Arua District Research Articles

Challenges associated with access to safe water in Rhino Camp refugee settlement in Arua District, Uganda

ABSTRACT The study evaluated water access and disease prevalence in the Rhino Camp refugee settlement by mapping water sources, interviewing residents, and reviewing health centre records. Primary water sources were tanks providing 10.2 litres per person per day (l/p/d). Microbial contamination including total coliforms reaching 2.8 × 104 cfu/ml (household container – Tika), thermotolerant coliforms, and faecal enterococci were observed throughout the water supply chain, suggesting faecal contamination and posing a health risk. We attributed this to poor handling and storage related to poor sanitation in the settlement, highlighting the importance of promoting hygiene practices among refugees, particularly in the Ofua Zone, which had the highest contamination risks and the highest sanitary risk scores. Malaria and typhoid were the most prevalent diseases, with Ofua having the highest disease incidence. Water collection was mostly done by adult females and female children (34.7 and 30.3%, respectively) although water collection was generally low (<4 times a day). Boiling water was associated (p < 0.05) with the incidence of hepatitis A in Ofua. Adequate water (>20 l/p/d), water treatment, and education on hygiene practices especially for adult females are essential in lowering contamination and the incidence of diseases.

BACTERIOLOGICAL QUALITY OF DRINKING WATER AND ASSOCIATED FACTORS AT COMMUNITY POINT SOURCES, IN ARUA DISTRICT, UGANDA

Background: Access to ample and safe water is vital, yet many globally lack this essential resource. Each year, 3.4 million individuals die from water-related diseases. Specifically, in Uganda, annual estimates suggest 89,000 cholera cases, resulting in 3,000 deaths. Objective: This study aimed to evaluate the bacteriological quality of drinking water and related factors in Arua Districts community water sources. Method: Utilizing a cross-sectional design and laboratory experiments, 140 samples were analyzed for coliform bacteria presence on filter membranes. Factors relating to contamination risks were identified via a sanitary inspection checklist. Data analysis was conducted using Stata/SE 17.0. Results: About 70.71% of samples contained bacteria, primarily total coliform. Significant risk factors included defective wastewater drainage (aOR: 19.7[5.34-72.72]), malfunctioning appliance parts (aOR: 10.7[2.52-45.92]), and inadequate or absence of fencing (aOR: 9.2[2.43-34.96]), each with a P-value <0.001. Conclusion: Ensuring safe drinking water requires treatment, quality monitoring, maintenance of appliances, and proper fencing to reduce bacterial contamination.

Feeding Preferences of the Bean Leaf Beetle (Ootheca spp.) (Coleoptera: Chrysomelidae): Insights for Targeted Pest Control Strategies in Uganda.

The bean leaf beetle (BLB) (Ootheca spp.) is a polyphagous pest causing significant yield losses in Uganda, particularly in the Northern and Eastern regions on various hosts plants. Despite its polyphagous behaviour, the BLB exhibits preferential feeding, offering an opportunity for targeted pest management. This study explored its feeding preferences across seven crops: common bean, cowpea, greengram, okra, roselle (malakwang), groundnuts, and soybean. This study was conducted in Arua and Lira districts using a randomized complete block design for two rainy seasons (2018A and 2018B). The results showed significant differences in BLB abundance and foliar damage among host crops, locations, days after planting and seasons. Cowpea was the most preferred crop while groundnuts was the least preferred. Therefore, cowpea can be recommended for use as a trap for managing Ootheca spp. in gardens where it is not the main crop. There was a higher pest abundance in Arua than in Lira. There was also a higher pest abundance in 2018A than in 2018B. These findings highlight the importance of understanding BLB's feeding preferences for implementing effective IPM strategies, emphasizing the potential role of trap cropping, especially with cowpea, to minimize BLB damage in resource-constrained agricultural settings.

Cancer patterns in Arua district, Uganda: a hospital-based retrospective study.

