Amuru Districts Research Articles

Learners’ everyday experiences of violence in English medium secondary education in Uganda

This paper explores how Ugandan secondary school learners experience schooling in English-medium schools where the use of English only is strictly enforced. We conceptualise the ways that the learners sit at the intersection of direct, systemic and cultural violence that in turn impacts their educational experiences. We particularly focus on instances of direct violence through corporal punishment, and the ways that such violence, and associated fear, are part of many learners’ everyday schooling experiences. We demonstrate this through presentation of findings from thematic analysis of individual and focus group interviews with 64 learners at two public and two private secondary schools in the Amuru and Kitgum districts of Northern Uganda. Our conclusions advocate for greater attention to be paid to the ways that changes to enforced English-only policies could support more positive well-being and educational outcomes.

Cango Lyec (Healing the Elephant): HIV Prevalence and Vulnerabilities Among Adolescent Girls and Young Women in Postconflict Northern Uganda.

Adolescent girls and young women younger than 25 years (AGYW) account for disproportionate HIV infections in sub-Saharan Africa. Impacts of war in Northern Uganda continue to affect HIV-related health and wellbeing of young people postconflict. Prevalence and incidence of HIV infection were estimated, and factors associated with HIV prevalence among sexually active AGYW in Northern Uganda were investigated. Cango Lyec is a cohort involving conflict-affected populations in Northern Uganda. Nine randomly selected communities in Gulu, Nwoya, and Amuru districts were mapped. House-to-house census was conducted. Consenting participants aged 13-49 years were enrolled over 3 study rounds (2011-2015), of whom 533 were AGYW and had ever had sex. Data were collected on trauma, depression, and sociodemographic-behavioral characteristics. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression determined baseline factors associated with HIV prevalence. HIV prevalence among AGYW was 9.7% (95% CI: 7.3 to 12.6). AGYW living in Gulu (adjusted risk ratio, aRR: 2.48; 95% CI: 1.12 to 5.51) or Nwoya (aRR: 2.65; 95% CI: 1.03 to 6.83) were more likely than in Amuru to be living with HIV. Having self-reported genital ulcers (aRR: 1.93; 95% CI: 0.97 to 3.85) or active syphilis (aRR: 3.79; 95% CI: 2.35 to 6.12) was associated with increased risk of HIV infection. The likelihood of HIV was higher for those who experienced sexual violence in the context of war (aRR: 2.37; 95% CI: 1.21 to 4.62) and/or probable depression (aRR: 1.95; 95% CI: 1.08 to 3.54). HIV incidence was 8.9 per 1000 person-years. Ongoing legacies of war, especially gender violence and trauma, contribute to HIV vulnerability among sexually active AGYW. Wholistic approaches integrating HIV prevention with culturally safe initiatives promoting sexual and mental health in Northern Uganda are essential.

Ethnobotanical study of nutraceutical plants used to manage opportunistic infections associated with HIV/AIDS in Acholi sub-region, Northern Uganda

