Prevalence of undiagnosed dyspepsia associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University in Uganda

Prevalence of undiagnosed dyspepsia associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University in Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of undiagnosed dyspepsia associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University in Uganda Shamim Nabidda, Christine Atuhurra Kabahinda, David Wagaba, Samuel Okello, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8112225/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2026 Read the published version in BMC Gastroenterology → Version 1 posted 11 You are reading this latest preprint version Abstract Introduction Dyspepsia affects 6.9% of people globally and significantly impairs quality of life, yet it often remains undiagnosed. Undiagnosed dyspepsia (UD) affects up to one-third of patients and is prevalent among students due to stress, irregular eating, and self-medication. In Uganda, limited access to endoscopy results in many cases being undiagnosed, yet recent data among health professional students remains scarce. Objective To determine the prevalence of UD, associated factors, and its relationship with QoL among undergraduate health professional students at Makerere University. Methods This was a cross-sectional study involving 378 undergraduate health professional students from Makerere University between March and April 2025. Participants were pursuing Medicine and Surgery, Nursing, Pharmacy, and Dental Surgery, aged ≥ 18 years, and were selected by stratified simple random sampling. Data on socio-demographics, lifestyle, and dyspeptic symptoms were collected using a structured questionnaire based on various tools. Data was analyzed using STATA 17 in the survey window. Prevalence of UD was estimated with 95% confidence intervals. Modified Poisson regression was used to determine associated factors, while mixed-effects linear regression was used to analyze the relationship between dyspepsia and quality of life. Results The prevalence of undiagnosed dyspepsia (UD) was 13.5% (95% CI: 10.2–17.4). Drinking tea, either some days (aPR = 0.424; 95% CI: 0.197–0.913) or daily (aPR = 0.345; 95% CI: 0.167–0.713), and engaging in high physical activity (aPR = 0.374; 95% CI: 0.151–0.927) were associated with a protective effect. Predisposing factors were eating two meals daily (aPR = 2.637; 95% CI: 1.213–5.733), alcohol use (aPR = 1.775; 95% CI: 1.062–2.966), moderate fatigue (aPR = 1.842; 95% CI: 1.126–3.011), underweight Body Mass index (aPR = 2.202; 95% CI: 1.038–4.675), and longer sleep duration (aPR = 1.925; 95% CI: 1.156–3.204). No significant association was found with quality of life (p = 0.217). Conclusion The prevalence of UD among undergraduate health professional students was moderately high, though not significantly associated with quality of life. Targeted health education that promotes regular physical activity, addresses fatigue, and discourages excessive alcohol and coffee consumption may help reduce the burden of UD in this population. Dyspepsia Quality of Life Undergraduate Students Prevalence Uganda Figures Figure 1 BACKGROUND Dyspepsia is a common gastrointestinal disorder with a significant impact on quality of life (QoL), yet most often remains undiagnosed ( 1 ). It is defined by the ROME IV criteria as recurrent postprandial fullness, early satiety, epigastric pain, or burning severe enough to interfere with the usual activities and occur at least 3 days per week over the last 3 months, with an onset at least 6 months( 1 ). Undiagnosed dyspepsia (UD) affects about 37.9% of people with chronic dyspeptic symptoms globally( 2 ).High prevalence rates are reported in Sub-Saharan Africa (SSA), ranging from 25.5% in Uganda, 48.4% in Ethiopia, to 54.4% in Nigeria( 3 ). University students are particularly vulnerable due to academic stress and fatigue, irregular eating habits, and poor health-seeking behaviours( 4 ). The reported prevalence of UD is as high as 46% among American health professional students and 24% among their Ugandan counterparts ( 5 , 6 ). Yet few studies have explored its burden in this group. UD has also been associated with smoking, abnormal Body Mass Index (BMI), insufficient sleep, Non-Steroidal Anti-Inflammatory Drugs (NSAID) use, alcohol, and certain dietary habits( 7 ). Furthermore, about 31% of people with UD practice self-medication and 28% use inappropriate medications, which may worsen long-term outcomes( 8 ). UD has been linked to poor QoL( 9 ). The World Health Organization (WHO) describes QoL as a subjective evaluation of one's perception of their reality relative to their goals as observed through the lens of their culture and value system( 10 ). Chronic dyspeptic symptoms, such as epigastric pain, can reduce productivity, increase anxiety, negatively affect students' study habits, and severe cases, may lead to complications like gastrointestinal bleeding and perforation( 11 ). In Uganda, dyspepsia diagnosis relies on endoscopy, but its high cost and invasiveness leave many cases undiagnosed( 12 ). The only study conducted among students was a decade ago in Western Uganda ( 6 ). Given regional differences, especially the high cost of living in Kampala, we cannot generalise the findings to central Uganda. We therefore determined the prevalence of UD, associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University. Understanding the burden of UD would help develop strategies to mitigate this problem and improve the QoL of health students. METHODS Study design and setting. A cross-sectional study was conducted at Makerere University (Mak) in Central Uganda between March and April 2025. Mak is the largest university in Uganda, located in Kampala, the capital city. Mak offers over 143 programs across 10 academic units. It has a population of over 30,000 students, of which 2,185 are undergraduate health professional students. The students come from different parts of Uganda, as well as international students. Makerere University College of Health Sciences offers 11 undergraduate health professional programs, including Bachelor of Medicine and Surgery, Bachelor of Science in Speech and Language Therapy, Bachelor of Pharmacy, Bachelor of Science in Nursing, Bachelor of Optometry, Bachelor of Palliative Care, Bachelor of Biomedical Engineering, Bachelor of Biomedical Sciences, Bachelor of Science in Cytotechnology, Bachelor of Dental Surgery and Bachelor of Dental Technology. Study Population We included undergraduate health professional students pursuing a Bachelor of Medicine and Surgery, Bachelor of Science in Nursing, Bachelor of Pharmacy, or Bachelor of Dental Surgery, aged 18 years and above, who were physically present at the university on the day of data collection, and were willing to provide informed consent. We particularly included students from these courses because they have been shown to have higher perceived stress related to academics, poorer dietary habits, and poorer health-seeking behaviour influenced by their knowledge of medications, which puts them at higher risk of undiagnosed dyspepsia( 13 – 15 ). We excluded students who had physical signs of illness and reported being ill at the time of the interview. Sample size estimation. The sample size was calculated based on the three study objectives. For prevalence estimation, the Kish-Leslie formula was applied with an estimated prevalence of 1.9% among undergraduate health professional students in Japan( 16 , 17 ), at a 95% confidence level, 3% margin of error, and a design effect of 2, yielding 160 participants. For determining associated factors, a comparison of proportions considering sex as the variable of interest with estimates from a study in Northern India ( 17 ) applying design effects of 2 yielded 328 participants, while the analysis of quality of life required 67 participants. The highest estimate (328) was adopted, and after adjusting for a 15% non-response rate, the final sample size was 378 students. Sampling procedure Participants were chosen through stratified simple random sampling, with the strata defined by the course offered and the year of study. Eligible participants from each stratum based on the year of study were selected using simple random sampling. A list of undergraduate health professional students in each stratum was obtained through the College Registrar's office in the College of Health Sciences. Computer-generated random numbers were utilised to select participants in each stratum. Data Collection Tool and Procedures Students were found around the campus during lecture breaks to seek their consent to participate in the study. Class representatives helped locate some students around campus by calling them. Data was collected from eligible participants using a semi-structured questionnaire which was developed for this study using several globally validated tools (Appendix 1). These included the Rome IV criteria for diagnosing undiagnosed dyspepsia (UD), the Perceived Stress Scale (PSS) for assessing stress levels, the Food Frequency Questionnaire (FFQ) for evaluating dietary habits, the International Physical Activity Questionnaire Short Form (IPAQ-SF) for measuring physical activity, and the Fatigue Assessment Scale (FAS) for assessing fatigue. In addition, the Alcohol Use Disorders Identification Test (AUDIT) and the World Health Organization Quality of Life Brief Questionnaire (WHOQOL-BREF) were used to assess alcohol consumption and quality of life (QoL), respectively. Anthropometric measurements were obtained using a calibrated weighing scale and stadiometer to determine weight and height, respectively, and body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Data analysis Data was analysed using STATA version 17 in the survey methods window to account for clustering. Numerical data was summarised using means and standard deviations when normally distributed or medians and interquartile ranges for non-normally distributed data. Categorical data were summarised using proportions and percentages and presented as tables and graphs. The prevalence of UD was determined by calculating the proportion of participants with UD divided by the total number of study participants and expressed as a percentage with a 95% confidence interval (CI). Modified poisson regression (using robust standard errors to account for non-normal distributions) was employed in both bivariate and multivariate analyses reporting adjusted prevalence ratios with their 95% CIs to determine factors associated with UD. Sample size adequacy was