply chain management and human resource capacity are essential, as well as political will, public–private partnerships, and adequate funding. Development of effective, sustainable local and regional policies and governance is essential to strengthen diagnostic supply chains and workforce training in SSA and other LMIC areas. Diagnostic services in rural and remote areas in many LMICs need to be vastly improved.
Background: Atrial fibrillation (AF) affects over 37 million people worldwide, and its prevalence is projected to increase by 60% by 2050. Addressing AF is critical in Uganda and elsewhere in sub‑Saharan Africa, where data are lacking despite the high prevalence of AF risk factors, comorbidities, and sequelae. Objectives: To evaluate AF prevalence among inpatients with acute heart failure or acute ischemic stroke in Uganda. Methods: Between November 4, 2024 and November 30, 2025, we recruited a cohort of inpatients at the Regional Referral Hospital in Mbarara, Uganda with either acute heart failure or acute ischemic stroke. We collected baseline clinical data and hospital outcomes, performed a transthoracic echocardiogram, and equipped participants with a 24‑hour Holter monitor. A multivariable logistic regression model was fitted for a primary outcome of AF detection. Results: Among 250 individuals, mean age was 61.7 years (SD 20.5), of whom 175 (70.0%) were women. 123 (49.2%) had acute heart failure; 127 (50.8%) had acute ischemic stroke. Holter monitors detected AF in 105 (42.0%), with a mean AF duration of 11.0 hours (IQR 1.0–21.9) with a bimodal distribution. Mean stroke risk (CHA2DS2VA) was 3.5 (SD 1.6). Factors associated with AF included increasing age in years (OR 1.04, 95% CI 1.02–1.06) and left atrial volume index (mL/m2) (OR 1.02, 95% CI 1.01–1.03). Conclusions: We found high rates of AF among inpatients with acute heart failure or acute ischemic stroke, comparable to studies from the United States and Europe. These findings highlight the need to address AF in Uganda, with improved screening using long‑term monitors, updated treatment protocols, and broadened access to cardiac care.
Background: Group interpersonal psychotherapy (IPT‑G) has universal elements that appeal to non‑Western cultural contexts, while offering flexibility for contextual adaptations, making it an intervention of choice for adolescent populations in low‑ and middle‑income countries (LMICs). We anticipate that a shorter four‑session version, which we are calling IPT‑G Mini, offered to adolescents and young people during the COVID‑19 pandemic, would effectively mitigate psychological distress. Objective: The objective of this study was to test the feasibility of a short version of IPT‑G among adolescents screened for depression and anxiety. Methods: IPT‑G Mini was offered by lay health workers to 40 adolescents aged 10–19 years in Nairobi, Kenya, experiencing depressive, stress, and anxiety symptoms during the COVID‑19 pandemic during June–September 2021. Primary outcomes were a reduction in depression and psychological distress on the Patient Health Questionnaire‑9 (PHQ‑9), Revised Children’s Anxiety and Depression, and Kessler Psychological Distress (K10) scales. Findings: The intervention was effective, with a significant reduction in psychological distress (K10) and depression (PHQ‑9) scores at the end of the intervention (with p < 0.05), Cohen’s d = 0.49 (95% C.I. = 0.04–0.94) and d = 0.51 (95% C.I. = 0.06–0.96), respectively. Younger participants (10–14 years) had better outcomes than older ones on K10 and PHQ‑9 assessments. Conclusions: IPT‑G Mini must be tested in a more controlled setting with a larger and more diverse sample. It does appear to reduce distress and depressive symptoms, and further evaluation may be needed to refine the adapted version. Despite the challenges brought by the pandemic, the timely and effective intervention focused on interpersonal issues proved beneficial to participants. Addressing various problem areas helped provide perspective and support in dealing with multiple losses and socioeconomic hardships experienced by our young participants.
Background: Global measles vaccination programs have achieved significant reductions in measles‑related mortality, with World Health Organization (WHO)‑led initiatives expanding vaccine coverage to over 85% of children worldwide. Despite this progress, measles elimination remains elusive, undermined by anti‑vaccine sentiment, armed conflicts, migration, refugee crises, and post‑COVID‑19 disruptions. No WHO region has achieved or sustained measles elimination status since the COVID‑19 pandemic, and elimination remains challenging in resource‑limited and conflict‑affected contexts. A critical yet underappreciated consequence of this ongoing burden is the rise of post‑measles complications (PMCs). Vaccine‑preventable diseases and malnutrition constitute two critical global health priorities; PMCs represent an important intersection of these agendas that warrant greater attention within the global health framework. Objectives: To review and synthesize current epidemiological evidence on PMCs, examine their pathogenesis, and understand the need for integrated post‑measles care strategies in vulnerable populations. Methods: This narrative review included all papers that published primary data on any of the PMCs in the last 55 years, identified through PubMed and Google Scholar. Findings: Epidemiological data show that 30–40% of measles cases in low‑ and middle‑income countries (LMICs) develop complications, including pneumonia, diarrhea, otitis media, and, less commonly, encephalitis and ocular disease. PMCs are frequently misattributed to independent illnesses because they often emerge after a delay following the acute infection. Compounding this, measles‑induced immune amnesia renders affected individuals vulnerable to secondary infections for up to 2–3 years post‑infection. In LMICs and conflict‑affected settings, this prolonged immunological vulnerability intersects with pre‑existing risk factors such as malnutrition, micronutrient deficiencies, and poor healthcare access, which amplify the consequences substantially. Conclusions: As measles cases resurge globally, the associated burden of PMCs is expected to increase correspondingly. Where PMCs represent a pressing, underaddressed concern, integrated post‑measles care strategies are urgently needed from a global health perspective, especially in resource‑limited and conflict‑affected settings.
