BACKGROUND:Poor access to water, sanitation and hygiene exacerbates the spread of infections among newborns. The BabyGel cluster randomised trial assessed the effectiveness of a community-level alcohol-based hand rub with a training component in reducing infection or death rates among newborns in Uganda. OBJECTIVE:Nested in the BabyGel trial, this study investigated the acceptability of the BabyGel intervention among mothers and household members in Eastern Uganda, using the Theoretical Framework of Acceptability. METHODS:In 2022, we conducted individual semistructured interviews with mothers, and group interviews with mothers and other household members, all recruited from intervention-arm clusters. Thematic analysis combined inductive and deductive coding, structured by the framework's seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy. RESULTS:Twenty mothers and 14 household members participated in 10 individual and 10 small group interviews. Participants found the intervention generally acceptable, appreciating its convenience and perceived protection against infection. Many described hand hygiene changes that persisted beyond the intervention period. However, concerns related to its harmful effects, spiritual beliefs and social tensions with visitors occasionally influenced its use. CONCLUSION:Alcohol-based hand rub combined with a training component was generally well accepted, driven by perceived health and practical benefits, although concerns related to safety, belief systems and social dynamics remained. Because data collection coincided with the COVID-19 pandemic, a period of heightened hygiene awareness, the acceptability observed could differ in nonpandemic periods. Culturally adapted education, community engagement and reinforcement of correct use may enhance acceptability and sustainability in similar settings.

Abstract Background Substance use among children and adolescents is an emerging public health concern, with studies from some settings reporting substantial levels of alcohol and other substance use among young people. However, in many low- and middle-income countries, including Uganda, the role, feasibility, and implications of routine substance use screening in primary healthcare settings remain poorly understood. Validated tools such as the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument have been used in other contexts, but evidence on their acceptability among children, caregivers, and health workers in African primary care settings is limited. This study assessed the acceptability of the CRAFFT tool among children aged 6–17 years, their caregivers, and health workers in primary healthcare settings in Uganda. Methods A cross-sectional study was conducted with 824 children, their caregivers, and 47 health workers across selected health facilities. Acceptability was measured using Likert-scale questionnaires tailored to each participant group; children, caregivers, and health workers alongside open-ended questions. Quantitative data were analyzed using STATA 18, and qualitative feedback was analyzed thematically. Results The CRAFFT screening tool was generally acceptable across all participant groups. Children found the tool easy to understand and informative, caregivers appreciated its potential for early identification of risky behaviors, and health workers viewed it as useful in identification of substance use. However, several concerns were raised, including long screening durations, lack of privacy, cultural and religious sensitivities, and doubts about the relevance of screening younger children. Conclusion CRAFFT screening was found to be acceptable among children, caregivers, and health workers in Ugandan health facilities. However, successful implementation requires addressing key barriers such as confidentiality, time burden, and cultural appropriateness. Integrating screening into routine care, especially in community and school settings, may enhance uptake and early intervention for substance use among children and adolescents.

Primary school-age children are particularly vulnerable to undernutrition, especially anaemia and underweight. School feeding programs in food-insecure areas aim to reduce undernutrition, but many vulnerable children in Ethiopia have not benefitted due to inadequate food quality and sustainability challenges. Exploring underutilized nutrient-rich foods may help address the shortage of energy-dense supplements for these programs. Amaranth, with its leaves consumed as a vegetable and seeds used like cereals, has shown superior nutrient content when compared to maize. Previous interventions with amaranth in younger children demonstrated a significant reduction in anaemia prevalence. This study aims to assess nutritional health and to reduce undernutrition among school children by promoting amaranth-plus-flaxseed food from locally grown, standardised foods in Sidama, Ethiopia. Under this research project, the following three study designs will be undertaken: a laboratory-based food analysis study, a cross-sectional study, and an experimental pilot study. In the pilot study, we aim to observe a weight increase of 0.5 kg, a haemoglobin increase of 0.5 mg/dl, and a reduction in school dropout. This protocol outlines the detailed procedure of the school intervention from food formulation to the pilot study. The outcomes generated from this project will provide policymakers with valuable insights to consider alternative approaches for school intervention.

