Post-conflict Northern Uganda Research Articles

Is the glass half full or half empty? A qualitative exploration on treatment practices and perceived barriers to biomedical care for patients with nodding syndrome in post-conflict northern Uganda.

BackgroundNodding syndrome has increasingly become an issue of public health concern internationally. The etiology of the disorder is still unknown and there are yet no curative treatments. We explored perceptions about treatment practices and barriers to health seeking for nodding syndrome in Pader and Kitgum districts in northern Uganda in order to provide data necessary for informing policy on treatment adherence and rehabilitations.MethodsWe used focus group discussions and individual interviews to gain deep insights into help-seeking and treatment practices for nodding syndrome. Purposive sampling was used to identify information-rich participants that included village health teams, community members not directly affected with nodding syndrome, district leaders, healthcare professionals, and caregivers of children affected with nodding syndrome. We used qualitative content analysis to analyze data and presented findings under distinct categories and themes.ResultsCaregivers and communities sought care from multiple sources including biomedical facilities, traditional healers, traditional rituals from shrines, and spiritual healing. Nodding syndrome affected children reportedly have showed no enduring improvement with traditional medicines, traditional rituals, and prayers. A substantial minority of participants reported minimal improvements in symptoms of convulsions with use of western medicines. Challenges involved in health seeking included; (1) health system factors e.g. long distances to facilities, frequent unavailability of medicines, few healthcare providers, and long waiting times; (2) contextual and societal challenges e.g. lack of money for transport and medical bills, overburdening nature of the illness that does not allow time for other activities, and practical difficulties involved in transporting the physically deformed and mentally retarded children to the health facilities.ConclusionsHelp-seeking for nodding syndrome is pluralistic and include use of traditional and biomedical practices. Western medicines admittedly showed at least short term control on nodding syndrome symptoms, especially convulsions and led in a few cases to regain of functional abilities. However, multiple barriers hinder health seeking and interfere with adherence to biomedical treatments. Regarding cure, there are hitherto no treatments participants perceive cure nodding syndrome.

Structural determinants of dual contraceptive use among female sex workers in Gulu, northern Uganda.

To describe the characteristics of female sex workers (FSWs) who do and do not use dual contraceptives (i.e. male condoms plus a non-barrier method) in Gulu, northern Uganda. The present analysis was based on data gathered as part of a questionnaire-based, cross-sectional study conducted between May 2011 and January 2012. FSWs aged 14 years or older were recruited through peer-led or sex worker-led outreach and community-based services. Logistic regression was used to identify correlates of dual contraceptive use. Among the 400 FSWs who participated, 180 (45.0%) had ever used dual contraceptives. In the multivariate model, dual contraceptive use was positively associated with older age (adjusted odds ratio [AOR] 1.09, 95% confidence interval [CI] 1.04-1.15; P=0.001), prior unintended pregnancy (AOR 1.53, 95% CI 1.01-2.34; P=0.046), and HIV testing (AOR 5.22, 95% CI 1.75-15.57; P=0.003). Having to rush sexual negotiations owing to police presence was negatively associated with dual contraceptive use (AOR 0.65, 95% CI 0.42-1.00; P=0.050). Although a history of unintended pregnancy and accessing HIV testing might promote contraceptive use, criminalized work environments continue to pose barriers to uptake of sexual and reproductive health services among FSWs in post-conflict northern Uganda. Integrated links between HIV and sexual health programs could support contraceptive uptake among FSWs.

TB co-infection with HIV/AIDS: a unique radiological presentation at Lacor hospital -a postconflict northern Uganda.