checked to determine if all variables were to be analysed by considering all variables when the sample size was greater than 40 times the number of variables to be analyzed. Variables with a p-value < 0.2 at bivariate analysis were included in multivariate analysis. The relationship between QoL and UD was determined by mixed effects linear regression, adjusting for potential confounders. Variables with a p-value < 0.2 were included in the multivariate analysis, maintaining UD in the model regardless of its p-value, since it was the main predictor. A p-value less than 0.05 indicated statistical significance. RESULTS Social demographic characteristics of participants Most of the participants were aged 18-24 years (75.1%, n=284), males (59.8%, n=226), in year four (28.0%, n=106), single (92.6%, n=350), unemployed (84.1%, n=318), and on government sponsorship (69.1%, n=261) (Table 1). Table1. Social demographic factors of 378 undergraduate health professional students at Makerere University (N=378). Variable Frequency (n) Percentage (%) Age 18-24 284 75.1 >24 94 24.9 Sex Female 152 40.2 Male 226 59.8 Year of Study Year one 69 18.3 Year two 61 16.1 Year three 71 18.8 Year four 106 28.0 Year five 71 18.8 Marital status Married 28 7.4 Single 350 92.6 Employment status Employed 60 15.9 Unemployed 318 84.1 Sponsorship Government 261 69.1 Private 117 30.9 Table 5. The Dietary habits of undergraduate health professional students at Makerere University. Most participants reported occasional consumption of spicy foods (59.3%, n=224), and hot foods daily (66.4%, n=251). Additionally, most participants consumed deep-fried foods on some days (60.3%, n=228), raw foods some days (56.1%, n=212), and dairy products some days (58.5%, n=221). A high proportion of participants consumed black tea daily (61.9%, n = 234), while coffee and chocolate were consumed by most participants some days (38.1% n = 144) and (54.2% n = 205), respectively (Table 5). Table 6. Lifestyle factors of undergraduate professional students at Makerere University. Most participants reported eating three meals a day (42.6%, n=161), did not consume alcohol (70.6%, n=267), and did not smoke (99.5%, n=376). More than half of the participants had trouble sleeping (58.2%, n=220), had moderate physical activity (53.2%, n=201), and spent between UGX 35,000–100,000 on food weekly (75.9%, n=287). Lastly, the largest proportion of participants (77.3%, n=292) reported sleeping less than 7 hours on most days and didn’t consume energy drinks (72.2%, n=273) (Table 6). Table 7. Psychological and biological factors of 378 undergraduate professional students at Makerere University. Most participants had moderate stress (82.3%, n= 311), no/mild fatigue (71.4%, n=270), and had normal Body Mass Index (51.6%, n=195) (Table 7). Prevalence of UD among 378 undergraduate health professional students at Makerere University. The prevalence of UD was 13.5% (95% confidence interval (CI): 10.2%- 17.4%) (Figure 1). Figure 1. Prevalence of UD among undergraduate health professional students at Makerere University. Factors associated with UD among undergraduate health professional students. Bivariate analysis of factors associated with UD among 378 undergraduate health professional students. Table 8. Bivariate analysis of social demographic factors associated with UD among 378 undergraduate health professional students at Makerere University. Sex (cPR 1.673, p=0.037) and academic program (BPharm: cPR 0.544, p=0.177) were considered for multivariate analysis because they had a p value less than 0.2 (Table 8). Table 9. Bivariate analysis of dietary factors associated with UD among 378 undergraduate health professional students at Makerere University. Taking coffee (sometimes: cPR 1.667, p=0.086), and black tea (daily:cPR 0.494, p=0.048) were considered for multivariate analysis because they had a p-value less than 0.2 (Table 9). Table 10. Bivariate analysis of lifestyle factors associated with UD among 378 undergraduate health professional students at Makerere University. Eating patterns (two meals a day:cPR 2.200, p= 0.036), alcohol drinking (low-risk alcohol drinking:cPR 1.708, p=0.039), and physical activity (high physical activity:cPR 0.370, p=0.035), sleep hours (sleeping 7 hours and above:cPR 1.698, p=0.041), were considered for multivariate analysis because they had a p-value less than 0.2 (Table 10). Table 11. Bivariate analysis of psychological and biological factors associated with UD among 378 undergraduate health professional students at Makerere University. Fatigue (moderate fatigue:cPR 2.131, p= 0.002), BMI (underweight: cPR 1.665, p=0.185; overweight: cPR 1.625, p= 0.108; obese: cPR 1.688, p=0.138) were considered for multivariate analysis because they had a p-value less than 0.2 (Table 11). Multivariate analysis Protective factors against UD included drinking black tea (some days: aPR = 0.424; 95% CI: 0.197–0.913; daily: aPR = 0.345; 95% CI: 0.167–0.714) and engaging in high physical activity (aPR = 0.374; 95% CI: 0.151–0.927). In contrast, drinking coffee (s: aPR = 2.491; 95% CI: 1.277–4.859), eating two meals a day (aPR = 2.637; 95% CI: 1.213–5.733), low-risk alcohol use (aPR = 1.775; 95% CI: 1.062–2.966), moderate fatigue (aPR = 1.842; 95% CI: 1.126–3.011), underweight BMI (aPR = 2.202; 95% CI: 1.038–4.675), and sleeping ≥7 hours (aPR = 1.925; 95% CI: 1.156–3.204) were significantly associated with higher prevalence of UD (Table 2). Table 2. Multivariate analysis of factors associated with UD among 378 undergraduate health professional students at Makerere University. Variable aPR CI (95%) P value Black Tea Never 1 Some days 0.424 0.197- 0.913 0.028 Daily 0.345 0.167-0.714 0.004 Coffee Never 1 Some days 2.491 1.277- 4.859 0.008 Daily 1.931 0.988- 3.772 0.054 Eating patterns One meal a day 1 Two meals a day 2.637 1.213- 5.733 0.015 Three meals a day 1.418 0.598- 3.361 0.426 Alcohol drinking No alcohol 1 Low risk drinker 1.775 1.061-2.966 0.029 Hazardous /dependent drinker 0 .583 0.1556-2.185 0.423 Physical activity Low physical activity 1 Moderate activity 0.977 0.564- 1.691 0.933 High activity 0.374 0.151- 0.926 0.034 Fatigue No/Mild 1 Moderate 1.842 1.126- 3.011 0.015 Severe 1.296 0.377-4.449 0.680 BMI Normal weight 1 Underweight 2.202 1.038–4.675 0.040 Overweight 1.254 0.689–2.283 0.458 Obese 1.613 0.832–3.127 0.156 Sleep hours Less than 7 hours 1 7 hours and above 1.925 1.156-3.204 0.012 Relationship between QoL and UD among 378 undergraduate health professional students at Makerere University. There was no significant difference between undergraduate health professional students with UD and those without UD in all QoL domains and overall QoL scores (Table 3). Table 3. Summary of different domains of QoL. DOMAINS NO UD (MEAN ± SD) UD (MEAN ± SD) P value Physical 27.77 ±3.63 26.75 ±3.29 0.059 Psychological 23.25 ± 3.33 22.35 ±3.02 0.072 Environmental 29.49 ± 3.68 29.37 ± 3.09 0.200 Social 11.25 ± 2.26 10.82 ± 1.99 0.830 TOTAL QoL* 91.76 ± 10.24 89.29 ± 7.77 0.087 There was no significant relationship between QoL and UD (p = 0.217; 95% CI: (-0.161- 0.037). Physical activity, sleep hours, years of study, eating patterns and fatigue were confounding the relationship between QoL and UD (Table 4). Table 4. Adjusted model showing the relationship between QoL and UD among 378 undergraduate health professional students at Makerere University. Variable aβ CI (95%) P value UD No 1.00 Reference Yes -0.06 -0.161- 0.037 0.217 Age 18-24 1.00 Reference >24 -0.13 -0.214 - -0.052 0.001 Eating patterns One meal a day 1.00 Reference Two meals a day 0.13 -0.123 - 0.032 0.005 Three meals a day 0.19 -0.273 - -0.086 0.000 Trouble sleeping Never 1.00 Reference Some days -0.21 -0.285 - -0.131 0.005 Always -0.26 -0.368 - -0.160 0.000 Physical activity Low physical activity 1.00 Reference Moderate activity 0.05 -0.285 – 0.131 0.177 High activity 0.10 0.005–0.202 0.004 Amount spent on food per week (UgShs) Less than 35000 1.00 Reference 35000-100,000 0.11 0.027–0.194 0.010 Greater than 100,000 0.01 -0.122–0.323 0.375 Stress Low stress 1.00 Reference Moderate stress -0.26 -0.366 – -0.158 0.000 High stress -0.29 -0.471 – -0.115 0.001 Fatigue No/Mild 1.00 Reference Moderate -0.17 -0.257 - -0.092 0.000 Severe -0.24 -0.430 - -0.050 0.013 Sleep hours Less than 7 hours 1.00 Reference 7 hours and above 0.05 -0.031 - 0.134 0.217 Year of study Year one -0.13 Reference Year two -0.02 -0.243 – -0.015 0.026 Year three -0.05 -0.134 – 0.092 0.712 Year four -0.05 -0.148 – 0.055 0.370 Year five -0.13 -0.168 – 0.059 0.345 aβ: adjusted coefficient DISCUSSION Undiagnosed dyspepsia significantly affects young adults, particularly university students, and impacts their academic performance, well-being, and long-term health( 18 ). In this study, we found a relatively high prevalence of UD among undergraduate health professional students at Makerere University, with several associated factors, including protective ones like black tea consumption and physical activity, while coffee intake, irregular eating patterns, alcohol use, fatigue, underweight BMI, and longer sleep duration increased risk. Although UD was common, no significant association with quality of life was observed. Prevalence of UD among undergraduate health professional students The prevalence of UD among undergraduate health professional students in this study was 13.5% (95% CI: 10.2–17.4%). This estimate is lower than the 46% reported among medical students at Kampala International University in Western Uganda( 6 ). This is possibly due to methodological differences, as the latter study employed a broader definition that included any gastrointestinal disorder, regardless of symptom duration. Conversely, our prevalence was higher than the 5.7% reported among college students in China( 19 ). This difference may be attributed to variations in study populations. This study focused on health professional students, who are more prone to stress and irregular lifestyles, unlike the Chinese study, which included students from various academic programs. Our results are comparable to a European study that reported a 10.9% prevalence among foreign medical students ( 20 ), probably due to shared predisposing factors such as high fatigue levels. Overall, these findings show that a substantial proportion of health professional students experience UD, with potential consequences for academic performance, well-being, and long-term health. Factors associated with UD among undergraduate health professional students Taking black tea daily or on some days significantly reduced the prevalence of UD by 60% and 70%, respectively. These findings align with a prospective cohort study, which reported that consuming one to two cups of black tea per day reduced the risk of UD by 66%( 21 – 23 ). This protective effect may be due to black tea’s ability to stimulate beneficial intestinal bacteria and suppress harmful microorganisms, thereby improving gut health ( 24 ). Similarly, students who engaged in high physical activity had a 60% lower prevalence of UD compared to those with low activity. These results are consistent with a study in Australia that found regular high physical activity reduced UD risk by 35%.