Uganda Shillings Research Articles

Women who pay their own brideprice: reimagining provider masculinity through Uganda's thriving wedding industry

AbstractIn Uganda, the ‘traditional’ wedding, wherein a groom brings money and gifts to his father‐in‐law's home, has long been understood as the ultimate demonstration of a man's social maturity. Yet masculine adulthood is becoming increasingly elusive as weddings become more difficult to afford. Widespread unemployment has rendered most young men unable to fund the rituals while weddings themselves have become exceptionally lavish: brideprice payments now include ‘cows’, or millions of Ugandan shillings, as well as furniture sets, refrigerators, televisions, and even cars. With wedding expenses surging and their fiancés out of work, women have begun ‘paying their own brideprice’, as Ugandans say, by contributing substantially to wedding costs. In this article, we explore this oft‐debated phenomenon. We propose that the emergence of women who pay their own brideprice has invited a broad reimagining of the gendered economic ideologies that tether men to money under the rubric of provider masculinity. That celebratory, seemingly innocuous events such as weddings occasion the questioning of hegemonic forms of masculinity is particularly notable in Uganda, where gender conservatism dominates public discourse. Beyond Uganda, our case suggests revisiting the normative as a potent site for observing gendered social change.

Factors Associated with Increased Cases of Brucelosis among Patients at Kampala International University Teaching Hospital, Bushenyi District, Uganda

Background: The government has employed numerous strategies ranging from animal vaccination, quarantines, free tests and diagnosis.
 The purpose of this study was to determine factors associated with increased cases of brucellosis at Kampala International University Teaching Hospital.
 Methodology: We conducted a quantitative cross-sectional study which employed simple random sampling to select 36 patients aged 18 years and above attending at Kampala International University Teaching Hospital who consented to take part.
 Results: The majority of the respondents (n=14, 38.9%) belonged to the age group of 26-30years, followed by the respondents belonged to the age group of 31 years and above 12 (n=12, 33.3%) while the interrogated persons belonged to the age group of 18-25 years were weak (n= 10; 27.8%). Majority of the respondents (n= 15; 41.7%) revealed that they were Christian-catholic. Moreover, most of these respondents (n= 19; 52.8%) revealed that they studied only secondary education meanwhile only (n=10, 27.8%) were primary leavers. These respondents belonged in the majority to Banyankole/Bakiga tribe (n= 19; 52.8%) and were married (n= 28; 77.8%). The results of this study showed that 36.1% (n= 13) of respondents lived with the incomes included between 100,000 and 150,000 Uganda shillings. They were in majority 14 (n= 14; 38.9%) at 1 – 2 kilometers to the nearest health facility meanwhile 27.8% (n= 10) of respondents were at 5 and above kilometers. Approximately 58.4% (n= 21) of respondents were agreed that there is presence of diagnostic facilities of brucellosis and 63.9 % (n= 23) of these respondents adhered to treatment of brucellosis.
 Conclusion: This study showed that age, level of education, tribe, household income, property ownership, cost of treatment, distance from the health facility and poor service utilization influence increase in brucellosis cases among patients at Kampala International University Teaching Hospital. Brucellosis places significant burdens on human healthcare systems and limits the economic potential of individuals, communities, and nations where such development is especially important to diminish the prevalence of poverty.

Understanding patient-level costs of weekly isoniazid-rifapentine (3HP) among people living with HIV in Uganda.

BACKGROUND: Twelve weeks of weekly isoniazid and rifapentine (3HP) prevents TB disease among people with HIV (PWH), but the costs to people of taking TB preventive treatment is not well described.METHODS: We surveyed PWH who initiated 3HP at a large urban HIV/AIDS clinic in Kampala, Uganda, as part of a larger trial. We estimated the cost of one 3HP visit from the patient perspective, including both out-of-pocket costs and estimated lost wages. Costs were reported in 2021 Ugandan shillings (UGX) and US dollars (USD; USD1 = UGX3,587)RESULTS: The survey included 1,655 PWH. The median participant cost of one clinic visit was UGX19,200 (USD5.36), or 38.5% of the median weekly income. Per visit, the cost of transportation was the largest component (median: UGX10,000/USD2.79), followed by lost income (median: UGX4,200/USD1.16) and food (median: UGX2,000/USD0.56). Men reported greater income loss than women (median: UGX6,400/USD1.79 vs. UGX3,300/USD0.93), and participants who lived further than a 30-minute drive to the clinic had higher transportation costs than others (median: UGX14,000/USD3.90 vs. UGX8,000/USD2.23).CONCLUSION: Patient-level costs to receive 3HP accounted for over one-third of weekly income. Patient-centered approaches to averting or defraying these costs are needed.

