Northern Uganda Research Articles

Stakeholder influence, local revenue mobilisation and service delivery in district local governments: evidence from districts in Northern Uganda

Stakeholder influence, local revenue mobilisation and service delivery in district local governments: evidence from districts in Northern Uganda

Revisiting forum shopping: navigating normative pluralism, navigating sentiments

People live their lives and experience the conflicts in which they are involved in the context of competing normative orders. But how do people navigate this normative pluralism? To understand this, Keebet von Benda-Beckmann’s model of ‘forum shopping’ and ‘shopping forums’, derived from an ethnographic analysis of conflict resolution, remains an indispensable starting point. Building on this approach, I argue that in order to understand the navigation of normative orders more broadly, it is important to bring the analysis of sentiments to the study of normative pluralism. Drawing on ethnographic fieldwork on the International Criminal Court’s transitional justice interventions in northern Uganda, I argue that when confronted with different international, national, religious, and indigenous normative options for dealing with mass violence, people navigate normative pluralism by creating, mobilising, maintaining, and transforming sentiments.

An ethnobotanical survey of plant species used for medicinal purposes in Amuru district, northern Uganda

An ethnobotanical survey of plant species used for medicinal purposes in Amuru district, northern Uganda

Community-Based Mycetoma Surveillance in Uganda: Identifying Knowledge Gaps and Training of Community Health Workers to Improve Case Detection.

Mycetoma is an uncommon and neglected tropical disease in Uganda. We aimed to assess baseline knowledge and provide community health workers (CHWs) in Northern Uganda with knowledge to identify and refer presumptive mycetoma cases. Between March and August 2023, we conducted a concurrent triangulation mixed methods study among CHWs in Gulu and Pader districts on mycetoma. We conducted a 1 day in person training on mycetoma. Quantitative data were collected before (pretest), immediately (immediate posttest) and six months (6-month posttest) after the training and results compared using paired sample t test or one-way ANOVA. Qualitative data were collected using four focused group discussions, audio recorded, and analyzed using thematic content analysis. Forty-five CHWs were enrolled, mostly male (66.7%, n = 30), with a median age of 36 years (IQR 29 43). Out of a total score of 18, the baseline mean knowledge score was 7±2.42, improving to 11±1.99 immediately posttest (p<0.001), and 10±2.35 at 6 months (p<0.001), without additional training. Significant knowledge improvements at 6 months were observed among female participants (p = 0.004), those aged 30 40 years (p = 0.031) or 40+ years (p = 0.035), and those with secondary education (p = 0.007). Over 6 months, CHWs screened 2,773 adults, identifying and referring 30 presumptive mycetoma cases. Qualitative findings revealed challenges and barriers to early identification and referral of mycetoma presumptive cases including limited knowledge, stigma, myths, lack of an indigenous name for mycetoma, delayed decision making, and transportation barriers. This study highlights a significant knowledge gap among CHWs about mycetoma, with substantial improvement following training. The identification of presumptive cases by CHWs reflects their potential in community-based surveillance, emphasizing the need to integrate well-trained CHW to lead efforts for mycetoma surveillance and capacity building to enhance health outcomes in Uganda.

Complementary feeding and food handling practices among caregivers in a semi-urban setting in Northern Uganda

Background: Complementary feeding practices influence the nutritional status and health of children, especially in developing countries where sub-optimal infant feeding practices are the major cause of childhood undernutrition, morbidity, and mortality. This study sought to characterize the adequacy of complimentary feeding and food handling practices among caregivers of children aged 6-23 months in a semi-urban setting. Methods: Exploratory cross-sectional study was conducted in Adyel division, Lira district in Northern Uganda among 127 child-caregiver pairs randomly selected from three villages. Caregivers were interviewed about their child-feeding practices, complementary foods used, and common practices in handling and preparation of foods used as complementary feeds. Results: Overall, children’s feeding patterns met the recommended dietary intake when assessed using the child feeding index (CFI) whereby children aged 6-8, 9-11, and 12-23 months scored 8.03, 9.17, and 7.59, respectively. However, most children were complemented with foods from the household meals and dietary diversity was limited by frequent use of food leftover from the previous meals. Conclusions: Inappropriate meal patterns and food handling practices identified are likely to compromise child nutrition and health. Nutrition education is needed to improve the caregivers’ child-feeding and food handling practices within their socio-economic and cultural context. Keywords: Complementary feeding practices; food handling; diet quality; food safety; children; Uganda.