( 25 , 26 ). Exercise may alleviate dyspeptic symptoms by reducing gastric acid reflux, enhancing intestinal gas transport, and suppressing the production of inflammatory cytokines ( 26 ). In contrast, a study among pre-clinical students in the United Arab Emirates showed no significant association, possibly due to a small sample size ( 27 ). Coffee consumption was associated with a higher prevalence of UD, with occasional drinkers showing a 2.49-fold increased risk compared to non-drinkers. This finding is consistent with a multicenter survey in Latin America, which found that UD prevalence was 51% higher among coffee consumers ( 18 , 28 , 29 ). This is likely due to coffee’s stimulatory effect on gastric acid secretion and subsequent gastric irritation ( 30 ). However, the results contrast with those of a cross-sectional study conducted among 3,362 adults in Iran, and the discrepancy may be due to variations in the study populations ( 31 ). Eating two meals a day was associated with a 2.64 times higher prevalence of UD compared to those who had one meal a day. This finding aligns with a multicenter survey conducted among four Latin American schools( 5 ).This may be a result of reserve causation, where those with UD modify their eating patterns to alleviate symptoms. However, the results contradict with findings of the study conducted among 3,362 adults in Iran ( 32 ).The discrepancy is likely due to variations in the study population and the diagnostic tool used for dyspepsia, as the latter study was conducted in the community and utilised Rome III criteria. Alcohol intake increased risk as well, with low-risk drinkers experiencing an 80% higher prevalence compared to abstainers. Similarly, a narrative review found that alcohol consumption was associated with an increased risk of H. pylori infection, which is a contributor to dyspepsia ( 33 ).The low concentrations of alcohol are mild stimulants of acid secretion, which may predispose to UD, whereas at higher concentrations, it has either no or a mild inhibitory effect ( 34 ). Other significant factors included moderate fatigue, which increased prevalence by 80%. This finding aligns with a prospective cohort study conducted in a tertiary hospital in Greece, which found a significant association between UD and fatigue ( 39 ). Fatigue is associated with low-grade inflammation marked by elevated cytokines like IL-6 and TNF-α, which later influence behaviours such as irregular eating, poor nutrition, and inactivity, which are known risk factors for UD ( 35 ). Underweight was also associated with a 2.2-fold higher prevalence. Similarly, Japanese university students that were underweight had a significantly higher prevalence of UD compared to those with normal BMI ( 36 ). Since UD causes weight loss, this may be the possible reason for the significant association between BMI and UD.( 37 ) Sleeping seven or more hours daily showed a 90% higher prevalence. Similar findings were reported in Korea, where UD was associated with poorer sleep quality and greater daytime sleepiness ( 38 ). Prolonged sleep may be a consequence of dyspeptic symptoms, as dyspepsia can increase sleep latency and nighttime awakenings, leading to non-restorative sleep and longer time in bed ( 39 ). Relationship between QoL and UD. There was no significant relationship between QoL and UD. This implies that, despite undergraduate health professional students with UD having a slightly lower mean total QoL compared to those without UD, this study could not conclusively attribute the reduction in QoL to UD, probably because the standard diagnostic tool (endoscopy) was not used to diagnose dyspepsia. These results are different from the findings of a hospital-based study among 324 dyspeptic patients, and the discrepancy may be due to differences in the study population ( 40 ). Hospital patients are likely to have more severe and persistent symptoms and, hence more likely to report impaired QoL, while students may tolerate mild symptoms, underestimating their impact on their QoL. Additionally, the differences may be due to the tools used to diagnose dyspepsia, where the study conducted among dyspeptic patients in Nigeria used endoscopy to diagnose dyspepsia, whereas our study utilised Rome IV criteria, hence chance of information bias in our study, which would have distorted the findings ( 41 ). Strengths and Limitations Variables were collected using globally valid tools by well-trained research assistants with certificates of good clinical practice. Likely confounders were adjusted for in the multivariate analysis and the sample size was adequate to increase generalization of findings to other public institutions. The findings of this study may have been influenced by some limitations. Information bias may have arisen from recall errors regarding symptom duration, food expenditure, eating patterns, and socially desirable responses, such as reporting non-smoking status. Misclassification was also possible, given the limited sensitivity of the Rome IV criteria for diagnosing UD (75%) and potential differences in how participants assessed symptom severity and quality of life. Random error may have occurred due to sparse data in variables such as smoking, marital status, employment, and sponsorship, which reduces the power to detect true associations, particularly when smoking is excluded from the analysis entirely. Residual confounding cannot be ruled out, as factors such as academic pressure and menstrual-related gastrointestinal symptoms were not adjusted for, which may explain why variables like sex and academic program were not significant at multivariate analysis. Finally, the results may not be generalizable to rural settings or private institutions since the study was conducted in an urban public university. CONCLUSION AND RECOMMENDATION The prevalence of UD among undergraduate health professional students was moderate, with up to 1 in 7 students with UD. Factors significantly associated with UD included black tea, coffee, alcohol drinking, physical activity, fatigue, BMI, food frequency, and sleep hours. There was no significant relationship between QoL and UD. Undergraduate health professional students should seek timely medical management for gastrointestinal symptoms, engage in regular physical activity, and limit their consumption of black tea to less than that of alcohol and coffee. University administrators should provide free services, such as endoscopy, at the university hospital to identify and manage dyspepsia among students and should also design strategies to increase student engagement in physical activity. Further studies are recommended, specifically among undergraduate health professional students, to investigate the relationship between UD and QoL using standard diagnostic procedures for dyspepsia, such as endoscopy. Abbreviations AUDIT Alcohol Use Disorders Identification Test BDS Bachelor of Dental Surgery Bpharm Bachelor of Pharmacy BMI Body Mass Index BScN Bachelor of Science in Nursing FAS Fatigue Assessment Scale FFQ Food Frequency questionnaire GERD Gastroesophageal Reflux Disease GI Gastrointestinal HP Helicobacter Pylori HRQoL Health Related Quality of Life IPAQ-SF International Physical Activity Questionnaire Short Form MBChB Bachelor of Medicine and Bachelor of Surgery NSAIDS Non-Steroid Anti-inflammatory drugs PSS Perceived Stress Scale PPI Proton Pump Inhibitors QoL Quality of life. SOMREC School of Medicine Research Ethics Committee UD Undiagnosed dyspepsia WHO World Health Organization WHOQOL BREF World Health Organization Quality of Life Brief Version Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Makerere University School of Medicine Research and Ethics Committee (Mak- SOMREC-2024-1202) and informed consent to participate in the study was obtained from all the participants. The authors confirm that the ethical policies of the journal, as noted on the journal's author guidelines page, have been adhered to. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding The authors did not receive funding to do this work. Author Contribution S.N conceived the research idea, wrote the research protocol, and led the data collection, performed the data analysis. O.S, C.A. K, E.A, A.M.K, H.U, D.W, D.L D.M & I. S wrote the original draft of the manuscript. J.K, I.E.M & M.K. M polished the research idea and were key in protocol and manuscript writing. Acknowledgements I express my heartfelt gratitude to all the Clinical Epidemiology lecturers for imparting invaluable research skills and knowledge throughout my academic journey. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Barberio B, Mahadeva S, Black CJ, Savarino EV, Ford AC. Systematic review with meta-analysis: global prevalence of uninvestigated dyspepsia according to the Rome criteria. Aliment Pharmacol Ther. 2020;52(5):762–73. Koloski NA, Talley N, Huskic S, Boyce P. Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia. Aliment Pharmacol Ther. 2003;17(6):841–51. Seid A, Tamir Z, Demsiss W. 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Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol. 1990;85(10):1339–42. Al Huda H, Marfianti E, Kurniawan NU, Ihsana N. The Effect of Coffee Consumption Pattern on The Incidence of Dyspepsia in Medical Faculty Students. Jurnal Kedokteran Diponegoro (Diponegoro Med Journal). 2024;13(6). Cohen S, Booth GH Jr. Gastric acid secretion and lower-esophageal-sphincter pressure in response to coffee and caffeine. N Engl J Med. 1975;293(18):897–9. Koochakpoor G, Salari-Moghaddam A, Keshteli AH, Esmaillzadeh A, Adibi P. Association between coffee and caffeine intake and functional dyspepsia. Sci Rep. 2024;14(1):31690. Keshteli AH, Feizi A, Esmaillzadeh A, Zaribaf F, Feinle-Bisset C, Talley NJ, Adibi P. Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia. Br J Nutr. 2015;113(5):803–12. Cheng DD, He C, Ai HH, Huang Y, Lu NH. The Possible Role of Helicobacter pylori Infection in Non-alcoholic Fatty Liver Disease. Front Microbiol. 