A Google Earth-GIS based approach to examine the potential of the current rainwater harvesting practices to meet water demands in Mityana district, Uganda

Rainwater harvesting (RWH) has become an integral part of global efforts to improve water access. Despite the increasing adoption of RWH in Uganda, there remains a significant knowledge gap in the assessment of RWH systems to meet water demands. In this study, a simplified methodology to estimate rainwater harvesting potential (RWHP) as a function of mean seasonal rainfall and rooftop area, generated using Google Earth and GIS tools is applied. Desired tank storage (DTS) capacities based on user population, demand and dry period lengths, were compared with RWHP to assess whether rooftop areas and tank storage can sustainably supply water for use during the March—May (MAM) and September-November (SON) 90-day dry periods, for three demand levels (i.e. for drinking and cooking (15 litres per capita per day (l/c/d)); for drinking, cooking and hand washing (20 l/c/d); and for drinking, cooking, hand washing, bathing and laundry (50 l/c/d)). Our findings document minimum catchment areas of 60m2 to have rainwater harvesting potential that can sustain households for 90-day dry periods for all three demand levels. However, considering their storage capacities, 25%, 48% and 97% of the existing RWHTs (with storage capacities below 8,000, 10,000 and 20,000 litres respectively) are unable to meet the demand of 15 l/c/d, 20 l/c/d and 50 l/c/d respectively for a 90-day dry period. The results document that the existing storage systems are under-sized for estimated water use under 50 l/c/d demand scenarios. Costs of between 2,000,000–4,500,000 Ugandan shillings (~ 600–1, 250 USD) would be needed to increase existing tank capacities to meet the 50 l/c/d demands for a 90-day dry period. These findings document onerous financial costs to achieve rainwater harvesting potential, meaning that households in Mityana district may have to resort to other sources of water during times of shortage.

Nutritional status research in Uganda: A critical review and trend analysis

Uganda is ranked 77th out of 95 countries in terms of under-nutrition prevalence. Under-nutrition is closely linked to 40% of all mortalities among children below 5 years of age. It is projected that by 2050 malnutrition in all its dimensions combined will cost the country US $ 7.7 billion (19 trillion Uganda Shillings) in lost productivity, yet timely investing in nutrition would translate into an economic gain of US$ 1.7 billion (4.3 trillion Uganda shillings) through enhanced productivity. A critical review and trend analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) approach was carried out. This was aimed at critically assessing the status of nutrition and identifying existing research gaps and intervention options. In addition, the study was focused on generating evidence for nutrition policy discourse. The review mainly focused on peer reviewed publications, covering the period from 2011 to 2022. A total of 215 materials were downloaded, 28 articles were used for literature review and 14 were used for further synthesis and trend analysis. It was found that stunting among children under 5 years was higher in the rural areas (37%) than in the urban areas (34%). Wasting and underweight among the same age group were most rampant in northern region, with prevalence rates of 7.5% and 14.6%, respectively, while stunting was most prevalent in western region (33.2%). Available data showed increasing prevalence of obesity and overweight. The proportion of women 15-49 years who were overweight or obese increased from 17% in 2006 to 19% in 2011 and 24% in 2016. On the other hand, prevalence of thinness among women aged 15-49 years declined from 12% in 2006 and 2011 to 9% in 2016. The review unearthed dearth of literature on nutrition for the elderly, adolescents and young adults. It would be prudent to invest in research to bridge the identified gaps. The outcome of such studies would be instrumental in informing nutrition policy in Uganda. Key words: Stunting, Obesity, Underweight, Overweight, Micronutrient deficiency