Oral health status and factors associated with oral health of primary school children in Gulu district, northern Uganda

BackgroundGlobally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rural areas of the Gulu district of northern Uganda.MethodsA comparative cross-sectional study was conducted among 356 school children aged 11–13 years attending six schools located in urban and rural areas. The children received a clinical oral examination and participated in a questionnaire survey that collected information on sociodemographic and oral health knowledge, attitude, and practices. All data were entered and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp statistical software. Logistic regression analyses examined factors associated with dental caries and gingival bleeding.ResultsOf the 356 children (11–13 years) included, the mean age was 12.2 years, 140 (39.3%) were male and 176 (49.4%) were from urban areas. The proportion of school children with dental caries was 33.6% (n = 119), with the mean decayed, missing due to caries, and filled teeth (DMFT) index of 0.81 (25th percentile = 0; 75th percentile = 1.00). There was no significant difference in caries prevalence between rural and urban children (31.6% versus 35.6%, p = 0.33). Of the children involved in the study, 141(39.8%) had gum bleeding. The mean oral knowledge score was 2.85 ± 1.53 (range, 0–7), while the mean attitude, hygiene practice, frequency of sweets consumption, and oral health related impact scores were 4.25 ± 1.23 (range, 1–6), 5.40 ± 1.81 (range, 0–9), 25.66 ± 4.29 (range 9–54) and 2.1 ± 1.65 (range, 0–6), respectively. Using logistic regression analyses, as oral health knowledge score increased the odds of not having dental caries increased (aOR = 1.19, 95% CI 1.02–1.39).ConclusionThe prevalence of dental caries and gum bleeding of primary school children in Gulu district is high. Children lacked knowledge on causes of oral disease, and behaviour towards oral disease prevention. In addition, oral health knowledge scores were significantly associated with dental caries. Oral health education programs in schools should emphasise providing skills-based education.

The influence of Uganda women’s entrepreneurship program on livelihoods and cultural dynamics in Amolatar, Northern Uganda

This article examines the influence of women’s economic empowerment initiatives under Uganda Women Entrepreneurship Programme (UWEP) on livelihoods and cultural dynamics in Amolatar Sub-Region, Northern Uganda. The study focused on how UWEP has contributed to improving women’s economic status and their roles within the cultural practices in the region. A Qualitative interpretive framework as well phenomenological research design was employed in this study involving in-depth and key informant interviews as well as focus group discussion with 28 participants. The study is grounded in Agency theory by Kabeer and Cultural Capital Theory by Bourdieu, which emphasise women’s participation in entrepreneurship to transform their economic lives and well-being within existing social structures. This research indicates that, UWEP greatly contributes to women’s active agency, allowing them to challenge obstacle within the communities, particularly gender inequality and social stratification. In addition, women’s participation in entrepreneurship coupled with the positive shifts in cultural attitudes in Amolatar sub-region have improved their livelihoods through self-employment. This study emphasise the significance of continuous support by Uganda government through Ministry of Gender, Labour, and Social Development (MoGLSD) for UWEP. Constant support is important to further empower women as well as improve their economic status and well-being within their families and communities.

Surface-derived groundwater contamination in Gulu District, Uganda: Chemical and microbial tracers