2017;8:743. Chari S, Teyssen S, Singer MV. Alcohol and gastric acid secretion in humans. Gut. 1993;34(6):843–7. Talley NJ. Moving away from focussing on gastric pathophysiology in functional dyspepsia: new insights and therapeutic implications. Official J Am Coll Gastroenterology| ACG. 2017;112(1):141–4. Yamamoto Y, Furukawa S, Watanabe J, Kato A, Kusumoto K, Takeshita E, et al. Association between body mass index and functional dyspepsia in young Japanese people. J Neurogastroenterol Motil. 2022;28(2):276. Ford AC, Moayyedi P, Dyspepsia. BMJ. 2013;347. Kim SY, Lee SK, Choe JW, Jung SW, Hyun JJ, Koo JS, et al. Self-reported sleep impairment in functional dyspepsia and irritable bowel syndrome. J Neurogastroenterol Motil. 2018;24(2):280. Billey A, Saleem A, Zeeshan B, Dissanayake G, Zergaw MF, Elgendy M, Nassar ST. The Bidirectional Relationship Between Sleep Disturbance and Functional Dyspepsia: A Systematic Review to Understand Mechanisms and Implications on Management. Cureus. 2024;16(8). Egbo O, Omuemu C, Okeke E, Egbo OH, Mokogwu N. Health-related quality of life in patients with dyspepsia presenting at the University of Benin Teaching Hospital, Benin City, South-South Nigeria: a cross-sectional study. Pan Afr Med J. 2024;47:107. Egbo O, Omuemu C, Okeke E, Egbo OH, Mokogwu N. Health-related quality of life in patients with dyspepsia presenting at the University of Benin Teaching Hospital, Benin City, South-South Nigeria: a cross-sectional study. Pan Afr Med J. 2024;47:107. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":20298,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of UD among undergraduate health professional students at Makerere University.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8112225/v1/3c7dc14bb64395778b4e7802.png"},{"id":105223454,"identity":"563331a9-60c4-4a05-a237-d259b6aabe0f","added_by":"auto","created_at":"2026-03-23 16:06:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1701311,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8112225/v1/b251c1a0-dd4a-4946-8293-e0f2a96f7a19.pdf"},{"id":97674837,"identity":"e120c80c-3e5c-4e0c-b390-713269c90f00","added_by":"auto","created_at":"2025-12-08 09:44:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":37866,"visible":true,"origin":"","legend":"","description":"","filename":"1SUPPLEMENTARYMATERIALS.docx","url":"https://assets-eu.researchsquare.com/files/rs-8112225/v1/d11423aa9078fe4f05e38895.docx"},{"id":97654229,"identity":"cfb6945a-4433-4e0a-97c0-bcc1fcacc035","added_by":"auto","created_at":"2025-12-08 06:59:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":60589,"visible":true,"origin":"","legend":"","description":"","filename":"2SUPPLEMENTARYMATERIALS.docx","url":"https://assets-eu.researchsquare.com/files/rs-8112225/v1/b33394c2283d41a097959cda.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of undiagnosed dyspepsia associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University in Uganda","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eDyspepsia is a common gastrointestinal disorder with a significant impact on quality of life (QoL), yet most often remains undiagnosed (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is defined by the ROME IV criteria as recurrent postprandial fullness, early satiety, epigastric pain, or burning severe enough to interfere with the usual activities and occur at least 3 days per week over the last 3 months, with an onset at least 6 months(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Undiagnosed dyspepsia (UD) affects about 37.9% of people with chronic dyspeptic symptoms globally(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).High prevalence rates are reported in Sub-Saharan Africa (SSA), ranging from 25.5% in Uganda, 48.4% in Ethiopia, to 54.4% in Nigeria(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUniversity students are particularly vulnerable due to academic stress and fatigue, irregular eating habits, and poor health-seeking behaviours(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The reported prevalence of UD is as high as 46% among American health professional students and 24% among their Ugandan counterparts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Yet few studies have explored its burden in this group. UD has also been associated with smoking, abnormal Body Mass Index (BMI), insufficient sleep, Non-Steroidal Anti-Inflammatory Drugs (NSAID) use, alcohol, and certain dietary habits(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Furthermore, about 31% of people with UD practice self-medication and 28% use inappropriate medications, which may worsen long-term outcomes(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUD has been linked to poor QoL(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The World Health Organization (WHO) describes QoL as a subjective evaluation of one's perception of their reality relative to their goals as observed through the lens of their culture and value system(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Chronic dyspeptic symptoms, such as epigastric pain, can reduce productivity, increase anxiety, negatively affect students' study habits, and severe cases, may lead to complications like gastrointestinal bleeding and perforation(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Uganda, dyspepsia diagnosis relies on endoscopy, but its high cost and invasiveness leave many cases undiagnosed(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The only study conducted among students was a decade ago in Western Uganda (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Given regional differences, especially the high cost of living in Kampala, we cannot generalise the findings to central Uganda. We therefore determined the prevalence of UD, associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University. Understanding the burden of UD would help develop strategies to mitigate this problem and improve the QoL of health students.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cb\u003eStudy design and setting.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA cross-sectional study was conducted at Makerere University (Mak) in Central Uganda between March and April 2025. Mak is the largest university in Uganda, located in Kampala, the capital city. Mak offers over 143 programs across 10 academic units. It has a population of over 30,000 students, of which 2,185 are undergraduate health professional students. The students come from different parts of Uganda, as well as international students. Makerere University College of Health Sciences offers 11 undergraduate health professional programs, including Bachelor of Medicine and Surgery, Bachelor of Science in Speech and Language Therapy, Bachelor of Pharmacy, Bachelor of Science in Nursing, Bachelor of Optometry, Bachelor of Palliative Care, Bachelor of Biomedical Engineering, Bachelor of Biomedical Sciences, Bachelor of Science in Cytotechnology, Bachelor of Dental Surgery and Bachelor of Dental Technology.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Population\u003c/h2\u003e\u003cp\u003e We included undergraduate health professional students pursuing a Bachelor of Medicine and Surgery, Bachelor of Science in Nursing, Bachelor of Pharmacy, or Bachelor of Dental Surgery, aged 18 years and above, who were physically present at the university on the day of data collection, and were willing to provide informed consent. We particularly included students from these courses because they have been shown to have higher perceived stress related to academics, poorer dietary habits, and poorer health-seeking behaviour influenced by their knowledge of medications, which puts them at higher risk of undiagnosed dyspepsia(\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). We excluded students who had physical signs of illness and reported being ill at the time of the interview.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size estimation.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was calculated based on the three study objectives. For prevalence estimation, the Kish-Leslie formula was applied with an estimated prevalence of 1.9% among undergraduate health professional students in Japan(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), at a 95% confidence level, 3% margin of error, and a design effect of 2, yielding 160 participants. For determining associated factors, a comparison of proportions considering sex as the variable of interest with estimates from a study in Northern India (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) applying design effects of 2 yielded 328 participants, while the analysis of quality of life required 67 participants. The highest estimate (328) was adopted, and after adjusting for a 15% non-response rate, the final sample size was 378 students.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eParticipants were chosen through stratified simple random sampling, with the strata defined by the course offered and the year of study. Eligible participants from each stratum based on the year of study were selected using simple random sampling. A list of undergraduate health professional students in each stratum was obtained through the College Registrar's office in the College of Health Sciences. Computer-generated random numbers were utilised to select participants in each stratum.\u003c/p\u003e\n\u003ch3\u003eData Collection Tool and Procedures\u003c/h3\u003e\n\u003cp\u003eStudents were found around the campus during lecture breaks to seek their consent to participate in the study. Class representatives helped locate some students around campus by calling them. Data was collected from eligible participants using a semi-structured questionnaire which was developed for this study using several globally validated tools (Appendix 1). These included the Rome IV criteria for diagnosing undiagnosed dyspepsia (UD), the Perceived Stress Scale (PSS) for assessing stress levels, the Food Frequency Questionnaire (FFQ) for evaluating dietary habits, the International Physical Activity Questionnaire Short Form (IPAQ-SF) for measuring physical activity, and the Fatigue Assessment Scale (FAS) for assessing fatigue. In addition, the Alcohol Use Disorders Identification Test (AUDIT) and the World Health Organization Quality of Life Brief Questionnaire (WHOQOL-BREF) were used to assess alcohol consumption and quality of life (QoL), respectively. Anthropometric measurements were obtained using a calibrated weighing scale and stadiometer to determine weight and height, respectively, and body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData was analysed using STATA version 17 in the survey methods window to account for clustering. Numerical data was summarised using means and standard deviations when normally distributed or medians and interquartile ranges for non-normally distributed data. Categorical data were summarised using proportions and percentages and presented as tables and graphs. The prevalence of UD was determined by calculating the proportion of participants with UD divided by the total number of study participants and expressed as a percentage with a 95% confidence interval (CI). Modified poisson regression (using robust standard errors to account for non-normal distributions) was employed in both bivariate and multivariate analyses reporting adjusted prevalence ratios with their 95% CIs to determine factors associated with UD. Sample size adequacy was checked to determine if all variables were to be analysed by considering all variables when the sample size was greater than 40 times the number of variables to be analyzed. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 at bivariate analysis were included in multivariate analysis. The relationship between QoL and UD was determined by mixed effects linear regression, adjusting for potential confounders. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 were included in the multivariate analysis, maintaining UD in the model regardless of its p-value, since it was the main predictor. A p-value less than 0.05 indicated statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eSocial demographic characteristics of participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc180560347\"\u003eMost of the participants were aged 18-24 years (75.1%, n=284), males (59.8%, n=226), in year four (28.0%, n=106), single (92.6%, n=350), unemployed (84.1%, n=318), and on government sponsorship (69.1%, n=261) (Table 1).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eTable1. Social demographic factors of 378 undergraduate health professional students at Makerere University (N=378).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eFrequency (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e75.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026gt;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e152 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e226 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of Study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eYear one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 69 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eYear two\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 61 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e16.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eYear three\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 71 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eYear four\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e106 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eYear five\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 71 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e92.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp; 60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e318 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e84.1 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSponsorship\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e69.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e30.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. The Dietary habits of undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants reported occasional consumption of spicy foods (59.3%, n=224), and hot foods daily (66.4%, n=251). Additionally, most participants consumed deep-fried foods on some days (60.3%, n=228), raw foods some days (56.1%, n=212), and dairy products some days (58.5%, n=221). A high proportion of participants consumed black tea daily (61.9%, n = 234), while coffee and chocolate were consumed by most participants some days (38.1% n = 144) and (54.2% n = 205), respectively (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;Lifestyle factors of undergraduate professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost participants reported eating three meals a day (42.6%, n=161), did not consume alcohol (70.6%, n=267), and did not smoke (99.5%, n=376). More than half of the participants had trouble sleeping (58.2%, n=220), had moderate physical activity (53.2%, n=201), and spent between UGX 35,000\u0026ndash;100,000 on food weekly (75.9%, n=287). Lastly, the largest proportion of participants (77.3%, n=292) reported sleeping less than 7 hours on most days and didn\u0026rsquo;t consume energy drinks (72.2%, n=273) (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc201650461\"\u003e\u003cstrong\u003eTable 7. Psychological and biological factors of 378 undergraduate professional students at Makerere University.\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eMost participants had moderate stress (82.3%, n= 311), no/mild fatigue (71.4%, n=270), and had normal Body Mass Index (51.6%, n=195) (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of UD among 378 undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of UD was 13.5% (95% confidence interval (CI): 10.2%- 17.4%) (Figure 1).\u003c/p\u003e\n\u003cp id=\"_Toc201578283\"\u003eFigure 1. Prevalence of UD among undergraduate health professional students at Makerere University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with UD among undergraduate health professional students.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate analysis of factors associated with UD among 378 undergraduate health professional students.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8. Bivariate analysis of social demographic factors associated with UD among 378 undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSex (cPR 1.673, p=0.037) and academic program (BPharm: cPR 0.544, p=0.177) were considered for multivariate analysis because they had a p value less than 0.2 (Table 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9. Bivariate analysis of dietary factors associated with UD among 378 undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTaking coffee (sometimes: cPR 1.667, p=0.086), and black tea (daily:cPR 0.494, p=0.048) were considered for multivariate analysis because they had a p-value less than 0.2 (Table 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10. Bivariate analysis of lifestyle factors associated with UD among 378 undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEating patterns (two meals a day:cPR 2.200, p= 0.036), alcohol drinking (low-risk alcohol drinking:cPR 1.708, p=0.039), and physical activity (high physical activity:cPR 0.370, p=0.035), sleep hours (sleeping 7 hours and above:cPR 1.698, p=0.041), were considered for multivariate analysis because they had a p-value less than 0.2 (Table 10).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 11. Bivariate analysis of psychological and biological factors associated with UD among 378 undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFatigue (moderate fatigue:cPR 2.131, p= 0.002), BMI (underweight: cPR 1.665, p=0.185; overweight: cPR 1.625, p= 0.108; obese: cPR 1.688, p=0.138) were considered for multivariate analysis because they had a p-value less than 0.2 (Table 11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProtective factors against UD included drinking black tea (some days: aPR = 0.424; 95% CI: 0.197\u0026ndash;0.913; daily: aPR = 0.345; 95% CI: 0.167\u0026ndash;0.714) and engaging in high physical activity (aPR = 0.374; 95% CI: 0.151\u0026ndash;0.927). In contrast, drinking coffee (s: aPR = 2.491; 95% CI: 1.277\u0026ndash;4.859), eating two meals a day (aPR = 2.637; 95% CI: 1.213\u0026ndash;5.733), low-risk alcohol use (aPR = 1.775; 95% CI: 1.062\u0026ndash;2.966), moderate fatigue (aPR = 1.842; 95% CI: 1.126\u0026ndash;3.011), underweight BMI (aPR = 2.202; 95% CI: 1.038\u0026ndash;4.675), and sleeping \u0026ge;7 hours (aPR = 1.925; 95% CI: 1.156\u0026ndash;3.204) were significantly associated with higher prevalence of UD (Table 2).\u003c/p\u003e\n\u003cp id=\"_Toc201650466\"\u003eTable 2. Multivariate analysis of factors associated with UD among 378 undergraduate health professional students at Makerere University.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eaPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eCI (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlack Tea\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eSome days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.424\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.197- 0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eDaily\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.167-0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoffee\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eSome days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.277- 4.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eDaily\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.988- 3.772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.054 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEating patterns\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eOne meal a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eTwo meals a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.213- 5.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eThree meals a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.418\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.598- 3.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.426 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol drinking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eNo alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLow risk drinker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.775\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.061-2.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHazardous /dependent drinker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0 .583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.1556-2.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLow physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eModerate activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.564- 1.691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.933\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHigh activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.151- 0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFatigue\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eNo/Mild\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.126- 3.