Costs of treating childhood malaria, diarrhoea and pneumonia in rural Mozambique and Uganda

BackgroundGlobally, nearly half of all deaths among children under the age of 5 years can be attributed to malaria, diarrhoea, and pneumonia. A significant proportion of these deaths occur in sub-Saharan Africa. Despite several programmes implemented in sub-Saharan Africa, the burden of these illnesses remains persistently high. To mobilise resources for such programmes it is necessary to evaluate their costs, costs-effectiveness, and affordability. This study aimed to estimate the provider costs of treating malaria, diarrhoea, and pneumonia among children under the age of 5 years in routine settings at the health facility level in rural Uganda and Mozambique.MethodsService and cost data was collected from health facilities in midwestern Uganda and Inhambane province, Mozambique from private and public health facilities. Financial and economic costs of providing care for childhood illnesses were investigated from the provider perspective by combining a top-down and bottom-up approach to estimate unit costs and annual total costs for different types of visits for these illnesses. All costs were collected in Ugandan shillings and Mozambican meticais. Costs are presented in 2021 US dollars.ResultsIn Uganda, the highest number of outpatient visits were for children with uncomplicated malaria and of inpatient admissions were for respiratory infections, including pneumonia. The highest unit cost for outpatient visits was for pneumonia (and other respiratory infections) and ranged from $0.5 to 2.3, while the highest unit cost for inpatient admissions was for malaria ($19.6). In Mozambique, the highest numbers of outpatient and inpatient admissions visits were for malaria. The highest unit costs were for malaria too, ranging from $2.5 to 4.2 for outpatient visits and $3.8 for inpatient admissions. The greatest contributors to costs in both countries were drugs and diagnostics, followed by staff.ConclusionsThe findings highlighted the intensive resource use in the treatment of malaria and pneumonia for outpatient and inpatient cases, particularly at higher level health facilities. Timely treatment to prevent severe complications associated with these illnesses can also avoid high costs to health providers, and households.Trial registration: ClinicalTrials.gov, identifier: NCT01972321.

Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment

ObjectiveTo explore how respondents with common chronic conditions—hypertension (HTN) and diabetes mellitus (DM)—make healthcare-seeking decisions.SettingThree health facilities in Nakaseke District, Uganda.DesignDiscrete choice experiment (DCE).Participants496 adults with HTN and/or DM.Main outcome...

Farmer-led protected zero-grazed dairy cattle initiative in tsetse-infested areas of Southeast Uganda

A farmer-led protected zero-grazed dairy cattle initiative, involving pyrethroid treated netting around zero-grazing cowsheds, was implemented over a four-year period in tsetse-infested areas of Southeast Uganda. The pyrethroid treated netting was intended to prevent dairy cattle against tsetse bites and consequently transmission of trypanosomosis, while boosting milk production as an economic venture. A longitudinal study was conducted in six districts, including Budaka, Busia, Iganga, Manafwa, Mayuge and Tororo, during which a total of 184 protected zero-grazing units holding 289 dairy cattle were visited five times. The prevalence of trypanosomosis, mortality, mean packed cell volume (PCV), status of netting, spraying practices, and pasture and legume feed status, cowshed hygiene status, and milk yield were monitored. The findings revealed low prevalence of trypanosomosis among dairy cattle (1.0-5.5%), due to Trypanosoma brucei (0.0-0.4%), Trypanosoma congolense (0.0-0.7%) and Trypanosoma vivax (0.4-3.4%) infections. Only 25 adult cattle and 40 calves were reported dead. Dairy cattle had good health, given high mean PCV values (27.7 - 30.6). 99.2% and 100.0% of the zero-grazing units had lost netting by visit IV and V, respectively. By the second to the fourth year, prevention of dairy cattle from tsetse or tick bites hugely relied on spraying because all zero-grazing units had lost netting. Dual tsetse and tick control was practised by 66.9% of the 184 zero-grazing units, while only 33.1% of the units applied tick-selective control. Correct spraying intervals were observed by 57.8% of the zero-grazing units. Most zero-grazing units (range 67.9-97.5%) had sufficient pasture, while few units (range 17.9-34.8%) had sufficient legumes. Poorest cowshed hygiene was observed in zero-grazing units in Budaka district (93.1%), followed by Busia district (33.3%), Iganga district (31.1%), Mayuge district (12.1%), Tororo district (10.0%) and Manafwa district (6.3%).The best average milk yield per cow per day was registered in Iganga district (6.2 L-8.7 L), followed by Mayuge district (4.5 L- 8.2 L), Manafwa district (4.5 L-6.2 L), Busia district (4.0 L-6.3 L), Tororo district (3.3 L-6.7 L), and Budaka district (3.7 L-6.0 L). Overall average milk yield per cow per day of 5.0 L to 6.4 L across visits with a minimum of 0.5 L and maximum of 19.0 L per cow per day were achieved. In conclusion, pyrethroid treated netting around zero-grazing units supplemented with spraying of cattle effectively protected dairy cattle against trypanosomosis and maintained their good health. However, farmers’ observation indicated that as netting became older, it became more fragile. Larger nets of 1.5 m high had a longer duration of 6 to 8 months than smaller nets of 1.0 m high (shorter duration of 3 to 4 months). Replacement of netting for all zero-grazing units was desirable after the first year of installation, however, farmers could not afford the cost of 100,000 Uganda shillings (approx. USD 30) per zero-grazing unit.