Groundwater is consumed by over 2 billion people globally, though it can be impacted by microbial and chemical contamination in both rural and (peri-)urban areas. This issue is particularly pertinent in regions like East Africa, where rapid urbanisation has strained local infrastructure, including water and sanitation systems. We use selected tracers of human and animal waste to assess the quality of community drinking sources with regards to surface-derived groundwater inputs and to compare urban versus rural water quality, under the rapidly developing urban area of Gulu, Northern Uganda. Specifically, we examine bulk and fluorescent dissolved organic matter (DOM), microorganisms (total coliforms, E.coli) and inorganic tracers of anthropogenic waste (NO3−, SO42−, Cl/Br) from various sources: boreholes (12–76 m depth; n = 90), protected springs (n = 11) and municipal taps (n = 4). Our results show that NO3− and SO42− were elevated in groundwater sources in the Gulu city urban area and the Cl/Br ratio was elevated in springs, compared to concentrations in the more rural Aswa and Omoro County area (p < 0.05). Interestingly, human and animal waste indicators E.coli and Tryp:FA (the ratio of tryptophan-like to fulvic-like fluorescence) displayed no significant difference between rural and urban settings (p > 0.05), though total coliforms were significantly higher in rural boreholes (p < 0.05). The presence of a pollution source, pollution carrier and a breakdown of a sanitary barrier at the borehole, as spot-checked by a visual sanitary risk assessment, was significantly associated with groundwater E.coli abundances. Evidence suggests monitoring and mitigation should be improved for all water types in Gulu District to meet WHO and Uganda Standard guidelines for potable water. This study offers valuable insights for water management planning and risk assessment of community water sources particularly in the context of East Africa and similar settings.

Determinants of shea nut marketing arrangements in northern Uganda

This study assessed factors influencing shea nut actors’ choices of shea nut marketing arrangements in northern Uganda. An understanding of these factors is vital in influencing the choice of the different marketing arrangements. Cross-sectional data was collected from a sample of 325 shea nut actors. Data was analysed using descriptive statistics and multinomial logit model. The shea nut actors in this study were composed of 78% collectors, 16% traders and 7% processors. About 73% and 43% of shea collectors and traders, respectively, sold their shea nuts and/or products through spot markets, while, 45% of the processors sold their shea nut and/or products through informal contracts. Formal contract was the least common marketing arrangement among all the actors. The probability of choosing each the marketing arrangement were influenced by several factors including experience, education, income level, access to extension, training, access to credit, awareness of innovations in the shea value chain, awareness of value addition supporting institutions, main occupation (farming), distance to the market, access to information and means of transport used (head portage). Efforts to increase formal contract participation should focus on providing extensions and creating awareness about institutions that support value addition. There is need for a location and actor specific approach in promoting the different market arrangements in shea products marketing.

First evidence on the occurrence of multi-mycotoxins and dietary risk exposure to AFB1 along the cassava value chain in Uganda

This study investigated the occurrence and distribution of multiple mycotoxins (aflatoxin B1, B2, G1, G2, fumonisins B1, B2, ochratoxin A (OTA), deoxynivalenol (DON), zearalenone (ZEN), and citrinin (CIT)) in cassava products and as assessed the potential risk of aflatoxin B1 (AFB1) exposure among cassava consumers. A total of 192 samples of cassava products (96 flour and 96 chips, each with 48 samples from farmer and 48 from wholesaler) were analysed using LC/MS–MS. All positive samples irrespective of their origin (flour or chips) exhibited AFB1 levels exceeding the EU regulatory threshold of 5 µg/kg. The sum of fumonisins (FB1 + FB2), ZEN, and DON were significantly (P < 0.05) higher in cassava flour (14.3 µg/kg; 3.71 µg/kg; 25.1 µg/kg) compared to chips (6.54 µg/kg; 1.25 µg/kg; 0.25 µg/kg), respectively. Aflatoxins G2 was not detected in any of 192 samples. Cassava flour samples from farmers exhibited significantly (P < 0.05) higher mean concentrations of AFB1 (27.1 µg/kg), total aflatoxins (78.2 µg/kg), and ochratoxin A (79.6 µg/kg) in contrast to wholesalers, whose mean levels were notably lower at 8.91, 5.79 µg/kg, and 2.44 µg/kg, respectively, pointing the likely critical source of mycotoxin contamination. Cassava consumers in Northern Uganda are at a higher risk, with an estimated 2.06 cancer cases per 100,000 individuals per year compared to those in Eastern Uganda at 0.25. This study underscores the urgent need for interventions to manage aflatoxins in cassava flour, particularly at farm level in Northern Uganda. It accentuates a shift market to household-level sampling and the need for analytical methods targeting multiple mycotoxins.