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.377-4.449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.680\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eNormal weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.038\u0026ndash;4.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.689\u0026ndash;2.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.458 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.832\u0026ndash;3.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cspan id=\"_Toc197550822\"\u003e\u003cstrong\u003eSleep hours\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cspan id=\"_Toc197550823\"\u003eLess than 7 hours\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cspan id=\"_Toc197550824\"\u003e7 hours and above\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.925 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.156-3.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.012\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRelationship between QoL and UD among 378 undergraduate health professional students at Makerere University.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no significant difference between undergraduate health professional students with UD and those without UD in all QoL domains and overall QoL scores (Table 3).\u003c/p\u003e\n\u003cp id=\"_Toc201650467\"\u003eTable 3. Summary of different domains of QoL.\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"right\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eDOMAINS\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eNO UD (MEAN \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003eUD (MEAN \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003ePhysical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e27.77 \u0026plusmn;3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e26.75 \u0026plusmn;3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.059 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003ePsychological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e23.25 \u0026plusmn; 3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e22.35 \u0026plusmn;3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eEnvironmental\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e29.49 \u0026plusmn; 3.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e29.37 \u0026plusmn; 3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eSocial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e11.25 \u0026plusmn; 2.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e10.82 \u0026plusmn; 1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.830 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eTOTAL QoL*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e91.76 \u0026plusmn; 10.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e89.29 \u0026plusmn; 7.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was no significant relationship between QoL and UD (p = 0.217; 95% CI: (-0.161- 0.037). Physical activity, sleep hours, years of study, eating patterns and fatigue were confounding the relationship between QoL and UD (Table 4).\u003c/p\u003e\n\u003cp id=\"_Toc201650468\"\u003eTable 4. Adjusted model showing the relationship between QoL\u0026nbsp;and UD among 378 undergraduate health professional students at Makerere University.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003ea\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCI (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.161- 0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u0026gt;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.214 - -0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEating patterns\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eOne meal a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eTwo meals a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.123 - 0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eThree meals a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.273 - -0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrouble sleeping\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eSome days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.285 - -0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eAlways\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.368 - -0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLow physical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eModerate activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.285 \u0026ndash; 0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eHigh activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e0.005\u0026ndash;0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmount spent on food per week (UgShs)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLess than 35000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e35000-100,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e0.027\u0026ndash;0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eGreater than 100,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.122\u0026ndash;0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLow stress\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eModerate stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.366 \u0026ndash; -0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eHigh stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.471 \u0026ndash; -0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFatigue\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eNo/Mild\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eModerate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.257 - -0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.430 - -0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep hours\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eLess than 7 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e7 hours and above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.031 - 0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear of study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eYear one\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eYear two\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.243 \u0026ndash; -0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eYear three\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.134 \u0026ndash; 0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eYear four\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.148 \u0026ndash; 0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eYear five\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e-0.168 \u0026ndash; 0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.345\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003ea\u0026beta;: adjusted coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eUndiagnosed dyspepsia significantly affects young adults, particularly university students, and impacts their academic performance, well-being, and long-term health(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In this study, we found a relatively high prevalence of UD among undergraduate health professional students at Makerere University, with several associated factors, including protective ones like black tea consumption and physical activity, while coffee intake, irregular eating patterns, alcohol use, fatigue, underweight BMI, and longer sleep duration increased risk. Although UD was common, no significant association with quality of life was observed.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePrevalence of UD among undergraduate health professional students\u003c/h2\u003e\u003cp\u003eThe prevalence of UD among undergraduate health professional students in this study was 13.5% (95% CI: 10.2–17.4%). This estimate is lower than the 46% reported among medical students at Kampala International University in Western Uganda(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This is possibly due to methodological differences, as the latter study employed a broader definition that included any gastrointestinal disorder, regardless of symptom duration. Conversely, our prevalence was higher than the 5.7% reported among college students in China(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This difference may be attributed to variations in study populations. This study focused on health professional students, who are more prone to stress and irregular lifestyles, unlike the Chinese study, which included students from various academic programs. Our results are comparable to a European study that reported a 10.9% prevalence among foreign medical students (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), probably due to shared predisposing factors such as high fatigue levels. Overall, these findings show that a substantial proportion of health professional students experience UD, with potential consequences for academic performance, well-being, and long-term health.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with UD among undergraduate health professional students\u003c/h2\u003e\u003cp\u003eTaking black tea daily or on some days significantly reduced the prevalence of UD by 60% and 70%, respectively. These findings align with a prospective cohort study, which reported that consuming one to two cups of black tea per day reduced the risk of UD by 66%(\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e–\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This protective effect may be due to black tea’s ability to stimulate beneficial intestinal bacteria and suppress harmful microorganisms, thereby improving gut health (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Similarly, students who engaged in high physical activity had a 60% lower prevalence of UD compared to those with low activity. These results are consistent with a study in Australia that found regular high physical activity reduced UD risk by 35%.