Determinants of Maize Production Income in Western Uganda

Many smallholder farmers produce maize for both consumption and income purposes. Despite the role played by maize, its income production is low, especially in developing countries. In order to formulate policies targeting maize productivity, it was necessary to have knowledge of the determinants of maize production income. As such, this study aimed at determining the level of income and its determinants from maize farmers. Consequently, data was collected from 220 maize farmers using structured questionnaires. The ordinary least squares model was used to determine the determinants. The results showed that the farmers earned a mean of 372,207 Ugandan shillings (105.18 USD) from maize production. Accordingly, farm size, access to credit and household size had a significant positive influence on income from maize production, while gender (female) of the household heads had a significant negative relationship with income from maize production. It is based on these results that this study recommended that the government should offer training programs targeting female-headed households. These trainings should incorporate farm production as well as marketing. Additionally, farmers should be encouraged to access various sources of agricultural credit including financial institutions that offer agricultural loans at low-interest rates.

Evaluating the performance and profitability of varied combinations of brewery by-products for fattening pigs

Context The consumption of pork is rapidly increasing in Uganda and presents an opportunity for pig farmers to maximise profits. However, the population and productivity of pigs remains low and this is attributed to the high cost of commercial feeds. Aims We aimed to evaluate the effects of various combinations of brewery by-products on the performance, carcass characteristics and profitability of fattening pigs. Methods The study involved 48 crossbred (Large White × Camborough) pigs weaned at 2 months of age and weighing 10.3 ± 1.2 kg. Group pens of four pigs, balanced for sex and weight, were assigned in a completely randomised design with three replications to four diets: BYM, 22% brewers’ spent grain + 15% yeast cake + 60% malt dust; BY, 33% brewers’ spent grain + 14% yeast cake (with 50% maize bran); YM, 27% yeast cake + 70% malt dust; and a commercial diet (control). Feed intake and efficiency, costs and carcass characteristic were determined. Key results Feeding brewery by-products increased (P < 0.05) average daily feed intake by 1.40, 1.11, 1.09 kg/day for BYM, BY and YM compared with the control diet. Pigs fed the control diet had better (P < 0.05) feed efficiency (feed conversion ratio 3.4) than those fed BYM (6.6), BY (5.7) and YM (6.1). The unit cost of diets (Ugandan shillings, USh) increased in the order BYM (USh410) < YM (USh439) < BY (USh551) < commercial diet (USh1313). The unit cost of producing meat increased in the order YM (USh2691) < BYM (USh2713) < BY (USh3150) < commercial diet (USh5331). The highest gross margins accrued from BYM (USh36 769), followed by YM (USh34 853), whereas a loss of USh41 735 was incurred when feeding the commercial diet. Dressing percentage and organ yield were comparable across diets (P > 0.05). Backfat thickness measured at four sites was similar (P > 0.05) across dietary treatments. Conclusion A blended mixture of brewery by-products containing brewers’ spent grain (22%), yeast (15%) and malt dust (60%) is an economical replacement of commercial diets for fattening pigs. Implications Brewery by-products can be used to increase profit margins without affecting the carcass characteristics of pigs.