BackgroundNutraceutical plants play a potential role as supportive treatment with antiretroviral drugs in the management of opportunistic infections associated with HIV/AIDS. There is limited documentation of nutraceutical plants in Northern Uganda and limited literature addressing processes to be adopted for quality assurance of herbal formulations in Uganda. This study aimed to document plant species with nutritional and medicinal properties used for managing opportunistic infections associated with HIV/AIDS by traditional medicine practitioners (TMPs), who included professional herbalists, herbal farmers and herbal sellers in Acholi sub region, Northern Uganda.MethodsAn ethnobotanical study was carried out in Amuru, Gulu and Pader districts, Northern Uganda. Cross-sectional data were collected using purposive and snowball sampling techniques. A total of four hundred (378 women and 22 men) informants were selected. Data were collected using semistructured interviews, focus group discussions and direct observation. Data were analysed using descriptive statistics, familiarity index (FI), fidelity level (FL) and informant consensus factor (ICF).ResultsThis study recorded a total of 84 nutraceutical plant species, which are used to manage opportunistic infections associated with HIV/AIDS. Most abundant families were Leguminoceae, Asteraceae and Solanaceae. Six nutraceutical plants that had higher fidelity level and familiarity index values included Momordica foetida Schumach, Erigeron floribundus (Kunth) Sch. Bip, Mangifera indica L, Cajanus cajan L. Millsp, Eucalyptus globulus Labill and Cucurbita pepo L. Respondents’ knowledge on nutraceutical plants had a positive significant correlation with age (R2 = 0.0524, p ≤ 0.01). The popular mode of preparation are decoctions/boiling in water (70%), while the most used route of administration is oral (76%). TMPs tried to ensure that during collection and processing, plant materials were free from contamination. TMPs reported limited knowledge on preservation techniques.ConclusionsThis study demonstrates the availability and diversity of nutraceutical plants in Uganda and reports methods of processing and administration used by TMPs. Both men and women used nutraceutical plants to manage opportunistic infections associated with HIV/AIDS and showed great extent of their traditional knowledge. Most of the nutraceutical plants in study area are wild and abundant; however, high percentage use of plant roots and bark threatens the sustainable use from the wild.

Status of food safety knowledge, attitude, and practices of caregivers of children in northern Uganda.

The safety of homemade weaning foods in low- and middle-income countries is of great concern as rural households have limited access to standardized commercial weaning foods. In the Acholi subregion of Uganda, complementary foods are locally produced. However, there is limited information on the Food safety knowledge (FSK), food safety attitude (FSA), and food hygiene practices (FHP) of the caregivers. This study examined food safety knowledge, attitude, and practices of the caregivers of children 6-23 months of age in Amuru and Nwoya districts, Northern Uganda, between March 2019 and June 2019. A cross-sectional study was conducted involving 180 caregivers. Data were collected using semi-structured questionnaires and focus group discussions and analyzed using descriptive statistics, multivariate binary logistic regression, and thematic content analysis. Caregivers had sufficient FSK (74.1%) and positive FSA (68.1%). However, only 17.6% of them adhered to FHP. Frequency of food safety training (p = .041) and households with children who suffered from foodborne illness (p = .001) significantly predicted FSK. Conversely, both FSK and FSA were significantly predicted by gender roles in decision-making on household income (p = .006) and households with older children (p = .041). A significant positive correlation was observed between FSK and FSA (r = .406, p = .000). However, major barriers to adherence to FHP were inadequate sanitation facilities and caregiver's workload. The overall nontranslation of sufficient FSK and positive FSA into proper FHP calls for future intervention to harness the sociodemographic factors that influence FSK and FSA and address the barriers to FHP among caregivers.

Knowledge, attitudes, and adherence relating to COVID-19 and its prevention measures in high-risk districts of Uganda in 2020.

COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. There were no licensed vaccines or explicit medicines available for treatment at the time of conducting this study. Public health and social measures (PHSM) have been widely adopted to reduce the transmission of COVID-19. Hence, assessing people's knowledge, attitudes, and adherence/practices related to the management of COVID-19 is crucial for identifying the factors that may promote or hinder adherence to the implementation of PHSM. We conducted a cross-sectional study in the Amuru, Kyotera, Wakiso, and Kampala districts of Uganda. We used a simple random sampling technique to select households and conducted face-to-face interviews in selected households. We administered questionnaires to respondents to assess the factors that promote or hinder adherence to and knowledge about PHSM implementation. We used a Likert scale to assess respondents' attitudes toward COVID-19. Out of the 270 respondents, 54 (20%), 73 (27%), 42 (15.6%), and 101 (37.4%) were from the Kampala, Amuru, Wakiso, and Kyotera districts, respectively. Most of the respondents had adequate knowledge (72.2%), a high level of adherence (63.7%), and approximately 57.8% had good attitudes relating to COVID-19 and its prevention measures. An inferential analysis revealed that people from the Kampala district had higher chances (odds ratio = 4.668) of having a high level of knowledge compared to people from the Amuru district. It was also found that respondents who had a high level of (adequate) knowledge were twice as likely to have good attitudes compared to those with a low level of knowledge. In addition, people with good attitudes were 2.5 times as likely to adhere to the COVID-19 prevention measures compared to those with poor attitudes. Most respondents had limited knowledge though the majority of them had adopted practices to prevent the spread of COVID-19. Respondents with low knowledge of COVID-19 need to be targeted, to improve their attitude toward the disease and their adherence to safe prevention practices.