Comparative Analysis of Profitability Drivers of Pig Production Systems in Northern Uganda

Pork consumption has risen significantly in many emerging nations, with producers using various systems to meet demand. However, the profitability of these systems remains largely unexplored. Therefore, the drivers of profitability of pig production systems in Northern Uganda were examined. Data were collected using a pretested structured questionnaire through a cross-sectional survey of 240 randomly selected pig farmers. Data were analyzed using descriptive statistics, gross margin analysis, and ordinary least squares model. Results revealed that the cost of initial stock (p &amp;lt; 0.1), cost of feed (p &amp;lt; 0.05), cost of vaccines (p &amp;lt; 0.01), output (p &amp;lt; 0.05), and quantity of feed (p &amp;lt; 0.05) were drivers of profitability in the farrow-to-finish pig production system. Further, profitability in the farrow-to-weaner pig production system was influenced by access to credit (p &amp;lt; 0.1), household size (p &amp;lt; 0.1), access to extension service (p &amp;lt; 0.01), and cost of initial stock (p &amp;lt; 0.05). In the weaner-to-slaughter pig production system, drivers of profitability included access to extension service (p &amp;lt; 0.1), cost of feed (p &amp;lt; 0.1), cost of vaccines (p &amp;lt; 0.05), and cost of initial stock (p &amp;lt; 0.05). Researchers recommend that the government arrange sufficient capacity-building initiatives and training, particularly on the farrow-to-weaner pig production system to increase the output and profitability of this production system. Further, the government and non-governmental organizations should make inputs such as vaccines, drugs, and breeding stock available to pig farmers at competitive market prices to enable farmers to make price-responsive decisions.

Agronomic potential of maize stover biochar under cowpea–maize sequential cropping in Northern Uganda

Biochar is a nature-based solution for sustainable agriculture but its potential adoption in some parts of sub-Saharan Africa is still minimal. In this study, we evaluated the agronomic potential of maize stover biochar in cowpea-maize sequential cropping in Uganda under field conditions. The treatments included; the common farmer practice of no inorganic fertilizer and no biochar (CTR), inorganic fertilizer (F), 10 t ha−1 biochar (B10), 40 t ha−1 biochar (B40), 10 t ha−1 biochar + inorganic Fertilizer (FB10), and 40 t ha−1 biochar + inorganic Fertilizer (FB40), arranged in a randomized complete block design (RCBD) with three replications. The results showed that cowpea seed yield was not significantly affected by biochar and fertilizer application but the haulm yield was significantly improved only in FB40 treatment. Maize grain and stover yield was significantly improved only in the FB40 treatment but biochar showed a high potential to also improve yield even without inorganic fertilizer. The potential for biochar to improve maize yield either in the presence or absence of fertilizers could be attributed to the residual soil fertility from cowpeas. In both seasons, biochar significantly improved soil pH, EC, SOC, total N, available P, exchangeable K and Ca, irrespective of fertilizer application. However, exchangeable Mg did not significantly vary among the treatments. This study further revealed that in cowpea-maize rotation, optimum yield could also be possible with sole biochar application. Therefore, instead of burning the maize stovers after harvest, farmers should convert the residues into biochar and return it to the soil so as to achieve sustainable food systems.Graphical

Intimate Partner Violence in Emergency Situation, Lessons from Lango Sub-Region, Northern Uganda, Implications for Future Marriage Partnership

Intimate Partner Violence in Emergency Situation, Lessons from Lango Sub-Region, Northern Uganda, Implications for Future Marriage Partnership

Sustainability of farmer organizations in Uganda: the role of organizational and institutional factors

In Uganda, despite government support, many farmer organizations are short-lived or exist solely to receive subsidies. Existing literature evaluates the sustainability of farming systems, technology impacts, and non-certified markets, yet a gap remains regarding the sustainability of farmer organizations. This study addresses this gap by determining a sustainability index and the effect of organizational and institutional factors on the sustainability of farmer organizations in central and northern Uganda. It highlights how regional disparities impact organizational sustainability. Using cross-sectional data from 272 farmer organizations across 12 randomly selected districts, a multilevel mixed-effects linear regression in Stata13 was employed. Results indicate that Ugandan farmer organizations have a low sustainability index of 36%, with central organizations slightly outperforming northern counterparts by 2%. Significant differences exist between northern and central organizations in terms of finances, resources, value addition, training, and leadership. Additionally, internal financial dependence, leadership committee size, farm management, and value addition training greatly enhance sustainability. Specifically, regional level variables contribute 21% to changes in the sustainability of farmer organizations in Uganda. To enhance sustainability, farmer organizations should engage in income-generating activities aligned with their economic, environmental, and social welfare objectives. The government should also intensify leadership, farm management, and value addition training.

