Districts In Uganda Research Articles

A Struggle for Survival: Meaning of Late Life in a Rural District in Uganda: A Qualitative Study.

Background: Between 2015 and 2050, the aging population of Uganda (aged 50 years and older) will be nearly doubled. Therefore, later-life problems have become an area of increasing research and policy interest. This study aimed at exploring how aging people living in extreme poverty in a low-income country experience their everyday life and what kind of meaning systems employed by them to understand and cope with their living conditions.Methods: We conducted a qualitative interview with 14 participants in the Buikwe district. In this interview, 11 women and 3 men were included, and a thematic analysis was employed for data processing and analysis.Results: Unanimously, all participants reported their condition as extreme poverty. The key informants (KIs) emphasized respect from descendants and the community as a foundation for a meaningful later life. In contrast, this aspect has been ever mentioned by no caregivers but by only one care-receiver. The willingness/ability of children to support the elderly who are in need of support formed a major part of the reflections of care-receivers, which would be decisive for their position in the society and the respect they would receive. In addition, both Christianity and traditional beliefs as well as beliefs in witchcraft and ancestral spirits were employed as a basis for actions and reflections.Discussion: The question arises whether life in extreme poverty conditions can be perceived as meaningful. Respect was mentioned as fundamental by the KIs, thereby giving priority to social relations as the most meaningful factor for living a meaningful life. The ability and willingness of the possible descendants for support as the focus of care-receivers might be a more down-to-earth description of this aspect but without using the same level of abstraction. For the majority, due to their belief system did not serve as a source of consolation their main focus was on social relationships for support. To improve the wellbeing of the old people, their sense of meaning must be restored through a system, guaranteeing the coverage of basic needs and measures to restore dignity through a reintegration in both community and congregations. Social service agencies who are targeting the elderly people need to work toward this objective.

The Early Impact of COVID-19 on a Cardiovascular Disease Prevention Program in Mukono and Buikwe Districts in Uganda: A Qualitative Study

<strong>Background:</strong> In 2011, the United Nations set out an ambitious plan to dramatically reduce the effect of non-communicable diseases (NCDs) including cardiovascular diseases (CVD) in all regions of the world. However, the outbreak of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-Cov-2) is slowing current efforts and the set targets may not be achieved, yet NCDs have been associated with the risk of more severe COVID-19 disease. In the current study, we explore the early impact of the COVID-19 pandemic on a CVD prevention program in Mukono and Buikwe districts in Uganda. <strong>Methods:</strong> We collected qualitative data through interviews and mini focus group discussions (FGDs) in the months of May and June 2020. A total of 39 community health workers (CHWs) and 10 healthcare workers (HCW) participated in the study. The data were transcribed verbatim and analysed with the help of the ATLAS.ti software following a content analysis approach. Emerging themes and sub themes were generated and these exemplified with quotations from the transcripts. <strong>Results:</strong> Negative and positive impact themes were observed. The negative observations were: (1) Disruption of CVD prevention services including halting screening for CVD risk factors at the community and health facility, halting sensitisation and health promotion activities at the community; (2) Reduction in patient health seeking behaviours; (3) Acute health facility staff absenteeism (4) Disruption in reporting and referral mechanisms; and (5) Disruption in supply chain. On the other hand, two positive attributes were observed: (1) Perceived reduction in alcohol consumption; and (2) perceived reduction in crime related psychosocial stress. <strong>Conclusion:</strong> COVID-19 disrupted the implementation of CVD prevention activities in this low-income context. Screening programs and CVD prevention activities at the community and health facility levels were literally halted mainly due to fear, the non-discriminatory lockdown measures and a lack of medicines and supplies – including personal protective equipment. There is need for a balance in measures to sustain CVDs interventions while controlling the COVID-19 pandemic.

