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Agriculture has been the backbone of African economies, and agricultural development has the potential to drive overall economic growth. Considering the importance of agriculture in Africa, foreign aid donors have supported the sector to help push economic growth and reduce poverty. Studies indicate governance quality of a recipient country is an important factor for agricultural aid. Building upon this, the paper explores how bilateral donors provided agricultural aid to two African countries that have different institutional quality, Ghana and Uganda. The analysis of agricultural aid in those two countries was carried out with bilateral aidprofile data from 2011 to 2022. Despite the similar economic importance of agriculture in Ghana and Uganda, donors to Ghana invested the largest amount in agriculture among aid sectors, followed by health. On the other hand, donors to Uganda supported mainly health-relevant sectors with agriculture being ranked only fifth. Donors in both countries implemented agricultural aid mostly as project types. Yet, donors disbursed their aid funds through different aid channels. Donors to Ghana disbursed 48% of agricultural aid funds through the public sector institutions channel (or the state channel). By contrast, donors to Uganda disbursed only 24% of agricultural aid funds through the state channel, essentially bypassing Ugandan public agencies. They instead provided 76% of agricultural aid through the non-state channels such as non-governmental organizations, multilateral organizations, and private entities. Similar donor preferences of the aid disbursement channels were observed with total aid across all aid sectors. Overall, the donor aid profiles suggested donors provided Ghana with more flexible agricultural aid, while in Uganda they controlled agricultural aid more tightly. There could exist multiple underlying reasons for this, but the different level of institutional quality is highly likely one of the possible reasons. For foreign aid, governance quality is an important issue equally to both donors and recipients. [ABSTRACT FROM AUTHOR]

Objectives Artemisinin-resistant Plasmodium falciparum malaria is currently spreading globally, including in Africa. Artemisinin resistance also leads to resistance to partner drugs used in artemisinin-based combination therapies. Sequencing of kelch13 , which is associated with artemisinin resistance, culture-based partner drug susceptibility tests, and ELISA-based growth measurement are conventionally used to monitor resistance; however, their application is challenging in resource-limited settings. Methods An experimental package for field studies with minimum human/material requirements was developed. Results First, qPCR-based SNP assay was applied in artemisinin resistance screening, which can detect mutations within 1 h and facilitate sample selection for subsequent processes. It had 100% sensitivity and specificity compared with DNA sequencing in the detection of the two common artemisinin resistance mutations in Uganda, C469Y and A675V. Moreover, in the partner drug susceptibility test, the cultured samples were dry-preserved on a 96-well filter paper plate and shipped to the central laboratory. Parasite growth was measured by ELISA using redissolved samples. It well reproduced the results of direct ELISA, reducing significant workload in the field (Pearson correlation coefficient: 0.984; 95% CI: 0.975–0.990). Conclusions Large-scale and sustainable monitoring is required urgently to track rapidly spreading drug-resistant malaria. In malaria-endemic areas, where research resources are often limited, simplicity and feasibility of the procedure is especially important. Our approach combines a qPCR-based rapid test, which is also applicable to point-of-care diagnosis of artemisinin resistance and centralized analysis of ex vivo culture. The approach could improve efficiency of field experiments and accelerate global drug resistance surveillance. [ABSTRACT FROM AUTHOR]

As in other African countries, activists in Uganda play an important role during political campaigns. Monetary handouts, called 'transport refund', often facilitate their participation. Although these handouts often cover more than just the costs of transportation, the label indicates that mobility is seen as an important financial item for campaign activists. Despite this, little has been published about the role that mobility plays in the processes of political mobilisation in Africa. This article therefore examines mobility as an important yet neglected aspect of political mobilisation by evaluating the role of motorcycle taxi riders during elections in Uganda. Usually referred to as Boda‐Bodas, they are essential short‐distance transport providers in the country. Beyond that, being Boda‐Boda has become a way of survival, a form of social organisation, and a promise that every youth can make a living if he dares to face the dangers of the country's accident‐prone roads. Politicians have since discovered the potential of these bold young men and recruit them en masse ahead of elections. Based on fieldwork conducted between 2018 and 2022, this paper examines the unique mobilities inherent in Boda‐Bodas. It finds that characteristic mobilities enable their movements as transport providers and argues that these mobilities also enhance political rallies. Boda‐Boda motorcycle riders have therefore become a crucial activist group during political campaigns in Uganda. This acticle reviews the role of Boda‐Boda motorcyclists during political rallies in Uganda. It uses a mobility lens to highlight how political mobilisation modernised through the inclusion of more mobile activists. [ABSTRACT FROM AUTHOR]

