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Factors Associated with Return to Treatment Following Interruption Among HIV-Positive Clients on Art in Public Health Facilities, Katakwi District
(Lira University, 2024) Okello, William; Acio, Christine
Background Return to treatment following interruptions is vital for maintaining optimal HIV care. Despite efforts, Uganda faces a 20% treatment interruption rate, with only 58% of clients resuming treatment. However, studies on factors associated with returning to treatment remain limited. Objectives This study aimed to identify factors associated with returning to HIV treatment among clients in Katakwi District, Uganda. Methods This cross-sectional, mixed-method study investigated factors influencing return to HIV treatment after interruptions in Katakwi District. Data were collected from three high-volume ART clinics Katakwi General Hospital, Magoro Health Centre III, and Ngariam Health Centre III-and included 355 adult participants. Quantitative data were collected and entered into Excel and analyzed using STATA 18, while qualitative data were collected through focused group discussion. Return to treatment was assessed using frequency counts, percentages, and a 95% confidence interval. Bivariate and multivariate analyses using Chi-square and logistic regression were used to identify predictors, while qualitative data was collected through Focused group discussions and analyzed by theme. Results Return to treatment was 63.9%, influenced by factors including occupation, distance to the health facility, community beliefs, and family support. Clients without an occupation were less likely to return to treatment (AOR = 0.17, 95% CI: 0.04-0.70, p = 0.015), and those living within 5 km of a facility were also less likely to return (AOR = 0.37, 95% CI: 0.11-0.67, p = 0.001). Positive community beliefs significantly increased the likelihood of returning to treatment (AOR = 3.05, 95% CI: 1.78-5.22, p<0.001). Key qualitative themes included home visits and counselling as facilitators, while limited rural support, clinic hours, and religious beliefs promoting alternative healing were barriers. Conclusion Return to HIV treatment was associated with occupation, facility proximity, and community beliefs. Enhancing supportive community beliefs, home visits, and counselling improved return rates, while barriers included limited rural support and inflexible clinic hours. Recommendations include providing targeted support for unemployed clients, conducting anti-stigma campaigns, offering flexible clinic hours, and improving rural access through mobile clinics and transport assistance. Continuous client education at both facility and community levels is essential for sustaining return rates.
Safety and efficacy of herbal medicines for the management of sickle cell disease in Africa: a systematic review and meta-analysis
(PAMJ One Health, 2024) Awor, Silvia; Bongomin, Felix; Kaggwa, Mark Mohan; Pebolo, Francis Pebalo; Kivumbi, Ronald Muganga; Malinga, Geoffrey Maxwell; Ongwech, Acaye; Nnamuyomba, Proscovia; Oryema, Christine; Abola, Benard; Epila, Jackie; Musoke, David
This systematic review and meta-analysis evaluated the safety and efficacy of herbal remedies used to manage sickle cell disease (SCD) in Africa. Before the advent of western medicine, people depended on herbal medicines for treating different illnesses. Using herbal medicines to sickle cell disease (SCD) is still common in Africa. However, data on the safety and efficacy of any of these remedies are limited. We searched PubMed, Embase, Google Scholar and Web of Science from inception to 11thJanuary 2024 using the keywords "herbal medicine" and "sickle cell" and the name of each of the countries in Africa without language restrictions. We included cross-sectional studies that reported the safety or efficacy of herbal medicine for managing sickle cell disease. Two reviewers assessed all included studies for suitability for inclusion in this review. All included articles were assessed using ROBINS-1, a tool for assessing the risk of bias in non-randomized studies of interventions. We used the random-effect model to pool the efficacy and safety profiles of the herbal medicines using RStudio version 4.2.2. Overall, we included five studies involving 1,489 individuals with SCD. Of these, 789 (53.0%) used herbal remedies like Aloe barbadensis (Aloe vera), Zingiber officinale (ginger), Cymbopogon citratus (lemongrass), Forever Living products, Golden Neo-Life Diamite International (GNLD) diet supplements and ginseng products. About 22.9% (181 out of 789) of the participants who used herbal remedies reported side effects, while 38.5% (304 out of 789) reported improving their symptoms. There was a high risk of publication bias in the articles included in this review. The pooled adverse effects of the herbal medicines for SCD treatment were 48% lower (Odds ratio: 0.52, 95% confidence interval (CI): 0.26 - 1.05, I²= 82%, p<0.01) while the pooled efficacy of herbal remedies for treating SCD was nearly 100% higher (odds ratio= 2.07, 95% confidence interval 0.99 - 4.32, I²= 78%, p<0.01) among the users than controls. However, these findings were not statistically significant. Our findings indicate no significant difference in the safety and efficacy of herbal medicines among people with SCD who used or did not use herbal remedies. However, the sample sizes of the primary studies were small. Thus, more extensive controlled studies with better-defined endpoints are required to inform the use of herbal medicines in managing SCD in Africa.
