Systems In Uganda Research Articles

Breast cancer care in Uganda: A multicenter study on the frequency of breast cancer surgery in relation to the incidence of breast cancer

BackgroundBreast cancer is the most common cancer in women worldwide. Considerable funding and efforts are invested in breast cancer research and healthcare, but only a fraction of this reaches women and healthcare systems in low income countries. Surgical treatment is an essential part of breast cancer care, but access to surgery is in general very limited in low income countries such as Uganda. In this study, the previously unknown nationwide rate of breast cancer surgery was investigated.Methods and findingsThis was a multicenter, retrospective study, investigating breast cancer surgery in the public healthcare system in Uganda. Data were collected from operating theater registries at primary, secondary and tertiary level healthcare centres throught the country, including 14 general hospitals, the 14 regional referral hospitals and the national referral hospital. Patients who underwent major surgery for breast cancer at these hospitals during 2013 and 2014 were included. The number of breast cancer procedures performed, geographical variation, level of healthcare staff performing surgery and patient characteristics were investigated. After correction for missing data, a total of 137 breast cancer procedures were performed each year within the public healthcare system, corresponding to 5.7% of the breast cancer incidence in the country at that time. Most procedures (n = 161, 59.0%) were performed at the national referral hospital by qualified surgeons. Many of the patients were young; 30.1% being less than 40 years old. The proportion of male breast cancers in the study was large (6.2%).ConclusionsThe rate of breast cancer surgery in Uganda is minimal and in several parts of the country breast cancer surgery is not performed at all. More resources must be directed towards breast cancer in low income countries such as Uganda. The fact that the patients were young calls for further research, prevention and treatment specifically targeting young women in the study setting.

Malaria burden through routing reporting: Relationship between incidence estimates

ObjectiveTo evaluate the relationship between test positivity rate and test-confirmed malaria case rate both in time and space, to provide better understanding of the utility and representativeness of HMIS data for changing malaria burden in endemic settings.IntroductionRoutine surveillance is an important global strategy for malaria control. However, there have been few studies comparing routine indicators of burden, including test positivity rate (TPR) and test-confirmed malaria case rates (CMCR), over spatial and temporal scales.MethodsWe studied the relationship between these indicators in children under 11 years, presenting with suspected malaria at outpatient department clinics in three health facilities in locations of varying transmission across Uganda. We evaluated trends in each indicator over time (month) and space (by village) and explored the relationship between them using multivariable regression models.ResultsOverall, 65,710 participants visited the three clinics during the study period. Pairwise relationships between TPR and CMCR showed good agreement over time, particularly for TPR’s below 50% and during low transmission seasons, but the relationship was complex at the village level. Village mean annual TPR remained constant while CMCR was drastically reduced with increased distance from health facility, highlighting health care access’ importance. The forth quartile of distance from the health facility, relative to the first, was associated with reduction in CMCR with IRR of 0.40 (95% CI: 0.23-0.63; p=0.001), 0.55 (0.40-0.75; p<0.001), and 0.25 (0.12-0.51; p<0.001) for Nagongera, Kihihi, and Walukuba respectively. Regression analysis results emphasized a non-linear (cubic) relationship between TPR and CMCR, after accounting for month, village, season and demographic factors.ConclusionsAltogether, these results suggested a strong non-linear relationship between the two indicators regardless of transmission setting. However, the current malaria surveillance system in Uganda may under-represent burden from patients living furthest from sentinel health facilities.

Tree Seed and Seedling Supply and Distribution System in Uganda

In Uganda, the tree seed sector is largely centralized, limiting access by farmers to high quality seedlings due to distant supply locations. This has left suppy of most of the tree germplasm to the informal sector, characterized by road-side tree nurseries and seed dealers who have limited knowledge on seed sourcing and collection and seedling production. Through semi-structured and key informant interviews, a sample survey involving 73 smallholder tree seed collectors, processors and tree nursery operators, this study investigates the role of government, smallholder tree seed collectors, processors and suppliers, nursery operators and the private sector in Uganda’s tree seed and seedling production and supply system. The study also identifies constraints in the seed and seedlings distribution system in Uganda and suggests key policy and institutional reforms. The source of tree germplasm is found to be heavily influenced by ease of access. About 60%) of the germplasm is purchased by individual farmers for their own planting. Low quality seed, limited seed sources and overgrown seedlings remain key deficiencies in the tree seed sector. Potential business opportunities in the tree seed and seedling production and supply value chain are identified, including production and sale of high quality germplasm. These will enhance availability of tree germplasm of high quality to meet the growing need for afforestation and reforestation in Uganda.

