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Barriers and facilitators to diabetes management among adults and healthcare providers in a peri-urban Ugandan health facility: A qualitative study

Diabetes mellitus is an increasing public health challenge in Uganda and other low- and middle-income countries, where health systems face growing demands for chronic disease care. Although quantitative studies have documented poor glycemic control and health system constraints, less is known about how patients and healthcare providers experience diabetes management in peri-urban public health settings. This study explored barriers and facilitators to diabetes management among adults with diabetes mellitus and healthcare providers at a peri-urban health facility in Uganda. We conducted a qualitative descriptive study at Kasangati Health Centre IV, Wakiso District, Uganda, between February and March 2025. Data were collected through 15 in-depth interviews with adults living with diabetes mellitus and 8 key informant interviews with healthcare providers involved in diabetes care. Participants were purposively selected based on their experience with diabetes management and service delivery. Interviews were audio-recorded, transcribed verbatim, translated where necessary, and analyzed using a hybrid inductive-deductive thematic approach informed by the Theoretical Domains Framework. Five interrelated themes were identified: (1) institutional and environmental factors influencing access to diabetes care; (2) cognitive and informational factors influencing medication adherence; (3) social influences on diabetes management; (4) emotional experiences of patients and healthcare providers; and (5) self-management strategies and continuity of care. Across these themes, participants identified barriers including resource limitations, communication challenges, medication management difficulties, stigma, emotional distress, and weak follow-up systems. Facilitators included peer support, religious and community networks, health education, provider flexibility, and patient-developed adherence strategies. Diabetes management was influenced by interacting health-system, social, informational, and behavioural factors. Resource constraints, limited health literacy, stigma, and weak follow-up systems hindered effective management, while social support, health education, and patient self-management strategies facilitated continued engagement in care. Interventions that strengthen chronic care services, patient education, and community support may improve diabetes outcomes in similar resource-constrained settings.

Prevalence and Correlates of Ideal Cardiovascular Health among Ugandan Adolescents: A Cross-Sectional Study

Introduction: Cardiovascular disease (CVD) risk factors often emerge during adolescence and track into adulthood, yet data on cardiovascular health (CVH) in sub-Saharan Africa remain limited. We assessed the prevalence and correlates of ideal CVH among Ugandan adolescents. Methods: We analysed baseline data of adolescents enrolled in a cluster-randomised controlled trial being conducted in urban (Kampala) and rural (Jinja) districts of Uganda. In this study, Ideal CVH was defined as meeting "ideal" status of 5-7 of the American Heart Association's Life's Simple 7 metrics. Random-effects logistic regression was used to identify factors associated with ideal CVH, accounting for village-level clustering. Results: We recruited 1316 participants with a mean age of 13.2 years, of whom 58.1% were female. Overall, the prevalence of ideal CVH was 66.8% (95% CI: 64.2% - 69.3%). The prevalence was higher in Jinja (74.4%, 95%CI: 70.9% - 77.7%) than Kampala (59.6%, 95%CI: 55.8%-63.2%) and the difference was evident (p

Clinician knowledge and self-efficacy in snakebite management: A cross-sectional assessment in Northern Uganda

Background: Snakebite envenomation (SBE) is a major public health crisis in rural Uganda, yet it remains a neglected tropical disease. Effective management is often compromised by systemic barriers and a lack of clinician training. This study assessed clinician self-efficacy and objective knowledge regarding SBE management in Northern Uganda. Methods: A descriptive, cross-sectional study was conducted between February and July 2025 among 379 healthcare workers in Gulu, Omoro, and Pader districts. A validated questionnaire was used to collect data on socio-demographics, self-reported efficacy (scale 1-10), and objective knowledge. Knowledge scores [&ge;]70% were categorized as adequate. Multivariable logistic regression identified independent predictors of adequate knowledge, and Spearmans correlation ({rho}) assessed the relationship between knowledge and self-efficacy. Results: The participants had a mean age of 35.6 years (SD {+/-}7.3), were predominantly female (56.5%, 214/379), and most (83.6%, 317/379) practiced at Health Centre III level facilities. While 53.8% (204/379) reported prior training, 48.3% (183/379) of these had not received an update in over 10 years. Adequate knowledge was demonstrated by 51.5% (195/379) of participants. In the multivariable analysis, practicing in Omoro (adjusted odds ratio [aOR]: 0.3, 95% CI: 0.1-0.6, p < 0.001) or Pader (aOR: 0.2, 95% CI: 0.1-0.4, p < 0.001) was associated with lower odds of adequate knowledge compared to Gulu district. Prior training significantly increased the odds of adequate knowledge (aOR: 2.3, 95% CI: 1.3-4.2, p = 0.006). A moderate positive correlation was observed between self-efficacy and objective knowledge (Spearmans {rho} = 0.33, p < 0.0001). Conclusion: Approximately half of the frontline healthcare workers in Northern Uganda lack adequate knowledge on SBE management, with significant geographic differences and outdated training. The gap between clinician self-efficacy and objective knowledge poses a risk to patient safety. Regular, mandatory refresher training and targeted educational outreach to remote districts are required to reduce SBE-related morbidity and mortality.