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Exercise may alleviate dyspeptic symptoms by reducing gastric acid reflux, enhancing intestinal gas transport, and suppressing the production of inflammatory cytokines (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In contrast, a study among pre-clinical students in the United Arab Emirates showed no significant association, possibly due to a small sample size (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCoffee consumption was associated with a higher prevalence of UD, with occasional drinkers showing a 2.49-fold increased risk compared to non-drinkers. This finding is consistent with a multicenter survey in Latin America, which found that UD prevalence was 51% higher among coffee consumers (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). This is likely due to coffee’s stimulatory effect on gastric acid secretion and subsequent gastric irritation (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, the results contrast with those of a cross-sectional study conducted among 3,362 adults in Iran, and the discrepancy may be due to variations in the study populations (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Eating two meals a day was associated with a 2.64 times higher prevalence of UD compared to those who had one meal a day. This finding aligns with a multicenter survey conducted among four Latin American schools(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).This may be a result of reserve causation, where those with UD modify their eating patterns to alleviate symptoms. However, the results contradict with findings of the study conducted among 3,362 adults in Iran (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).The discrepancy is likely due to variations in the study population and the diagnostic tool used for dyspepsia, as the latter study was conducted in the community and utilised Rome III criteria.\u003c/p\u003e\u003cp\u003eAlcohol intake increased risk as well, with low-risk drinkers experiencing an 80% higher prevalence compared to abstainers. Similarly, a narrative review found that alcohol consumption was associated with an increased risk of H. pylori infection, which is a contributor to dyspepsia (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).The low concentrations of alcohol are mild stimulants of acid secretion, which may predispose to UD, whereas at higher concentrations, it has either no or a mild inhibitory effect (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Other significant factors included moderate fatigue, which increased prevalence by 80%. This finding aligns with a prospective cohort study conducted in a tertiary hospital in Greece, which found a significant association between UD and fatigue (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Fatigue is associated with low-grade inflammation marked by elevated cytokines like IL-6 and TNF-α, which later influence behaviours such as irregular eating, poor nutrition, and inactivity, which are known risk factors for UD (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnderweight was also associated with a 2.2-fold higher prevalence. Similarly, Japanese university students that were underweight had a significantly higher prevalence of UD compared to those with normal BMI (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Since UD causes weight loss, this may be the possible reason for the significant association between BMI and UD.(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) Sleeping seven or more hours daily showed a 90% higher prevalence. Similar findings were reported in Korea, where UD was associated with poorer sleep quality and greater daytime sleepiness (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Prolonged sleep may be a consequence of dyspeptic symptoms, as dyspepsia can increase sleep latency and nighttime awakenings, leading to non-restorative sleep and longer time in bed (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eRelationship between QoL and UD.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere was no significant relationship between QoL and UD. This implies that, despite undergraduate health professional students with UD having a slightly lower mean total QoL compared to those without UD, this study could not conclusively attribute the reduction in QoL to UD, probably because the standard diagnostic tool (endoscopy) was not used to diagnose dyspepsia.\u003c/p\u003e\u003cp\u003eThese results are different from the findings of a hospital-based study among 324 dyspeptic patients, and the discrepancy may be due to differences in the study population (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Hospital patients are likely to have more severe and persistent symptoms and, hence more likely to report impaired QoL, while students may tolerate mild symptoms, underestimating their impact on their QoL.\u003c/p\u003e\u003cp\u003eAdditionally, the differences may be due to the tools used to diagnose dyspepsia, where the study conducted among dyspeptic patients in Nigeria used endoscopy to diagnose dyspepsia, whereas our study utilised Rome IV criteria, hence chance of information bias in our study, which would have distorted the findings (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eVariables were collected using globally valid tools by well-trained research assistants with certificates of good clinical practice. Likely confounders were adjusted for in the multivariate analysis and the sample size was adequate to increase generalization of findings to other public institutions.\u003c/p\u003e\u003cp\u003eThe findings of this study may have been influenced by some limitations. Information bias may have arisen from recall errors regarding symptom duration, food expenditure, eating patterns, and socially desirable responses, such as reporting non-smoking status. Misclassification was also possible, given the limited sensitivity of the Rome IV criteria for diagnosing UD (75%) and potential differences in how participants assessed symptom severity and quality of life. Random error may have occurred due to sparse data in variables such as smoking, marital status, employment, and sponsorship, which reduces the power to detect true associations, particularly when smoking is excluded from the analysis entirely. Residual confounding cannot be ruled out, as factors such as academic pressure and menstrual-related gastrointestinal symptoms were not adjusted for, which may explain why variables like sex and academic program were not significant at multivariate analysis. Finally, the results may not be generalizable to rural settings or private institutions since the study was conducted in an urban public university.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSION AND RECOMMENDATION","content":"\u003cp\u003eThe prevalence of UD among undergraduate health professional students was moderate, with up to 1 in 7 students with UD. Factors significantly associated with UD included black tea, coffee, alcohol drinking, physical activity, fatigue, BMI, food frequency, and sleep hours. There was no significant relationship between QoL and UD. Undergraduate health professional students should seek timely medical management for gastrointestinal symptoms, engage in regular physical activity, and limit their consumption of black tea to less than that of alcohol and coffee. University administrators should provide free services, such as endoscopy, at the university hospital to identify and manage dyspepsia among students and should also design strategies to increase student engagement in physical activity. Further studies are recommended, specifically among undergraduate health professional students, to investigate the relationship between UD and QoL using standard diagnostic procedures for dyspepsia, such as endoscopy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAUDIT\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlcohol Use Disorders Identification Test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Dental Surgery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBpharm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Pharmacy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBScN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Science in Nursing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFAS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFatigue Assessment Scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFood Frequency questionnaire\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGERD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGastroesophageal Reflux Disease\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGastrointestinal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHelicobacter Pylori\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHRQoL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth Related Quality of Life\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIPAQ-SF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternational Physical Activity Questionnaire Short Form\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMBChB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBachelor of Medicine and Bachelor of Surgery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNSAIDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-Steroid Anti-inflammatory drugs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePerceived Stress Scale\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePPI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProton Pump Inhibitors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQoL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuality of life.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSOMREC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool of Medicine Research Ethics Committee\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndiagnosed dyspepsia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWHO\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWHOQOL BREF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorld Health Organization Quality of Life Brief Version\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Makerere University School of Medicine Research and Ethics Committee (Mak- SOMREC-2024-1202) and informed consent to participate in the study was obtained from all the participants. The authors confirm that the ethical policies of the journal, as noted on the journal's author guidelines page, have been adhered to.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors did not receive funding to do this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.N conceived the research idea, wrote the research protocol, and led the data collection, performed the data analysis. O.S, C.A. K, E.A, A.M.K, H.U, D.W, D.L D.M \u0026amp; I. S wrote the original draft of the manuscript. J.K, I.E.M \u0026amp; M.K. M polished the research idea and were key in protocol and manuscript writing.