Cancer is the second leading cause of mortality with over 19 million cases and 10 million deaths worldwide. Available data on cancer patterns in Uganda are through modelling of data from two population-based cancer registries (PBCRs) representing only about 10% of the cancer situation in Uganda. This study sought to determine the common types of cancer among adults and children in Arua District over a 5-year period (2017-2021). Retrospective cohort chart review and 'catchment population approach' were employed. All newly diagnosed cancer patients from Arua between 2017 and 2021 were included in this study. Data were collected using Redcap whereas management and analysis were conducted using Stata 17. Cancer patterns were computed as frequencies and percentages and the interest was in finding out the common cancers among adults (above 19 years) and children (0-19 years). Over the 5-year study period, a total of 1,118 new cancer cases were registered, with slightly more females (52.1%). The top five common cancers irrespective of sex and age were: liver cancer (13.7%), cervical (11.8%), breast (10.7%), oesophagus (10.5%) and Burkitt's lymphoma (BL) (6.4%). In this study, 15.3% (n = 171) of the study participants were children. The top five common childhood cancers included BL (42%), leukemia (10.5%), other lymphomas (9.4%), osteosarcoma (4.7%) and nephroblastoma (3%). There is a high incidence of liver cancer in Arua district. The high levels of cervical, breast and oesophagus cancer were consistent with what is reported by the two PBCRs in Uganda. However, BL could be due to the presence of a BL treatment centre at Kuluva hospital in Arua. Cancer interventions in Arua should therefore be targeted towards liver, cervix, breast, and oesophagus cancer and furthering research on the reason for the high incidence of liver cancer.

Identification and distribution of Rhipicephalus microplus in selected high-cattle density districts in Uganda: signaling future demand for novel tick control approaches

BackgroundRhipicephalus (Boophilus) microplus (Canestrini, 1888), the Asian blue tick, is a highly invasive and adaptable ectoparasite. This tick species has successfully established itself in most regions of the world, with movement of cattle being a major driver for its spread. In the recent past, R. microplus ticks have been reported in three districts of Uganda. Information on its spread and distribution are vital in deepening our understanding of the ecological scenarios that lead to tick persistence and in the formulation of control strategies. This is especially important in the cattle-dense districts.MethodsWe randomly collected tick specimens from 1,461cattle spread across seven cattle dense districts located in the Central, Karamoja and West Nile regions of Uganda from January to September 2020. The ticks were identified using standard morpho-taxonomic keys and the R. microplus tick species identities were confirmed by sequencing of the ITS2 region, 12S rRNA and 16S rRNA genes and phylogenetic analyses.ResultsAdult ticks (n = 13,019) were collected from 1,461 cattle. Seventeen tick species were identified based on morpho-taxonomic keys and the majority (47.4%; n=6184) of these were R. appendiculatus. In total, 257 R. microplus ticks were found infesting cattle in 18 study sites in the districts of Amudat, Kaabong, Napak (Karamoja region) and Arua (West Nile region). The identity of R. microplus was confirmed using molecular technics. No R. microplus tick was recorded in the districts of Lyantonde and Nakaseke (Central region). Arua district accounted for 82.1% (n=211) of the R. microplus ticks recorded followed by Napak district at 16.3% (n=42), while Amudat and Kaabong districts accounted for 1.5% (n=4).Rhipicephalus microplus and R. decoloratus co-existed in 6 of the 13 study sites in Arua district, while in another 6 study sites, no R. decoloratus was recorded. In the Karamoja region districts R. decoloratus co-existed with R.microplus. Of the total 618 ticks belonging to four species of the subgenus Boophilus recorded in this study, R. decoloratus accounted for 50.04% (n=334), followed by R. microplus at 41.58% (n=257), R. geigyi at 2.75% (n=17) and R. annulatus at 1.61% (n=10). In the districts of Amudat, Kaabong and Napak, R. decoloratus was more dominant (76.1%; n=179) of the three Rhipicephalus (Boophilus) tick species recorded, followed by R. microplus (19.5%; n=46) and R. geigyi (4.2%; n=10). Contrariwise, R. microplus was more dominant (84%; n=211) in Arua district followed by R. decoloratus (10.7%; n=27), R. annulatus (3.9%; n=10) and R. geigyi (1.1%; n=3). Phylogenetic analyses of the ITS2 region, 12S rRNA and 16S rRNA genes revealed subgrouping of the obtained sequences with the previously published R. microplus sequences from other parts of the world.ConclusionRhipicephalus microplus ticks were found infesting cattle in four districts of Uganda. The inability to find R. decoloratus, an indigenous tick, from six sites in the district of Arua is suggestive of its replacement by R. microplus. Rhipicephalus microplus negatively affects livestock production, and therefore, there is a need to determine its distribution and to deepen the understanding of the ecological factors that lead to its spread and persistence in an area.