Implications of the Covid-19 mitigation model on people’s right to health in Uganda

PurposeThe purpose of this paper is to review the approach used by the Ugandan Government in implementing the Covid-19 mitigation model and establish whether it did not expose government’s failure to soundly protect and respect all her citizens’ right to health during the first four months of the Covid-19 crisis in the country.Design/methodology/approachThe study was qualitative focusing on a population of households of vulnerable and chronically ill patients in Mukono and Wakiso districts of Uganda. The sample was identified through purposive and snowball sampling techniques. Purposive and snowball sampling was chosen for this study to select unique informative cases which were subjected to in-depth interviews.FindingsThe findings of the study revealed that disadvantaged and vulnerable citizens of Uganda experienced severe and increased shortages of food, increased cases of ill-health, compromised ability and mobility to access health services as a result of the government's Covid-19 mitigation model.Research limitations/implicationsThe data collection exercise was conducted during the Covid-19 lockdown when the mobility was restricted to only essential services so data was collected in the two districts of Mukono and Wakiso in Uganda.Practical implicationsPandemic mitigation models ought to be people-centred executed by a multidisciplinary team which are empathetic towards the views of disadvantaged communities and thereby cultivate a culture of care over time.Social implicationsPublic health models and policies work more effectively if they are contextualized to work for both the high and low classes of people across the whole spectrum.Originality/valueGiven this awareness of the Covid-19 mitigation model, this paper unveils the immediate consequential effects of the model considering the manner under which it was formulated and implemented in the Ugandan society. While the government implemented the model in exercise of its obligations, contextual factors had advance limitations to the efficacy of the model. Most significantly, among the expectant mothers, the old, the sick with terminal illnesses, the physically challenged and hunger-stricken families with no daily sources of income.

A qualitative study of the development and utilization of health facility-based immunization microplans in Uganda

BackgroundIn 2006, Uganda adopted the Reaching Every District strategy with the goal of attaining at least 80% coverage for routine immunizations in every district. The development and utilization of health facility/district immunization microplans is the key to the strategy. A number of reports have shown suboptimal development and use of microplans in Uganda. This study explores factors associated with suboptimal development and use of microplans in two districts in Uganda to pinpoint challenges encountered during the microplanning process.MethodsA qualitative study was conducted comparing two districts: Kapchorwa, with low immunization coverage, and Luwero with high immunization coverage. Data were collected through multilevel observation of health facilities, planning sessions and planning meetings; records review of microplans, micromaps and meeting minutes; 57 interviews with health workers at the ministry level and lower-level health facility workers. Data were analysed using NVivo 8 qualitative text analysis software. Transcripts were coded, and memos and display matrices were developed to examine the process of developing and utilizing microplans, including experiences of health workers (implementers).ResultsThree key findings emerged from this study. First, there are significant knowledge gaps with regard to the microplanning process among health workers at all levels (community and district health facility and nationally). Limited knowledge about communities and programme catchment areas greatly hinders the planning process by limiting the ability to identify hard-to-reach areas and to prioritize areas according to need. Secondly, the microplanning tool is bulky and complex. Finally, microplanning is being implemented in the context of already overtasked health personnel who have to conduct several other activities as part of their daily routines.ConclusionsIn order to achieve quality improvement as outlined in the Reaching Every District campaign, the microplanning process should be revised. Health workers’ misunderstanding and limited knowledge about the microplanning process, especially at peripheral health facilities, coupled with the complex, bulky nature of the microplanning tool, reduces the effectiveness of microplanning in improving routine immunization in Uganda. This study reveals the need to reduce the complexity of the tool and to identify ways to train and support workers in the use of the revised tool, including support in incorporating the microplanning process into their busy schedules.