Background: Tuberculosis (TB) infection is thought to develop at any stage of HIV infection. Pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis are major complications in HIV/AIDS patients. Tuberculosis is still a diagnostic dilemma in low resource countries, with approximately 68.4% of all active pulmonary cases being negative for AAFBs on sputum. Additionally, it is reported that 46.7% of the active cases have disseminated TB with extra-pulmonary TB; further complicating the diagnosis in post-conflict northern Uganda. We therefore sought to clinically and radiologically characterize the various TB diagnosed in HIV/AIDS patients in this low resource and post conflict environment. Materials and Methods: A prospective cohort study was conducted on 320 sero-positive patients in Lacor Hospital. Clinical features, radiographic and ultrasonographic features of confirmed HIV sero-positive patients with suspected TB co-infection were assessed. Patients were recruited consecutively and the Chest radiographs, thoraco-lumbar and lumbar spine radiographs were taken and analyzed. Trans-thoracic ultrasonography (USS) for justified cases with pleural and pericardial effusion was conducted. FNAB and Tru-cut biopsies were performed for histological confirmation. Cases were followed-up for clinical outcomes (improvement and demise) within 2 months. The ethics and review committee of Gulu University Medical School approved the study and patients who did not meet the inclusion criteria were excluded. Data was analyzed using SPSS 13.0. Results: Atypical Chest x-ray finding included: reticulo-nodular infiltrates (69.7%); hilar and mediastinal adenopathy (40%); pleural effusion (27.5%) and miliary (20.6%). Typical Chest x-ray finding included: Apical reticulo-nodularities and fibro-cavitations (27.5%), and normal Chest x-ray (2.2%). Abdominal Ultrasonographic finding included: porta-hepatis, para-aortic and splenic hilum lymphadenopathy (15.9%); Ascitis (8.1%); TB splenitis (5.3%) and TB nephritis with peri-renal abscess (0.3%). PTB was observed in (53.4%); disseminated TB in (42.2%) and EPTB in (4.4%). Majority (81.9%) of the patients improved and was discharged on DOTS while 18.1% died. Conclusion: Imaging assessment is important adjuvant in HIV/AIDS/TB co-epidemic diagnosis. Early diagnosis and prompt management of TB co-infection ensures longer life and reduce morbidity and mortality.

‘Bones in the wrong soil’: reburial, belonging, and disinterred cosmologies in post-conflict northern Uganda

In the aftermath of the war in northern Uganda between the Lord's Resistance Army and the Ugandan government, most of the internally displaced have returned to pre-displacement areas of residence. As efforts to remake homes and reorder lives take centre stage, reburials from sites of displacement to former homesteads have become a widespread practice. Based on an ethnographic study in the formerly largest internal displacement camp in Acholiland, northern Uganda, we argue that the importance of reburial is twofold: first, it stems from a cosmological idiom in which, while in constant flux, belonging is spiritually embedded and territorially circumscribed; and second, the practice of reburial becomes implicated in post-conflict agendas of development and ‘reconstruction’ with pronounced material and cosmological consequences. Yet, contemporary debates in refugee studies have failed to grasp the importance of cosmological concerns and the ways these are bound up with questions of territoriality in post-displacement societies. It is therefore theoretically important to shift the contours of debate around post-conflict return and reconstruction from a focus on the critique of fluidity of social identities – or alternately emphasizing livelihoods and material ‘reconstruction’ – to an interrogation of the myriad ways in which place is made meaningful through ritual action invoking the material and the non-material alike, while at the same time being attentive to how the politics and materiality of post-conflict developmentalism continually shape, intersect with, and disrupt cosmological practice.

Major depressive disorder seven years after the conflict in northern Uganda: burden, risk factors and impact on outcomes (The Wayo-Nero Study).

BackgroundMajor depressive disorder (MDD) is a major public health burden in conflict areas. However, it is not known for how long and by how much the observed high rates of MDD seen in conflict settings persist into the post-conflict period.MethodsA cross sectional survey was employed seven years after the conflict in northern Uganda had ended in the three districts of Amuru, Gulu and Nwoya.ResultsThe prevalence of major depressive disorder (MDD) was 24.7% (95% CI: 22.9%-26.4%). The distribution by gender was females 29.2% (95% CI: 14.6%-19.5%) and males 17.0% (95% CI: 26.9%-31.5%). The risk factors for MDD fell under the broad domains of socio-demographic factors (female gender, increasing age, being widowed and being separated/divorced); distal psychosocial vulnerability factors ( being HIV positive, low social support, increasing war trauma events previously experienced, war trauma stress scores previously experienced, past psychiatric history, family history of mental illness, negative coping style, increasing childhood trauma scores, life-time attempted suicide, PTSD, generalized anxiety disorder and alcohol dependency disorder) and the psychosocial stressors (food insufficiency, increasing negative life event scores, increasing stress scores). ‘Not receiving anti-retroviral therapy’ for those who were HIV positive was the only negative clinical and behavioral outcome associated with MDD.ConclusionsThese findings indicate that post-conflict northern Uganda still has high rates for MDD. The risk factors are quite many (including psychiatric, psychological and social factors) hence the need for effective multi-sectoral programs to address the high rates of MDD in the region. These programs should be long term in order to address the long term effects of war. Longitudinal studies are recommended to continuously assess the trends of MDD in the region and remedial action taken.