Prevalence of food insecurity and associated factors among refugee households in Rhino Camp Refugee Settlement, Arua District, Uganda

Prevalence of food insecurity and associated factors among refugee households in Rhino Camp Refugee Settlement, Arua District, Uganda

INSTRUCTIONAL SUPERVISION AND TEACHER COMPETENCE ENHANCEMENT IN SECONDARY SCHOOLS IN GREATER ARUA, UGANDA

The development of teacher competence has been essential throughout history because the quality of every education system depends on the quality of its teachers. This study investigated the relationship between instructional supervision and teacher competence enhancement in secondary schools in Greater Arua, Uganda. Specific objectives were to examine the relationship between directive, collaborative and non-directive supervision and teacher competence enhancement in secondary schools in Greater Arua. The study hypothesised that there was no statistically significant positive relationship between directive, collaborative and non-directive supervision and teacher competence enhancement in secondary schools in Greater Arua, Uganda. The Positivist paradigm and a correlational design were adopted. The population comprised secondary school teachers (n=241) of selected secondary schools in Arua City and Arua District, Uganda. The data collection method was a survey. Study hypotheses were tested using the Pearson Correlation technique. The results revealed a positive relationship between directive supervision (r = 0.144** sig = 0.026), collaborative supervision (r = 0.145*, sig = 0.024) and non-directive supervision (r = 0.161* sig = 0.012, and teacher competence enhancement. The study concluded that all three dimensions of developmental supervision (directive, collaborative and non-directive) have a positive relationship with teacher competence enhancement. As a recommendation, school-based supervisors should apply a supervisory approach according to the competence level of a teacher. Ministry of Education and Sports should organise regular workshops and seminars for school-based supervisors on the principles of instructional supervision.

Barriers and opportunities for improving management of snakebites: Perspectives of healthcare workers in Northern Uganda.

Snakebites are a neglected public health problem that pose a significant burden on affected individuals and communities in many sub-Saharan African countries, including Uganda. However, the barriers and facilitators to snakebite management within healthcare settings are not as well understood and well-documented. The aim of this study was to explore the experiences and perspectives of healthcare workers involved in handling snakebite incidents at individual and health system levels in Arua and Gulu districts in Northern Uganda. We sought to understand how healthcare workers manage snakebite cases, what challenges they encounter, and what opportunities they perceive for improvement. We conducted a qualitative study using in-depth interviews with 18 healthcare workers from different cadres, seniority levels, and facility types. We used iterative thematic analysis to explore the management procedures, challenges, and opportunities for snakebite management. Using thematic analysis, we identified the overarching themes and subthemes related to snakebite management and associated barriers and opportunities. The main barriers to snakebite management identified by healthcare workers were inadequate knowledge and skills; limited availability of antivenom; lack of protocols for snakebite management; delayed treatment-seeking for patients; and poor referral systems. The main opportunities for improvement were regular in-service training; increasing public education and awareness about snakebite prevention and management; and increased funding and research. This study highlights the need for interventions to address the identified barriers while leveraging the existing opportunities to enhance snakebite management in Uganda. Specifically, we recommend the provision of regular training and support to healthcare workers, developing clinical guidelines, and improving the availability of antivenoms.

Sexual and reproductive healthcare utilisation and affordability for South Sudanese refugees and host populations in Northern Uganda: A mixed methods study.

Given Uganda's increasing refugee population, the health financing burden on refugee and host populations is likely to increase because Uganda's integrated health system caters to both populations. We used sexual, reproductive, and maternal health (SRMH) as a lens to assess the utilisation and user cost of health services in Northern Uganda to identify potential gaps in SRMH services and their financing. We conducted a cross-sectional survey among 2,533 refugee and host women and girls in Arua and Kiryandongo districts. We conducted 35 focus group discussions and 131 in-depth interviews with host and South Sudanese refugees, community members, health workers, NGO and governmental actors. Qualitative data were analysed thematically using a framework approach. Quantitative data were analysed using t-test, chi-square tests, multivariate logistical regression, and a two-part model. We found high levels of access to maternal care services among refugee and host communities in Northern Uganda, but lower levels of met need for family planning (FP). Refugees had higher uptake of delivery care than host communities due to better-resourced refugee facilities, but incurred higher costs for delivery kits and food and less for transport due to facilities being closer. FP uptake was low for both groups due to perceived risks, cultural and religious beliefs, and lack of agency for most women. Host communities lack access to essential maternal healthcare services relative to refugees, especially for delivery care. Greater investment is needed to increase the number of host facilities, improve the quality of SRMH services provided, and further enhance delivery care access among host communities. Ongoing funding of delivery kits across all communities is needed and new financing mechanisms should be developed to support non-medical costs for deliveries, which our study found to be substantial in our study. All populations must be engaged in co-designing improved strategies to meet their FP needs.