Due to small firm sizes and inter-linkages between household and business finances, small-scale entrepreneurs in developing countries are inherently vulnerable to temporary and permanent income shortfalls, and hence household poverty. While the International Labour Organisation (ILO) generally defines self-employment without employees as vulnerable employment, little empirical research has been done on the extent to which the self-employed are indeed vulnerable. This paper makes two main contributions: first, it operationalises the concept of vulnerability in the context of self-employment in developing countries by defining vulnerability as the risk of having business income below a living wage threshold. Secondly, it investigates the extent and correlates of vulnerability. Using a six-year balanced entrepreneur panel dataset from Kampala, Uganda, it is shown that the self-employed are heterogeneous with respect to vulnerability and observed earnings: 58–74% of the samples are classified as vulnerable in a given year and mostly earn incomes below the living wage threshold. Vulnerable entrepreneurs are shown to be significantly different from non-vulnerable entrepreneurs in several dimensions, including those that do not directly predict income. [ABSTRACT FROM AUTHOR]

Through some empirical studies, the flow of FDI and trade openness have proven to support economic growth in developing countries. This paper examines the significance of FDI and trade openness in five African countries (Ghana, Morocco, Kenya, Uganda, and Zambia). The study employed the panel data analysis method using data from the World Bank for the period 1994-2019 for the five selected countries. The result from the Random effect model indicated that FDI positively supports growth, whereas trade openness harms economic growth in these countries. The outcome further revealed that Uganda enjoys more significance than the other countries using the countries' dummies through the pooled model estimation. We recommend that various governments focus more on exports, reduce imports, attract more FDI through incentives, and create a regulatory environment that is friendly to FDI. [ABSTRACT FROM AUTHOR]

Discussions on African responses to Covid‐19 have focused on the state and its international backers. Far less is known about a wider range of public authorities, including chiefs, humanitarians, criminal gangs, and armed groups. This paper investigates how the pandemic provided opportunities for claims to and contests over power in Uganda, the Democratic Republic of the Congo, and South Sudan. Ethnographic research is used to contend that local forms of public authority can be akin to miniature sovereigns, able to interpret dictates, policies, and advice as required. Alongside coping with existing complex protracted emergencies, many try to advance their own agendas and secure benefits. Those they seek to govern, though, do not passively accept the new normal, instead often challenging those in positions of influence. This paper assesses which of these actions and reactions will have lasting effects on local notions of statehood and argues for a public authorities lens in times of crisis. [ABSTRACT FROM AUTHOR]

To understand the impact of the COVID-19 public health response on families of children with disabilities in Central Uganda we conducted phone interviews with parents and children during the first 5 months of the outbreak (March - July 2020). Most parents and children were well informed about COVID-19 and were keen to adhere to government prevention measures. The majority said lock-down measures had a negative effect on their mental and physical health, social life, finances, education and food security. Access to medical services and medication for chronic illness had been limited or absent due to restrictions in travel, some facilities restricting access, and limited financial resources. The majority of parents reported loss of work which resulted in difficulties in finding enough food and paying rent. Parents worried about children missing education and friends. We suggest greater attention to children with disabilities and their families when implementing mitigating and long-term responses. This paper reports a study with families of children with disabilities in Uganda during the Coronavirus pandemic in 2020, known as COVID-19. Families of children with disabilities in Uganda are well informed about COVID-19 and try to follow prevention measures. Families of children with disabilities have difficulties meeting daily basic needs as they were unable to work and had no income during the COVID-19 related lock down. The COVID-19 response affects access to health and rehabilitation services for children with disabilities in Uganda. Parents of children with disabilities struggle with home education and learning due to lack of access to accessible learning materials and learning support in Uganda. The COVID-19 response affects the peer support networks and social support for parents of children with disabilities in Uganda. Children with disabilities and their families should be involved and considered in the development and implementation of the COVID-19 response. [ABSTRACT FROM AUTHOR]