Analyses of community willingness-to-pay and the influencing factors towards restoration of River Malaba floodplains

The high productivity of soils along River Malaba floodplains and various functions (like, transport and recreation) increase the desire for humankind settlement adjacent to floodplain corridors. However, human life and property have unceasingly been destroyed by floods. Strategies have been established to deal with floods but the problem still exists. This study employed the double-bound dichotomous choice contingent valuation method to quantify the community willingness-to-pay (WTP) and associated influencing factors for restoration of River Malaba floodplains. Reconnaissance surveys, focus group discussions, key informant interviews, observations study, and household questionnaires from 498 out of the targeted 550 respondents were employed in data collection. Amongst the adaptation strategies at household and community level, the post-flood strategies were more efficient than those practiced before- and during-floods. Amongst the suggested structural and non-structural strategies, “embankment/river training structures” and “flood forecasting and early warning” were highly preferred, respectively. The results revealed that 55% of the households expressed WTP an individual amount between Uganda shillings (UGX) 5,000 (United States Dollar, US$ 1.35) to UGX 500,000 (US$ 135.14), with a monthly average of UGX 97,080 (US$ 26.24). Total monthly amount would be UGX 38,249,500 (US$ 10,333.70) considering the 498 households. Amongst the factors analysed, age, gender, marital status, education level, occupation, household income, business affected, lost property due to floods, flooding a major problem had significant (p<0.01) positive impact on WTP. This study findings are pertinent in supporting stakeholders’ decision regarding predictive planning of flood adaptation strategies in the study area.

Patient Perspectives and Willingness to Accept Incentives for Tuberculosis Diagnostic Evaluation in Uganda

ObjectivesWe assessed attitudes and perceptions and willingness to accept (WTA) varying incentive structures for completing tuberculosis (TB) diagnostic evaluation among patients in Uganda. MethodsWe surveyed 177 adult patients undergoing TB evaluation at 10 health centers between September 2018 and March 2019. We collected household sociodemographic information and assessed attitudes and perceptions of incentives. We surveyed patients regarding their willingness to complete TB diagnostic evaluation in exchange for incentives ranging in value from 500 Ugandan shillings (USh) to 25 000USh (~$0.15-$6.75). We compared associations between WTA and patient characteristics using ordered logistic regression. ResultsParticipant willingness to return to the health center to complete TB diagnostic evaluation increased proportionally with incentive amount. The median participant accepted between 2000 and 5000 USh. Cash (52%) and transportation vouchers (34%) were the most popular incentive types. Half of respondents preferred unconditional incentives; for a multiday evaluation, 84% preferred conditioning incentive receipt upon returning to the health center. In multivariate models, we found the pairwise difference between the third and lowest income quartile (aOR = 2.38, 95% CI: 1.20-4.69; P = .01), younger age, and difficulty returning to the health center to be significantly associated with WTA higher incentive thresholds. ConclusionsIn Uganda, incentives such as cash transfers or transportation vouchers are an acceptable intervention for facilitating adherence to TB diagnostic evaluation. Household income is associated with preferred incentive structure and amount, especially for those at the cusp of the poverty threshold who are more likely to prefer unconditional and higher valued incentives. Targeted and context-specific socioeconomic supports for at-risk patients are needed to optimize outcomes.