Evaluation of Factors contributing to high Alcoholism among Youths in Adumi Village, Arua District Uganda

High rate of alcoholic intake and abuse has become a global epidemic among Youths especially the under aged people. Adumi is a village in Arua district of Uganda. This study was conducted to ascertain the factors that contributed to alcoholism among youths. Youths aged 16 to 17 have the second highest rate (16.4%) of current alcohol abuse in the surveyed countries, and although consumption of alcoholic beverages is illegal for people under 18 years of age. 10.4 million current drinkers were aged 12 to 20 and of this group, nearly half 5.1 million engage in binge drinking, including 2.3 million who would also be classified as heavy drinkers. This study used a descriptive research design with both qualitative and quantitative methods. A sample of 50 respondents were sampled using questionnaires. The data was collected and analyzed using Microsoft excel and then presented using tables and figures. The major factors contributing to alcoholism among the youths in Adumi village were found to be, lack of full time employment leading to idleness of the youths, Peer group influence, easy accessibility, availability and affordability of alcohol in Adumi village without no restrictions. Physical and emotional stress resulting from poor conditions of living leading to psychiatric conditions such as anxiety and depression, chaotic home environments and child negligence leading to school dropouts. Lack of information about the disadvantages of alcoholism from the community development officers and policies to prevent the vice in the study area and the district at large. The government and other stakeholders such as Non-Governmental Organizations (NGOs) and CBOs should establish youth livelihood programs to combat idleness among the youths and should put in place bylaws on the time of opening bars and also the age of people allowed to drink and make sure that these bylaws are strictly enforced. Keywords: Alcoholism, Adumi Village, Youths, Abuse and Drinkers.

Determinants of malaria infections among children in refugee settlements in Uganda during 2018–2019

BackgroundWhile 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda.MethodsWe utilized data from Uganda’s Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors.ResultsOverall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (aOR) = 1.22, 95% CI: 0.08–0.59, P = 0.002], boreholes (aOR = 2.11, 95% CI: 0.91–4.89, P = 0.018) and water tanks (aOR = 4.47, 95% CI: 1.67–11.9, P = 0.002). Other factors included pit-latrines (aOR = 1.48, 95% CI: 1.03–2.13, P = 0.033), open defecation (aOR = 3.29, 95% CI: 1.54–7.05, P = 0.002), lack of insecticide treated bed nets (aOR = 1.15, 95% CI: 0.43–3.13, P = 0.003) and knowledge on the causes of malaria (aOR = 1.09, 95% CI: 0.79–1.51, P = 0.005).ConclusionsThe persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness.Graphical

High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda: A cross-sectional study.

Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.

Consumer preferences for rice in East Africa

PurposeImproving the competitiveness of East Africa's rice industries necessitates increased and viable production of rice of the quality desired by consumers. This paper aims to understand consumer preferences for rice quality attributes in Uganda and Kenya to inform the countries' rice breeding programs and value chain development interventions.Design/methodology/approachRice samples are obtained from retail markets in various districts/counties across the two countries. The samples are analyzed in a grain quality laboratory for the rice's physicochemical characteristics and the resulting data are used to non-parametrically estimate hedonic price functions. District/county dummies are included to account for potential heterogeneity in consumer preferences.FindingsUgandan consumers are willing to pay a price premium for rice with a relatively high proportion of intact grains, but the consumers discount chalkiness. Kenyan consumers discount high amylose content and impurities. There is evidence of heterogeneity in consumer preferences for rice in Mbale, Butaleja and Arua districts of Uganda and in Kericho and Busia counties of Kenya.Originality/valueThe study makes a novel contribution to the literature on consumer preferences for rice in East Africa by applying a hedonic pricing model to the data generated from a laboratory analysis of the physicochemical characteristics of rice samples obtained from the market. Rather than base our analysis on consumers' subjective sensory assessment of the quality characteristics of rice, standard laboratory methods are used to generate the data, which enables a more objective assessment of the relationship between market prices and the quantities of attributes present in the rice samples.