A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda.

BackgroundArmed conflict has been described as an important contributor to the social determinants of health and a driver of health inequity, including maternal health. These conflicts may severely reduce access to maternal health services and, as a consequence, lead to poor maternal health outcomes for a period extending beyond the conflict itself. As such, understanding how maternal health-seeking behaviour and utilisation of maternal health services can be improved in post-conflict societies is of crucial importance. This study aims to explore the determinants (barriers and facilitators) of women’s uptake of maternal, sexual and reproductive health services (MSRHS) in two post-conflict settings in sub-Saharan Africa; Burundi and Northern Uganda, and how uptake is affected by exposure to armed conflict.MethodsThis is a qualitative study that utilised in-depth interviews and focus group discussions (FGDs) for data collection. One hundred and fifteen participants took part in the interviews and FGDs across the two study settings. Participants were women of reproductive age, local health providers and staff of non-governmental organizations. Issues explored included the factors affecting women’s utilisation of a range of MSRHS vis-à-vis conflict exposure. The framework method, making use of both inductive and deductive approaches, was used for analyzing the data.ResultsA complex and inter-related set of factors affect women’s utilisation of MSRHS in post-conflict settings. Exposure to armed conflict affects women’s utilisation of these services mainly through impeding women’s health seeking behaviour and community perception of health services. The factors identified cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women’s fear of developing pregnancy-related complications, status of women empowerment and support at the household and community levels, removal of user-fees, proximity to the health facility, and attitude of health providers.ConclusionsImproving women’s uptake of MSRHS in post-conflict settings requires health system strengthening initiatives that address the barriers across the individual, socio-cultural, and political and health system spheres. While addressing financial barriers to access is crucial, attention should be paid to non-financial barriers as well. The goal should be to develop an equitable and sustainable health system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0449-8) contains supplementary material, which is available to authorized users.

Tuberculosis (TB) Co-infection with HIV/AIDS: Clinical Presentation at Lacor Hospital, a Post-conflict Northern Uganda

Aims: To characterize the various clinical presentations of TB diagnosed in HIV/AIDS patients in the post-conflict Northern Uganda. Study Design and Setting: A prospective cohort study was conducted on 320 TB/HIV/AIDS coinfected patients at St. Mary’s Hospital, Lacor which is a specialist hospital in Gulu, Northern Uganda from July 2009 to July 2010. Methodology: Clinical features of confirmed 320 HIV sero-positive patients with confirmed TB coinfection (170 males and 150 females) recruited consecutively were studied and followed up for three months, their clinical presentations analyzed using SPSS version13.0. Ethics and Review Committee approved the study and those who did not meet the inclusion criteria were excluded. All patients gave an informed consent/Assent for the study.

Misconceptions to Primary Pyomyositis in Post-conflict Northern Uganda

Aims: To assess the perceptions and views of the community to the possible causes and the factors responsible for the high prevalence of primary pyomyositis in the region. Study Design: A cross-sectional study design Place and Duration of Study: Gulu Regional Referral Hospital and 4 other Hospitals in Northern Uganda from September 2011 to September 2013. Methodology: A cross-sectional study was conducted on primary pyomyositis patients, their relatives, health workers and managers of hospitals. Qualitative research methods such as Focus Group Discussions, Key Informant Interviews, and In-Depth Interviews were used to obtain the information on the possible causes, experiences and socio-economic effects of the disease to their family, community, health facility and the patients. The information obtained was triangulated before transcribing to an electronic text. Ethical approval for the study was obtained from the IRB of Gulu University Medical School and Uganda National Council of Science and Technology (UNCST IJTDH, 6(3): 86-93, 2015; Article no.IJTDH.2015.043 87 Thematic content analysis was used for data analysis. Results: There was a wide and varying view about pyomyositis, its causes, and its socio-economic effects to the patient, family, health facilities and communities. The knowledge of the community on the disease is completely at variant with that of health workers and this may present with lack of compliant of patients to the western medical treatment in health facilities. The community beliefs that it is caused by witchcraft and that traditional methods by use of red hot arrow was the best method of management of the disease which should take place in the villages and not health facilities. Conclusion: Pyomyositis is a common surgical disease and highly prevalent in Northern Uganda but there are misconceptions about its aetiology and approach to management.