The Profitability of Fertilizer Micro Dosing and Timing of Weeding in Finger Millet Production in the Semi-Arid Areas of Uganda

Despite the recommendation for fertilizer use in crop production by research, there is a low rate of adoption among farmers. The low adoption rate of fertilizer usage has been partly attributed to high costs of fertilizer in addition to use of agronomic recommendation without fertilizer economic analysis. The study therefore, set out to determine the profitability of fertilizer micro dosing and weeding regimes in finger millet production in eastern Uganda. A randomized complete block design in split plot treatment arrangement with three replications was used. Weeding regime treatments were the main plot and fertilizer micro dosing treatments as the sub plots. The treatments included: different micro dosing rates of nitrogen and phosphorus, weeding regimes and SEREMI II finger millet variety. Nitrogen was applied in the form of urea (46%), in two splits of 50% each at vegetative and flowering stages respectively. The results of the study indicate that weeding once at 20 Days After Sowing (DAS) and a combination of N and P (16.6 kg N ha^-1 and 10.6 kg P ha^-1) fertilizer micro dose application is the most profitable combination and could make farmers earn up to Uganda shillings 1,984.220 per hectare compared to only Uganda shillings 373,000 from none application of fertilizer. We therefore conclude that finger millet producers can achieve higher economic and environmental gains when weeding is done once at 20 DAS in combination with sole P fertilizer micro dosing applied at 10.6 kg P ha^-1.

Social and financial barriers may contribute to a “hidden mortality” in Uganda for children with congenital anomalies

BackgroundThe true incidence of congenital anomalies in sub-Saharan Africa is unknown. Owing to complex challenges associated with congenital anomalies, many affected babies may never present to a health facility, resulting in an underestimation of disease burden. MethodsInterviews were conducted with Ugandans between September 2018 and May 2019. Responses from community members versus families of children with congenital anomalies were compared. ResultsA total of 198 Ugandans were interviewed (91 family members, 80 community members). All participants (N = 198) believed that seeking surgical care would lead to poverty, 43% (n = 84) assumed fathers would abandon the child, and 26% (n = 45) thought a child with a congenital anomaly in their community had been left to die. Causes of anomalies were believed to be contraceptive methods (48%, n = 95), witchcraft (17%, n = 34), or drugs (10%, n = 19). Of family members, 25 (28%) were advised to allow the child to die. Families with affected children were more likely to have a lower income (P < .001), believe anomalies could be treated (P = .007), but thought that allowing the child to die was best for the family (32% vs 9%; P < .0001). Monthly household income <50,000 Uganda shillings ($13 United States dollars) was a significant predictor of the father leaving the family (P = .024), being advised to not pursue medical care (P = .046), and believing that God should decide the child’s fate (P = .047). ConclusionFamilies face significant financial and social pressures when deciding to seek surgical care for a child with a congenital anomaly. Many children with anomalies may die and never reach a health facility to be counted, thus contributing to a hidden mortality.

The impact of the Country’s health services’ expenditure on the success of MDGs, Goal 4/SDG 3: Reduction of child mortality in Uganda (2000-2016).

Safeguarding access to health services is a serious challenge for poor countries if the Sustainable Development Goals are to (SDGs) are to be achieved. This paper scrutinizes the case of Uganda, a country which is trying to improve its health sector amid a lot of challenges between 2000-2016 to assess how the country has performed in the reduction of child mortality given its expenditure. This study involved analyzing the available data drawn from various sources i.e., time series data on public health expenditure was obtained from Ministry of Health reports and the budget and Ministerial Policy Statements for the period 2000-2016. This data was further demarcated into parameters such as per capita government spending on health in Uganda shillings, health spending as a proportion of Gross Democratic Product (GDP) and private health spending as a proportion of total health spending. Findings revealed that non-significant negative effect of GDP per capita growth on infant mortality rate from 2000 to 2016, a negative effect of GDP per capita on under-five mortality in Uganda from 2000 to 2016, albeit the effect is non-significant (P&gt;0.05), decline in Maternal Mortality Rate (MMR) from 527 death per 100,000 live birth in 1995 to 336 death per 100,000 live birth in 2016, and there is a negative but insignificant effect of health sector budget allocation on the MMR in Uganda since the P-value (0.199). Maternal mortality fell significantly in Uganda due to some interventions in the health sector. The decline is likely to have been cause due to supply and demand situations. There is need to improve funding in the health sector in order to improve quality health services through better coordination, health management, transportation, access, infrastructure at the district level.