Sex differences in family planning knowledge, attitudes, and use in Uganda

BackgroundLiterature is satiated with studies focusing on knowledge, attitude, and practices of family planning (FP) among the female population, conversely, the gaps in sex-disaggregated data on FP continue to exist. This study sought to report sex differences existing in FP knowledge, attitude, and use in Uganda.MethodsThis study uses data from a household survey that covered 16 districts in Uganda. Multi-stage cluster randomized sampling was employed for participant selection. Bivariate analysis for categorical data was conducted. Multilevel logistic regression model was applied to model the effects of socio-demographic characteristics on the use of modern FP methods.ResultsData from 4,352 respondents in the ratios of 70 % females and 30 % of males were analyzed. The mean age was 28.7 SD (8.5) and was not significantly different between males and females. More male respondents had secondary or higher level of education (44 %) than females (36 %). Knowledge of at least one modern FP method was high, but small significant differences were revealed between males (96 %) and females (98 %). Significant knowledge differences were seen in specific FP methods. A higher proportion of females (71 %) than males (67 %) perceived modern FP methods as always available in the community whereas more males (40 %) believed that modern FP methods can result in infertility than females (35 %). There was high self-efficacy about family planning methods use in both males and females. The proportion of married females that reported using or their partner using a modern FP method was 39 % compared to 45 % reported by the married males. Approx. 53 % of the males compared to 37 % of the females that reported condom use also cited STI/HIV prevention as the main reason for condom use suggesting dual protection as a driver for use. Males, young adults, the more educated, and those in marriage or active relationships were more likely to use modern FP methods.ConclusionsOur study found significant sex differences in knowledge, attitudes, and use of FP methods. The young adults and more educated respondents were more likely to use FP methods. The high self-efficacy observed for both males and females is a signal that both sexes can use FP methods. Project strategies and implementation should take into consideration the existing differences by sex and devise sex-tailored approaches to improve FP knowledge, attitudes, and use in this population. There was increased reporting of condom use as an FP and STI/HIV prevention method, follow-up studies aiming at succinctly measuring dual protection, and its drivers for both sex should be done.

English

SMEs are considered huge boosters to the economy of Uganda. They serve as the engine and driving force for growth, development, innovation, economic prosperity and wealth creation of Uganda. The study aimed at establishing the upshot of COVID 19 on the operations and sustainability of SMEs in Uganda with a view to creating a lucid model for successful SMEs operations and improved performance. The study examined factors for efficient operations and sustainability for SMEs in Uganda. The study embraced a positivist quantitative approach with correlational design and cross sectional, survey design, underpinned on the interpretivism philosophy. The study used a sample of 205 SMEs working in Kabale, Kisoro, Rukiga, Rukungiri and Ntungamo. The findings revealed that COVID19 pandemic accounted for a significant variance in the operations and sustainability of SMEs in the selected boarder districts in Uganda. The study confirmed the hypothesis that the effects of COVID19 pandemic have positively affected performance, operations and sustainability of SMEs. The pecking order theory was largely supported by the study and resource based view lays the ground in explaining, sustainability, performance and operations of SMEs in Uganda. The study recommends that the respective government of Uganda authorities and partners offer appropriate liquidity intercessions to support SMEs in handling instant liquidity encounters, to avoid closures and bankruptcies. &nbsp; Key words: COVID 19, operations, performance, sustainability, small and medium enterprise, business.

Assessment of sorghum production constraints and farmer preferences for sorghum variety in Uganda: implications for nutritional quality breeding

ABSTRACT Sorghum [Sorghum bicolor (L.) Moench] is the main food staple grain widely cultivated in sub-Sharan Africa including Uganda. There is a lack of current information on sorghum production constraints and varietal trait preferences in the major sorghum production areas in Uganda. Therefore, the objective of this study was to assess the sorghum production constraints and farmer preferences for sorghum variety in Uganda. A participatory rural appraisal study was undertaken in four selected sorghum production districts in Uganda (Kumi, Bukedea, Oyam and Gulu). Data were collected through surveys using semi-structured questionnaires and focus group discussion involving 128 and 55 participants, respectively. Data were subjected to parametric and non-parametric statistical analyses to draw inferences. A lack of improved sorghum varieties was the major sorghum production constraint reported by 82.8% of participants. Farmer preferred ideal sorghum varieties were short to medium plant height with high grain yield. The quality attributes mostly preferred by farmers were baking quality, nutrition, and seed colour. Farmers in the study areas mainly grew unimproved sorghum varieties with low food values. Overall, the study provides the current evidence on sorghum production constraints and farmer-preferred attributes that will guide sorghum nutritional quality breeding with farmer preferred traits.

Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children.

Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt.

Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda

BackgroundThe notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown.MethodsWe conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach.ResultsFive broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities.ConclusionWhile Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.

Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda

BackgroundPostpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother’s response to the child’s needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda.MethodsThis was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks’ postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression.ResultsOverall prevalence of PPD was 27.1% (95% CI: 22.2–32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively.Conclusion and recommendationsPrevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.

Transitioning health workers from PEPFAR contracts to the Uganda government payroll.