‘These nodding people’: Experiences of having a child with nodding syndrome in postconflict Northern Uganda

BackgroundNodding syndrome, an epidemic epileptic encephalopathy of unknown etiology, has affected an estimated 1834 children in Northern Uganda. Children are being treated symptomatically but inconsistently with antiepileptic drugs. DesignTen semistructured interviews with caregivers of affected children and five focus group discussions with 23 relatives, teachers, and religious leaders were conducted to examine the experiences of affected families and communities in Kitgum and Pader districts.The researcher also did participant observation during MoH outreach clinics. Data collection was carried out from July to September 2012, and data were analyzed through inductive thematic analysis. ResultsNodding syndrome severely affects the children's ability to participate in daily life activities. Daily seizures and physical features such as salivating and stunting make them unable to pass as normal, and mood changes make it difficult for some to interact with others. Caregivers of children with nodding syndrome feel confined to their homes, and economic activities are reduced, which affects entire families, especially the education of healthy siblings. The familial clustering and the unknown etiology made many separate from the affected children when eating, sleeping, and having seizures because of a fear of transmission through saliva. Families struggle to provide care with minimal resources and have experienced a reduction in visitors since their children were affected by nodding syndrome. There were signs of apathy in patterns of care, and, generally, parents felt that antiepileptic medicine had brought only slight improvement in their child's condition because many had begun treatment when developmental milestones had already been lost. ConclusionsA consistent supply of antiepileptic medication is likely to reduce the stigma and fear of transmission, as the affected children's acceptance among others was greatly compromised whenever they had seizures. The loss and suffering involved with nodding syndrome are seen as a continuation of the confinement and trauma once caused by war, and a good regimen of medication is not the whole answer.

‘You sit in fear’: understanding perceptions of nodding syndrome in post-conflict northern Uganda

Background Nodding syndrome, a disabling epidemic epileptic encephalopathy, has affected an estimated 1,834 children in northern Uganda, with reports of as many as 3,000. Etiology is unknown and children are being treated symptomatically but inconsistently with anti-epileptic drugs. Design This qualitative study comprised 10 semi-structured interviews with caregivers of affected children and five focus group discussions with 23 participants; relatives, teachers, and religious leaders. Data collection and participant observation were carried out from July to September 2012 in Kitgum and Pader districts. The material was coded through inductive thematic analysis. Results Nodding syndrome has brought signs of discrimination in school admission procedures, founded in a fear of transmission. The suffering and loss caused by nodding syndrome is collective, and participants felt that nodding syndrome was viewed as a threat to the Acholi only, and that interventions had therefore been delayed. Multiple theories of causation exist, most commonly that the disease is caused by chemicals from bombs or that food aid distributed in IDP camps had expired or been poisoned. A feeling of uncertainty was present in all focus group discussions, fueled by the fact that results of investigations were not being shared with the communities. It was especially agonizing that CDC results had been given to the Ugandan government in 2010 but not to the public. The definitive fear is that the disease will be the end of the Acholi. Conclusions This study provided insight into the perceptions of communities affected by an unknown emerging disease. Families of affected children are grieving not only their child's illness; it is a loss of social value and of lineage. The loss and suffering involved with nodding syndrome should be seen in the context of the wider suffering of a society disrupted by violent conflict. The memory of war is omnipresent and is also how nodding syndrome is understood.

Resettlement and Gender Dimensions of Land Rights in Post-Conflict Northern Uganda

Summary Evidence shows even low levels of land conflict may undermine land governance and management, constrain agricultural productivity, and serve to perpetuate civil violence. This study estimates the effect of conflict-related displacement experiences on gender-differentiated land outcomes in Northern Uganda. We exploit exogenous variation in displacement to identify impacts on land among returning households. Results indicate that although female-headed households are disadvantaged in land outcomes, and land outcomes are affected by displacement experience, there is no joint effect in determining post-conflict land outcomes. Policy and programmatic attention to gender in land governance in Uganda should continue to be emphasized.