Evaluation of Users’ Knowledge and Concerns of Biometric Passport Systems

The increase in terrorism and identity fraud has forced governments worldwide to make a combined effort to enhance the security of national borders. Biometric passports are the emergent identity travel document deployed in guaranteeing the safekeeping of the entry point of the border and limiting the usage of counterfeit documents. This study analyzes users’ concerns and threats to the biometric passport delivery system in Uganda, where the first biometric passports are planned for rollout in 2019. We used a mixed approach to compute and articulate the results. Factors impacting fear of technology like disclosure of personal data, improper data transmission, and data abuse were determined. Relevance knowledge of preferred technology such as the personal experience of the technology, data privacy awareness and perceived usefulness was confirmed. Threats and attacks on the technology such as counterfeit and brute-force were identified. It is important for policymakers and security expertise to understand that biometric technologies evoke fears of privacy and public liberties infringements. Therefore, end user’s acceptance of biometric passports will be dependent on the degree of trust in the technology itself and in those operating the applications.

A comparative analysis of two paddy irrigation schemes under contrasting water management of participatory and top-down systems in Uganda

This research focused on two large-scale paddy irrigation schemes of Doho (1000 ha) and Lwoba (700 ha) in Uganda for a comparative analysis of major factors affecting the effectiveness of water management. The schemes have almost the same irrigation and farming conditions, while they adopt contrasting water management methods of participatory and top-down in Doho and Lwoba, respectively. A questionnaire survey targeting the farmers in both schemes on their farming, yields and evaluation of water management was conducted, and the results were analyzed by paying attention to the locations of their farms. The survey reveals that the average yield is higher in Lwoba than in Doho. A tendency of lower evaluation on water distribution by farmers in Doho is found especially in the downstream part at the terminal canal level. Doho has the government’s operation in the main facilities with farmer operation in the on-farm systems. In contrast, the water management in Lwoba is totally controlled by a single landlord of the whole scheme, appointing block leaders, water guards and supervisor who watch the block leaders and his children as farmer to spy on the block leaders. The landlord has strong incentives for higher and stable rent income, thus requiring this strong monitoring and feedback system to achieve equitable water management. It is concluded that for the successful achievement of higher water productivity within the framework of PIM, one of the main problems is to install a practically effective system to secure the equitable water distribution in a democratic manner.

Feasibility assessment of grid-tied rooftop solar photovoltaic systems for industrial sector application in Uganda

This paper proposes an alternative approach to determination of rooftop area suitable for solar PV deployment by using validated open source tools that require minimal computational know-how. The paper goes ahead to evaluate the feasibility of implementing grid-tied rooftop solar PV systems in the industrial sector in Uganda. For the considered sample space of 36 industries, a total suitable rooftop area for solar PV application was found to be around 164594.56 m2 and would be able to accommodate about 25.4 MWp capacity. The investigation of energy generation potential showed the possibility of annual energy yield in the range of 1046 kWh/kW–1344 kWh/kW for all roof orientations and roof tilt angles in the range 0°–45°. The economic analysis for PV system in Uganda resulted in an LCOE of 5.75 US cent/kWh, internal rate of return of 7% and BCR of 1.27 for a system implemented entirely on equity. The sensitivity to debt of economic analysis indicated that the project with short loan period of 5 years was still feasible when the loan share of investment cost reached up to 75%.

Assessing the potential of trees to sustain soil fertility in the banana agroforestry system in Uganda

ABSTRACTLow indigenous soil fertility is cited as a major problem in Uganda, where trees are integrated with bananas. Dominant trees were subjected to pruning regimes; 0, 25 and 50%. Litter decomposition was assessed using 480 bags (4 bags per tree × 4 trees × 3 regimes × 5 sites × 2 seasons). Decomposition was in order Ficus natalensis > Albizia coriaria > Mangifera indica > Artocarpus heterophyllus and highest in the wet season. Sprouting was highest in the dry season. Albizia coriaria had longest sprouts. Based on our results Ficus natalensis and Albizia coriaria should be integrated more and 50% pruning regime should be done.