Farmers’ Knowledge, Control Methods, and Challenges of Managing Bean Leaf Beetles (Ootheca spp.) in Uganda

Bean leaf beetles (BLBs) (Ootheca spp.) are important field insect pests of the common bean (Phaseolus vulgaris L.) in agricultural communities in Sub-Saharan Africa. A survey of 128 farmers was conducted in Arua, Hoima, Lira, and Lwengo districts in Uganda, where the common bean is a major food and income crop. This paper evaluated farmers’ knowledge, control strategies, and challenges in managing BLBs. Over 87% of the farmers in Arua and Lira could identify BLBs by local names, compared to less than 45% in Hoima and Lwengo. Less than 8% of the farmers in all districts were aware that BLBs oviposit, diapause, and then emerge from the soil. Many farmers (75%) in Lwengo perceived BLBs infestation as mild, 65.6% in Hoima thought it was moderate, and 78% and 56% in Arua and Lira respectively thought it was severe. The use of chemicals was popular in all districts and also perceived to be the most effective method for controlling BLBs. The reported obstacles to controlling BLBs were a lack of understanding of proper control methods, and the existence of fake insecticides on the market. We recommend that the Ministry of Agriculture, Animal Industry and Fisheries customizes the agricultural extension information packages to include BLBs and cost-effective control strategies for them.

Sustainability of health services in refugee hosting districts: a qualitative study of health services in three west Nile refugee hosting districts, Uganda

BackgroundHumanitarian health assistance programmes have expanded from temporary approaches addressing short-term needs to providing long-term interventions in emergency settings. Measuring sustainability of humanitarian health services is important towards improving the quality of health services in refugee settings.ObjectiveTo explore the sustainability of health services following the repatriation of refugees from the west Nile districts of Arua, Adjumani and Moyo.MethodsThis was a qualitative comparative case study conducted in three west Nile refugee-hosting districts of Arua, Adjumani, and Moyo. In-depth interviews were conducted with 28 purposefully selected respondents in each of the three districts. Respondents included health workers and managers, district civic leaders, planners, chief administrative officers, district health officers, project staff of aid agencies, refugee health focal persons and community development officers.ResultsThe study shows that in terms of organization capacity, the District Health Teams provided health services to both refugee and host communities with minimal support from aid agencies. Health services were available in most former refugee hosting areas in Adjumani, Arua and Moyo districts. However, there were several disruptions notably reduction and inadequate services due to shortage of drugs and essential supplies, lack of health workers, and closure or relocation of health facilities in around former settlements. To minimize disruptions the district health office reorganized health services. In restructuring health services, the district local governments closed or upgraded health facilities to address reduced capacity and catchment population. Health workers employed by aid agencies were recruited into government services while others who were deemed excess or unqualified were laid off. Equipment and machinery including machines and vehicles were transferred to the district health office in specific health facilities. Funding for health services was mainly provided by the Government of Uganda through the Primary Health Care Grant. Aid agencies, however, continued to provide minimal support health services for refugees who remained in Adjumani district.ConclusionOur study showed that while humanitarian health services are not designed for sustainability, several interventions continued at the end of the refugee emergency in the three districts. The embeddedness of the refugee health services in the district health systems ensured health services continued through public service delivery structures. It is important to strengthen the capacity of the local service delivery structures and ensure health assistance programmes are integrated into local health systems to promote sustainability.

Uptake of community antiretroviral group delivery models for persons living with HIV in Arua district, Uganda: A parallel convergent mixed methods study.