Older people are at high risk of protein deficiency, which accelerates the age-related loss of muscle mass. However, there is a paucity of data on the consumption of protein-rich animal-sourced foods and their relationship with dietary intake and muscle mass of older adults in low- and middle-income countries. Therefore, this study assessed ASF consumption and its associations with protein intake and muscle mass of older adults. A cross-sectional study was conducted among community-dwelling older adults in the Gasabo district, Rwanda. Dietary intake was estimated using two non-consecutive 24-h recalls. A structured questionnaire was used to collect data on socio-demographic characteristics. Inverse propensity score weighting was employed to assess the association between animal-source food (ASF) consumption and protein intake and muscle mass. Slightly more than half (56%, n = 189) of the older adults consumed ASFs. In adjusted models, ASF consumption was positively associated with protein intake (ATE: 9.6 g/d; CI, 6.8 to 12.4) and muscle mass (ATE: 1.7 kg; CI, 0.0 to 3.4). The results also showed that adding one and two or more ASFs to the diet was proportionally associated with an increase in protein intake (ATE: 4.7 g/d; 95% CI, 0.2 to 9.3 and ATE: 13.9 g/d; 95% CI, 5.9 to 22.0, respectively), but not with muscle mass (ATE: 1.2 kg; 95% CI − 1.4 to 3.9 and ATE: 1.4 kg; 95% CI − 0.6 to 9.6, respectively). The consumption of ASFs was generally low among community-dwelling older adults. However, older adults who consumed ASFs had improved protein intake and muscle mass compared with those who consumed plant-based diets. Large and prospective studies, extending beyond urban settings, are needed to identify factors that can be targeted to improve ASF consumption and overall dietary intake among older adults in Rwanda.

Vitamin A deficiency (VAD) is a major public health problem in sub-Saharan Africa. Vitamin A supplementation (VAS) – the main strategy used to combat VAD – does not have optimal coverage in the Democratic Republic of the Congo, and several disparities exist between provinces, particularly in the health zones of Kasaï-Oriental province. Over two decades since the implementation of the VAS, no evaluation has been carried out to improve this strategy compared to other countries. This study aimed to identify the facilitators and barriers of the VAS campaigns conducted in Kasaï-Oriental province, aiming to enhance the overall comprehension of implementation challenges and opportunities in similar low-resource environments. A qualitative exploratory approach was used, involving stakeholders at national, provincial, health zone, and community levels. It comprised key informant interviews, in-depth interviews, and focus groups. Inductive thematic analysis was carried out, supported by NVivo 14 software. Several factors were recognised as facilitators of VAS, including heightened awareness of its benefits, the communication strategies employed during campaigns, and the properties of vitamin A supplements. Conversely, this strategy was impeded at the community level by certain beliefs, lack of motivation of healthcare providers, and insufficient vitamin A capsules. This study identified facilitators and barriers to VAS affecting the current VAS programme. Interventions will need to address barriers related to the health system and the community level by increasingly involving relevant stakeholders in VAS implementation.

BACKGROUND:In sub-Saharan Africa, stillbirth rates remain high. To design effective interventions to reduce stillbirths, accurate determination of their aetiology is important. Conventional autopsy for accurate confirmation of cause is not acceptable or feasible in several societies in sub-Saharan Africa; minimal invasive tissue sampling (MITS), is a recently developed, less invasive alternative. In this study, we explored the acceptability of MITS in the community and among healthcare workers in Uganda to guide the future implementation. METHODS:A qualitative study was done among community members and healthcare workers in Mbale in Eastern Uganda. We undertook in-depth interviews and focus group discussions in English or local languages. Interviews were audio-recorded, transcribed as necessary prior to formal content analysis. The themes were organised using NVivo software and presented according to Sekhon's theoretical framework. RESULTS:Overall, participants preferred the idea of MITS to conventional autopsy because of the perception that it was fast, maintained the facial appearance and kept the body intact. It was thought that the procedure would improve the detection of the cause of stillbirths, which in turn would help to prevent future stillbirths. It would also resolve conflicts in the community between community members or the women and the healthcare workers about the cause of a stillbirth. It was suggested that some community members may not approve of MITS because of their religious beliefs; the fear that the body parts may be extracted and stolen for witchcraft or organ donation; and a lack of trust in the healthcare system. To implement the procedure, it was suggested that extensive community sensitization should be done, space limitations in healthcare facilities overcome, healthcare workers should be trained and limited human resource should be addressed. CONCLUSION:The implementation of MITS in Mbale, Eastern Uganda, is likely to be acceptable given sufficient training and sensitisation.

