Browsing by Author "Obua, Celestino"
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Item Antibiotic prescription practices among prescribers for children under five at public health centers III and IV in Mbarara district(PLOS ONE, 2020) Okello, Nelson; Oloro, Joseph; Kyakwera, Catherine; Kumbakumba, Elias; Obua, CelestinoIntroduction Rational use of medicines requires that patients receive medications appropriate to their clinical needs. Irrational prescription of antibiotics has been reported in many health systems across the world. In Uganda, mainly nurses and assistant medical officers (Clinical officers) prescribe for children at level III and IV primary care facilities (health center II and IV). Nurses are not primarily trained prescribers; their antibiotic prescription maybe associated with errors. There is a need to understand the practices of antibiotic prescription among prescribers in the public primary care facilities. We therefore determined antibiotic prescription practices of prescribers for children under five years at health center III and IV in Mbarara district, South Western Uganda. Methods This was a retrospective descriptive cross-sectional study. We reviewed outpatient records of children <5 years of age retrospectively. Information obtained from the outpatient registers were captured in predesigned data abstraction form. Health care providers working at health centers III and IV were interviewed using a structured questionnaire. They provided information on socio-demographic, health facility, antibiotic prescription practices and availability of reference tools. Data was analyzed using STATA software version 13�0. Results There were 1218 outpatients records of children under five years reviewed and 35 health care providers interviewed. The most common childhood illness diagnosed was upper respiratory tract infection. It received the most antibiotic prescription (53%). The most commonly prescribed oral antibiotics were cotrimoxazole and amoxicillin, and ceftriaxone and benzyl penicillin were the commonest prescribed injectable antibiotics. Up to 68.4% of the antibiotic prescription was irrational. No prescriber or facility factors were associated with irrational antibiotic prescription practices.Item Artemisia Annua L. Infusion Consumed Once a Week Reduces Risk of Multiple Episodes of Malaria: A Randomised Trial in a Ugandan Community(Tropical Journal of Pharmaceutical Research, 2012) Ogwang, Patrick E; Ogwal-Okeng, Jasper; Kasasa, Simon; Olila, Deogratius; Ejobi, Francis; Kabasa, David; Obua, CelestinoPurpose: To evaluate the protective effect of Artemisia annua infusion against malaria in a community that uses it as herbal ‘tea’ for malaria prevention. Methods: 132 flower farm workers who met the study inclusion criteria and were not yet using A. annua infusion were randomized either to A. annua or placebo groups in the ratio of 1:1. Treatments were administered once a week under direct observation to participants. Malaria episodes were documented over a 9-month period while adverse effects were documented over 12 months. Results: A. annua herbal ‘tea’ significantly reduced the risk of suffering more than one episode of malaria in nine months by 55 % (12/67 vs 26/65, p = 0.005 No participant experienced any serious adverse effect although bitter taste was the most common side effect of the infusion. Conclusion: Artemisia annua infusion consumed once a week was effective in preventing multiple episodes of malaria in humans living in malaria endemic areas. However, its bitter taste and the risk of development of malaria parasite resistance to the artemisinin contained in it remain major challenges for its use in the mass control of malaria.Item Caregiver’s perspectives on the Central Nervous System infection illness trajectory among older persons with dementia in Northern Uganda—a qualitative community‑based study(BMC Geriatrics, 2022) Benyumiza, Deo; Kumakech, Edward; Gutu, Jastine; Banihani, Jude; Mandap, Joshua; Talib, Zohray M.; Wakida, Edith K.; Maling, Samuel; Obua, CelestinoBackground: Few studies have explored the Central Nervous System (CNS) infection illness trajectory among older persons with dementia in sub-Saharan African (SSA) settings. This study explored the Caregiver’s perspectives on the Central Nervous System infection illness trajectory among the older persons with dementia in Northern Uganda. Methods: This was a qualitative study conducted in Lira District northern Uganda in March 2022 amongst purposively selected 20 caregivers of the older persons aged 50 + years with a positive history of CNS infection and later life dementia. Data were collected using an in-depth interview guide. Audio recordings and field notes of the interviews were undertaken. The interviews generated data on the CNS infection illness trajectory from onset to the current demented state of the older persons. The audio-recorded interviews were transcribed verbatim before manual reflective thematic analysis. Results: Older persons with a positive history of CNS infection illness and later life dementia in rural northern Uganda presented with symptoms of early life CNS infection illness ranging from neck pain, back pain, chronic headache, and fatigue. There were also manifestations of comorbidities particularly road traffic accidents involving traumatic injury to the head, neck, and spine, high blood pressure, chronic headache, and or their medications in the older person’s trajectory to later life dementia. A plurality of healthcare which included both formal and informal healthcare medicines was sought and utilized for the treatment and care of the CNS infection illness and dementia by the older persons amidst improper diagnosis and mismanagement. Conclusions and recommendations: Older persons with early-life CNS infections illness and later-life dementia were reported to present with symptoms including neck pain, back pain, chronic headache, high blood pressure, and fatigue. The reported symptoms of CNS infection illness may be intertwined with co-morbidities particularly traumatic injury involving the head, neck, and spine, high blood pressure, and chronic headache. Healthcare professionals should integrate routine screening of older persons for the history of CNS infections, chronic headache, high blood pressure, trauma to the head, neck, and spine, and dementia and early treatmentItem Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda(PLOS ONE, 2023) Rukundo, Godfrey Zari; Wakida, Edith K.; Karungi, Christine K.; Asasira, Jenipher; Kumakech, Edward; Obua, CelestinoBackground Mental disorders are common in people living with HIV (PLHIV) but they are often unrecog nized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already lim ited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. Methods We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Refer ral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lock down. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to deter mine the burden of the disorders, and logistic regression to determine the associated fac tors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. Results Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004–1.148, P = 0.038), lack of formal education (PR0.859–0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722–0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787–0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876–0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834–0.941, p = 0.000*) were significantly associated with having a substance-use disor der. Only depression was independently associated with suicidality after adjusting for con founding factors (PR 0.108, 95%CI 0.054–0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidal ity among the PLHIV during the COVID-19 containment measures. Conclusion There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.Item Depression, suicidality, substance-use and associated factors among people living with HIV the COVID-19 pandemic in Uganda.(Plos one, 2023) Rukundo, Godfrey Zari; Wakida, Edith K.; Karungi, Christine K.; Asasira, Jenipher; Kumakech, Edward; Obua, CelestinoBackground Mental disorders are common in people living with HIV (PLHIV) but they are often unrecog nized and untreated. Furthermore, the COVID-19 pandemic has disrupted the already lim ited mental health services in low resource countries such as Uganda, and yet the extent to which the COVID-19 mitigation measures have affected the mental health of PLHIV is not fully known. We aimed to determine the burden of depression, suicidality, substance use and associated factors among adult PLHIV who were seeking care at two HIV clinics in northern and southwestern Uganda. Methods We conducted a phenomenological qualitative and quantitative cross-sectional study among 431 PLHIV to determine the burden of depression, suicidality and substance-use disorders at two HIV clinics, at Lira Regional Referral Hospital and Mbarara Regional Refer ral Hospital in northern and southwestern Uganda respectively, during the COVID-19 lock down. We used the Patient Health Questionnaire (PHQ-9) to assess for depression and suicidality, and the Michigan Assessment-Screening Test for Alcohol and drugs (MAST-AD) to assess for substance use disorder. We conducted descriptive statistics analysis to deter mine the burden of the disorders, and logistic regression to determine the associated fac tors. For the qualitative method we conducted in-depth interviews with 30 PLHIV and did thematic analysis. Results Of the 431 PLHIV surveyed, mean age was 40.31 ± 12.20 years; 53.1% (n = 229) had depression; 22.0% (n = 95) had suicidality; and 15.1% (n = 65) had substance-use disorder. Female gender (PR = 1.073, 95%CI 1.004–1.148, P = 0.038), lack of formal education (PR= 1.197, 95% CI 1.057–1.357, P = 0.005), substance-use disorder (PR = 0.924, 95%CI 0.859–0.994, P = 0.034) and suicidality (PR = 0.757, 95%CI 0.722–0.794, p = 0.000) were associated with