Virulence analysis of wheat stem rust (Puccinia graminis f. sp. tritici) in Horro Guduru Wollega, Western Ethiopia

AbstractStem rust caused by Puccinia graminis f. sp. tritici is one of Ethiopia's most serious wheat diseases. Because of mutation and genetic recombination, stem rust can rapidly evolve new virulence to resistant genes. The Ethiopian highlands are well‐known hotspots for the rapid emergence and spread of new wheat stem rust races. The objective of this study was to determine the virulence diversity and spatial distribution of Pgt races in the main wheat‐growing districts, Horro Guduru Wollega. Wheat stem rust samples were collected from Abay Chomen, Amuru, Guduru, Hababo Guduru, Horro, Jardaga Jarte, Jimma Ganati and Jimma Rare districts during the main cropping seasons of 2015 and 2016. In the study, 147 stem rust isolates were derived from 121 viable samples. The physiological races of stem rust were determined on seedlings of standard wheat stem rust differentials using the International System of nomenclature. Twelve (12) physiological races of stem rust were identified. TKTTF, TTKSK, JRCQC, TRTTF and TTTTF were the most common in all districts with a frequency of 53.1%, 15.6%, 14.3%, 6.8% and 2.7%, respectively. TKTTF and TTKSK, two highly virulent races, were found in all districts. Four stem rust resistance genes (Sr11, Sr31, Sr36 and SrTmp) confer resistance to the majority of the virulent races identified. Sr24 was effective against all virulent races in this study but ineffective against the Ug99 variant (race TTKTT) detected in the country. The findings could be helpful for breeders to select many effective resistance gene combinations to provide more durable stem rust resistance.

Farmers’ adaptation to climate change and crop yield: a case of Amuru and Apac districts of Northern Uganda

ABSTRACT With increasing incidences of the negative impacts of climate change to smallholder farming, an understanding of the effects of farmers’ adaptation options to climate change on crop yield is critical in designing practical measures and policies for increasing food production and food security. This study assessed the effects of smallholder farmers climate change adaptation intensity on crop yield with focus on maize, groundnuts and beans in Apac and Amuru districts, northern Uganda. Cross-sectional survey design was employed for data collection. Data were analysed using both descriptive and econometric approaches. Results showed that the most common climate change adaptation strategies used by smallholders related to varietal adjustments including planting different crop varieties each time, drought-resistant varieties, early maturing varieties, improved seeds and changing the time of planting. Yield comparisons between adapters and non-adapters for the three major crops showed that adapters realized significantly higher yields than non-adapters for most of the climate change adaptation strategies. This study suggests that farmers who used more adaptation strategies realized higher yields than the non-adapters. Our findings call for increased efforts by stakeholders to strengthen agricultural extension services and coverage to enhance smallholder farmers capacity to adapt to the effects of climate change.

Climate change vulnerability, adaptation measures, and risk perceptions at households level in Acholi sub-region, Northern Uganda