Differences in need for and access to eye health services between older people with and without disability: A cross-sectional survey in four districts of northern Uganda.

Eye health and disability are both common among older people, and it is important to understand how disability relates to visual health status and access to services. While people with disabilities face barriers to accessing health services, few studies have measured participants' functional status in domains other than vision and little evidence exists on how disability impacts eye health services access. This paper describes how visual impairment and access to eye health services differ between people aged 50 years and above with and without disability in Karamoja, Uganda, and explores the factors driving that difference. This was a cross-sectional survey among individuals aged 50 years and above. A standardised eye health survey was conducted, with additional questions on personal and health characteristics. Ophthalmologists conducted a vision examination, and recorded participants' self-reported functional difficulties using the Washington Group Short Set Enhanced. Descriptive analyses were conducted using Stata, and multivariate models constructed to explore relationships. 21.7% of respondents self-reported some sort of functional difficulty. Twenty-five percent of individuals with a non-visual functional difficulty are also blind, and a further 29% experience a lower level of VI. In a multivariate model, blindness was associated with self-reported difficulties seeing, but not any other type of difficulty. Blindness was also associated with age, not being married, and living in a smaller household. Access to cataract surgery was associated with non-visual functional difficulties, male gender, and having a regular household income. This study confirms that in the study area, disability and visual impairment are common among people aged 50 years and above, access to eye health services is low, and self-reported functional difficulties are not associated with lower access to services.

Unspeakable: reflections on relational approaches to research in post-conflict settings

ABSTRACT In this article, I offer reflections on a research project with former combatants who fathered children as the result of conflict-related sexual violence in northern Uganda. The research sought to understand how becoming a father shaped their decision making as soldiers, and reintegration experiences following demobilisation. What roles, if any, do they play in their children’s lives post-conflict, and what futures do they envision for them? I consider the ethical and methodological challenges of the research project through the concept of the unspeakable, what Judith Herman refers to as ‘traumatic events that take place outside socially validated reality.’ How does one come to know beyond what one can imagine, or that which is socially unrecognisable, such as the love of fathers associated with the perpetration of violent atrocities? I foreground a relational approach to the research encounter, one that fostered intimate, steadfast, and mutually giving relationships between the research team and participants, and opening pathways to explore intimacy between a father and child. I then reflect on what this methodology offers in terms of thinking beyond Western-centric conceptualizations of peacebuilding.

Challenges of Malaria Control in Northern Uganda: Infrastructure, Access, and Healthcare Delivery

Malaria remained a significant public health challenge in sub-Saharan Africa, with Uganda, particularly its northern region, bearing a high burden of the disease. This article examined the persistent malaria crisis in Northern Uganda, focusing on the interplay between inadequate healthcare infrastructure, limited access to medical services, and systemic inefficiencies in healthcare delivery. Northern Uganda’s healthcare infrastructure, weakened by historical conflicts, poverty, and underdevelopment, presents significant barriers to effective malaria control. Geographic isolation, socioeconomic inequities, and cultural practices further constrained access to healthcare, while human resource shortages, supply chain disruptions, and fragmented health services undermined the quality and continuity of care. The article utilized a comprehensive review of existing literature and data to analyze these challenges and proposed potential solutions. Strategies such as strengthening healthcare infrastructure, enhancing access to care, improving healthcare delivery, and fostering collaboration among stakeholders were essential for reducing the malaria burden and improving health outcomes in the region. Keywords: Malaria Control, Healthcare Infrastructure, Northern Uganda, Access to Care, Systemic Inefficiencies

Soil Physical and Chemical Properties under Shea Tree (Vitellaria paradoxa) at Different Stages of Growth

