Limited data exist on temporal changes in antibiotic use in low and middle-income countries. We evaluated trends in antibiotic use at tertiary hospitals in Uganda.

Retrospective trend analysis of a repeated point prevalence survey (PPS).

This study utilised antibiotic use data from quarterly PPS conducted among inpatients at nine regional referral hospitals in Uganda between October 2020 and December 2023.

We determined the proportions of antibiotic use, prescriptions guided by culture and sensitivity tests (CST), WHO AWaRe (Access, Watch and Reserve) categories, and prescriptions without documented indication. Linear regression was used to derive slope coefficients and 95% confidence interval (CI).

Of 15,154 patients surveyed, 8,892 (58.7%) received systemic antibiotics. The median age was 23 years (IQR: 11–38), 5,338 (60.5%) were female, and 4,583 (51.5%) were on treatment for infectious syndromes, including sepsis (1,400, 15.7%) and pneumonia (867, 9.8%). The drug utilisation index (DU75) consisted of ceftriaxone, metronidazole, gentamicin and ampicillin, which accounted for 76.9% (12,291/15,989) of total antibiotic use. The distribution of prescribed antibiotics was 46.6% Access, 45.5% Watch, 0.1% Reserve and 7.7% unrecommended combinations. Overall, 5,402 (60.8%) prescriptions were aligned with national guidelines, 2,147 (24.1%) prescriptions were issued without an indication, and CST guided 271 (3%) prescriptions. Over time, there was no significant change in antibiotic prescription prevalence (slope=0.09, CI –0.93 to 1.10) and prescriptions without indication (slope=–0.70, CI –1.79 to 3.98). However, adherence to treatment guidelines (slope=2.06, CI 0.14 to 3.98) and prescriptions based on CST results (slope=0.62, CI 0.12 to 1.13) significantly increased, while ‘Watch’ antibiotics prescriptions decreased (slope=–0.40, CI –0.63 to –0.17).

The antibiotic prescription rate remained high, with no significant change over time. Improvements were seen in adherence to treatment guidelines, use of CST and reduced use of ‘Watch’ antibiotics. Strengthening antibiotic stewardship is recommended to further improve practices.

Pre-exposure prophylaxis (PrEP) use among cisgender female sex workers (FSWs), a population at disproportionately high HIV acquisition risk in Uganda, remains suboptimal. Uptake and continued use are constrained by barriers, such as limited clinical hours, long distances to access facility-based PrEP services, and high mobility among FSWs. Community pharmacies may offer a more accessible PrEP delivery model due to extended operating hours and convenient locations. This study aims to evaluate the accessibility and capacity of pharmacies in Kampala, Uganda, to serve as potential sites for PrEP delivery.

We will conduct a concurrent mixed-methods study combining geospatial mapping, structured surveys, a discrete choice experiment (DCE), and in-depth interviews (IDIs). First, the study will compare the reach and accessibility of PrEP services through community pharmacies versus public healthcare facilities. To highlight PrEP service reach, we will use geospatial analysis to map pharmacies, PrEP clinics, FSW hotspots (i.e., areas where sex is exchanged), and HIV incidence. We will also calculate a PrEP facility needs ratio (number of PrEP facilities/HIV incidence) for each of Kampala’s administrative divisions and estimate travel distance and time to access PrEP services using cost–distance analysis. Perceived accessibility of PrEP services will be assessed through FSW surveys (n=50) and IDIs (n=20–30), guided by Levesque’s framework. Then, we will evaluate pharmacy capacity via surveys (n=274) and IDIs (n=20–30), exploring infrastructure, resources, and staff perspectives, informed by the Consolidated Framework for Implementation Research. Additionally, a DCE will be embedded in the pharmacy survey to elicit staff preferences for delivery approaches and analysed using mixed logit models. Finally, we will integrate quantitative and qualitative findings to provide a broad assessment of whether pharmacies are suitable venues for PrEP delivery to FSWs in Kampala. Enrolment will begin by April 2026 for FSWs and July 2026 for pharmacy staff.

Ethical approval has been obtained from the Infectious Diseases Institute Research Ethics Committee (IDI-REC-2025-175) and the Uganda National Council for Science and Technology (HS6178ES). Written informed consent will be obtained from all participants. We will disseminate study findings through stakeholder meetings, scientific conferences, and peer-reviewed publications.

Coronavirus disease 2019 (COVID-19) caused a global public emergency between 2020 and 2022 with various morbidity and mortality across the regions. While the impact in sub-Saharan Africa appeared relatively limited, data from regional referral hospitals remain scarce.

To determine the in-hospital mortality rate, risk factors and clinical characteristics of COVID-19 patients admitted to the COVID-19 treatment unit (CTU) at Lira Regional Referral Hospital (LRRH) in northern Uganda

Cross-sectional study with the use of secondary data

This study was conducted at LRRH between January 2023 and December 2023. The data used were for patients admitted from May 2020 to March 2022.

Records of 490 patients admitted with laboratory confirmed COVID-19 were collected and analysed. Selection was by simple census sampling technique. Inclusion criteria were moderately to critically ill patients and those with mild/asymptomatic infection but with comorbidities.

Of the 490 participants, 52% were females and 41% were aged ≥60 years. The most common symptoms were cough (89.6%), difficulty in breathing (78.8%) and chest pain (69.3%). Hypertension (30%), diabetes mellitus (19.5%) and human immunodeficiency virus (10%) were the leading comorbidities. Severe and critical illness was observed in 40% and 7% of cases, respectively. The overall in-hospital mortality rate was 29%. Factors significantly associated with reduced mortality included normal oxygen saturation (SPO₂) (adjusted odds ratios (aOR) 0.11, 95% CI 0.03 to 0.44), normal body temperature (aOR 0.22, 95% CI 0.05 to 0.99), absence of chronic liver disease (aOR 0.01, 95% CI 0.001 to 0.46) and younger age (31–45 years; aOR 0.14, 95% CI 0.03 to 0.74).

The study revealed a high in-hospital mortality rate of 29% among COVID-19 patients admitted to the CTU at LRRH, primarily driven by severe disease presentation and limited access to critical interventions such as oxygen therapy. Independent predictors of survival included younger age, normal oxygen saturation, absence of chronic liver disease and normal body temperature at admission. These findings underscore the urgent need for early identification of high-risk patients and improved access to supportive care, particularly oxygen delivery systems, to reduce mortality in future outbreaks. Strengthening diagnostic capacity, clinical monitoring and preparedness for respiratory pandemics—alongside prospective studies capturing broader patient data—will be essential to refine response strategies and improve outcomes.