Uganda is among the world's susceptible countries to climate extremes, such as droughts (IPCC, 2007). This study assesses the risks associated with climate change vulnerability, adaptation techniques used by young smallholder farmers to ease its adverse effects on agriculture. A dataset of 600 randomly selected respondents was collected using the household survey method from Gulu, Kitgum, Pader, Amuru, Nwoya, and Lamwo districts. Finding reveals droughts, increased temperature, pests and diseases, degradation, and poor socioeconomic conditions as the main determinants of climate change. The main adaptation measures revealed were changing crop types, planting early-maturing crops, crop rotation, mixed cropping, and livelihood diversification. Lack of knowledge and information, poverty, inadequate governmental support, limited agricultural extension, insufficient financial capital, illiteracy, and markets were the main constraints hindering access and adoption of advanced adaptation measures. This research provides useful insights and evidence for policy implementation on household farm-level climate change vulnerability, adaptation measures, and risk perceptions in absorbing, adapting, and transforming from climate shocks and threats. The analysis implies that the government should provide agricultural extension services on climate vulnerability and adaptation measures, access to market, financial credits, knowledge and information, accessible livelihoods assets, and end-to-land grabbing. Overall, our results recommend that government authorities and relevant stakeholders integrate and implement climate change adaptation policies at local government operations to ease the vulnerability of smallholder farmers and augment their climate change absorptive, adaptive, and transformative abilities.

Analysis of land surface temperature using Geospatial technologies in Gida Kiremu, Limu, and Amuru District, Western Ethiopia

Degradation of vegetation cover and expansion of barren land are remained the leading environmental problem at global level. Land surface temperature (LST), Normalized Difference Vegetation Index (NDVI), Normalized Difference Barren Index (NDBaI), and Modified Normalized Difference Water Index (MNDWI) were used to quantify the changing relationships using correlation analysis. This study attempted to analyze the relationship between LST and NDVI, NDBaI, and MNDWI using Geospatial technologies in Gida Kiremu, Limu, and Amuru districts in Western Ethiopia. All indices were estimated by using thermal bands and multispectral bands from Landsat TM 1990, Landsat ETM+ 2003, and Landsat OLI/TIRS 2020. The correlation of LST with NDVI, NDBaI and MNDWI were analyzed by using scatter plot. Accordingly, the NDBaI was positive correlation with LST (R2 = 0.96). However, NDVI and MNDWI were substantially negative relationship with LST (R2 = 0.99, 0.95), respectively. The result shows that, LST was increased by 5 °C due to decline of vegetation cover and increasing of bare land over the study periods. Finally, our result recommended that, decision-makers and environmental analysts should give attention on the importance of vegetation cover, water bodies and wetland in climate change mitigation, particularly, LST in the study area.

Cango Lyec (Healing the Elephant): Probable post-traumatic stress disorder (PTSD) and depression in Northern Uganda five years after a violent conflict

BackgroundFrom 1986 to 2006, Northern Uganda experienced an atrocious civil war between the Lord's Resistance Army (LRA) and the Ugandan government. Acholi people living in the region continue to be impacted by trauma sequelae of the war and a wide range of daily stressors including poverty, hunger, and high rates of HIV infection. To date, there is a dearth of gender-differentiated mental health research in this post-conflict setting. The current study aimed to estimate the prevalence of probable post-traumatic stress disorder (PTSD) and depression in three districts most affected by the Northern Ugandan conflict and examine socio-structural, war-related, and sexual vulnerability factors associated with mental health. MethodsCango Lyec (Healing the Elephant) is an open cohort study involving participants from eight randomly selected communities in Amuru, Gulu, and Nwoya districts of Northern Uganda. Between November 2011 and July 2012, the baseline cohort (N = 2,458) completed the Harvard Trauma Questionnaire (HTQ) and Hopkins Symptom Checklist-25 (HSCL-25) for screening PTSD and depression, in addition to a detailed questionnaire assessing socio-demographic-behavioral characteristics. Baseline categorical variables were compared between males and females using Fisher's exact test. Multivariate logistic regression was used to model correlates of probable PTSD and depression. All analyses were stratified by gender. ResultsThe overall prevalence of probable PTSD and depression was 11.7% and 15.2% respectively. Among former abductees, the prevalence was 23.2% for probable PTSD and 26.6% for probable depression. Women were significantly more likely to experience mental distress than men. Factors associated with mental distress included wartime trauma (adjusted odds ratios ranging from 2.80 to 7.19), experiences of abduction (adjusted odds ratios ranging from 1.97 to 3.03), and lack of housing stability and safety (adjusted odds ratios ranging from 1.95 to 4.59). Additional risk factors for women included HIV infection (AOR=1.90; 95% CI: 1.29–2.80), sexual abuse in the context of war (AOR=1.58; 95% CI: 1.02–2.45), and intimate partner violence (AOR=2.45; 95% CI: 1.07–5.63). ConclusionCango Lyec participants displayed lower than previously reported yet significant levels of probable PTSD and depression. Based on findings from this study, providing trauma-informed care, ensuring food and housing security, eliminating gender-based violence, and reintegrating former abductees remain important tasks to facilitate post-conflict rehabilitation in Northern Uganda.