Every Day the War Continues in My Body: Examining the Marked Body in Postconflict Northern Uganda

Human bodies have assumed centre stage in modern warfare, and few armed conflicts epitomize this more than the war in northern Uganda, where both rebel groups and government forces violated bodily integrity and altered human tissue to communicate messages, humiliate the enemy and their support base, and dominate both people and territory. The injuries and disabilities inflicted during wartime continue to affect people long after the conflict has come to an end. People whose bodies were ‘marked’ continue to embody the war in everyday activities in terms of pain, disabilities and loss of mobility. In other words, the war continues in their bodies. Most marked bodies struggle to conform gender performances to expectations. Furthermore, a decline in the productivity of people with marked bodies and failure to reciprocate mutual beneficial interaction leads to ruptures within social capital networks, resulting in widespread stigmatization and discrimination. Yet, focus on the body seems to be largely missing in peace processes and transitional justice. In the aftermath of armed conflict, where so many bodies have been marked, disability mainstreaming should become a quintessential element in transitional justice. This goes beyond medical interventions, meaning that in all transitional justice thinking and practice, attention is paid to how marked bodies can be included, participate and benefit. To ensure inclusion of marked bodies and other victim groups, more micro-analysis is needed that distinguishes survivor groups in terms of their day-to-day survival concerns, challenges, experiences, needs and aspirations.

Patterns and Predictors of Self-Medication in Northern Uganda

Self-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult (≥18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method. One respondent who reported having an illness within three months in each household was recruited. In each household, information was obtained from only one adult individual. Data was analyzed using STATA at 95% level of significance. The study found that a high proportion (75.7%) of the respondents practiced antimicrobial self-medication. Fever, headache, lack of appetite and body weakness were the disease symptoms most treated through self-medication (30.3%). The commonly self-medicated antimicrobials were coartem (27.3%), amoxicillin (21.7%), metronidazole (12.3%), and cotrimoxazole (11.6%). Drug use among respondents was mainly initiated by self-prescription (46.5%) and drug shop attendants (57.6%). On average, participants obtained 13.9±8.8 (95%CI: 12.6–13.8) tablets/capsules of antimicrobial drugs from drug shops and drugs were used for an average of 3.7±2.8 days (95%CI: 3.3–3.5). Over half (68.2%) of the respondents would recommend self-medication to another sick person. A high proportion (76%) of respondents reported that antimicrobial self-medication had associated risks such as wastage of money (42.1%), drug resistance (33.2%), and masking symptoms of underlying disease (15.5%). Predictors of self-medication with antimicrobial agents included gender, drug knowledge, drug leaflets, advice from friends, previous experience, long waiting time, and distance to the health facility. Despite knowledge of associated risks, use of self-medication with antimicrobial drugs in management of disease symptoms is a common practice in post-conflict northern Uganda.

The Reconciliation Attitudes of Former Child Soldiers in Northern Uganda

Introduction: While the reintegration processes of former child soldiers have been widely studied, little attention has been paid to their reconciliation attitudes, and in particular possible associations between these reconciliation attitudes and different risk factors. Therefore, this study examined reconciliation attitudes of formerly abducted adolescents living in post-conflict Northern Uganda, compared to non-conscripted youth, and possible associations with war-related stressful experiences and daily stressors. Methods: Four hundred forty five war-affected adolescents living in Northern Uganda were included, of which 214 (48.1%) were formerly abducted. All completed questionnaires on exposure to stressful war experiences (Stressful War Events Questionnaire), daily stressors (Adolescent Complex Emergency Daily Stressors Scale), and attitudes towards reconciliation (Openness to Reconciliation Questionnaire). Associations between several sociodemographics, war-related and daily stressors and reconciliation attitudes were explored using hierarchical linear regression models. Results: Findings showed that conscripted youth experienced more stressful war experiences and daily stressors than non-conscripted youth, and that they scored higher on the different reconciliation attitudes (goodwill attitudes, positive feelings towards the future, feelings of avoidance and of revenge). Having been recruited as child soldier was associated with more revenge attitudes compared to non-abducted children, and girls showed more goodwill attitudes than boys. Above, a larger exposure to war-related and daily stressors was associated with overall higher reconciliation attitudes, although particular interaction effects showed complex relationships here. Conclusion: Overall war-related stressors, daily stressors and, to a lesser degree, abduction status and gender are associated with reconciliation attitudes. The findings have implications for agencies working to promote postconflict recovery among war-affected children.