BackgroundCytomegalovirus (CMV) infection poses risks to both maternal and neonatal health, however there are limited comprehensive data on congenital CMV in low-resource settings where the virus is widespread, particularly among women of reproductive age. Our research in eastern Uganda aimed to assess the prevalence of congenital CMV and outcomes among infants to inform public health policies and interventions in similar settings, addressing a significant gap in current knowledge.MethodsWe conducted a descriptive study, nested within the BabyGel Trial, across Mbale and Budaka districts in eastern Uganda, between May 2023 and January 2024. Infants underwent saliva sampling within the first week of life, which was validated through urine polymerase chain reaction testing within the first 21 days of life. At three months of age, a cranial ultrasound examination, neurological examination, developmental evaluation, and audiological assessment were conducted for all infants diagnosed with congenital CMV infection. Statistical analyses were performed using Stata 17.0.ResultsCongenital CMV infection was found in 5 out of 1,265 newborns tested, indicating a prevalence of 0.4% (95% CI: 0.16 to 0.96). Of these 5 infected infants, two experienced febrile illness at birth and required hospitalisation within the first week of life, and three had findings on ultrasound examination consistent with congenital cytomegalovirus during the neonatal period. Audiologic follow-up until three months of age revealed that three infants had failed unilateral and bilateral hearing screening. Neurodevelopment assessments using the Malawi Development Assessment Tool fell within optimal ranges for all 5 infants; however, when evaluated using the Hammersmith Infant Neurological Examination, four infants scored below optimal levels.ConclusionOur community-based study revealed a low prevalence of congenital CMV infection. Further longitudinal multi-site research is needed to assess the generalisability of these findings. Also, long-term follow-up of children is crucial to understanding the outcomes and sequelae of infected infants to inform prevention strategies, targeted interventions and scalable screening frameworks in resource-limited settings.

Uganda has one of the youngest populations in the world, with around 55

Background Every year, 1.9 million stillbirths occur worldwide, of whom 1.5 million occur in sub-Saharan Africa (SSA) and Southeast Asia. Objectives This study aims to determine the incidence and risk factors and to describe underlying causes for term stillbirths in Eastern Uganda. Methods This was a cohort study of pregnant women enrolled at 34 weeks of gestation or more and followed to birth between January 2021 and January 2024. Enrolment and follow-up were done in the community by trained midwives. Using structured questionnaires, details of maternal health, pregnancy and birth were captured. Results We enrolled 6101 participants and analysed 5496 for incidence of term stillbirth and 5296 for risk factors. Of the participants, 4913/5296 (92.8%) were between 14 and 35 years, and 4456/5296 (84.1%) had a health facility birth. There were 101 term stillbirths (61 were intrapartum and 40 antepartum). The incidence of term stillbirth was 18.4 per 1000 births (95% CI 14.8 to 22.9). The most common underlying causes of stillbirth were prolonged or obstructed labour 32/101 (31.7%) and malaria 20/101 (19.8%). The factors associated with term stillbirths were caesarean birth (aRR 3.3; 95% CI 2.00 to 5.4), intimate partner violence (aRR 1.8; 95% CI 1.1 to 2.8) and maternal age above 35 years (aRR 2.2; 95% CI 1.2 to 3.9). Conclusion Eastern Uganda has a high rate of term stillbirths with more than half occurring during labour. Efforts are needed to improve the quality of birth care and to prevent intimate partner violence.