Community antiretroviral groups (CAGs) is one of the innovative and efficient differentiated service delivery models (DSDM) for reaching persons needing human immunodeficiency virus (HIV) treatment in the community. Since DSDM adoption in Uganda, evidence suggests better care outcomes for patients in DSDM compared to counterparts in routine health facility care. However, uptake of CAG models for eligible community groups of persons living with HIV (PLHIV) has been slow in Arua district, Uganda and stakeholders' perceptions regarding its implementation unexplored. The objective of the study was to determine the uptake, barriers and facilitators influencing CAG model implementation in Arua district, Uganda. We conducted a parallel convergent mixed-methods study from March 2020 to December 2020 at Adumi health centre IV and Kuluva hospital in Arua district. We enrolled and extracted data for every fifth virally suppressed participant on antiretroviral therapy (ART) at the two health facilities. Data were analysed using STATA 13.0. Uptake was determined as the proportion of eligible PLHIV that were enrolled into a group. We performed logistic regression to determine factors associated with uptake. We conducted one focus group discussion per facility among healthcare workers involved in the management of PLHIV. We also conducted 7 focus group discussions among PLHIV across the two facilities. Thematic analysis was used to describe the data. A total of 399 PLHIV were eligible for CAG, 61.6% were female, and 44.9% were on dolutegravir (DTG) based regimen. Uptake was 6.8%, 95% CI (4.7-9.7) and was found to be significantly associated with being divorced or separated in a marriage (OR; 0.14, 95%CI; 0.02-0.92, P = 0.014). Members picking drugs in turns, comforting and encouraging others to take the drugs, and health workers advising them to join and stay with other group members were perceived as facilitators to uptake of community antiretroviral group delivery model. Having few and distant eligible members in the local area to form a group, lack of transport among the member to pick the drugs when it's their turn, misunderstandings and lack of confidentiality amongst the members, and lack of partner disclosure were perceived as barriers to uptake of community antiretroviral group delivery model. Uptake of community antiretroviral group delivery model in Arua district is very low. There may be a need to support community antiretroviral group delivery models with income- generating activities, transport facilitation, closer community drug pick-up points and improved partner disclosure support mechanisms among married group members.

A healthy diet for a growing population: a case study of Arua, Uganda

It is uncertain whether Sustainable Development Goal 2 (SDG2), a healthy diet for all, can be achieved in East Africa given its strong population growth, low agricultural yields, and the high perishability of nutrient-dense foods. We examine the consequences of a locally produced healthy diet on land use in a case study of the Arua district in Uganda. This type of analysis can alert policy makers to looming nutrition gaps and support the selection of alternative solution strategies. Using a linear programming (LP) model and three population growth projections, we estimate the minimum agricultural area needed in 2040 to produce a healthy diet that follows EAT-Lancet dietary diversity guidelines and supplies the average requirements of calories, proteins, Iron, and vitamin A. We also compare in scenarios to what extent i) production intensification, ii) food loss reduction, iii) by-product consumption, and iv) vitamin supplementation could reduce the required agricultural area. Results show that the necessary area to produce a healthy diet in 2040 is 160% larger than Arua’s current crop area and would greatly exceed the district’s total area. We also show that none of the changes proposed in our scenarios allows a sufficient increase in food production, suggesting that a mix of even more drastic changes across sectors will be necessary. The results underline the challenge for rural areas in East Africa like Arua to provide a healthy diet to its fast growing population, requiring integrated food system changes and policy coordination to orchestrate the increased availability of diverse and nutritious foods.

Anthrax bio-surveillance of livestock in Arua District, Uganda, 2017–2018

Anthrax, caused by Bacillus anthracis, is a widespread zoonotic disease with many human cases, especially in developing countries. Even with its global distribution, anthrax is a neglected disease with scarce information about its actual impact on the community level. Due to the ecological dynamics of anthrax transmission at the wildlife-livestock interface, the Sub-Saharan Africa region becomes a high-risk zone for maintaining and acquiring the disease. In this regard, some subregions of Uganda are endemic to anthrax with regular seasonal trends. However, there is scarce data about anthrax outbreaks in Uganda. Here, we confirmed the presence of B. anthracis in several livestock samples after a suspected anthrax outbreak among livestock and humans in Arua District. Additionally, we explored the potential risk factors of anthrax through a survey within the community kraals. We provide evidence that the most affected livestock species during the Arua outbreak were cattle (86%) compared to the rest of the livestock species present in the area. Moreover, the farmers’ education level and the presence of people's anthrax cases were the most critical factors determining the disease's knowledge and awareness. Consequently, the lack of understanding of the ecology of anthrax may contribute to the spread of the infection between livestock and humans, and it is critical to reducing the presence and persistence of the B. anthracis spores in the environment. Finally, we discuss the increasingly recognized necessity to strengthen global capacity using a One Health approach to prevent, detect, control, and respond to public threats in Uganda.

