Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow- up: a continuous quality improvement study in Uganda

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.Background While the UNAIDS 95- 95- 95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return- to- care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county- level rural health facility in eastern Uganda. Methods Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root- cause analysis using a f ishbone diagram, and developed and ranked improvement changes using the impact- effort matrix. The improvement changes were implemented using Plan- Do- Study- Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements. Results Before the implementation of CQI initiatives (August 2022–January 2023), the average return- to- care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return- to- care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024. Conclusion The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies.The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for- profit sectors

Effect of corticosteroids on haemoglobinuria resolution among children with blackwater fever at Soroti regional referral hospital, Uganda: a retrospective cohort study

The authors would like to acknowledge the support rendered by Soroti Regional Referral Hospital Senior Executive Consultant, Dr.Watmon Benedict during the process of administrative clearance and data collection. In addition, we would like to acknowledge Dr.Samuel Kabwigu, the Dean School of Health Sciences- Soroti University for granting the funds for ethical clearance and data collection for this research project.Background Corticosteroids are sometimes used in clinical practice in the treatment of blackwater fever (BWF), a complication of severe malaria, despite limited evidence of benefit. This study aimed to compare the time to haemoglobinuria resolution between children with BWF who received corticosteroids and those who did not, and determine if corticosteroid use significantly influences this outcome. Methods This was a retrospective cohort study carried out at Soroti Regional Referral Hospital in Soroti, Uganda, among children diagnosed with blackwater fever (BWF), between 1st January 2023 to 31st December 2024. Participants included in the study were 889. Time to haemoglobinuria resolution was determined using the Kaplan–Meier survival function and compared using log rank test. Predictors of time to haemoglobinuria resolution were determined using an extended cox proportional hazard model, with results expressed as adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results The median time to haemoglobinuria resolution was 3 days in both the corticosteroid and non-corticosteroid groups. Corticosteroid use was not significantly associated with time to haemoglobinuria resolution (aHR: 0.90; 95% CI 0.75–1.07, p = 0.239). The predictors of time to haemoglobinuria resolution were: antibiotic use (aHR: 0.68; 95% CI 0.58–0.81, p < 0.001), blood transfusion (specifically for those who received transfusions twice [aHR: 0.78; 95% CI 0.62–0.97, p = 0.024], three times [aHR: 0.59; 95% CI 0.40–0.88, p = 0.010], and four times [aHR: 0.36; 95% CI 0.24–0.53, p < 0.001]), presence of jaundice (aHR: 1.49; 95% CI 1.14–1.94, p = 0.003), and administration of normal saline (aHR: 0.57, 95% CI 0.45–0.74, p < 0.001). Conclusion Corticosteroid use did not accelerate haemoglobinuria resolution in children with blackwater fever, supporting current WHO guidance against their use. These findings suggest limited benefit of corticosteroids in BWF management.This study was funded by Soroti University, awarded to Dr.Opito Ronald

Educational factors influencing academic achievement in biomedical sciences among undergraduate nursing students in Uganda: analytical cross‑sectional study

Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s44217- 025- 00601-8.Introduction Biomedical science courses, including anatomy, physiology, and biochemistry, are challenging for many undergraduate nursing students. This study explored academic achievement in these subjects and the impact of student educational factors on performance among nursing students in Uganda. Methods Analytical cross-sectional study of 208 nursing students from four Ugandan public universities examined aca demic achievement in biomedical sciences. Using Grade Point Average (GPA) and letter grades as measures, the study analysed the influence of student educational factors like prior academic performance, career choice, and learning methods through Welch’s Analysis of Variance, Pearsons’s correlation and Linear Mixed-Effects model. Results Academic achievement varied slightly across universities, with physiology having the highest mean GPA of 2.89 (1.83–3.70) and anatomy the lowest at 2.63 (2.04–3.30), resulting in an overall GPA of 2.80 ± 0.747. Most students received C (37%) and D (33.7%) grades. Choosing nursing as a lower-priority career (β = 0.42, 95% CI 0.08–0.76, p = 0.02) and infrequent participation in group discussions (β = −0.61, CI −1.21 to −0.12, p < 0.001) influenced academic achieve ment in biomedical sciences. Secondary school performance showed negligible correlation with biomedical science GPA (r = 0.1163). Conclusion Academic achievement in biomedical sciences among Ugandan nursing students is marginal to moderate, with most earning C and D grades. Universities should provide extra support to students who select nursing as their f irst choice while continuing to admit those who choose nursing as a later option. Encouraging small group discussions among students could also be beneficial. Keywords Academic · Performance · Biomedical · Sciences · NursingThis study did not have external funding. The funds that were involved were internally generated by the corresponding author

Uptake and Completion of Human Papilloma Virus Vaccination by Adolescent Girls Attending Primary Healthcare Facilities in Soroti City, Northeastern Uganda; A Cross Sectional Study

Acknowledgement We would like to acknowledge the contribution of the Departments of Nursing and Public Health, School of Health Sciences, Soroti University which provided guidance throughout the process of proposal development, protocol approval, data collection and report writing. In addition, we acknowledge Associate Professor Fred Kirya, the Dean School of Health Sciences who facilitated the faculty members to oversee and supervise this research project.Introduction: Uganda adopted and implemented Human Papilloma Virus (HPV) vaccination since 2015 for adolescent girls aged 9-13 years for primary prevention of cervical cancer. However, the vaccine uptake and dose completion have remained relatively low national wide. Therefore, this study aimed at determining the uptake and dose completion of HPV vaccination and associated factors in Soroti city, Northeastern Uganda. Methodology: This was a cross-sectional study that employed quantitative methods of data collection and analysis. A sample of 287 adolescent girls aged 10-19 years were selected consecutively from four health centers in Soroti City between March and April 2024. Data was analyzed using Stata statistical software, version 15.0. Descriptive statistical analysis was performed to determine the level of HPV vaccine uptake and dose completion. Bivariate and multivariate analyzes were performed using modified Poisson regression with robust error estimates to determine association between independent factors and uptake and dose completion. Results were reported with a 95% confidence interval (CI) and factors whose P-Values were less than 0.05 were considered statistically significant. Results: Of the 287 adolescent girls, their mean age was 14 years (SD=2.9). Most of the participants were in school, 231(80.5%). Majority, 79 % (n=228) had never heard about HPV Vaccination. HPV Vaccination uptake among the study participants was suboptimal as only 58.8% (n=166) had received at least one dose whereas only 30% (n=86) had completed the two doses of the vaccine. The factors that were significantly associated with vaccination uptake were school enrollment status (P=0.022), religion (P=0.010), and awareness about HPV vaccine (P<0.001), while factors that were significantly associated with completion of HPV vaccination were: School enrollment status (P=0.046) and awareness about HPV vaccine (P=0.007). Conclusion: The uptake and completion of HPV vaccination in Soroti was suboptimal compared to WHO target of 90%. School enrollment status and awareness about HPV vaccine were factors significantly associated with HPV uptake and dose completion. Strengthening the school-based HPV vaccination program and creating awareness about HPV vaccination, in schools, at the health facilities and in the community may significantly improve the HPV vaccination and dose completion in the region.Non

Applying Learning Theories to Clinical Teaching in Contemporary Settings: A Conceptual Analysis

Copyright © 2025 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited.Abstract: Background: Learning theories play a crucial role in shaping clinical instructional strategies, materials, and activities. By applying these theories, clinical teachers can create engaging, interactive, and student-centred learning experiences. However, some theories are complex and require time and adequate training to fully understand and implement. This study presents a theoretical concept analysis aimed at identifying clear and readily applicable concepts from well-known learning theories to enhance clinical teaching and learning in contemporary settings. Methods: A search for published articles on well-known learning theories was conducted. Articles were retrieved from Google Scholar and PubMed using search terms such as 'learning theories,' 'learning theories and clinical teaching,' 'applying learning theories to clinical teaching,' and 'learning theories in clinical instruction.' The principal investigator screened articles at the title, abstract, and full-text levels. Selected articles were thoroughly reviewed to identify relevant learning theories, from which key concepts underpinning clinical teaching and learning in contemporary settings were extracted and described. Results: We retrieved 625 articles, removed 38 duplicates, and screened the remaining articles at the title, abstract, and full-text levels. Ultimately, 23 articles were included in the study. The documented learning theories included behaviorism, social learning, constructivism, social constructivism, discovery learning, meaningful learning, experiential learning, humanistic theory, self-determination theory, and expectancy-value theory. Conclusion: Guiding clinical teaching sessions with well established learning theories can significantly enhance learning outcomes in contemporary settings. Therefore, we recommend the intentional application of learning theories in clinical education to improve student engagement, knowledge retention, and skill acquisition. Additionally, policymakers should integrate evidence-based learning theories into clinical teaching guidelines and training programs to standardize and enhance the quality of education in healthcare settings. Keywords: Learning, Theories, Clinical, Teaching, Contemporary, Concepts.N/

A Case Series

All the patients provided informed written consent for publication of this manuscript.Background: Mainz II pouch urinary diversion is an alternative surgery for patients with an incurable vesicovaginal fistula (VVF). We report six (6) cases of patients who had incurable VVF and were offered Mainz II pouch surgery at Soroti Regional Referral Hospital, between 2009 and 2018 and followed up in 2023. Methods: A retrospective review of charts of 6 patients who were offered Mainz II pouch procedure and a cross-sectional assessment of their biochemical, sonographic and clinical profiles five (5) or more years after the procedure at Soroti Regional Referral Hospital were done. All case notes of patients who underwent the Mainz II procedure between 2009 and 2018 were retrieved from the registry and each patient profiled using a standard data abstraction tool. Results: The ages of the six participants ranged between 16 and 65 years at the time of the procedure. Four of the 6 participants had lived with the fistula for less than 10 years. Four participants had only one delivery and the other 2 had five and six deliveries. All the participants had lived with the Mainz II pouch urine diversion for at least five years (5–14 years). One participant (1/6) had hypertension (BP=161/101). Most participants reported nocturnal incontinence. Sonographic findings revealed one-sided mild vesi coureteral reflux with loss of corticomedullary differentiation in two participants (2/6). One of six (1/6) patients had severe vesicoureteral reflux grade 4. The commonest metabolic disorders were compensated metabolic acidosis (4/6). Conclusion: The Mainz II pouch procedure remains a viable option for managing incurable obstetric fistulas. However, the prevalence of metabolic complications, including acidosis and renal impairment, underscores the need for routine biochemical and sonographic monitoring to ensure optimal long-term patient outcomes. Keywords: Mainz II pouch, vesicovaginal fistula, urinary diversion, acidosiThis study was supported by funding from Government of Uganda, through the Soroti University Research and Innovation Fund (SUN-RIF/2022/21), which provided financial resources for data collection, analysis, and manuscript preparation. The funding did not have any influence on the conduct of the study and the views and opinions reflected here do not in any way reflect the opinion of the funder

Factors associated with uptake and acceptability of cervical cancer screening among female sex workers in Northeastern Uganda: A cross-sectional study

Acknowledgments The authors acknowledge the contribution of Professor JR Odong Ikoja, the Soroti Univer sity Vice Chancellor who acquired the funds for the research activities and Professor Francis Ejobi, the Soroti University Director of Research and Innovation for his administrative sup port and oversight on the management of this research projectBackground Cervical cancer screening program in Uganda is opportunistic and focuses mainly on women aged 25–49 years. Female sex workers (FSWs) are at increased risk of developing invasive cervical cancer. There is limited data regarding the uptake and acceptability of cervical cancer screening among FSWs in Uganda. This study aimed at identifying factors associated with uptake and acceptability of cervical cancer screening among FSWs in Eastern Uganda. Methods This was a cross-sectional study conducted among 423 FSWs aged 18–49 years attending care at six health facilities serving Key Populations (FSWs, Men who have sex with men, transgender people, people who inject drugs and people in prisons) in the Teso sub-region. Data was collected using structured investigator administered questionnaire and analyzed using Stata statistical software version 15.0 (Stata Corp, Texas, USA). The primary outcome was uptake of cervical cancer screening measured as the proportion of female sex workers who have ever been screened for cervical cancer. Chi-square test was used to compare the differences in uptake of cervical cancer screening by HIV status. Modified Poisson regres sion model with a robust variance estimator was used to determine association between the outcome variables and selected independent variables including demographic charac teristics. Prevalence ratios (PR) with accompanying 95% confidence intervals have been reported. Statistical significance was considered at two-sided p-values ≤ 0.05. Results The mean age of the participants was 28.1 (±SD = 6.6) years. The self-reported HIV prevalence was 21.5% (n = 91). There were 138 (32.6%) participants who had ever been screened for cervical cancer (uptake), while 397 (93.9%) were willing to be screened (acceptability). There was a significant difference in cervical cancer screening uptake between women living with HIV (WLHIV) and those who were HIV negative, 59.3% vs 26.9% respectively (P < 0.001). The significant factors associated with uptake of cervical cancer screening included living with HIV, adjusted prevalence ratio (aPR) = 1.53 (95%CI: 1.15–2.07), increasing number of biological children, aPR = 1.14 (1.06–1.24) living near a private not for profit (PNFP) facility, aPR = 2.84 (95% CI; 1.68–4.80) and availability of screening services at the nearest health facility, aPR = 1.83 (95% CI, 1.30–2.57). Factors significantly associated with acceptability of cervical cancer screening included being 40 years or older, aPR = 1.22 (95%CI: 1.01–1.47), having a family history of cervical cancer, aPR = 1.05 (1.01–1.10), and living near a PNFP facility, aPR = 1.17 (95% CI, 1.09–1.27) and having ever screened before, aPR = 0.92 (0.86–0.98). Conclusion Female sex workers living with HIV are more likely to screen for cervical cancer than the HIV negative clients. Cervical cancer screening uptake is relatively low among the female sex workers. However, majority of the FSWs are willing to be screened for cervical cancer if the services are provided in the nearby healthcare facilities. There is need to make cer vical cancer screening services available to all eligible women especially the female sex workers and integrate the services with sexual reproductive health services in general and not just HIV/ART clinics servicesGovernment of Uganda. Soroti University Research and Innovation Funds (SUNRIF

Factors Associated with Cervical Cancer Screening Uptake Among Women Attending Outpatient Department in a Rural District Hospital in Uganda. A Cross-Sectional Study

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.Background: Sub-Saharan Africa (SSA) faces persistently low cervical cancer screening uptake, averaging only 13% over the past f ive years, with Uganda reporting less than 5%. This study aimed to assess the factors influencing cervical cancer screening uptake in a rural district hospital to inform targeted interventions that enhance screening coverage for the rural community. Methods: This was a cross-sectional study conducted at Kaberamaido General Hospital (KGH) outpatient department. A total of 422 participants aged between 25 and 49 years were interviewed and data analyzed using STATA version 16.0. Bivariate and multivariate analyses were performed using modified Poisson regression with robust error estimates to identify key factors associated with cervical cancer screening uptake. Variables with P-value <0.05 were considered statistically significant. Results: The average age of participants was 32 (SD ±7) years. 77.5% (n=327) of participants were married, had primary level of education, 69.2% (n=292), and were unemployed, 89.3% (n=377). Awareness about screening was high as 85.5% (n=360) of respondents had heard about cervical cancer screening. Cervical cancer screening uptake was low, as only 20.4% (n=86) had been screened in the past five years. Factors significantly associated with increased screening uptake, including age older than 35 years, adjusted Prevalence Ratio [aPR]= 1.7 (95% CI: 1.08–2.69), availability of free government screening services, aPR = 1.6 (95% CI: 1.09–2.38), provision of screening service at the nearest health facility, aPR = 2.1 (95% CI: 1.09–3.97), and a positive family history of cervical cancer, aPR = 1.7 (95% CI: 1.14–2.65). Conclusion: Our study confirms that cervical cancer screening uptake in Kaberamaido District remains low, highlighting the need for enhanced awareness campaigns and improved access to screening services. Our findings emphasize the need for policies that strengthen community outreach programs and expand cervical cancer screening services at primary healthcare facilities. Keywords: uterine cervical neoplasms, cervical cancer screening, women, cervical cancer awarenessThere was no funding received for this stud

Maternal satisfaction with intrapartum care services and its associated factors among mothers who delivered from health facilities within a city in Uganda. A descriptive cross-sectional community study

NAAbstract Background: keeping an eye on and assessing maternal satisfaction enhances the effectiveness and quality of care during the intrapartum period and if not regularly accessed, could lead to detrimental effects on maternal and newborn outcomes following intrapartum. Therefore this study aimed at assessing maternal satisfaction with intrapartum care services and its associated factors among mothers who delivered from health facilities within Soroti City Methods: Background characteristics of participants were collected using an interviewer-administered questionnaire was used. Data entry and analysis were performed using Statistical Package for the Social Sciences (SPSS) version 27.0 software. A crude and adjusted odds ratio with a 95% confidence interval (CI) was computed to identify associated factors. Results: 86.5% gave birth from government facilities while 13.5 % delivered from private facilities. Overall 70.4% of mothers were satisfied with the intrapartum care services received from health facilities in Soroti City. Mothers who gave birth in private facilities were more satisfied (95.2%) compared to those in public facilities (66.5%). Type of the healthcare facility AOR(95%CI) 7.504(1.573-35.787),duration of hospital stay before delivery AOR(95% CI)2.674(1.300-5.502),periodic updates AOR (95% CI) 0.247(0.116-0.530),plan to have the pregnancy AOR(95%CI),2.483(1.280-4.814)overall cleanness AOR(95%CI) 0.07(0.013-0.378),delivery position of patient choice AOR(95% CI) 0.228(0.069 0.754),privacy AOR(95% CI) 0.102(0.050-0.209), and Pain management AOR (95% CI) 0.334(0.152 0.738) were significantly associated with satisfaction. Conclusion: The overall satisfaction of mothers with intrapartum care services provided was relatively high. Majority of the mothers gave birth from government facilities however a higher percentage of satisfaction was reported in private facilities. Therefore, all stakeholders have to emphatically work on those identified factors to improve maternal satisfaction with intrapartum care services Keywords: Intrapartum care services, maternal outcome, satisfaction.N

Factors Associated with Cervical Cancer Screening Uptake Among Women Attending Outpatient Department in a Rural District Hospital in Uganda. A Cross-Sectional Study

© 2025 Ekinu et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v4.0) License (http://creativecommons.org/licenses/by-nc/4.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).Background: Sub-Saharan Africa (SSA) faces persistently low cervical cancer screening uptake, averaging only 13% over the past five years, with Uganda reporting less than 5%. This study aimed to assess the factors influencing cervical cancer screening uptake in a rural district hospital to inform targeted interventions that enhance screening coverage for the rural community. Methods: This was a cross-sectional study conducted at Kaberamaido General Hospital (KGH) outpatient department. A total of 422 participants aged between 25 and 49 years were interviewed and data analyzed using STATA version 16.0. Bivariate and multivariate analyses were performed using modified Poisson regression with robust error estimates to identify key factors associated with cervical cancer screening uptake. Variables with P-value <0.05 were considered statistically significant. Results: The average age of participants was 32 (SD ±7) years. 77.5% (n=327) of participants were married, had primary level of education, 69.2% (n=292), and were unemployed, 89.3% (n=377). Awareness about screening was high as 85.5% (n=360) of respondents had heard about cervical cancer screening. Cervical cancer screening uptake was low, as only 20.4% (n=86) had been screened in the past five years. Factors significantly associated with increased screening uptake, including age older than 35 years, adjusted Prevalence Ratio [aPR]= 1.7 (95% CI: 1.08–2.69), availability of free government screening services, aPR = 1.6 (95% CI: 1.09–2.38), provision of screening service at the nearest health facility, aPR = 2.1 (95% CI: 1.09–3.97), and a positive family history of cervical cancer, aPR = 1.7 (95% CI: 1.14–2.65). Conclusion: Our study confirms that cervical cancer screening uptake in Kaberamaido District remains low, highlighting the need for enhanced awareness campaigns and improved access to screening services. Our findings emphasize the need for policies that strengthen community outreach programs and expand cervical cancer screening services at primary healthcare facilities. Keywords: uterine cervical neoplasms, cervical cancer screening, women, cervical cancer awarenessN/