Although increasing public spending on health worker (HW) recruitments could reduce workforce shortages in sub-Saharan Africa, effective strategies for achieving this are still unclear. We aimed to understand the process of transitioning HWs from President’s Emergency Plan for AIDS Relief (PEPFAR) to Government of Uganda (GoU) payrolls and to explore the facilitators and barriers encountered in increasing domestic financial responsibility for absorbing this expanded workforce. We conducted a multiple case study of 10 (out of 87) districts in Uganda which received PEPFAR support between 2013 and 2015 to expand their health workforce. We purposively selected eight districts with the highest absorption rates (‘high absorbers’) and two with the lowest absorption rates (‘low absorbers’). A total of 66 interviews were conducted with high-level officials in three Ministries of Finance, Health and Public Service (n = 14), representatives of PEPFAR-implementing organizations (n = 16), district health teams (n = 15) and facility managers (n = 22). Twelve focus groups were conducted with 87 HWs absorbed on GoU payrolls. We utilized the Consolidated Framework for Implementation Research to guide thematic analysis. At the sub-national level, facilitators of transition in ‘high absorber’ districts were identified as the presence of transition ‘champions’, prioritizing HWs in district wage bill commitments, host facilities providing ‘bridge financing’ to transition workforce during salary delays and receiving donor technical support in district wage bill analysis—attributes that were absent in ‘low absorber’ districts. At the national level, multi-sectoral engagements (incorporating the influential Ministry of Finance), developing a joint transition road map, aligning with GoU salary scales and recruitment processes emerged as facilitators of the transition process. Our case studies offer implementation research lessons on effective donor transition and insights into pragmatic strategies for increasing public spending on expanding the health workforce in a low-income setting.

Impact of the Sachet Alcohol Ban on Alcohol Availability in Uganda

Alcohol use continues to be a major public health problem in Uganda. This study sought to estimate the availability of sachet alcohol among retail food and beverage establishments in two Ugandan districts (Kampala and Jinja) before and after enactment of the national sachet alcohol ban. Independent observations in 100 establishments were conducted by a pair of trained observers during the peak hours of 7 P.M. to 1 A.M. Using a standardized checklist, observers recorded indications of alcohol availability before and after enactment of the sachet alcohol ban. Availability of (a) alcohol and (b) sachet alcohol were significantly affected by the ban. Before the ban, 69% of all establishments sold alcohol; there was a significant reduction in alcohol availability after enactment of the ban to 43% of the establishments (p < .001). This reduction was observed in off-premise establishments (p < .001), but not in on-premise establishments (p = .710). Additionally, before the sachet alcohol ban, 52% of all establishments sold sachet alcohol; however, there was a significant reduction in sachet availability after enactment of the ban (1.4%, p < .001). Legislation banning the manufacture and sale of sachet alcohol has the potential to reduce sachet availability. Future studies should examine changes in alcohol consumption following the sachet alcohol ban.

Promotion of Effective COVID-19 Response Interventions among Health Workforce in Virika Hospital, Kabarole District-Uganda

Introduction: The Novel Corona Virus Disease (COVID-19) caused by SARS-CoV2 virus was first identified and reported in 2019 by the people’s Republic of China in Wuhan and declared a pandemic disease in march 2020. Since then, the disease has continued to spread to the rest of the communities in the world and Kabarole district in Uganda has not been spared. The need to promote effective COVID-19 Response Interventions through a capacity-building project of health workforce in Kabarole and Uganda in general was ostensible. The effective COVID-19 interventions strengthened among Virika Hospital Health workforce were, enhanced risk communication by health workers and Community engagements through Social mobilisation. In this paper, we share how a capacity building project for health workforce at Virika Hospital, Kabarole district Uganda, contributed to the reduction of community COVID-19 transmission and death as a result of increased levels of awareness of the risk by Health workers and community. Methods: This was a hospital-based project initiated by the Hospital nursing officer and the administration soliciting technical support from Kabarole District Surveillance Health office. It targeted hospital technical and support staff. At community, the Village Health Team and Village chairpersons were targeted and drawn from 5 randomly selected parishes. Risk communication practice was done using five FM Radio stations and King TV station in Fort Portal City. Results: A health workforce capacity of 60 staff was built, 92% technical and 8% support staff. Skills in Risk communication were acquired by the health workforce through Radio presentations that followed 3 workshop sessions at the hospital. Sessions on infection prevention and control were dominated by demonstrations and return demonstrations on hand hygiene and use of PPEs in COVID-19 prevention. Through dialogue meetings with the VHTs and community leaders, the community was empowered on early detection and reporting of COVID-19 Alert simulations. Despite the enhanced health workforce capacity however, inadequate PPEs was noted as a limiting factor amidst good workforce risk response competencies built. Conclusion: The enhanced health workforce capacity with effective Response interventions like risk communication, Infection Prevention and Control and community engagement, contributed to reduction in community Covid-19 transmission In Kabarole District. This could ensure a long term and sustained response capacity to any other emerging infections in the district.