Uganda public health fellowship program’s contribution to building a resilient and sustainable public health system in Uganda

ABSTRACTBackground: Low-income countries with relatively weak-health systems are highly vulnerable to public health threats. Effective public health system with a workforce to investigate outbreaks can reduce disease impact on livelihoods and economic development. Building effective public health partnerships is critical for sustainability of such a system. Uganda has made significant progress in responding to emergencies during the past quarter century, but its public health workforce is still inadequate in number and competency.Objectives: To reinforce implementation of priority public health programs in Uganda and cultivate core capacities for compliance with International Health Regulations.Methods: To develop a competent workforce to manage epidemics and improve disease surveillance, Uganda Ministry of Health (MoH) established an advanced-level Field Epidemiology Training Program, called Public Health Fellowship Program (PHFP); closely modelled after the US CDC’s Epidemic Intelligence Service. PHFP is a 2-year, full-time, non-degree granting program targeting mid-career public health professionals. Fellows spend 85% of their field time in MoH placements learning through service delivery and gaining competencies in major domains.Results: During 2015–2018, PHFP enrolled 41 fellows, and graduated 30. Fellows were placed in 19 priority areas at MoH and completed 235 projects (91 outbreaks, 12 refugee assessments, 50 surveillance, and 60 epidemiologic studies, 3 cost analysis and 18 quality improvement); made 194 conference presentations; prepared 63 manuscripts for peer-reviewed publications (27 published as of December 2018); produced MoH bulletins, and developed three case studies. Projects have resulted in public health interventions with improvements in surveillance systems and disease control.Conclusion: During the 4 years of existence, PHFP has contributed greatly to improving real-time disease surveillance and outbreak response core capacities. Enhanced focus on evidence-based targeted approaches has increased effectiveness in outbreak response and control, and integration of PHFP within MoH has contributed to building a resilient and sustainable health system in Uganda.

English

Weeds represent one of the major biological constraints to upland rice production in low input agricultural systems. The effects of weeding regimes and rice cultivars on weed growth and rice yield were investigated over three seasons. Four weeding regimes [0 (no weeding control), 1, 2, and 3] and three popular rice varieties (NARIC 2, a local cultivar, and NERICA 4), were tested in 4x3 factorial experiment in a Randomised Complete block with three replicates. The most important weed species recorded were; Biden pilosa, Commelina benghalensis L., Euphorbia hirta L., Micrococca mercurialis Benth., Galisonga parviflora Cav, Sida rhombifolia L., Triumfeta spp, Guizotia scabra, Celocia trigyna, Cyprus rotundus, Panicum Maximum Jacq, and Imperata cylindrica L. Across cultivars, the best weeding regimes for weed control and rice yields were single weeding and weeding twice. Differences among interaction effects between variety and weeding regime were not significant for most traits, except ripening ratio and grain yield in experiment one and experiment two. Across weeding regimes, NERICA 4 out yielded the other varieties in all the three experiments. However, a single well timed hand hoe weeding, together with the use of a cultivar with good adaptation to unfavourable rice growing conditions, such as NERICA 4, would increase land and labour productivity of upland rice-based systems in Uganda. Key words: Genotype, rice, upland, weeding regimes, yield.

Assessing the Extent of Historical, Current, and Future Land Use Systems in Uganda

Sustainable land use systems planning and management requires a wider understanding of the spatial extent and detailed human-ecosystem interactions astride any landscape. This study assessed the extent of historical, current, and future land use systems in Uganda. The specific objectives were to (i) characterize and assess the extent of historical and current land use systems, and (ii) project future land use systems. The land use systems were defined and classified using spatially explicit land use/cover layers for the years 1990 and 2015, while the future prediction (for the year 2040) was determined using land use systems datasets for both years through a Markov chain model. This study reveals a total of 29 classes of land use systems that can be broadly categorized as follows: three of the land use systems are agricultural, five are under bushland, four under forest, five under grasslands, two under impediments, three under wetlands, five under woodland, one under open water and urban settlement respectively. The highest gains in the land amongst the land use systems were experienced in subsistence agricultural land and grasslands protected, while the highest losses were seen in grasslands unprotected and woodland/forest with low livestock densities. By 2040, subsistence agricultural land is likely to increase by about 1% while tropical high forest with livestock activities is expected to decrease by 0.2%, and woodland/forest unprotected by 0.07%. High demand for agricultural and settlement land are mainly responsible for land use systems patchiness. This study envisages more land degradation and disasters such as landslides, floods, droughts, and so forth to occur in the country, causing more deaths and loss of property, if the rate at which land use systems are expanding is not closely monitored and regulated in the near future.

An atoxigenic L-strain of Aspergillus flavus (Eurotiales: Trichocomaceae) is pathogenic to the coffee twig borer, Xylosandrus compactus (Coleoptera: Curculionidea: Scolytinae).