Cango Lyec (Healing the Elephant): Chronic Hepatitis B Virus among post-conflict affected populations living in mid-Northern Uganda.

BackgroundThe legacy of war in Northern Uganda continues to impact people’s health and wellbeing in the Acholi region. Despite increasing attention to Hepatitis B Virus (HBV) in Uganda and globally, concerns remain that unique drivers of infection, and barriers to screening, and treatment, persist among those affected by conflict.MethodsCango Lyec (Healing the Elephant) cohort survey involved conflict-affected adults aged 13–49 in three mid-Northern Uganda districts (Gulu, Amuru and Nwoya). Baseline (2011–2012) samples were tested for HBV surface antigen (HBsAg), HBV e-antigen (HBeAg), antibodies to HBV surface antigen (HBsAb), antibodies to HBV e-antigen (HBeAb), and antibodies to HBV core antigen (HBcAb). All HBsAg positive samples were tested for IgM antibodies to HBV B core antigen (HBc-IgM) and where available, >6-month follow-up samples were tested for HBeAg and HBV DNA. Data were analyzed using STATA 15 software. Logistic regression accounted for variance due to complex two-stage sampling that included stratification, unequal selection probabilities and community clustering. Odds ratios measured effect potential risk factors associated with chronic HBV infection.ResultsAmong 2,421 participants, 45.7% were still susceptible to HBV infection. HBsAg seropositivity was 11.9% (10.9–13.0), chronic HBV was 11.6% (10.4–12.8), acquired immunity resulting from vaccination was 10.9%, and prior natural infection was 31.5%. Older age (OR:0.570; 95%CI:0.368–0.883) and higher education (OR:0.598; 95%CI:0.412–0.868) were associated with reduced odds of chronic HBV infection. Being male (OR:1.639; 95%CI:1.007–2.669) and having been abducted (OR:1.461; 95%CI:1.055–2.023) were associated with increased odds of infection. Among women, having 1 or 2 pregnancies (compared to none or >2) was associated with increased odds of infection (OR:1.764; 95%CI:1.009–3.084).ConclusionChronic HBV is endemic in Gulu, Amuru and Nwoya districts. Recommended strategies to reduce post-conflict prevalence include establishment of Northern Uganda Liver Wellness Centres, integration of screening and treatment into antenatal care, and roll out of birth-dose vaccination.

Distribution, Severity Status, Farmers Knowledge and Management Practices of Wild Radish (Raphanus raphanistrum L.) in Horro Guduru Wollega Zone, Western Ethiopia