Comparing costs and cost-efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda.

Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost‐efficiency of distributed MNP through community‐based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9‐month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale‐up integrated into a partner agency program) to $1.62 million (government scale‐up scenario). Unlike previous estimates, these included opportunity costs. Community‐based MNP delivery costs were greater, yet more cost‐efficient per child reached and adhering to protocol than facility‐based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive.

Financial protection and coping strategies in rural Uganda: an impact evaluation of community-based zero-interest healthcare loans.

In low- and middle-income countries, catastrophic health expenditures and economic hardship constitute a common risk for households' welfare. Community health financing (CHF) represents a viable option to improve financial protection, but robust impact evaluations are needed to advance the debate concerning universal health coverage in informal settings. This study aims at assessing the impact of a CHF pilot programme and, specifically, of the initial phase involving zero-interest loans on health expenditures and coping strategies in a rural district of Uganda. The analysis relies on a panel household survey performed before and after the intervention and complemented by qualitative data obtained from structured focus group discussions. Exploiting an instrumental variable approach, we measured the causal effect of the intervention, and the main findings were then integrated with qualitative evidence on the heterogeneity of the programme's impact across different household categories. We found that the intervention of zero-interest healthcare loans is effective in improving financial protection and longer-term welfare. Community perceptions suggested that the population excluded from the scheme is disadvantaged when facing unpredictable health costs. Among the enrolled members, the poorest seem to receive a greater benefit from the intervention. Overall, our study provides support for the positive role of community-based mechanisms to progress towards universal coverage and offers policy-relevant insights to timely design comprehensive health financing reforms.

USING SOCIAL MEDIA FOR POLITICAL CAMPAIGN COMMUNICATION AND ITS IMPACT ON POLITICAL POLARIZATION AMONG YOUTHS IN UGANDA

The current study is aimed at examining the use of social media for political communication and its impact on the political polarization of youths in Uganda. The study specifically focuses on determining social media platforms that are often used by youths in Uganda, find out the levels of social media usage, political campaign communication, and political polarization among youths in Uganda as a result of social media usage. Lastly, the study also focuses on determining the relationship between social media platforms, social media usage, political communication, and political polarization amongst youths in Ugandans. The study adopts the uses and gratifications theory to help in guiding the study and explaining the available relationships between the variables of the study. A quantitative research design and survey method with a questionnaire as the tool for data collection were used in this study. 192 valid responses were extracted from youths residing in Kampala and Wakiso districts in Uganda as the respondents of the study. The findings of the study reveal that youths in Uganda often use Facebook, WhatsApp, Twitter, and Instagram while looking for political-related information to help them form a decision on who to give their support in the election. In addition, the study also reveals that the more the youths look for such political information, the more they become polarized because all the politicians just feed them with information that is divisive and there exists a huge amount of hatred as a result of the consumption of such information on the Ugandan internet space. The uses and gratifications theory is also supported in the study.

Intraspecific Variation of Phytochemicals, Antioxidant, and Antibacterial Activities of Different Solvent Extracts of Albizia coriaria Leaves from Some Agroecological Zones of Uganda.