This study isolated and evaluated virulence of fungal entomopathogens of Xylosandrus compactus - an important pest of Robusta coffee in Sub-Saharan Africa. A survey was conducted in five farming systems in Uganda to isolate entomopathogens associated with X. compactus. Four fungal isolates were screened for virulence against X. compactus in the laboratory at 1 × 107 conidia ml-1 where an atoxigenic L-strain of A. flavus killed 70%-100% of all stages of X. compactus compared with other unidentified isolates which caused 20%-70% mortalities. The time taken by A. flavus to kill 50% of X. compactus eggs, larvae, pupae and adults in the laboratory was 2-3 days; whereas the other unidentified fungal isolates took 4-7 days. The concentrations of A. flavus that killed 50% of different stages of X. compactus were 5 × 105 , 12 × 105 , 17 × 105 and 30 × 105 conidia ml-1 for larvae, eggs, pupae and adults respectively. A formulation of A. flavus in oil caused higher mortalities of X. compactus larvae, pupae and adults in the field (71%-79%) than its formulation in water (33%-47%). The atoxigenic strain of A. flavus could therefore be developed into a safe biopesticide against X. compactus.

Ugandan providers\u2019 views on the acceptability of contraceptive self-injection for adolescents: a qualitative study

BackgroundSelf-injection of subcutaneous depot medroxyprogesterone acetate may offer greater discretion and increase access to injectable contraception, particularly for those who face challenges accessing clinic services. In particular, unmarried adolescents often encounter stigma when seeking services, and may also lack the financial means to travel to clinics on the quarterly basis that injectable contraception requires. Whether self-injection is offered to women on a wide scale basis, and to adolescents specifically, will depend in part upon the willingness of providers to train clients of diverse ages and educational backgrounds. This study explores the views of providers with regard to self-injection as an option for women and adolescents in Uganda.MethodsIn-depth qualitative interviews were conducted with family planning providers in Gulu district, to understand their views on injectable self-injection for women, with a specific focus on unmarried adolescents ages 15 to 19 years. The in-depth interviews, which lasted up to 60 min were audio-recorded, translated and transcribed simultaneously, and analyzed using Atlas.ti software to identify key themes and common perspectives.ResultsA total of 40 health care providers were interviewed with equal numbers of each type (public, NGO, and private clinics, pharmacies, and community-based health workers). While most providers were receptive to self-injection for adult women, fewer than half were supportive of adolescent self-injection. Their reservations focused on age, marital status and parity concerns around adolescent use of the injectable more broadly, and concerns about the ability of adolescents to self-inject safely.ConclusionsSelf-injection presents an opportunity to reduce the enormous burden on the public sector health system in Uganda, which is particularly compounded by the heavy reliance on injectable contraception requiring quarterly clinic visits. The results of this study reveal a level of cautious support for self-injection among providers when it comes to self-injection by adult women. With respect to adolescent clients, family planning policymakers and program implementers should design, implement, and evaluate self-injection interventions with the needs of adolescent clients uppermost in mind, recognizing that extra attention will likely be needed to reduce provider-imposed restrictions on adolescent access to this injectable delivery modality.

Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives

BackgroundAlthough there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda.MethodsA qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability.ResultsIntervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade.ConclusionOur study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.

Technical Efficiency in Seed Potato Production Systems in Uganda

This study established the level of technical efficiency and its determinants among the informal and formal seed potato producers in the southwestern highlands agro - ecological zone of Uganda. A multi- stage sampling procedure was employed to select 636 households (499 informal seed producers and 137 formal seed producers) from which data was collected for two seasons using a semi - structured questionnaire. Data was analyzed using the stochastic frontier approach with a one - step approach. Maximum likelihood estimates for the efficiency parameters showed that both informal and formal seed potato producers were not fully efficient. The mean technical efficiency for informal and formal seed potato producers was 8 1 .4 and 80.4 percent respectively. In terms of yield loss, informal and formal seed potato producers respectively lost an average of 981 and 1,208 kg/acre of seed potato tubers due to inefficiency factors . Specifically, off- farm income source, scale of production, seasonal variation, access to extension services and seed producer being male positively influenced informal seed producers’ technical efficiency while producers’ level of education and seed potato variety diversity negatively influenced their efficiency. For formal seed producers, technical efficiency was influenced positively by producers’ education and negatively by household size. The study suggests that there is an opportunity to improve technical efficiency of informal and formal seed producers by 19 and 20 percent respectively. Therefore, this calls for increased investment in developing and promoting high yielding varieties, provision of extension services, input intensification and addressing gender issues in seed potato production in the context of limited arable land .