Previous research has consistently highlighted the importance of stakeholder engagement in identifying and developing solutions to ethical challenges in genomic research, especially in Africa where such research is relatively new. In this paper, we examine what constitutes good ethical practice in research, from the perspectives of genomic research participants in Uganda. Our study was part of a multi-site qualitative study exploring these issues in Uganda, Ghana and Zambia. We purposively sampled various stakeholders including genomic research participants, researchers, research ethics committee members, policy makers and community members. This paper presents the findings from in-depth interviews with 27 people with diabetes who had participated in a diabetes genomic study. Data were collected using semi-structured interviews. Manual thematic content analysis was conducted using a framework approach. Findings indicate three key requirements that research participants see as vital for genomic research to be more responsive to research participants' needs and contextual realities: (1) de-emphasising the role of experts and institutions in the consenting process, (2) clarity about the timing and nature of feedback both of findings relevant to the health of individuals and about the broad progress of the study, and (3) more effective support for research participants during and after the study. [ABSTRACT FROM AUTHOR]

Objectives: HIV virological failure remains a major threat to programme success in sub‐Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood. The objective of this paper is to identify those characteristics among people failing first‐line antiretroviral therapy (ART). Methods: We enrolled a cohort of adults in HIV care experiencing virological failure on first‐line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. Results: Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49–56%] stated that they had > 90% adherence and 75% (95% CI 72–77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86–92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months. Conclusions: Patients failing first‐line ART in sub‐Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug resistance and utilize significant health care resources. Health systems interventions to promptly detect and manage treatment failure will be a prerequisite to establishing control of the HIV epidemic. [ABSTRACT FROM AUTHOR]

The resource curse literature argues that oil production reshapes the fiscal contract between citizens and the state: politicians become less responsive to citizen taxpayers and more likely to use public revenues for their own benefit. This paper examines whether and how bureaucrats influence this breakdown of the fiscal contract. Analysing results of a survey experiment conducted with government employees in Ghana and Uganda, we find that, when primed to think about oil revenue, bureaucrats do not generally express attitudes indicating that they contribute to the resource curse. Although oil revenue does lead some Ghanaian bureaucrats to become less interested in responding to taxpayers, this finding does not operate as predicted, i.e. by bureaucrats expressing greater partiality towards the ruling elite. Instead, we attribute this outcome to 'disgruntled employees' – political outsiders with low salaries – who, unlikely to benefit from oil revenue, become disaffected from citizen service. The results shed new light on processes through which resource extraction changes state institutions. [ABSTRACT FROM AUTHOR]

This paper seeks to identify the factors that explain how members of parliament improved budget scrutiny using unique empirical data collected in Uganda. Two instances are studied that mark the improvements. First, the 2001 Budget Act that established the Parliamentary Budget Committee with large competencies for African standards. Second, the change in the 2012 Health Budget, a rare instance when parliament made significant budget amendments. The analysis reveals that political entrepreneurs used a window of opportunity to build a coalition for change. The window of opportunity opened at an event organised by civil society. The process that followed improved legislative budget scrutiny in a country with strong executive systems and strong patronage. Two factors have proven influential that are understudied in the current literature, civil society and female members of parliament. [ABSTRACT FROM AUTHOR]

Background: Up to 1.45 billion people currently suffer from soil transmitted helminth infection, with the largest burden occurring in Africa and Asia. Safe and cost effective deworming treatment exists, but there is a debate about mass distribution of this treatment in high prevalence settings. While the World Health Organization recommends mass administration of anthelmintic drugs for preschool and school-aged children in high (>20%) prevalence settings, and several long run follow up studies of an influential trial have suggested large benefits that persist over time, recent systematic reviews have called this recommendation into question. Methods and findings: This paper analyzes the long-term impact of a cluster-randomized trial in eastern Uganda that provided mass deworming treatment to preschool aged children from 2000 to 2003 on the numeracy and literacy skills of children and young adults living in those villages in 2010-2015. This study uses numeracy and literacy data collected seven to twelve years after the end of the deworming trial in a randomly selected subset of communities from the original trial, by an education-focused survey that had no relationship to the deworming study. Building on an earlier working paper which used data from 2010 and 2011 survey rounds, this paper uses an additional four years of numeracy and literacy data (2012, 2013, 2014, and 2015). Aggregating data from all survey rounds, the difference between numeracy scores in treatment versus control communities is 0.07 standard deviations (SD) (95% CI -0.10, 0.24, p = 0.40), the difference in literacy scores is 0.05 SD (95% CI -0.16, 0.27, p = 0.62), and the difference in total scores is 0.07 SD (95% CI -0.11, 0.25, p = 0.44). There are significant differences in program impact by gender, with numeracy and literacy differentially positively affected for girls, and by age, with treatment effects larger for the primary school aged subsample. There are also significant treatment interactions for those living in households with more treatment-eligible children. There is no evidence of differential treatment effects on age at program eligibility or number of years of program eligibility. Conclusions: Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion. Point estimates were positive but imprecise; the study lacked sufficient power to rule out substantial positive effects or more modest negative effects. However, there is suggestive evidence that deworming was relatively more beneficial for girls, primary school aged children, and children living in households with other treated children. Research approval: As this analysis was conducted on secondary data which is publicly available, no research approval was sought or received. All individual records were anonymized by the data provider prior to public release. [ABSTRACT FROM AUTHOR]