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eI express my heartfelt gratitude to all the Clinical Epidemiology lecturers for imparting invaluable research skills and knowledge throughout my academic journey.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBarberio B, Mahadeva S, Black CJ, Savarino EV, Ford AC. Systematic review with meta-analysis: global prevalence of uninvestigated dyspepsia according to the Rome criteria. 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Nurs open. 2018;5(1):70\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamamoto Y, Furukawa S, Watanabe J, Kato A, Kusumoto K, Miyake T, et al. Positive association between sleep disturbance and prevalence of functional dyspepsia in Japanese young people. Dig Dis Sci. 2022;67(8):3929\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBasandra S, Bajaj D. Epidemiology of dyspepsia and irritable bowel syndrome (IBS) in medical students of Northern India. J Clin Diagn research: JCDR. 2014;8(12):JC13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTalledo-Ulfe L, Buitrago OD, Filorio Y, Casanova F, Campos L, Cort\u0026eacute;s F, Mejia CR. Factors associated with uninvestigated dyspepsia in students at 4 Latin American schools of medicine: A multicenter study. Rev Gastroenterol Mex (Engl Ed). 2018;83(3):215\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi M, Lu B, Chu L, Zhou H, Chen MY. 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BMC Gastroenterol. 2018;18(1):13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang Z-p, Wang K, Duan Y-h, Yang G. Correlation between lifestyle and social factors in functional dyspepsia among college freshmen. J Int Med Res. 2020;48(8):0300060520939702.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Liu Y, Wu Z, Zhang P, Zhang X. Tea Polyphenols: A Natural Antioxidant Regulates Gut Flora to Protect the Intestinal Mucosa and Prevent Chronic Diseases. Antioxid (Basel). 2022;11(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoloski NA, Jones M, Walker MM, Holtmann G, Talley NJ. Functional dyspepsia is associated with lower exercise levels: A population-based study. United Eur Gastroenterol J. 2020;8(5):577\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWei Z, Yang Y, Du T, Hao Y, Liu N, Gu Y, Wang J. Exercise is inversely associated with functional dyspepsia among a sample of Chinese male armed police recruits. BMC Gastroenterol. 2023;23(1):430.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaber N, Oudah M, Kowatli A, Jibril J, Baig I, Mathew E, et al. Dietary and Lifestyle Factors Associated with Dyspepsia among Pre-clinical Medical Students in Ajman, United Arab Emirates. Cent Asian J Glob Health. 2016;5(1):192.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElta GH, Behler EM, Colturi TJ. Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol. 1990;85(10):1339\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl Huda H, Marfianti E, Kurniawan NU, Ihsana N. The Effect of Coffee Consumption Pattern on The Incidence of Dyspepsia in Medical Faculty Students. Jurnal Kedokteran Diponegoro (Diponegoro Med Journal). 2024;13(6).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCohen S, Booth GH Jr. Gastric acid secretion and lower-esophageal-sphincter pressure in response to coffee and caffeine. N Engl J Med. 1975;293(18):897\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKoochakpoor G, Salari-Moghaddam A, Keshteli AH, Esmaillzadeh A, Adibi P. Association between coffee and caffeine intake and functional dyspepsia. Sci Rep. 2024;14(1):31690.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKeshteli AH, Feizi A, Esmaillzadeh A, Zaribaf F, Feinle-Bisset C, Talley NJ, Adibi P. Patterns of dietary behaviours identified by latent class analysis are associated with chronic uninvestigated dyspepsia. Br J Nutr. 2015;113(5):803\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheng DD, He C, Ai HH, Huang Y, Lu NH. The Possible Role of Helicobacter pylori Infection in Non-alcoholic Fatty Liver Disease. Front Microbiol. 2017;8:743.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChari S, Teyssen S, Singer MV. Alcohol and gastric acid secretion in humans. Gut. 1993;34(6):843\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTalley NJ. Moving away from focussing on gastric pathophysiology in functional dyspepsia: new insights and therapeutic implications. Official J Am Coll Gastroenterology| ACG. 2017;112(1):141\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYamamoto Y, Furukawa S, Watanabe J, Kato A, Kusumoto K, Takeshita E, et al. Association between body mass index and functional dyspepsia in young Japanese people. J Neurogastroenterol Motil. 2022;28(2):276.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFord AC, Moayyedi P, Dyspepsia. BMJ. 2013;347.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim SY, Lee SK, Choe JW, Jung SW, Hyun JJ, Koo JS, et al. Self-reported sleep impairment in functional dyspepsia and irritable bowel syndrome. J Neurogastroenterol Motil. 2018;24(2):280.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBilley A, Saleem A, Zeeshan B, Dissanayake G, Zergaw MF, Elgendy M, Nassar ST. The Bidirectional Relationship Between Sleep Disturbance and Functional Dyspepsia: A Systematic Review to Understand Mechanisms and Implications on Management. Cureus. 2024;16(8).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEgbo O, Omuemu C, Okeke E, Egbo OH, Mokogwu N. Health-related quality of life in patients with dyspepsia presenting at the University of Benin Teaching Hospital, Benin City, South-South Nigeria: a cross-sectional study. Pan Afr Med J. 2024;47:107.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEgbo O, Omuemu C, Okeke E, Egbo OH, Mokogwu N. Health-related quality of life in patients with dyspepsia presenting at the University of Benin Teaching Hospital, Benin City, South-South Nigeria: a cross-sectional study. Pan Afr Med J. 2024;47:107.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dyspepsia, Quality of Life, Undergraduate Students, Prevalence, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-8112225/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8112225/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDyspepsia affects 6.9% of people globally and significantly impairs quality of life, yet it often remains undiagnosed. Undiagnosed dyspepsia (UD) affects up to one-third of patients and is prevalent among students due to stress, irregular eating, and self-medication. In Uganda, limited access to endoscopy results in many cases being undiagnosed, yet recent data among health professional students remains scarce.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the prevalence of UD, associated factors, and its relationship with QoL among undergraduate health professional students at Makerere University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional study involving 378 undergraduate health professional students from Makerere University between March and April 2025. Participants were pursuing Medicine and Surgery, Nursing, Pharmacy, and Dental Surgery, aged ≥ 18 years, and were selected by stratified simple random sampling. Data on socio-demographics, lifestyle, and dyspeptic symptoms were collected using a structured questionnaire based on various tools. Data was analyzed using STATA 17 in the survey window. Prevalence of UD was estimated with 95% confidence intervals. Modified Poisson regression was used to determine associated factors, while mixed-effects linear regression was used to analyze the relationship between dyspepsia and quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of undiagnosed dyspepsia (UD) was 13.5% (95% CI: 10.2–17.4). Drinking tea, either some days (aPR = 0.424; 95% CI: 0.197–0.913) or daily (aPR = 0.345; 95% CI: 0.167–0.713), and engaging in high physical activity (aPR = 0.374; 95% CI: 0.151–0.927) were associated with a protective effect. Predisposing factors were eating two meals daily (aPR = 2.637; 95% CI: 1.213–5.733), alcohol use (aPR = 1.775; 95% CI: 1.062–2.966), moderate fatigue (aPR = 1.842; 95% CI: 1.126–3.011), underweight Body Mass index (aPR = 2.202; 95% CI: 1.038–4.675), and longer sleep duration (aPR = 1.925; 95% CI: 1.156–3.204). No significant association was found with quality of life (p = 0.217).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of UD among undergraduate health professional students was moderately high, though not significantly associated with quality of life. Targeted health education that promotes regular physical activity, addresses fatigue, and discourages excessive alcohol and coffee consumption may help reduce the burden of UD in this population.\u003c/p\u003e","manuscriptTitle":"Prevalence of undiagnosed dyspepsia associated factors, and its relationship with quality of life among undergraduate health professional students at Makerere University in Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 06:58:58","doi":"10.21203/rs.3.rs-8112225/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-05T14:34:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-02T17:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48572182768796562681346341640294721149","date":"2026-01-01T02:16:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-12T11:34:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52097948144428552790336912606281642824","date":"2025-12-07T17:09:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226106652743043279004545298315932838103","date":"2025-12-04T11:38:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-02T16:21:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-27T05:52:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-27T04:54:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-26T20:44:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-11-26T20:39:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"26fc8a5c-03bd-432f-a3cc-a7903406ac75","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T16:03:30+00:00","versionOfRecord":{"articleIdentity":"rs-8112225","link":"https://doi.org/10.1186/s12876-026-04736-2","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2026-03-18 15:59:44","publishedOnDateReadable":"March 18th, 2026"},"versionCreatedAt":"2025-12-08 06:58:58","video":"","vorDoi":"10.1186/s12876-026-04736-2","vorDoiUrl":"https://doi.org/10.1186/s12876-026-04736-2","workflowStages":[]},"version":"v1","identity":"rs-8112225","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8112225","identity":"rs-8112225","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}