Mind the gaps: a qualitative study of perceptions of healthcare professionals on challenges and proposed remedies for cervical cancer help-seeking in post conflict northern Uganda

BackgroundThere are limited data on perceptions of health professionals on challenges faced by cervical cancer patients seeking healthcare in the developing countries. We explored the views of operational level health professionals on perceived barriers to cervical screening and early help–seeking for symptomatic cervical cancer and the proposed remedies to the challenges.MethodsFifteen key informant interviews were held with health professionals including medical directors, gynecologists, medical officers, nurses and midwives in the gynecology and obstetrics departments of two hospitals in northern Uganda during August 2012 to April 2013. We used content analysis techniques to analyze the data.ResultsHealth professionals’ perceived barriers to cervical cancer care included: (i) patients and community related barriers e.g. lack of awareness on cervical cancer and available services, discomfort with exposure of women’s genitals and perceived pain during pelvic examinations, and men’s lack of emotional support to women (ii) individual healthcare professional’s challenges e.g. inadequate knowledge and skills about cervical cancer management; (iii) health facility related barriers e.g. long distances and lack of transport to cervical cancer screening and care centers, few gynecologists and lack of pathologists, delayed histology results, lack of established palliative care services and inadequate pain control; and (iv) health policy challenges e.g. lack of specialized cancer treatment services, and lack of vaccination for human papilloma virus. Other challenges included increased number of cervical cancer patients and late stage of cervical cancer at presentations.ConclusionsOperational level healthcare professionals in northern Uganda reported several practical challenges facing cervical cancer care that influence their decisions, management goals and practices. The challenges and proposed remedies can inform targeted interventions for early detection, management, and control of cervical cancer in Uganda.

Neuropsychiatric perspectives on nodding syndrome in northern Uganda: A case series study and a review of the literature

Nodding Syndrome (NS), previously called Nodding Disease, is a chronic and debilitating illness affecting thousands of children aged 3-18 years in post-conflict Northern Uganda and South Sudan. Characterised by malnutrition, stunted growth, mental retardation and seizures, some researchers have designated it as epilepsy. With reports appearing in Northern Uganda in1997, NS reached epidemic proportions around 2000-2003 when people were moved into Internally Displaced People's (IDP) camps. Investigations for infections (onchocerciasis) and toxins have been inconclusive as to cause, treatment or outcome. No study has addressed the possible relationship of NS to childhood war-trauma experiences. To explore a possible relationship of exposure to prolonged war-trauma and the emergence of epidemic NS in Northern Uganda. This study was a case-series descriptive psychiatric naturalistic field observations of NS cases from homesteads in Northern Uganda and psychiatric investigations and treatment of NS cases referred to Mulago National Referral and Teaching Hospital. Detailed Psychiatric clinical evaluations and field observations revealed that NS children had been exposed to severe war-related psychological and physical trauma as well as non-specific CNS insults including untreated CNS infections/infestations and malnutrition possibly causing seizures. Many children suffered post-traumatic stress disorder (PTSD) and depression. NS could present as an association of childhood complex PTSD, (called Developmental Trauma Disorder), occurring in the chronically war-traumatised children of Northern Uganda, complicated by severe prolonged depression with its characteristic symptoms of psychomotor retardation, anxiety, anhedonia and anorexia. This, coupled with food shortages, resulted in malnutrition, wasting and stunted growth with severe avitaminoses. Many children had seizures. All this calls for multi-disciplinary treatment approaches.