Background:Sub-Saharan Africa is facing a dietary transition with both undernutrition and rising rates of non-communicable diseases. Adopting the reference diet proposed by the EAT-Lancet Commission can reduce both the environmental burden and improve health outcomes. However, whether this diet provides micronutrient adequacy in older adults in low-income settings has not been investigated. This study examines adherence to the EAT-Lancet diet and its association with micronutrient intake among older adults in the Gasabo district, Kigali, Rwanda. Methods:This cross-sectional study involved 334 older adults aged 55-93 years from Kigali, Rwanda. Dietary intake was assessed using two non-consecutive 24-h recalls, and socio-demographic data were collected through interviews. Adherence to the EAT-Lancet diet was evaluated using a 42-point index based on food group consumption and micronutrient intake was analyzed in relation to adherence tertiles. Multivariable regression models, adjusted for age, sex, and energy intake, were used to assess associations between diet adherence and micronutrient intake. Results:The EAT-Lancet adherence score ranged from 13 to 36, with a mean of 24. Higher adherence was associated with increased consumption of whole grains, vegetables, fish, and nuts, while red meat, dairy, and poultry intake declined. Adherence was positively associated with energy intake and intake of retinol-equivalents, thiamine, niacin, folate, vitamins B12 and D, calcium, phosphorus, magnesium, iron, and zinc. When adjusting for energy intake, the association with zinc and potassium became non-significant and the association with riboflavin became negative. Conclusion:Higher adherence to the EAT-Lancet diet was associated with higher intake of energy and several micronutrients important for healthy aging in this population of predominantly older, poor adults in Kigali. However, the potential for nutrient gaps, particularly in riboflavin, highlights the need for context-specific dietary adaptations to ensure nutritional adequacy in older populations in Rwanda.

BACKGROUND:Hearing impairment and neurodevelopmental disorders pose a significant global health burden in children. The link between postnatal cytomegalovirus (CMV) infection and these outcomes remains unclear. This study explored the association of postnatal CMV infection with hearing and neurodevelopmental outcomes in term infants aged 3 to 10 months. METHODS:This was a cohort sub-study within the BabyGel cluster randomised trial in Eastern Uganda. From 1265 term infants screened for CMV, 219 were negative at birth but positive at 3 months, and were age-matched with 219 CMV-negative controls. CMV status was determined by PCR screening of saliva samples, with positive results confirmed using urine samples (Chai Open qPCR, Santa Clara, CA). From the established cohort, 424 infants were successfully followed up between 3 to 10 months of age. Clinical assessments included neurodevelopmental evaluation using the Malawi Developmental Assessment Tool, the Hammersmith Infant Neurological Examination, and hearing screening using Otoacoustic Emission testing (Otoport Lite, Otodynamics Limited). Statistical analyses were performed using descriptive statistics, chi-square tests and log binomial regression models with Stata 18. RESULTS:Of the 424 infants included in the study, 206 were postnatal CMV-infected and 218 were uninfected. Neurodevelopmental assessments indicated no differences between postnatal CMV-infected infants and uninfected groups (ARR 0.88, 95% CI [0.67, 1.15], p = 0.346). Hearing screening revealed a 1.99-fold increased risk of a positive result for postnatal CMV-infected infants compared to uninfected infants (67/106 vs. 39/106, 95% CI [1.27, 3.12], p = 0.003). CONCLUSION:Postnatal CMV infection was associated with more positive hearing screenings, though no significant differences in neurodevelopmental outcomes were observed in early infancy. Exploration into the feasibility of incorporating hearing and CMV screening into routine care will play a vital role in early identification and intervention, improving the management of both hearing and CMV-related conditions in resource-limited settings.

Background: According to the last national survey in 1998, the prevalence of vitamin A deficiency (VAD) was as high as 61% in the Democratic Republic of the Congo (DRC), leading to the implementation of the vitamin A supplementation (VAS) programme. The available data are outdated and require situation analysis and vitamin A status data. While these data are missing, the relevance of the VAS programme is currently at the centre of debate, and it is important to understand how policymakers and programme planners perceive VAS. This study aims to explore the insights of policymakers and programme planners regarding its relevance and justification. Methods: This study used an exploratory qualitative design. Data were collected using key informant interviews with policymakers and programme planners at the national, provincial and health zone levels, including a total of 25 participants. Data were analysed using thematic analysis. Results: The participants recognised the relevance of VAS in reducing morbidity and mortality, especially in children. However, they identified challenges in communication and delivery mechanisms, such as insufficient supplement supply and a lack of provider motivation. The participants' opinions diverged regarding the justification of the VAS programme. Some participants perceived VAS as an essential strategy due to its benefits, while others advocated for alternative, cost-effective approaches, such as improving vitamin A dietary intake through fortification. Conclusion: Although VAS was considered important, our findings highlight the need to investigate alternative approaches, such as promoting affordable vitamin A-rich foods. There is an urgent need for more objective information regarding vitamin A status in the child population, and further research on VAD is necessary to evaluate the impact of the VAS programme.