A contingent valuation analysis for assessing the market for genetically modified planting materials among banana producing households in Uganda

ABSTRACTBanana is an important livelihood source for more than 12 million smallholder farmers in Uganda. Despite this contribution, its productivity continues to decline due to Banana Xanthomonas wilt (BXW). Cultural practices have been deployed to effectively control BXW but require a continuous and timely application, thus, prompting scientists to develop genetically modified (GM) bananas which display BXW resistance or tolerance. With prospects for commercialization of these GM bananas on the agenda, this paper applied a Contingent Valuation Method to assess producer acceptance of GM banana suckers among 233 banana producing households. Results show that producers were willing to pay between Ugandan shillings (UGX) 1100 to 1700 (US$0.28–0.44) per GM banana sucker Annual demand for GM banana suckers ranged from 70 to 82 million suckers. The results suggest that, in the event of not commercializing BXW-resistant GM bananas, Uganda loses an annual revenue ranging from UGX 76 to 139 billion (US$ 19.51 to 35.70 million).

Effects of Inclusion Levels of Sweet Potato Vine Silage on Feed Intake, Milk Production and Profitability of Lactating Crossbred Dairy Cows

Feed scarcity is a major challenge in smallholder production systems especially during the dry season. Sweet potato vines (SPV) contribute over 40% of the crop residues fed to dairy cattle but they are highly perishable resulting into losses of about 24% per season. Ensiling SPV mitigates seasonal feed shortages and assists in coping with seasonal feed price fluctuations. This study was conducted to evaluate the effect of sweet potato vines silage (SPVS) supplementation on the performance of lactating Ankole × Friesian crossbred dairy cattle. Four primiparous cows in early lactation were randomly allotted a basal diet of Rhodes grass (Chloris gayana) hay supplemented with dairy pellets and four graded levels of SPVS (0, 100, 200 and 300 g/kg of the daily ration) in a 4 × 4 Latin square design. The animals were given a one-week adaptation period followed by a two weeks data collection period for each diet. Dry matter intake (DMI), live weight changes, milk yield and composition were determined. Dry matter intake improved with addition of SPVS (P ≤ 0.05), with intake being highest (11.9 kg) in cows that were fed the highest SPVS level and lowest in cows that were not given SPVS (6.8 kg). Although animals on diets with 0, 100, 200 g of SPVS/kg of daily ration lost weight, there were no significant differences (P ≥ 0.05) in body weight changes across all treatments. Milk yield increased with SPVS supplementation by 1.5 - 1.7 kg per cow per day but there were no significant differences between the different SPVS supplementation levels. Milk fat and solids-non-fat differed (P ≤ 0.05) across the four diets but there was no consistent trend observed. Considering profit margins, supplementing dairy cows with SPVS at a level of 100 g/kg of daily ration was the most profitable at Uganda shillings 1290 (0.344 USD) per cow per day. In conclusion, SPVS supplementation improved DMI and milk yield but supplementation beyond 100 g/kg of the daily feed intake was not cost-effective.

From Procedure to Poverty: Out-of-Pocket and Catastrophic Expenditure for Pediatric Surgery in Uganda

BackgroundFinancial protection from catastrophic health care expenditure (CHE) and patient out-of-pocket (OOP) spending are key indicators for sustainable surgical delivery. We aimed to calculate these metrics for a hospital stay requiring surgery in Uganda's pediatric population. MethodsA survey was administered to family members of postoperative patients in the pediatric surgical ward at Mulago Hospital. Cost categories included direct medical costs, direct nonmedical costs, indirect costs, plus money borrowed and items sold to pay for the hospital stay. CHE was defined as spending greater than 10% of annual household expenditure. Costs were reported in Ugandan shillings and US dollars. ResultsOne hundred and thirty-two patient families were surveyed between November 2016 and April 2017. Median direct costs were $27.55 (IQR 18.73-183.69) for diagnostics, $18.36 (IQR 9.52-41.33) for medications, $26.63 (IQR 9.19-45.92) for transportation, and $32.60 (IQR 12.85-64.29) for food and lodging. Forty-four percent of respondents were employed, and median indirect cost from productivity loss was $95.52 (IQR 55.10-243.38). Eighteen percent (16/87) borrowed money, and 9% (8/87) sold possessions to pay for the hospital stay. Total median OOP cost for patient families per hospital stay was $150.62 (IQR 65.21-339.82). Sixteen percent (21/132) of families incurred CHE from direct costs, and the proportion rose to 27% (32/132) when indirect cost was included. ConclusionsAlthough pediatric surgical services in Uganda are formally provided for free by the public sector, families accrue substantial OOP expenditure and almost a third of households incur CHE for a pediatric surgical procedure. This study suggests that broader financial protection must be established to meet Sustainable Development Goal targets.