The importance of on-farm biosecurity: Sero-prevalence and risk factors of bacterial and viral pathogens in smallholder pig systems in Uganda

BackgroundThe productivity of pigs in smallholder systems is affected by high disease burden, most of which might not be obvious, with their epidemiology and impact being poorly understood. This study estimated the seroprevalence and identified the risk factors of a range of bacterial and viral pathogens of potential economic and public health importance in domestic pigs in Uganda. A total of 522 clinically healthy pigs were randomly selected from 276 pig farms in Masaka (142) and Lira (134) districts of Uganda in 2015. ResultsOverall the highest animal prevalence was found for Streptococcus suis 73.0% (CI95: 67.0–78.3) in Lira and 68.2% (CI95: 62.7–73.4) in Masaka; followed by Porcine circovirus type 2 with 50.8% (CI95: 44.5–57.2) in Lira and 40.7% (CI95: 35.2–46.5) in Masaka and Actinobacillus pleuro-pneumoniae, 25.6% (CI95: 20.4–31.6) in Lira and 20.5% (CI95: 16.2–25.6) in Masaka. Mycoplasma hyopneumonia prevalence was 20.9% (CI95: 16.2–26.6) in Lira and 10.1% (CI95: 7.1–14.1) in Masaka, while Porcine parvovirus was 6.2% (CI95: 4.0–9.7) in Masaka and 3.4% (CI95: 1.7–6.6) in Lira. Less common pathogens were Influenza A, 8.5% (CI95: 5.6–12.8) in Lira and 2.0% (CI95: 0.9–4.5) in Masaka and Porcine Reproductive and Respiratory Syndrome Virus, 1.7% (CI95: 0.7–4.3) in Lira and 1.3% (CI95: 0.5–3.5) in Masaka. Even less common was Rotavirus A with 0.8% (CI95: 0.2–3.0) in Lira and 0.7% (CI95: 0.2–2.5) in Masaka; the same was for Aujeszky virus with 0.4% (CI95: 0.7–2.4) in Lira and 0.0% (CI95: 0.0-0.1) in Masaka. Co-infection with two pathogens was common and there was a significant association of M. hyo and PCV2 co-occurrence (p = 0.016). Multivariate analysis showed that for S. suis the use of disinfectant reduced odds of sero-positivitey (OR = 0.15; p = 0.017) and pigs less than 6 months were more likely to be infected than older pigs (OR = 3.35; p = 0.047). For M. hyo, crossbred pigs had higher odd of infection compared to local breeds (OR = 1.59; p < 0.001). ConclusionsThe studied pathogens have high prevalences in smallholder pig production systems and might be silent killers, thus affecting productivity and there is a possibility that some pathogens could spread to humans. Given the limited knowledge of veterinary workers and the poor diagnostic capacities and capabilities in these systems, the diseases are potentially usually under-diagnosed. These findings constitute baseline data to measure the impact of future interventions aiming to reduce disease burden in the pig production systems in Uganda.

Investing in multi-stakeholder dialogue to address natural resource competition and conflict

ABSTRACTHow can multi-stakeholder dialogue help assess and address the roots of environmental resource competition and conflict? This article summarises the outcomes and lessons from action research in large lake systems in Uganda, Zambia, and Cambodia. Dialogues linking community groups, NGOs and government agencies have reduced local conflict, produced agreements with private investors, and influenced government priorities in ways that respond to the needs of marginalised fishing communities. The article details policy guidance in four areas: building stakeholder commitment, understanding the institutional and governance context, involving local groups in the policy reform process, and embracing adaptability in programme implementation.

Building an AP Quality Management System in Uganda: My Month on the Inaugural ASCP Trainee Global Health Fellowship

Building an AP Quality Management System in Uganda: My Month on the Inaugural ASCP Trainee Global Health Fellowship

Canopy management, leaf fall and litter quality of dominant tree species in the banana agroforestry system in Uganda