Albizia coriaria Welw ex. Oliver is a customary African medicinal plant, which has a long history of utilization in the management of oxidative stress-induced and bacterial diseases. However, there is no report on the phytochemicals, antioxidant, and antibacterial activities of its leaves. The aim of this study was therefore to compare the phytochemicals, antioxidant, and antibacterial potential of A. coriaria leaves from Jinja, Kole, and Mbarara districts of Uganda. Shade-dried leaf samples were ground into powder and successively extracted with ethyl acetate, ethanol, and distilled water. Phytochemical screening indicated the presence of alkaloids, phenols, saponins, flavonoids, cardiac glycosides, tannins, and terpenes as the major secondary metabolites in the extracts. Total phenolic and flavonoid contents and total in vitro antioxidant activity were found to be the highest for ethanolic extracts, with the highest contents (101.72 ± 0.22 mg GAE/g DW; 13.23 ± 0.03 mg QE/g DW) and antioxidant potential (IC50 = 18.65 ± 0.06 mg/mL) being for leaves from Mbarara district. Antibacterial activity of the extracts determined by agar disc diffusion method revealed that ethanolic extracts had higher antibacterial activities with mean zones of inhibition of 6.00 ± 1.73 to 10.00 ± 1.73 mm, 5.00 ± 1.00 to 12.30 ± 1.53 mm, 17.00 ± 0.00 to 25.00 ± 2.65 mm, and 9.00 ± 1.73 to 16.00 ± 1.73 mm for Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Salmonella typhi, respectively. Ethyl acetate extracts of A. coriaria leaves from Kole and Mbarara had lower antibacterial activities, while aqueous extracts and ethyl acetate extract of leaves from Jinja showed no antibacterial activity. The current study for the first time established that A. coriaria leaves possess therapeutic phytochemicals with significant in vitro antioxidant and antibacterial activities, which lend credence to their use in traditional management of oxidative stress-induced conditions and bacterial diseases in Uganda. Structural elucidation of the responsible pure compounds for the observed bioactivities as well as toxicity studies of the extracts is recommended.

Factors Associated With Stunting Among Infants and Young Children Aged 7–29 Months in Post-conflict Northern Uganda

ObjectivesTo examine factors associated with stunting in Agago District, Uganda MethodsWe used cross-sectional data from a quantitative baseline survey of 870 households of the ONCE (One Nutrition in Complex Environments) project currently being conducted in Agago district of Uganda. Survey data used include infant anthropometry, infant feeding practices, 24-hour dietary recall, maternal heights, weights, education and household characteristics. Statistical methods include Pearson correlation coefficients, student T-tests, pair-wise mean comparisons with Bonferroni adjustment, and stepwise multivariable linear and logistic regression analyses controlled for clustering. Dependent variables include length-for-age z-score (LAZ, –6 to 6, continuous) and being stunted (binary). Independent variables include child age, child’s birth weight, diarrheal morbidity (past two weeks), maternal education, maternal height, household wealth index, and animal sourced foods consumption (ASF, categorical: no ASF (comparator), 1 ASF, >= 2 ASF). ASF is defined as consumption of dairy, animal flesh, fish of any kind, organ meat, insects, or eggs in previous 24 hours. ResultsInfants between 7 months and 2.5 years with complete data were included (N = 621), of whom 19.7% were classified as stunted. Mean LAZ was –1.05 (SD: 1.24). Most children did not consume any ASF in the past 24 hours (73.6%). ASF consumption was not associated with LAZ (1 kind of ASF: –0.0699, 95% CI: –0.329, 0.189) or stunting (1 kind of ASF OR: 1.186, 95% CI: 0.614, 2.292). Maternal height was associated with 7.8% decreased odds of being stunted (OR: 0.922, 95% CI: 0.878, 0.969); age was associated with 8.9% increased odds of being stunted (OR: 1.089, 95% CI: 1.011, 1.090); birth weight was associated with 54% decreased odds of being stunted (OR: 0.461, 95% CI: 0.296, 0.717). Infants with diarrhea were 96% more likely to be stunted than those without (OR: 1.956, 95% CI: 1.050, 3.642). ConclusionsFactors associated with stunting were maternal height, child age, birth weight and diarrheal morbidity. ASF consumption was not, possibly due to low levels and possibly low frequency of consumption. Mother’s nutritional status is likely to be an important predictor in this population. Funding SourcesFeed the Future Initiative, U.S. Agency for International Development.

Child health and the implementation of Community and District-management Empowerment for Scale-up (CODES) in Uganda: a randomised controlled trial

IntroductionUganda’s district-level administrative units buttress the public healthcare system. In many districts, however, local capacity is incommensurate with that required to plan and implement quality health interventions. This study investigates...

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.