Pharmacoeconomics of Antimalarials in Private-for-Profit (PFP) Drug-Outlets in Gulu and Kitgum Towns, Northern Uganda.

Clinically-diagnosed malaria is the leading cause of morbidity and mortality in Uganda accounting for 25 to 40% of outpatients, 15 to 20% of all hospital admissions, and 9 to 14% of all hospital deaths. This situation was exacerbated by The Lord's Resistance Army (LRA) rebellion in northern Uganda which completely ran down the health care system. While malaria remains the number one killer disease in northern Uganda, antimalarials are lacking in the public health facilities. Consequently, Private-for-profit drug-outlets have come up to help bridge the gap. However, the cost-effectiveness and treatment outcome ratings of antimalarials are not clear. Objective: To assess the pharmacoeconomics of malaria treatment in Private-for-profit (PFP) drug-outlets in Gulu Municipality and Kitgum Town Council. This was a descriptive cross-sectional study sites were registered drug outlets. Study participants were drug-outlet owners, their employees, and malaria patients. We employed both purposive and random sampling methods to select the study participants. Data were collected using questionnaires and analysed using the SPSS computer package. Up to 91.1% of the respondents indicated that antimalarials are expensive. The prices varied from less than 5,000 to over 20,000 Ugandan shillings per dose (Exchange rate: 1$ = Ush 2,650). Fansidar and chloroquine were rated as being relatively cheap and ACTs expensive (Ush 11,000 to 15,000). Duration of treatment, frequency of administration, needles and syringes, raised the cost of some medicines. Most patients preferred cheap medicines (76.2%); those with low administration frequencies (77.5%); and those with short treatment duration (95%). Most patients (80.9%) buy antimalarials without testing, while 66.6% do not buy full doses. The cost benefit analysis of the use of antimalarials is unfavourable. The unit price of the medicines, their irrational use and the lack of professionals in the outlets together add up to high overall costs and poor treatment outcomes.

Uganda experience—Using cost assessment of an established registry to project resources required to expand cancer registration

BackgroundThe objectives of this study are (1) to estimate the cost of operating the Kampala Cancer Registry (KCR) and (2) to use cost data from the KCR to project the resource needs and cost of expanding and sustaining cancer registration in Uganda, focusing on the recently established Gulu Cancer Registry (GCR) in rural Northern Uganda. MethodsWe used Centers for Disease Control and Prevention’s (CDC’s) International Registry Costing Tool (IntRegCosting Tool) to estimate the KCR’s activity-based cost for 2014. We grouped the registry activities into fixed cost, variable core cost, and variable other cost activities. After a comparison KCR and GCR characteristics, we used the cost of the KCR to project the likely ongoing costs for the new GCR. ResultsThe KCR incurred 42% of its expenditures in fixed cost activities, 40% for variable core cost activities, and the remaining 18% for variable other cost activities. The total cost per case registered was 28,201 Ugandan shillings (approximately US $10 in 2014) to collect and report cases using a combination of passive and active cancer data collection approaches. The GCR performs only active data collection, and covers a much larger area, but serves a smaller population compared to the KCR. ConclusionAfter identifying many differences between KCR and GCR that could potentially affect the cost of registration, our best estimate is that the GCR, though newer and in a rural area, should require fewer resources than the KCR to sustain operations as a stand-alone entity. The optimal structure of the GCR needs to be determined in the future.