The objective of the study was to study the distribution, severity status, farmers’ knowledge, impacts and management practices of Wild Radish (Raphanus raphanistrum L.) in Horro Guduru Wollega Zone, Western Ethiopia. The collected data were analyzed by using descriptive statistics. The Shannon Diversity Index (SDI), the evenness, species richness and Jaccards Similarity Index (JSI) was calculated from the recorded weed samples. Correlation of vegetation variables among and between sampled Administrative Kebeles’ was analyzed by SPSSv20 software. The result of the study indicates that out of the sampled 160 respondents 92 (57.5%) of them heard about wild radish plant as a weed and the rest of 68 (42.5%) of the respondents did not know this plant as a weed. Among the respondents 88 (55%) of them identify R.raphanistrum plant as a weed. There was high negative correlation between mean R. raphanistrium density and Shannon diversity index with R 2 = 0.642, p<0.001. This study showed that high infestation level of R . raphanistrum was observed in Horro district followed by Abayi Chomen, Amuru and Jima Rare districts. The highest and lowest mean population (±SD) of R. raphanistrum per quadrate was recorded at Horo (249.82 ± 34.67) and Jima Rare (13.72 ± 14.16), respectively. The biodiversity impact of R. raphanistrium at highly infested areas were more visible than the moderately infested areas. Horro and Abayi Chomen districts showed the lowest Shannon Diversity Index value of 1.78 and 2.12, respectively, due to the fact that, their species diversity was highly affected by the high population density of R. raphanistrium. Moreover, the standing herbaceous vegetation from the sampled sites of Horo district (Doyo Bariso and Gudina Abuna administrative kebeles) showed higher Jaccards Similarity coefficient (0.84), where there was high R.raphanistrium infestation level. The study proved that R. raphanistrum was emerged as invasive weed and have been disseminated into neighbor districts’ and zones. Therefore, further research should be conducted to quantify the distribution, increases in species abundance as well as its impact on biodiversity and socio-economic aspects, which may support to contain R. raphanistrum distribution and planning on its prevention and management. Keywords: Abundance, distribution, invasive , Raphanus raphanistrum, severity, wald radish DOI: 10.7176/JBAH/10-24-02 Publication date: December 31 st 2020

Farm level allocative efficiency of rice production in Gulu and Amuru districts, Northern Uganda

Smallholder farming, predominant in Uganda, is characterized by low productivity for most crops including rice which is gaining prominence as both a food and income crop. The low productivity is mostly attributed to allocative inefficiency. Allocative efficiency (AE) considers farmers’ ability to allocate resources efficiently, by producing the maximum possible output at minimum cost. Increasing AE requires an understanding of the specific sources of inefficiency that vary across farm enterprises, geographically and temporally. A cross-sectional study was carried out in Gulu and Amuru districts of Northern Uganda to assess the sources of farm-level allocative inefficiency in rice production using the stochastic frontier approach. Data were collected from a random sample of 200 smallholder rice farmers. Results show that the mean AE was 75%. Household size, distance to trading centre, farm size, number of crop enterprises, use of hired labour, use of ox-plough, and access to credit had significant effects on AE. We recommend adoption of technologies such as the use of ox-ploughs and reallocation of farm resources especially labour.

\u201cPosting policies don\u2019t change because there is peace or war\u201d: the staff deployment challenges for two large health employers during and after conflict in Northern Uganda

BackgroundBetween 1986 and 2006, the Acholi region in Uganda experienced armed conflict which disrupted the health system including human resources. Deployment of health workers during and after conflict raises many challenges for managers due to issues of security and staff shortage. We explored how deployment policies and practices were adapted during the conflict and post-conflict periods with the aim of drawing lessons for future responses to similar conflicts.MethodsA cross-sectional study with qualitative techniques for data collection to investigate deployment policy and practice during the conflict and post-conflict period (1986–2013) was used. The study was conducted in Amuru, Gulu and Kitgum districts in Northern Uganda in 2013. Two large health employers from Acholi were selected: the district local government and Lacor hospital, a private provider. Twenty-three key informants’ interviews were conducted at the national and district level, and in-depth interviews with 10 district managers and 25 health workers. This study focused on recruitment, promotions, transfers and bonding to explore deployment policies and practices.ResultsThere was no evidence of change in deployment policy due to conflict, but decentralisation from 1997 had a major effect for the local government employer. Lacor hospital had no formal deployment policy until 2001. Health managers in government and those working for Lacor hospital both implemented deployment policies pragmatically, especially because of the danger to staff in remote facilities. Lacor hospital introduced bonding agreements to recruit and staff their facilities. While managers in both organisations implemented the deployment policies as best as they could, some deployment-related decisions could lead to longer-term problems.ConclusionIt may not be possible or even appropriate to change deployment policy during or after conflict. However, given sufficient autonomy, local managers can adapt deployment policies appropriately to need, but they should also be supported with the necessary human resource management skills to enable them make appropriate decisions for deployment.