Factors Contributing to the Prevalence of Adolescent Pregnancy in Pajulu Sub County, Arua District

Introduction and problem: Adolescent pregnancy is a public health concern in both developed and developing countries. Globally, it affects more than 16 million girls and young women .It is estimated that about 11% of births worldwide are to adolescents aged 15-19 years, more than 90% of which occur in low and middle income countries (WHO, 2014). Adolescent pregnancy is a concern in Uganda despite the endless efforts put in place by Ministry of Health and the other health stakeholders to reduce and stop it. This study focused on assessing factors contributing to adolescent pregnancy in Pajulu Sub-county, Arua district. Objectives: To assess the health service related, individual, and social cultural factors contributing to the prevalence of adolescent pregnancy in Pajulu Sub-county, Arua district. Methodology: The study employed a descriptive cross-sectional research design involving both qualitative and quantitative approaches. It was conducted in Pajulu Sub-county, Arua district, West Nile region among adolescent girls, adolescent mothers and pregnant adolescents aged between 12 to 19 years, and some key informants in the community. Results: The prevalence of teenage pregnancy in Pajulu Sub County was found to be 22.7%. Negative attitude of the health workers, lack of adolescent specific S/RH services, contraceptive nonuse, peer pressure, alcohol, cultural norms, family neglect, adolescent’s education level, and adolescent’s poor social status were found to be significantly associated with adolescent pregnancy. Conclusions and recommendations: The relatively high prevalence of adolescent pregnancy and the factors contributing to it pose a task for all stakeholders in the communities and nationwide to work towards addressing the problem. Therefore parents, community members, schools, and health workers are recommended to adopt a culture of discussing sexual and reproductive health issues, advocating for abstinence and where necessary, contraception be made open and accepted without stigma.

Host and Seasonal Effects on the Abundance of Bean Leaf Beetles (Ootheca spp.) (Coleoptera: Chrysomelidae) in Northern Uganda.

Simple SummaryBean leaf beetles (Ootheca spp.) (Coleoptera: Chrysomelidae) are endemic in Africa and are pests of cropped legumes (Fabales: Fabaceae). On common beans (Phaseolus vulgaris L.), the beetles cause leaf and root damages, leading to losses sometimes exceeding 50% in northern Uganda. Additionally, legumes are often grown in neighboring plots or in rotation season after season. This promotes the multiplication of pests and thus complicate their management. We conducted field trials to assess the seasonal variations in the abundance of the Bean Leaf beetles on common beans, cowpea (Vigna sp. Walp) and soybean (Glycine max L.), which are major legumes grown in northern Uganda. The beetles were most abundant during the long rainy season of 2018 and on cowpea, but also present during short rainy seasons of 2017 and 2018. Pupae remained in the soil after the harvest of the first season’s crops and were detected during the second season as well. Ootheca spp. preferred cowpea for foraging and development. Our study indicates that management strategies should be designed to target the above- and below-ground stages of Ootheca spp. in both seasons. Bean leaf beetles (BLBs) (Ootheca spp.) are serious legume pests in Uganda and sub-Saharan Africa, but their ecology is not well understood. We planted host plants, viz., common bean, cowpea, and soybean, in an experiment in the hotspot areas of Arua and Lira districts in Northern Uganda in order to assess their influence on the density of adults and immature stages of BLBs in different seasons. Overall, the number of adults, larvae, and pupae were higher in cowpea than common bean and soybean plots. The number of adults were highest in cowpea (29.5 adults/15 plants) in Arua during the long rainy season (2018A). The number of adults did not differ significantly during short rains (season B) in 2017 and 2018. Similarly, in Lira district, the highest number of adult BLBs was in cowpea (4.6 beetles) compared to the common bean (2.7 beetles) and soybean plots, with a peak at four weeks after planting (WAP). During 2018A, larvae of BLBs first appeared at five WAP and seven WAP and peaked at 13 WAP and 11 WAP in Arua and Lira, respectively. The pupae were present in the soil after the harvesting of crops during 2018A, but peaked at seven WAP and eight WAP in 2018B season in Arua and Lira, respectively. The occurrence of below-ground adults in 2018B followed the peak abundance of pupae, although this was delayed until six WAP in Arua compared to Lira. We conclude that cowpea is the most preferred by adults and larvae compared to common bean and soybean. Similarly, the first rain season (2018A) attracted higher abundance and damage than the second rain season. Management of the BLBs should thus take into consideration avoidance of host crop rotation and dealing with the below-ground stages.