The Role of Rotary Clubs in Post-Conflict Peace Building: A Case of Northern Uganda (2006-2010)

This paper presents the Peace building experience of Rotary Clubs in Northern Uganda between 2006 and 2010, so as to identify their contributions in post-conflict peace building processes. Through the Reflective Peace Practice (RPP) analytical framework, the paper presents an insight into Rotary clubs’ post-conflict Peace building interventions in the Northern Ugandan districts of Gulu, Kitgum, Lira and Pader. The paper is premised on the theoretical framework of Rotary’s outline of international service that identifies the paths to peace as: patriotism, conciliation, freedom, progress, justice, sacrifice, and loyalty. The paper discusses Rotary clubs’ peace building projects in Northern Uganda as clustered along three generic lines: the improvement of health, alleviation of poverty, and education support. The effectiveness of the “paths to peace” principles was hampered by challenges such as: the eroded core values of the people owing to life in Internally Displaced People’s (IDP) camps, the beneficiary non-ownership of Rotary projects, the difficulty in recruitment and maintenance of Rotary clubs’ membership as well as limited funding. The paper acknowledges that Rotary clubs’ approaches to peace building especially the peaceplus ‘model’ has potential if adapted to the local context, to contribute to conflict transformation efforts in post conflict Northern Uganda

Tell them you are planning for the future: Gender norms and family planning among adolescents in northern Uganda

ObjectiveTo understand how social norms about gender and reproduction shape fertility desires and use of family planning among adolescents in post-conflict northern Uganda. MethodsA study was conducted in 2 post-conflict districts in north-central Uganda. Life histories were collected from 40 adolescents (20 males, 20 females). In-depth interviews were conducted with 40 individuals (20 males, 20 females) who were identified as significantly influencing the lives of adolescents in research areas. Data were analyzed through inductive and deductive approaches, facilitated by the qualitative software program ATLAS.ti (v.5.6). ResultsRigid gender norms and post-conflict economic realities create an environment in which young people struggle to bridge the gap between idealized and experienced gender roles. Social changes brought about by the conflict, combined with cultural values and gender norms, strongly influence fertility desires and contraceptive use. Despite support for smaller, spaced families, gendered barriers to adolescent use of family planning and access to services are significant, even among married couples. ConclusionThe increased recognition of the determining influence of gender on adolescent reproductive health provided by studies such as this can encourage greater investment in gender transformative interventions with the potential to significantly improve sexual and reproductive health across the life course.

Nodding syndrome or disease? On the conceptualization of an illness-in-the-making

ObjectiveTo explore processes of conceptualizing nodding syndrome (NS), an unknown illness which has been reported to affect thousands of children in post-conflict northern Uganda, in South Sudan and in Tanzania.DesignThis qualitative study comprised 40 in-depth interviews with affected families, health workers and politicians during five months of fieldwork in northern Uganda and a review of available reports, newspapers and academic literature on NS. In addition, observations have been made at treatment centers and during outreaches and meetings. Focus is put on how meanings of key terms related to NS are produced and negotiated. Attention is being paid to the circulation of different discourses and explanatory models.ResultsDiscourses and explanatory models play an active role in the conceptualization of illness, as much by medical personnel as by affected families and the media. The prominent use of biomedical terms in the academic discourse on NS is striking; links are suggested with onchocerciasis and epilepsy. In contrast, the local discourse associates NS with social issues. The illness experiences are connected to the trauma of past conflict, to poverty and to (region-bound) frustration over neglect. The cultural significance of physical symptoms raises the question of the impact of culture on health.ConclusionBy only looking at the biomedical significance of this new syndrome, we will miss important aspects of how this illness is being experienced and understood. In our future dealings with NS, we will have to consider and re-conceive the relation between culture and neurobiology.

<em>Peacebuilding through Education in Postconflict Northern Uganda:</em> The Importance of Placing War-Affected Youth in Community-Oriented Schools

We investigate the role of education in the reintegration of war-affected youth in Uganda by combining participant-observation data with a micro-level survey of different educational settings. By examining the effects of different educational settings upon the reintegration of war-affected youth in contemporary Uganda, we show that the greater the level of discipline, if embedded within a community-oriented structure, the greater the chance for effective reintegration of war-affected youth within their social settings. Additionally, the more targeted the use of financial resources, as long as they go beyond a basic threshold, the greater the chance for education to work as an engine for the reintegration of war-affected youth.