The effect of rural road transport infrastructure on smallholder farmers’ agricultural productivity in Horro Guduru Wollega Zone, Western Ethiopia

This study was carried out to examine access to rural road infrastructure and its effects on smallholder farmers’ agricultural productivity in Horro Guduru Wollega Zone, Western Ethiopia. A three stage random sampling technique was employed to select 500 farming households in the study area and data was collected on their socio-economic and farm specific characteristics. The collected data was analyzed using descriptive statistics and stepwise multiple regression analysis. The result of multiple regression model used revealed that distance to major market is important in predicting agricultural productivity of smallholder farmers at 5% levels of probability in Abe Dongoro, Amuru and Hababo Guduru districts. Ownership of intermediate means of transport was also found to influence agricultural productivity in Horro, Amuru and Hababo Guduru districts (p = 0.05). Further analysis of the regression model showed a significant negative correlation between distance to nearest all weather roads and distance to zonal head quarter on one hand and agricultural productivity on the other hand in Abe Dongoro, Hababo Guduru and Amuru districts. Rural kebeles of Abe Dongoro and Amuru districts which has vast agricultural potential were found to be the most inaccessible in Horro Guduru Wollega Zone. It is therefore suggested that interventions in the transport sector should include provision of rural roads as well as measures that will help improve vehicle supply in rural areas. An attempt has to be done also to increase the use of intermediate means of transport to ease agricultural inputs and outputs mobility and farm access.

"The Cango Lyec Project - Healing the Elephant": HIV related vulnerabilities of post-conflict affected populations aged 13-49 years living in three Mid-Northern Uganda districts.

BackgroundThe protracted war between the Government of Uganda and the Lord’s Resistance Army in Northern Uganda (1996–2006) resulted in widespread atrocities, destruction of health infrastructure and services, weakening the social and economic fabric of the affected populations, internal displacement and death. Despite grave concerns that increased spread of HIV/AIDS may be devastating to post conflict Northern Uganda, empirical epidemiological data describing the legacy of the war on HIV infection are scarce.MethodsThe ‘Cango Lyec’ Project is an open cohort study involving conflict-affected populations living in three districts of Gulu, Nwoya and Amuru in mid-northern Uganda. Between November 2011 and July 2012, 8 study communities randomly selected out of 32, were mapped and house-to-house census conducted to enumerate the entire community population. Consenting participants aged 13–49 years were enrolled and interviewer-administered data were collected on trauma, depression and socio-demographic-behavioural characteristics, in the local Luo language. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression was used to determine factors associated with HIV prevalence at baseline.ResultsA total of 2954 participants were eligible, of whom 2449 were enrolled. Among 2388 participants with known HIV status, HIV prevalence was 12.2% (95%CI: 10.8-13.8), higher in females (14.6%) than males (8.5%, p < 0.001), higher in Gulu (15.2%) than Nwoya (11.6%, p < 0.001) and Amuru (7.5%, p = 0.006) districts. In this post-conflict period, HIV infection was significantly associated with war trauma experiences (Adj. OR = 2.50; 95%CI: 1.31–4.79), the psychiatric problems of PTSD (Adj. OR = 1.44; 95%CI: 1.06–1.96), Major Depressive Disorder (Adj. OR = 1.89; 95%CI: 1.28–2.80) and suicidal ideation (Adj. OR = 1.87; 95%CI: 1.34–2.61). Other HIV related vulnerabilities included older age, being married, separated, divorced or widowed, residing in an urban district, ulcerative sexually transmitted infections, and staying in a female headed household. There was no evidence in this study to suggest that people with a history of abduction were more likely to be HIV positive.ConclusionsHIV prevalence in this post conflict-affected population is high and is significantly associated with age, trauma, depression, history of ulcerative STIs, and residing in more urban districts. Evidence-based HIV/STI prevention programs and culturally safe, gender and trauma-informed are urgently needed.