BACKGROUND:Nearly half of all stillbirths occur in sub-Saharan Africa and accurate registration could inform reduction efforts. We explored the beliefs and practices surrounding stillbirths in Eastern Uganda, revealing cultural factors that could influence the accurate counting of stillbirths. METHODS:We conducted a qualitative study among women with a history of stillbirths, and men, women and community leaders with an experience of childbirth in Eastern Uganda. The study also included healthcare workers from three health facilities. We conducted 30 in-depth interviews and six focus group discussions to explore the beliefs and practices about stillbirths. All discussions and interviews were audio recorded and transcribed into English. Thematic analysis was done using NVivo R1 (2020) software for coding. RESULTS:We enrolled a total of 74 participants: 44 in six focus group discussions and 30 in in-depth interviews. Four themes emerged: first, the community believed that stillborn babies can be used for witchcraft or as a source of curses therefore stillbirths were hidden from the public. Second, women were useful in marriage only when they bore live children and were despised when they had a stillbirth leading to discord in marriage and stigma. Third, stillborn babies were not considered human and therefore, the baby was not named or buried in a coffin. Fourth, the spirit of the stillborn baby was considered harmful to the next siblings and their parents sought the services of traditional healers and witch doctors to protect these siblings. CONCLUSION:The immediate tragedy of a stillbirth has long-term personal and societal effects on the mother, resulting in stigma, marital breakup and isolation. The secrecy about stillbirths may also contribute to underreporting of stillbirths. Efforts to improve documentation of stillbirths and support for families who have had stillbirths need to incorporate culturally sensitive interventions.

Alcohol use is a major health concern in Uganda, affecting children and adolescents directly through their own consumption or indirectly through other’s drinking. Schools have an opportunity to improve knowledge and address attitudes towards alcohol. While curriculum-based alcohol education is a widely used educational approach, there is limited research on its delivery and effectiveness in Ugandan primary schools. This study explored teachers’ and learners’ perspectives on alcohol education in Ugandan primary schools, focusing on teaching methods and key content areas. This qualitative study was conducted in six purposively sampled primary schools in Mbale, Eastern Uganda. We conducted two focus group discussions in each school, a total of twelve, with 7–8 learners per group, aged 11–13 and a total of twelve key informant interviews with the teachers. The data was coded in NVivo and analysed using reflexive thematic analysis. Alcohol education was primarily integrated into science lessons in Ugandan primary schools. Four main topics were covered during the lessons: what alcohol is and how it is made; the effects of alcohol use; why people drink; and, how to avoid it. The dangers of alcohol use were strongly emphasized by the teachers and the children were advised to avoid places and people including children that use alcohol. Teachers often used moralising and didactic methods of teaching to underline their message against alcohol use. This study shows that teachers considered alcohol education as an important topic aiming to teach children about the dangers and negative effects of alcohol use.