Introduction: The proportion of older persons in developing countries is increasing with no clear evidence of improvement in physical health. The aim of this paper was to examine the factors associated with older persons’ physical health in rural Uganda. Methods: This paper is based on a cross-sectional study of 912 older persons age 60 years and older across four major regions of Uganda. The study was conceptualized basing on World Health Organization quality of life BREF (WHOQOL-BREF). Analysis was done at three levels, that is, frequency distributions were generated to describe background characteristics of respondents and cross-tabulations were done to determine associations between dependent and each of the independent variables. Ordinal logistic regression was used to determine the predictors of physical health. Results: The likelihood of good physical health is high among older persons (Ops) who controlled their household assets (OR = 3.64; CI = 1.81–7.30) or the household assets controlled by their spouses (OR = 4.44; CI = 1.91–10.32) relative to those whose household assets were controlled by their children. There is high likelihood of good physical health among those who engage in physical activities (OR = 2.28; CI = 1.52–3.43) compared to those who do not. Conclusion: The findings have various policy implications, including creating an enabling environment and building capacities of older persons to remain in control of their household assets. Interventions focusing on deepening sensitization of older persons about importance of physical exercises could be a viable strategy for improving physical health of older persons. [ABSTRACT FROM AUTHOR]

Many education policies in low income countries impose eligibility limits, and these can generate household responses that distribute educational investments across children. In this paper, I study the effects of eligibility limits in the context of the Universal Primary Education (UPE) reform in Uganda. The program abolished elementary school fees for up to four children per household, with families paying fees on each additional child. Depending on the composition of children and their age at the onset of the reform, the policy generates costs for primary school that vary both within and across households. Children that are eligible for the tuition waiver but live in households with ineligible siblings complete fewer years of schooling. I estimate that the presence of ineligible siblings wiped out almost half of the overall impact of the UPE reform on educational attainment, with the effects concentrated among the poorest households. Household responses to the subsidy program are similar to those found in other types of schooling programs such as conditional cash transfers. [ABSTRACT FROM AUTHOR]

Genomic research and biobanking present several ethical, social and cultural challenges, particularly when conducted in settings with limited scientific research capacity. One of these challenges is determining the model of consent that should support the sharing of human biological samples and data in the context of international collaborative research. In this paper, we report on the views of key research stakeholders in Ghana on what should count as good ethical practice when seeking consent for genomic research and biobanking in Africa. This study was part of a multi-country qualitative case study conducted in three African countries: Ghana, Uganda and Zambia under the auspices of the Human Heredity and Health in Africa initiative (H3Africa). Our study suggests that while participants are willing to give consent for their samples and associated data to be used for future research purposes, they expect to receive feedback about the progress of the research and about the kinds of research being undertaken on their samples and data. These expectations need to be anticipated and discussed during the consent process which should be seen as part of an ongoing communication process throughout the research process. [ABSTRACT FROM AUTHOR]

Introduction: Homebirths are common in low and middle income countries and are associated with poor child survival. We assessed the feasibility of using smartphones by village health workers for pregnancy registration and the effectiveness of health text messages (SMS) sent to pregnant women through village health workers in reducing homebirths in rural Uganda. Methods: A non-randomised intervention study was undertaken in 26 villages. In the intervention arm, village health workers registered pregnant women (n = 262) in 13 villages using a smartphone app (doForm) and paper forms and gestation age-timed SMS were sent through village health workers to the pregnant women. In 13 control villages, (n = 263) pregnant women were registered on paper forms only and no SMS was sent. The main outcome was place of birth measured through a self-report. Logistic regression with generalised estimating equations was used to explore the effect of the intervention. Results: Comparing 795 corresponding data fields on phone and paper revealed that numeric variable fields were 86%-95% similar while text fields were 38%-48% similar. Of the 525 pregnant women followed, 83 (15.8%) delivered at home. In the adjusted analysis, the intervention was associated with lower odds of homebirths [AOR = 0.38, 95%CI (0.15–0.97)]. Muslim religion [AOR = 4.0, 95%CI (1.72–9.34)], primary or no maternal education [AOR = 2.51, 95%CI (1.00–6.35)] and health facility distance ≥ 2 km [AOR = 2.26, 95%CI (0.95–5.40)] were independently associated with homebirths. Conclusion: Village health workers can register pregnant women at home using phones and relay gestation age specific SMS to them to effectively reduce homebirths. [ABSTRACT FROM AUTHOR]