Reduced plasma concentrations of vitamin B6 and increased plasma concentrations of the neurotoxin 3-hydroxykynurenine are associated with nodding syndrome: a case control study in Gulu and Amuru districts, Northern Uganda.

IntroductionNodding syndrome was first reported in Uganda in 2003 among internally displaced populations. Risk factors for the syndrome remain unknown. We therefore explored vitamin B6 deficiency and resulting high 3-hydroxykynurenine (3-HK) levels as risk factor for nodding syndrome in Northern Uganda.MethodsCase-control study conducted in Gulu and Amuru districts. Cases were children/young adults with nodding syndrome. Healthy children/young adults were recruited as controls from same community as cases. Data on socio-demographic and other risk factors was collected using questionnaires. Whole blood was collected in EDTA tubes for assay of 3-HK and vitamin B6 using sandwich ELISA. Conditional logistic regression model was used to assess associations.Results66 cases and 73 controls were studied. Factors associated with nodding syndrome were being positive for 3-HK (AOR=4.50, p=0.013), vitamin B6 concentration below mean (AOR=7.22, P=0.001), child being taken care of by mother only (AOR=5.43, p=0.011), child being taken care of by guardian (AOR=5.90, p=0.019) and child consuming relief food at weaning (AOR=4.05, p=0.021).ConclusionHaving low vitamin B6 concentration which leads to a build up of 3-hydroxykynurenine concentration in cases as a main risk factor. Therefore, cases should be treated with vitamin B6 and community members should be sensitise to ensure adequate dietary intake of vitamin B6 so that the risk of nodding syndrome among children is averted. We encourage future prospective intervention study to be conducted to assess the effect of low vitamin B6 on the development of nodding syndrome via raised 3-HK concentration.

Challenges Faced by Village Health Teams (VHTs) in Amuru, Gulu and Pader Districts in Northern Uganda

Primary health care provision through innovative community level interventions such as the Village Health Team (VHT) concept in Uganda can be a rational way of achieving universal access to healthcare. This cross-sectional study interviewed 150 VHT members and 16 key informants in three districts in Northern Uganda to establish the roles of VHTs, the service gaps encountered and the measures in place to address these gaps. Quantitative data were analyzed using SPSS 16.0. Direct content analysis of themes of transcribed qualitative data was conducted manually for common codes. The majority of the respondents 64.29% (n = 72) reported to have been VHT volunteers for more than 5 years. Among the roles were community mobilization reported by 99.1% (n = 111) and home visiting of individuals reported by 97.3% (n = 109). Lack of transport, motivation, adequate skills and community appreciation with nearly no measures in place to counteract the challenges was reported by almost all respondents. Although the VHT concept can be a significant means of achieving universal access to primary health care, extensive community involvement and motivation of the volunteers are highly needed for a maximum benefit.

Nodding Syndrome (NS) in Northern Uganda: A Probable Metabolic Disorder

Aims: To conduct an epidemiological study to establish the association between malnutrition , metabolic disorder and Onchocerciasis to Nodding Syndrome (NS) in Northern Uganda. Study Design: Case-control study design. Place and Duration of Study: Odek and Atiak sub counties in Gulu and Amuru districts between 10 th to 20 th

Men in despair: A qualitative psychological autopsy study of suicide in Northern Uganda

The psychosocial circumstances surrounding men's suicide in postconflict Central Northern Uganda were investigated using qualitative psychological autopsy interviews. Records of 17 men who died by suicide were identified through police and local leaders in Internally Displaced Peoples' camps of Amuru and Gulu Districts. Two to five significant others were interviewed around each case. Data were analyzed by interpretative phenomenological analysis (IPA). Lost dignity and social value, lack of hope for the family's future, overwhelming family responsibility, and mental illness were circumstances found to have preceded the suicides. The protracted war in the Northern region of Uganda left men in rural communities feeling disempowered and disenfranchised. This may have contributed to suicidal behavior in some of them. Suicide prevention in this area needs to be multidisciplinary with an emphasis on helping both men and women understand and deal with the many social changes that have evolved over time and affected their traditional roles and responsibilities.