Shea tree (Vitellaria paradoxa), is one of the dominant agro-forestry species in Otuke district of Northern Uganda. Due to its economic importance and, in line with the numerous threats the tree is faced with, there is an urgent need for measures to conserve this species, for example, through incorporating annual food crops in the Shea tree parkland. This, however, requires a better understanding of tree-soil-food crop interactions. A number of studies of this aspect either considered only the mature Shea tree gardens or did not provide a clear distinction between the physiological states of the Shea tree. This was the motivation for this study where we compare variation in soil properties under mature and young Shea tree gardens with sites not having trees in Okwang sub-county, Otuke district. Five soil samples (up to 15 cm deep for top soil and 15-30 cm for sub-soil) were obtained per treatment using a soil auger. Our results show that in the top soil, only percent sand varied among the treatments, while, in the sub-soil, only percentage nitrogen and average phosphorus varied among the treatments. We also found that percentage top soil organic matter and percentage of sub-soil sand had negative strong correlations with maize and soybean yields, while percentage sub-soil clay had a strong positive correlation with maize and soybean yield. We conclude that variations in soil physical and chemical properties under Mature and Young Shea gardens only occur for those properties that have a direct link to tree residues

Bacterial Profile, Susceptibility Patterns, and Factors Associated with Culture-Positive Sputum Among HIV Patients Presenting with a Cough in Northern Uganda.

Sub-Saharan Africa bears the highest burden of HIV/AIDS infections and constitutes 72% and 69% of AIDS-related deaths and people living with HIV worldwide, respectively. Due to the relationship between pulmonary infections and HIV/AIDS, it is biologically plausible that the surge in morbidity and mortality among HIV/AIDS patients could be attributed to an increase in pulmonary infections among this cohort of patients. This study determined the bacterial profile, susceptibility patterns, and factors associated with culture-positive sputum among HIV patients presenting with cough at the Lira Infectious Disease Centre in Northern Uganda. This prospective cross-sectional study recruited 180 participants. Culture and sensitivity of the sputum samples were done to determine the causative organism and its susceptibility. Blood agar, MacConkey's agar, and Chocolate agar were deployed for the culture media. Antimicrobial susceptibility testing was done using the Kirby-Bauer disc diffusion test. Data were analyzed using SPSS version 26. Out of the 180 enrolled patients, 113 were females with a mean age of 45. Bacterial growth was seen in 56 of the 180 samples. The most common isolate was Staphylococcus aureus at 35.7% of the 56 growths. The minority that accounted for 1.8% each were Citrobacter freundii, Salmonella species and Acinetobacter baumanii, respectively. A combination of ceftriaxone and gentamicin was effective against most organisms isolated in this study. At the multivariate level of analysis, an unsuppressed viral load and low peripheral oxygen saturation were independently associated with a sputum culture-positive cough. HIV patients at LIDC who present with productive cough with low oxygen saturation and an unsuppressed viral load may be screened for Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumonia, Klebsiella pneumonia, and Enterobacter species infection. A combination of ceftriaxone and gentamicin may be used as empiric therapy before the culture and sensitivity results are available.

Determinants of smallholder membership in farmers’ groups in the pigeon pea-based farming system in Uganda

BackgroundMembership in farmers’ group (FGs) is an important social aspect of agricultural development. Little is known about the relative importance and benefits from participation in FGs in Uganda, specifically for pigeon pea smallholders in northern Uganda.MethodsWe conducted a cross-sectional survey with 257 smallholders to examine the factors that motivate farmer’s group membership and its influence on pigeon pea yield and technical efficiency (TE) in northern Uganda. We applied the Stochastic Production Frontier (SPF) model and complementary models to assess membership impact on pigeon pea yield and TE determinants, respectively. TE is defined as the degree to which smallholders use the minimum feasible farm inputs to produce a given level of pigeon pea grain.ResultsResults show that FG members were generally older and more experienced, and had better access to extension services (76%) and credit (43%) compared to non-members. Smallholders’ age, access to agricultural training, extension services, and the distance travelled to market centres were statistically significant (p < 0.05), thus limiting the likelihood of FG membership. TE for both groups was low and quite similar, at 63% and 59% for members and non-members, respectively, implying that both groups did not use the available farm resources to maximize pigeon pea yield.ConclusionOur results confirm that FG membership enhances smallholder’s access to extension, agricultural training services and credit. For northern Uganda, the study provides recommendations for increased government investment in the human, financial and physical capacity of extension agents as a strategy for rural development and improved livelihoods. In addition, policy incentives can encourage farmers to seek membership in farmers’ groups and related associations.