Small-scale farmers in the banana-coffee agro-zone of Central Uganda plant and maintain trees to provide a range of benefits. However, the impact of trees on soil fertility and crop yields is small. On many farms, trees exist in infinite numbers, compositions, with no proper spacing, sequencing and canopy management recommendations. The objectives of this study were to: quantify and compare leaf fall and leaf litter biomass for the dominant tree species subjected to different pruning regimes and during different seasons and determine the nutrient concentrations in leaf litter materials in order to assess their potential to improve soil fertility. A survey was conducted on 30 randomly selected farms to examine and document the tree species. Four tree species were dominant; Ficus natalensis (15.3%), Albizia coriaria (10.2%), Artocarpus heterophyllus (10.0%) and Mangifera indica (9.2%). Experiments such as canopy pruning, collecting leaf fall and weights of pruned leaf biomass were established for the four dominant trees on five randomly selected farms. A total of 120 trees were subjected to three pruning regimes (0%, 25% and 50%). Litter traps (1 m × 1 m) were placed 2 m from the tree trunk to collect falling leaves. Leaf biomass was collected from pruned branches and eighed. Leaf samples were collected from pruned leaves and a composite sample analysed for carbon and nutrient concentrations. Results showed that 40 tree and shrub species belonging to 21 families existed on farms. Leaf fall was highest in the dry season and A. Heterophyllus registered the highest amount. Leaf biomass from pruned trees was heaviest for M. indica (42.4 ±3 kg) in the wet season and at the 50% pruning regime (45.7± 2.1kg). Total nutrient concentrations were in the order A. coriaria > F. natalensis > A.heterophyllus > M.indica. We concluded that F. natalensis and A. Coriaria should be integrated more into the agroforestry system to improve soil fertility. A.heterophyllus and M.indica should be planted on farm boundaries. The 50% pruning regime was the best and should be carried out during the wet season. Key words : Tree species, canopy management, leaf fall, nutrient concentrations, soil fertility

\u201cWe are like co-wives\u201d: Traditional healers' views on collaborating with the formal Child and Adolescent Mental Health System in Uganda

BackgroundEarly identification and management of mental illness in childhood and adolescence helps to avert debilitating mental illness in adulthood but the attention given to Child and Adolescent Mental Health (CAMH) has until recently been low. Traditional healers are often consulted by patients with mental illness and in Uganda, up to 60% of patients attending traditional healers have moderate to severe mental illness. Poor access to CAMH care in Uganda creates a treatment gap that could be met through enhanced collaboration between traditional healers and biomedical health systems. The aim of this study was to explore traditional healers’ views on their collaboration with biomedical health systems so as to inform the implementation of strategies to improve access to CAMH services in Uganda.MethodsIn-depth interviews with 20 purposively selected traditional healers were conducted in November 2015. A semi-structured interview guide was used to explore: 1) The experiences of traditional healers with mental ill-health in children and adolescents; 2) their willingness to collaborate with the formal health system; and 3) their perception of clinicians’ willingness to collaborate with them. Interviews were conducted in local languages and tape recorded. Data were analysed using thematic analysis.ResultsTraditional healers described several experiences managing children and adolescents with mental illness, which they ascribed to spiritual and physical causes. The spiritual explanations were a consequence of unhappy ancestral spirits, modern religions and witchcraft, while physical causes mentioned included substance abuse and fevers. No traditional healer had received a patient referred to them from a medical clinic although all had referred patients to clinics for non-mental health reasons.Traditional healers expressed distrust in biomedical health systems and believed their treatments were superior to medical therapies in alleviating mental suffering. They expressed willingness to collaborate with biomedical providers. However, traditional healers believe clinicians disregard them and would not be willing to collaborate with them.ConclusionPotential for collaboration between traditional healers and biomedical health systems for improving access to CAMH services in Uganda exists, but is undermined by mutual mistrust and competition between traditional healers and clinicians.

Does certified organic agriculture increase agroecosystem health? Evidence from four farming systems in Uganda

ABSTRACTOver the past decades, the number of certified organic farms have increased significantly in Uganda. One assumption is that certified organic agriculture contributes to economic, social and ecological health of agroecosystems. In the literature, however, there is thin empirical evidence to support such claims. We therefore developed health indicators and contrasted data from four Ugandan farming systems with principles and objectives of organic agriculture. We identified four health patterns (ecology-driven, economically struggling, socially-driven, and hanging in) demonstrating the impact of farm management on agroecosystem health and trade-offs between health domains. Ecological farm health is strengthened only if the conversion goes beyond ‘organic by default’. Market-oriented specialization can create lock-in situations if production strategies cannot be changed easily. Food shortages occur when additional income from certified production does not compensate for the reduced area and effort devoted to food crops. We conclude that the positive effects of organic certification on agroecosystem health cannot be taken for granted. Interventions promoting organic agriculture should acknowledge risks smallholder farmers take by converting to cash crop-oriented certified organic farming. A challenging question will be how aspects of wellbeing and social health can be translated into certification standards and thus product attributes.