depression after adjusting for confounders. Further analysis showed that being female (PR = 0.843, 95% CI 0.787–0.903, P = 0.000*) and having depression (PR = 0.927, 95% CI 0.876–0.981, P = 0.009) and owning a large business (PR = 0.886, 95% CI 0.834–0.941, p = 0.000*) were significantly associated with having a substance-use disor der. Only depression was independently associated with suicidality after adjusting for con founding factors (PR 0.108, 95%CI 0.054–0.218, p = 0.000*). For the qualitative results, there were three apriori themes: a) Burden of depression, b) substance-use, and c) suicidal ity among the PLHIV during the COVID-19 containment measures. Conclusion There was high prevalence of depression, suicidality and substance-use disorder in adult PLHIV in Uganda during the COVID-19 pandemic and the associated lockdown measures. The three mental health problems seem to have bidirectional relationships and gender has a lot of contribution to the relationships. Interventions aimed at any of the disorders should consider these bidirectional relationships.Item Factors Associated with Linkage to Care following Community-Level Identification of HIV-Positive Clients in Lira District(Hindawi Advances in Public Health, 2022) Adwar, Claire; Puleh, Steven Sean; Ochaba, Isaac; Ogweng, Isaac; Benyumiza, Deo; Amusu, Kosta; Achola, Brenda; Ocen, Francis; Abolo, Lydia; Kumakech, Edward; Obua, CelestinoBackground. Community HIV testing helps to increase access to high-risk groups who are less likely to visit a clinic for a test. A large proportion of people identified with HIV following community-based testing are not easily linked to care compared to facility-based identified cases. (ere is a paucity of literature on linkage to HIV care and its predictors particularly following community-based testing in a rural setting. We assessed the level of linkage to the care of HIV-positive individuals and associated factors following community-level identification in Lira district. Method. A cross-sectional survey was conducted in Lira district employing mixed methods among HIV-positive adults identified in the communities. Quantitative data were collected from 329 randomly selected study participants using interviewer-administered questionnaires. Key informant interview guide was used to collect qualitative data. (e data were double entered, cleaned, and analyzed using SPSS version 23. Odds ratios and confidence intervals were used to assess the association between predictors of linkage with HIV care. Qualitative data were analyzed using thematic content analysis. Results. (e respondents were aged between 18 and 85 years with a mean age of 42.9 (SD � 11.6). (e level of linkage to HIV care following community-level identification of HIV testing in Lira district was 98% (95% CI 96.07–99.33). Clients who self-initiated the HIV testing were more likely to link to HIV care than their counterparts (AOR � 9.03; 95% CI 1.271–64.218, p � 0.028). Key informants identified factors influencing linkage to care as health education, counseling, follow-up, and family support. Fear of stigma, disclosure, denial, and distance to facility were reported as barriers to linkage. Conclusion/ Recommendation. (e level of linkage to HIV care following community identification was found to be excellent (98%). Predictors to linkage to care included self-initiated testing, positive perception of distance, and waiting time at health facilities. We recommend health education, counseling, follow-up, and family support as interventions to strengthen successfully linking to careLinItem Factors predicting home storage of medicines in Northern Uganda(BioMed Central, 2014) Ocan, Moses.; Bbosa, Godfrey; Waako, Paul; Ogwal-Okeng, Jasper; Obua, CelestinoBackground: Medicines are kept in households Worldwide for first aid, treatment of chronic or acute disease conditions. This promotes inappropriate use of medicines and hence the associated risks. The study explored the factors which predict availability and utilization of medicines in households of Northern Uganda. Method: A cross sectional survey of 892 households was performed from November-to-December 2012. Five data collectors administered the questionnaires, respondents were requested to bring out any medicines present in their households. Demographic characteristics, drug name, quantity, source, formulation, legibility of drug labels and reasons why the medicines were being kept at home was collected. Data was analyzed using STATA 12.0 at 95% level of significance. Results: Of the households visited, 35.1% (313/892) had drugs. Paracetamol (11.8%), coartem (11.3%), cotrimoxazole (10%), amoxicillin (9.2%) and metronidazole (8.2%) were the major medicines found. Antibacterial drugs were the most commonly (40.1%) kept type of drugs. The medicines present in households were for on-going treatment (48%); ‘leftover’ (30.5%) and anticipated future use (21.6%). Symptoms of malaria (34.1%) were common in households which had drugs. The medicines kept in homes were mainly from the private sector 60.5% (497/821). The rate of home drug storage was higher 85.3% (267/313) amongst the educated individuals. There was high prevalence 76% (238/313) of self-medication among respondents in households which stored drugs. The average number of medicines in each household was 6 ± 5 with majority (68.1%) having between 1–10 drugs. Previous successful treatment (OR: 1.3; 95% CI: 0.95-1.77), regular income (OR: 1.8; 95% CI: 1.2-2.6) and sex (OR: 0.63; 95% CI: 0.5-0.9) predicted storage of medicines in households in northern Uganda. Conclusion: Over a third of households in Northern Uganda store medicines with antibacterial agents being the most common. Self-medication is common among individuals in households which keep drugs. Past successful treatment, regular income and sex predict community home drug storage.Item Off-label antibiotic use among paediatric in-patients: a mixed-method prospective study at a tertiary hospital in southwestern Uganda(International Journal of Clinical Pharmacy, 2020) Obura, Bonniface; Obua, CelestinoBackground The off-label use of drugs to treat children is a global practice attributed to the traditional exclusion of children from clinical trials mainly due to practical and ethical reasons. Off-label drug use carries both benefits and risks, but data regarding this use pattern are scanty in sub-Saharan Africa. Objective To determine the incidence and predictors of off-label antibiotic use in children less than 5 years admitted at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Setting A prospective drug utilisation study was conducted among in-patients at the Paediatric Ward of MRRH from May to June 2019. Methods Clinical records and treatment notes of all children aged 0 to 59 months with at least one antibiotic prescription during the admission period were reviewed and included for data collection. Key informant interviews were conducted with physicians attending to patients in the Paediatric Ward. Main outcome measure Off-label use and potential predictors of off-label antibiotic use. Results Of 427 children admitted to the Paediatric Ward, 165 (38.6%) received 366 antibiotic prescriptions. However, 359 prescriptions belonging to 162 patients were analyzed. Off-label prescriptions occurred in 18.9% (95% CI: 14.9–23.0) of antibiotic prescriptions. Two categories of off-label prescriptions were found: off-label frequency of administration (n = 55, 80.9%), and off-label doses (n = 13, 19.1%). Ceftriaxone was the most common antibiotic prescribed at off-label doses, (n = 6, 8.8%) while ampicillin was the most common antibiotic prescribed with an off-label frequency of administration, (n = 39, 57.3%). Infants (1–23 months) received the majority (47.1%) of off-label antibiotic prescriptions; neonates (0–28 days) received 27.9%, and children (24–59 months) received 25% of the prescriptions. Controlling for sex and disease severity, age category remained significantly associated with off-label antibiotic use on multivariate analysis. Conclusion Off-label frequency of administration was the major category of off-label drug use, while off-label dose was the minor category. Age was a significant factor for off-label antibiotic prescription, with infants receiving the highest number of off-label prescriptions. Attending physicians identified several justifiable circumstances that warrant off-label antibiotic use and support emerging “well-founded” off-label uses of antibiotics in different paediatric age groupsItem Patterns and Predictors of Self-Medication in Northern Uganda(PLOS ONE, 2014) Ocan, moses.; Bwanga, freddie; Bbosa, Godfrey s; Bagenda, Danstan; Waako, paul.; Ogwal-Okeng, Jasper; Obua, CelestinoSelf-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult ($18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method. One respondent who reported having an illness within three months in each household was recruited. In each household, information was obtained from only one adult individual. Data was analyzed using STATA at 95% level of significance. The study found that a high proportion (75.7%) of the respondents practiced antimicrobial self-medication. Fever, headache, lack of appetite and body weakness were the disease symptoms most treated through self-medication (30.3%). The commonly self-medicated antimicrobials were coartem (27.3%), amoxicillin (21.7%), metronidazole (12.3%), and cotrimoxazole (11.6%). Drug use among respondents was mainly initiated by self-prescription (46.5%) and drug shop attendants (57.6%). On average, participants obtained 13.968.8 (95%CI: 12.6–13.8) tablets/capsules of antimicrobial drugs from drug shops and drugs were used for an average of 3.762.8 days (95%CI: 3.3–3.5). Over half (68.2%) of the respondents would recommend self-medication to another sick person. A high proportion (76%) of respondents reported that antimicrobial self-medication had associated risks such as wastage of money (42.1%), drug resistance (33.2%), and masking symptoms of underlying disease (15.5%). Predictors of self-medication with antimicrobial agents included gender, drug knowledge, drug leaflets, advice from friends, previous experience, long waiting time, and distance to the health facility. Despite knowledge of associated risks, use of self-medication with antimicrobial drugs in management of disease symptoms is a common practice in post-conflict northern Uganda.Item Perceptions of Undergraduates and Mentors on the Appropriateness, Acceptability, and Feasibility of the HEPI-TUITAH Micro-Research Approach to HIV Training in Uganda(Advances in Medical Education and Practice, 2022) Wakida, Edith K; Rukundo, Godfrey Z; Atuhaire, Clara; Karungi, Christine K; Kumakech, Edward; Haberer, Jessica E; Talib, Zohray M; Obua, CelestinoPurpose: To evaluate the perceptions of undergraduates and mentors on the appropriateness, acceptability, and feasibility of a mentored seed-grant (micro-research) by Health Professions Education Partnership Initiative - Transforming Ugandan Institutions Training Against HIV/AIDS (HEPI-TUITAH) program on HIV training in Uganda. Methods: We conducted a cross-sectional descriptive qualitative study with focus groups, on HIV micro-research training, with undergraduate health professions students and faculty mentors across three partner institutions in rural Uganda. Results: A total of 24 students and 13 mentors (5–8 per group) took part in the focus group discussions. Most participants stated that the HEPI-TUITAH micro-research program was acceptable, appropriate and feasible for health professions undergraduate students. The interprofessional education approach of bringing together students from different programs and years of study was valuable especially for peer mentorship. There was a need to provide for institution-based training in addition to the centrally organized training for the benefit of all the team members. Participants also noted a need for the program to find a way of providing the students with data collection experience even with the COVID-19 pandemic situation. Conclusion: The HEPI-TUITAH micro-research program was perceived as acceptable, appropriate, and feasible for health professions undergraduate students. It also promoted teamwork and academic collaboration. Provision for institution-based micro-research training activities and data collection experiences for the undergraduate students even during the COVID-19 pandemic would make the program more valuable. The lessons learnt will be applied to future training cohorts to optimize program impact and may be useful for similar programs in other settings.Item Prevalence of dementia and its association with central nervous system infections among older persons in northern Uganda: cross-sectional community-based study(BMC Geriatrics, 2023) Benyumiza, Deo; Kumakech, Edward; Gutu, Jastine; Banihani, Jude; Mandap, Joshua; Talib, Zohray M; Wakida, Edith K; Maling, Samuel; Obua, CelestinoBackground Dementia is a condition in which there is deterioration in cognitive function beyond what might be expected from the usual consequence of biological aging. Few studies have been conducted on the prevalence of dementia and its association with central nervous system (CNS) infections among older persons in African settings, particularly in Uganda. Therefore, this study assessed the prevalence of dementia and its association with CNS infections among older persons in Lira District, northern Uganda. Methods This was a cross-sectional community-based study in Lira district northern Uganda. The study was conducted in March 2022 among 434 older persons aged 50 and above years who were selected by multistage sampling. Data were collected using an interviewer-administered questionnaire supplemented with information from participant’s medical records and a brief community screening instrument for dementia. The instrument classifies dementia into unlikely, probable or possible dementia. Data were entered in duplicate into EpiData version 3.0, then transferred to Statistical Package for Social Sciences (SPSS) version 23 for statistical analysis. Results Our study found almost one in four (23%) of the older persons in Lira district northern Uganda were suffering from probable or possible dementia. Our study further found that older persons in Lira district northern Uganda with a positive history of central nervous system infections (CNS) had nearly five times higher odds of having probable or possible dementia compared to their counterparts (cOR: 4.5; 2.76–7.23; p≤0.001). Being in advanced age of 70+years (aOR: 2.6; 1.6–4.3; p≤0.001), positive history of CNS infection particularly Herpes simplex virus-1 (aOR: 5.4; 1.4–20.5; p=0.013), and chronic headache (aOR: 1.9; 1.1–3.1; p=0.019) were independent predictors of probable or possible dementia among participants in this study. Conclusion and recommendations Dementia is a common condition among older persons in Lira district northern Uganda with a prevalence of 23% in our study. Older persons with a positive history of CNS infection had higher odd of developing dementia compared to their counterparts. Having advanced age, cerebral malaria, Herpes simplex virus −1 (HSV-1) infections, and chronic headache were independent predictors for dementia. These results imply that health assessment for the risk of dementia should include screening for history of CNS conditions particularly cerebral malaria, HSV-1 and chronic headache. Keywords Dementia, Older persons, Central Nervous System infections, Northern UgandaItem Prevalence of K13-propeller gene polymorphisms among Plasmodium falciparum parasites isolated from adult symptomatic patients in northern Uganda(BioMed Central, 2016) Ocan, Moses; Bwanga, Freddie; Okeng, Alfred; Katabazi, Fred; Kigozi, Edgar; Kyobe, Samuel; Ogwal-Okeng, Jasper; Obua, CelestinoBackground: In the absence of an effective vaccine, malaria treatment and eradication is still a challenge in most endemic areas globally. This is especially the case with the current reported emergence of resistance to artemisinin agents in Southeast Asia. This study therefore explored the prevalence of K13-propeller gene polymorphisms among Plasmodium falciparum parasites in northern Uganda. Methods: Adult patients (≥18 years) presenting to out-patients department of Lira and Gulu regional referral hospitals in northern Uganda were randomly recruited. Laboratory investigation for presence of plasmodium infection among patients was done using Plasmodium falciparum exclusive rapid diagnostic test, histidine rich protein-2 (HRP2) (Pf). Finger prick capillary blood from patients with a positive malaria test was spotted on a filter paper Whatman no. 903. The parasite DNA was extracted using chelex resin method and sequenced for mutations in K13-propeller gene using Sanger sequencing. PCR DNA sequence products were analyzed using in DNAsp 5.10.01software, data was further processed in Excel spreadsheet 2007. Results: A total of 60 parasite DNA samples were sequenced. Polymorphisms in the K13-propeller gene were detected in four (4) of the 60 parasite DNA samples sequenced. A non-synonymous polymorphism at codon 533 previously detected in Cambodia was found in the parasite DNA samples analyzed. Polymorphisms at codon 522 (non-synonymous) and codon 509 (synonymous) were also found in the samples analyzed. The study found evidence of positive selection in the Plasmodium falciparum population in northern Uganda (Tajima’s D=−1.83205; Fu and Li’s D=−1.82458). Conclusions: Polymorphism in the K13-propeller gene previously reported in Cambodia has been found in the Ugandan Plasmodium falciparum parasites. There is need for continuous surveillance for artemisinin resistance gene markers in the country.Item Utilization of antiretroviral therapy services and associated factors among adolescents living with HIV in northern Uganda: A cross-sectional study(PLoS ONE, 2023) Odongo, Innocent; Arim, Barbara; Ayer, Patrick; Murungi, Tom; Akullo, Susan; Aceng, Docus; Oboke, Henry; Kumakech, Edward; Obua, Celestino; Auma, Anna Grace; Richard, NyekoBackground Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. Methods We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 soft ware. Descriptive analysis and logistic regressions were performed to determine the relation ship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. Results The level of utilization of ART services was suboptimal among 27.6% (81/293) of the partici pants, and only 63.1% (185/293) were virally suppressed. Of the participants who were opti mally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10– 14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. Conclusions and recommendations Not all ALHIV used ART services to their full potential. However, factors such as partici pants’ age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.Item Utilization of antiretroviral therapy services and associated factors among adolescents living with HIV in northern Uganda: A crosssectional study(PLoS ONE, 2023) Odongo, Innocent; Arim, Barbara; Ayer, Patrick; Murungi, Tom; Akullo, Susan; Aceng, Docus; Oboke, Henry; Kumakech, Edward; Obua, Celestino; Auma, Anna Grace; Nyeko, RichardBackground Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. Methods We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 software. Descriptive analysis and logistic regressions were performed to determine the relationship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. Results The level of utilization of ART services was suboptimal among 27.6% (81/293) of the participants, and only 63.1% (185/293) were virally suppressed. Of the participants who were optimally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10– 14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. Conclusions and recommendations Not all ALHIV used ART services to their full potential. However, factors such as participants’ age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.