Liver and renal biochemical profiles of people with sickle cell disease in Africa: a systematic review and meta‑analysis of case‑control studies
(BMC, 2024) Awor, Silvia; Bongomin, Felix; Kaggwa, Mark Mohan; Pebolo, Francis Pebalo; Epila, Jackie; Malinga, Geoffrey Maxwell; Oryema, Christine; Nnamuyomba, Proscovia; Abola, Benard; Ongwech, Acaye; Musoke, David
Background Sickle cell disease (SCD) is a genetic blood disorder characterized by a painful vaso-occlusive crisis due to the sickling of red blood cells in capillaries. Complications often lead to liver and renal dysfunctions, contributing to morbidity and mortality, particularly for children under 5. This systematic review and meta-analysis aimed to evaluate the liver and renal functions of people with SCD (HbSS) compared to those without it (HbAA) in Africa. Methods The protocol was registered with PROSPERO (CRD42022346771). We searched PubMed, Embase, Web of Science, and Google Scholar using the keywords “liver function”, “renal function”, “sickle cell disease”, and “Africa” on 6th May 2023 for peer-reviewed articles with abstracts in English. We included case-control studies comparing SCD (HbSS) with controls without hemoglobinopathies (HbAA). We used the random-effect model to calculate the pooled average values for the blood tests of people with SCD in RStudio version 4.2.2. Results Overall, 17 articles were analyzed from five African countries involving 1312 people with SCD and 1558 controls. The pooled mean difference of liver enzymes aspartate transaminase (AST) was 8.62 (95% CI − 2.99–20.23, I2 = 97.0%, p < 0.01), alanine transaminase (ALT) 7.82 (95% CI − 0.16–15.80, I2 = 99%, p < 0.01) and alkaline phosphatase (ALP) − 2.54 (95% CI − 64.72 – 59.64, I2 = 99%, p < 0.01) compared to controls. The pooled mean difference for the renal biochemical profiles creatinine − 3.15 (95% CI − 15.02; 8.72, I2=99%, p < 0.01) with a funnel plot asymmetry of t = 1.09, df = 9, p = 0.3048 and sample estimates bias of 6.0409. The pooled mean difference for serum urea was − 0.57 (95% CI − 3.49; 2.36, I2 = 99%, p < 0.01), and the estimated glomerular filtration (eGFR) rate was 19.79 (95% CI 10.89–28.68 mL/min/1.73 m2, I2 = 87%, p < 0.01) compared to controls. Conclusion People with SCD have slightly elevated liver enzymes and estimated glomerular filtration rates compared to controls in Africa. With all the heterogeneity (I2) > 50%, there was substantial variation in the reported articles’ results.
Haematological Profile of Patients with Sickle Cell Disease in the Acholi Sub-Region, Uganda
(Dovepress, 2026) Awor, Silvia; Opee, Jimmyy; Ocaya, Denis; Abola, Benard; Malinga, Geoffrey Maxwell; Oryema, Christine; Arwenyo, Beatrice; Ongwech, Acaye; Nnamuyomba, Proscovia; Epila, Jackie; Musoke, David
Background: Sickle cell disease (SCD) is a genetic blood disorder most prevalent in Eastern and Western Africa. With the high prevalence of SCD in northern Uganda, we set out to document the haematological profile of patients with SCD in Acholi sub-region of northern Uganda. Methods: This was a cross-sectional study at Gulu University Teaching Hospitals from February to May 2025. Patients with SCD gave blood, which was analysed at GRRH, and the results were shared with their healthcare providers. Logistic regression was done to determine the association between the haematological parameters and hydroxyurea use. Results: Four hundred eighteen blood samples were analysed. The mean age of the participants was seven years of age, and the median was 5 years of age, ranging from 1 to 28 years of age. About 95% of participants had anaemia, 92.1% erythropenia, and 92.6% low haemtocrit levels. Meanwhile, 47.9% of participants had leucocytosis and 49.1% thrombocytosis. Hydroxyurea use was associated with a normal platelet count (OR=0.35, 95% CI 0.18–0.65, p-value=0.001). Conclusion: In patients with sickle cell disease, there were increased white blood cells, platelets, and low red blood cells. That may reflect increased haemolytic activities that destroy the sickled red blood cells in low oxygen tension. Hydroxyurea use was associated with normal platelet counts.
Exposure of urban population to organophosphate esters and novel brominated flame retardants via indoor dust: Occurrence, sources and health risks in Uganda, East Africa
(Elsevier B.V. on behalf of KeAi Communications Co. Ltd., 2026) Muhwezi, Godfrey; Kyarimpa, Christine; Gumula, Ivan; Odongo, Silver; Matovu, Henry; Matsiko, Julius; Nagawa, Christine Betty; Drago, Charles Kato; Špánik, Ivan; Sillanpaä, Mika; Taiwo, Adewale M.; Miiro, Ashirafu; Ssebugere, Patrick
Indoor environments are critical exposure pathways to flame retardants, yet data from Africa remain scarce. This study provides the first quantitative assessment of organophosphate esters (OPEs) and novel brominated flame retardants (NBFRs) in indoor dust from Ugandan households, establishing baseline data for East Africa. Dust samples collected from homes in Kampala were analyzed using gas chromatography–mass spectrometry (GC–MS). Concentrations of total OPEs (Σ5OPEs) and total NBFRs (Σ4NBFRs) ranged from 1,520–102,000 ng g-1 and 214–6,600 ng g-1, respectively. Tris(1,3-dichloro-2-propyl) phosphate (TDCIPP) and 2,4,6-tribromophenyl allyl ether (TBP-AE) dominated OPE and NBFR profiles, respectively. Chlorinated OPEs contributed most to ΣOPEs, reflecting emissions from building materials and consumer products. Principal component analysis indicated household items, electrical equipment, and floor finishes as the major emission sources. Estimated human exposure doses showed that ingestion was the dominant route, with children more exposed than adults. Hazard index (HI) values were below 1 for all compounds, indicating negligible non-carcinogenic risk. Carcinogenic risk (CR) values ranged from 10-6–10-12, suggesting minimal lifetime cancer risks, though children exhibited relatively higher vulnerability. Compared with global datasets, OPE and NBFR levels in Kampala were within lower-to-median range but represent the inaugural dataset for sub-Saharan Africa. These findings provide a crucial regional reference for indoor flame-retardant exposure and highlight the need for extended studies across multiple indoor microenvironments to evaluate the long-term exposure pathways and inform safer chemical management.