BACKGROUND:Alcohol use among children in low-resource settings has received limited attention. This study investigated the prevalence of and biopsychosocial factors associated with alcohol use among children aged 6 to 13 years enrolled in primary education in Uganda. METHODS:This cross-sectional study conducted in primary schools within Mbale district, employed stratified random sampling to select 470 child-parent dyads. Screening for child alcohol consumption utilized the validated Ugandan (Lumasaaba) version of the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool. Alcohol Use Disorder (AUD) was diagnosed using the AUD module of the Mini International Neuropsychiatric Interview for children and adolescents (MINI KID). Logistic regression analysis explored associations between alcohol consumption (CRAFFT cut-off score: 1 or more) and biopsychosocial factors (age, sex, nutrition, family dynamics, socioeconomic indicators, and school environment). Data analysis utilized STATA-17 statistical software. RESULTS:The median age of the participants was 11 years, with an interquartile range (IQR) of 9 to 12 years and a male to female ratio of 1:1.3. The screened prevalence of alcohol consumption among the children in the past 12 months was 25.2% (95% CI: 21.4-29.4) and 7.2% (95% CI: 5.1-10.0) were diagnosed with AUD. The study found a comparable prevalence of alcohol use between boys (25.0%, 95% CI: 19.4-31.5) and girls (25.4%, 95% CI: 20.0-31.1). Age-specific variations indicated that early adolescents (10 to 13 years), were more likely to consume alcohol 28.1% (95% CI: 23.5-33.3) compared to pre-adolescent children (6 to 9 years) 17.6% (95% CI: 11.9-25.1) in the past 12 months. Factors associated with alcohol use included single-parent households, lower caregiver education, low socioeconomic status, maternal drinking, food insecurity, under-weight, physical discipline by parents, peer influence, rural school attendance, and the school environment. CONCLUSION:The prevalence of alcohol consumption among children in Mbale district, eastern Uganda was high with one-in-four primary-school-children aged 6 to 13 years consuming alcohol in the past year, and no significant gender differences. It highlights various interconnected factors associated with alcohol use among school-aged children. We recommend awareness campaigns at all levels, stricter implementation of alcohol policies, school prevention programs, and family-focused and socio-economic interventions. Nationwide school surveys should target pre-adolescent alcohol use.

CONTEXT:Consumers are increasingly encouraged to reduce meat and dairy consumption. However, few meta-analyses of randomized controlled trials (RCTs) on the effect of reducing meat and/or dairy on (absolute) protein intake, anthropometric values, and body composition are available. OBJECTIVE:The aim of this systematic review and meta-analysis was to evaluate the effect of reducing meat and/or dairy consumption on (absolute) protein intake, anthropometric values, and body composition in adults aged ≥ 45 years. DATA SOURCES:The MEDLINE, Cochrane CENTRAL, Embase, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases were searched up to November 24, 2021. DATA EXTRACTION:Randomized controlled trials reporting protein intake, anthropometric values, and body composition were included. DATA ANALYSIS:Data were pooled using random-effects models and expressed as the mean difference (MD) with 95%CI. Heterogeneity was assessed and quantified using Cochran's Q and I2 statistics. In total, 19 RCTs with a median duration of 12 weeks (range, 4-24 weeks) and a total enrollment of 1475 participants were included. Participants who consumed meat- and/or dairy-reduced diets had a significantly lower protein intake than those who consumed control diets (9 RCTs; MD, -14 g/d; 95%CI, -20 to -8; I2 = 81%). Reducing meat and/or dairy consumption had no significant effect on body weight (14 RCTs; MD, -1.2 kg; 95%CI, -3 to 0.7; I2 = 12%), body mass index (13 RCTs; MD, -0.3 kg/m2; 95%CI, -1 to 0.4; I2 = 34%), waist circumference (9 RCTs; MD, -0.5 cm; 95%CI, -2.1 to 1.1; I2 = 26%), amount of body fat (8 RCTs; MD, -1.0 kg; 95%CI, -3.0 to 1.0; I2 = 48%), or lean body mass (9 RCTs; MD, -0.4 kg; 95%CI, -1.5 to 0.7; I2 = 0%). CONCLUSION:Reduction of meat and/or dairy appears to reduce protein intake. There is no evidence of a significant impact on anthropometric values or body composition. More long-term intervention studies with defined amounts of meat and dairy are needed to investigate the long-term effects on nutrient intakes and health outcomes. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42020207325.

Background Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda. Methods We conducted a health facility cross-sectional study, involving 854 children aged 6–17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software. Results The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24–1.31) while that of probable AUD alone was 25.3% (95% CI 1.22–1.28). Peer substance use (APR = 1.24, 95% CI 1.10–1.32), sibling substance use (APR = 1.14, 95% CI 1.06–1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01–1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82–0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01–1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01–1.12) were found to be significantly associated with probable AUD/SUD. Conclusions Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.

Abstract Background Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG. Methods This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as “controls”. Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants’ outcomes include teachers’ mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour. Discussion Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services. Trial registration ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered.