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Background: Malaria is a leading cause of death among children under 5 years of age in sub-Saharan Africa. The malaria vaccine is an important preventive measure introduced by the World Health Organization to reduce malaria and its associated mortality and morbidity. We aimed to assess the acceptance of the malaria vaccine among next of kin of children under 5 years of age in Gulu City, Northern Uganda., Methods: Between October and December 2023, we conducted a cross-sectional study in Pece-Laroo division, Gulu City, Uganda. Socio-demographic, vaccine profile and health system factors were collected. Multivariable logistic regression was performed using STATA 16 to determine factors associated with acceptance of the malaria vaccine among next of kin of children under 5 years., Results: A total of 432 participants were enrolled. Of these, the majority were female (72.5%, n  = 313) with most aged 30 years and above (51.2%, n  = 221). Overall, 430 (99.5%) participants had good knowledge about malaria. The majority (91.4%, n  = 395) had good acceptance of the malaria vaccine. Factors independently associated with acceptance of the malaria vaccine were knowing a child who died of malaria [adjusted prevalence ratio (aPR): 1.07, 95% confidence interval (CI): 1.01-1.13, p  = 0.022] and preferring the injection route for a malaria vaccine (aPR: 1.1, 95% CI: 1.06-1.22, p  < 0.001). All 395 participants with good knowledge of malaria had good acceptance of the malaria vaccine ( p  = 0.007)., Conclusion: There was a high acceptance of the malaria vaccine in Laroo-Pece division, Gulu, Uganda. However, there is a need for further health education to achieve universal acceptability of the malaria vaccine in preparation for the malaria vaccine implementation program in Uganda., Competing Interests: The authors declare that there is no conflict of interest. The Associate Editor of Therapeutic Advances in Infectious Disease is an author of this article. Therefore, the peer review process was managed by alternative members of the Editorial Board and the submitting Editor had no involvement in the decision-making process., (© The Author(s), 2024.)

Objectives: Despite the rise in the common rheumatological and musculoskeletal disorders (RMDs) in Africa, rheumatology remains an under recognized field with limited training and exposure of medical students. We assessed the knowledge of undergraduate medical students in Uganda on RMDs occurring in our settings., Methods: A descriptive cross-sectional study was conducted among clinical year medical students at 9 universities in Uganda offering undergraduate medical degrees in March and April 2022. A self-administered, semistructured questionnaire was used to collect data on sociodemographic characteristics and basic knowledge on RMDs online using KoboToolbox. Sufficient knowledge was defined as a score of ≥50% (pass mark for undergraduate students in Uganda). Multivariable logistic regression was performed using STATA 16 to determine factors associated with knowledge acquisition on RMDs., Results: We enrolled 359 medical students from 9 medical training institutes across Uganda. Overall, 126 (35.1%) participants had sufficient knowledge and the overall mean score for all participants was 41.2%. Factors independently associated with sufficient knowledge were: being in fourth (adjusted odds ratio [aOR]: 2.6, 95% confidence interval [CI]: 1.49-4.64, P  < .001) and fifth year (aOR: 2.2, 95% CI: 1.18-4.18, P  = .013) compared to third year of study, awareness of the speciality of rheumatology (aOR: 4.0, 95% CI: 1.96-8.06, P  < .001), formal classes on rheumatology (aOR: 2.0, 95% CI: 1.15-3.35, P  = .012), prior bedside teaching on RMDs (aOR: 2.3, 95% CI: 1.49-3.69, P  < .001), awareness of common RMDs (aOR: 3.2, 95% CI: 1.67-6.04, P  < .001), and having seen a patient with an RMD (aOR: 1.8, 95% CI: 1.14-2.77, P  < .01)., Conclusion: There was a significant knowledge gap among undergraduate medical students nationwide on rheumatology. There is an urgent need to increase exposure to RMDs for undergraduate medical students to address the rising burden of RMDs in Uganda., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis., Methods: We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August 2023 using the key terms 'renal' OR 'kidney*' OR 'prostate' OR 'urinary bladder' OR 'urinary tract*AND 'aspergillosis' OR 'aspergillus' OR 'aspergilloma' OR 'mycetoma'. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies, protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded., Results: We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925-2023. Among the participants, 79 (86.8%) were male, with a median age of 46 years. Predominantly, presentations consisted of isolated renal infections (74 instances, 81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens ( p  = 0.739) or nephrectomy status ( p  = 0.8)., Conclusion: Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management., Prospero Registration Number: CRD42023430959., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2023.)

Introduction: The World Health Organization acknowledges the need for countries to incorporate neglected tropical disease care into their routine health care system. However, low detection rates and late presentation of mycetoma to health facilities have been observed in endemic countries, including Uganda., Objective: To empower community health workers (CHWs) in Northern Uganda to recognize and refer suspects of mycetoma to health facilities., Design: This will be a stepped-wedge cluster-randomized trial based in Gulu and Pader districts over a period of 9 months with sequential crossover from intervention phase to the control phase at different time points until both districts are exposed to the intervention., Methods and Analysis: The study will leverage on the ongoing partnership between Northern Uganda Medical Mission and the Uganda Ministry of Health that has trained over 300 CHWs in Gulu and Pader. The study evaluation will be done using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The expected outcome of the study is increased detection and referral of suspects of mycetoma. Data will be analyzed using STATA 17.0 and Friedman statistics or Analysis of Variance to determine increase in case identifications and referrals., Ethics and Registration: The study was approved by Mulago Hospital Research and Ethics Committee (MHREC 2406) and registered with Pan African Clinical Trial Registry (PACTR202301534749787)., Dissemination: The results from this trial will be published in a peer-reviewed journal. In addition, the findings will be shared at conferences, with funders, and at other research meetings., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2023.)

Background: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sex workers in Gulu, Uganda., Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3 months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p  < 0.05 was considered statistically significant., Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range: 24-32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with; regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11-6.35, p  < 0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32-35.77, p  = 0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI: 1.49-4.35, p  < 0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43-7.74, p  = 0.005), and use of postexposure prophylaxis (PEP) in the past 12 months (aPR: 0.31, 95% CI: 0.17-0.59, p  < 0.001)., Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2023.)