Inclusive education interventions in low-income countries are dominated by definitions and frameworks from disability studies and educational research scholars from high-income countries. Disability studies scholars have argued for valuing diverse understandings and a different discourse when studying disability and inclusion in low-income countries. In this paper, we explore the meaning of belonging and inclusion to parents of children with disabilities in central Uganda. Through case study analysis we aim to give alternative starting points for inclusive primary education programmes. We explore the themes 'missing parts', the 'ability to manage', 'belonging to a family', and 'being given a chance' as key concepts of disability and inclusion. We argue not to translate parents' descriptions into international categories and framework, but to reflect on the larger and underlying meaning of the concepts to form a more culturally embedded and relevant starting point of education for all. We propose to address the gaps of the postcolonial education system that has taken teachers' and families' away from the concept of 'obuntu bulamu', and focus interventions on re-creating this togetherness and value the strength of concepts of belonging and caring for each other. [ABSTRACT FROM AUTHOR]

Adolescent girls and young women have recently gained a central position in gender equality and development. However, little research investigates female experiences of the complex dynamics of both change and resistance to change in gender norms and structures. Drawing on the work of Bourdieu, Connell and Schippers to analyse longitudinal in-depth interviews, this paper explores how girls in northern Uganda learn, challenge and (re)produce patriarchal structures throughout the life-course and across social fields. It highlights the costs, consequences and benefits at stake in expressing hegemonic femininity and expands understanding of how adolescent girls and young women actively strategise to protect their wellbeing and create space for contestation. Findings call for greater attention to the coexistence of resistance to, and reproduction of, gender orders, and offer opportunities for additional research for theory building and programme implementation. [ABSTRACT FROM AUTHOR]

The Nubian Flapshell Turtle, Cyclanorbis elegans , is classified as one of the most threatened chelonian species globally (Critically Endangered according to the IUCN Red List). The species is presumed extinct in most of its historical distribution range, but still survives along the White Nile between South Sudan and northern Uganda. In this paper, we utilised the maximum entropy model (MaxEnt) to evaluate the habitat suitability of the species to explore its distribution decline by comparing historical and current presence data, as well as correlate the predicted past and present distribution with human population density. Our assumption is that overexploitation of the turtle occurs (and has occurred in the past) in sites with high human density. We show that: (1) a large number of historical sites where the turtle was present had high human population densities, whereas (2) the current distribution model showed low overlap between areas with high probability of turtle presence and high human population density. We suggest that Nubian flapshells are likely to have become extinct because of high human density (and therefore high overexploitation) and remnant populations have only survived along waterbodies with low numbers of people. However, the presence sites of this species in northern Uganda are under pressure by rapidly growing refugees'settlements. We also hypothesize that the range of the Nubian Flapshell may be shifting to the south (where the general environment is wetter and cooler) due to climate change affecting the distribution of this freshwater species. The conservation implications of these evidence are also presented. • The Nubian flapshell turtle is one of the most threatened reptile species in the world. • A spatial modelling approach revealed intriguing extinction patterns across Africa. • There was an association between historical sites of presence and high density of humans (hence fishers). • There i san association between current remnant presence sites and low human density. • Refugees' settlements represent a serious torea for turtles in northern Uganda. [ABSTRACT FROM AUTHOR]

but with greater attention to students’ computer literacy than teachers. At the same time, previous studies on digital literacy of teachers are unsustainable and mainly skewed on pre-service teachers than in-service teachers. These realities point to the need to investigate and implement effective and sustainable initiatives for improving digital literacy and online life-long learning for in-service teachers in Africa. This paper therefore presents a specialised MOOC platform known as TEP (Teachers’ E-learning Portal) for digital literacy and online life-long learning for in-service teachers in Uganda. TEP is built for environments with inadequate access to computers, internet and technical assistance. As such, TEP is accessible online or offline, managed by accredited local universities in collaboration with beneficiary secondary schools, and runs on existing resources in schools (technical personnel, computers and internet). Results from initial implementation of a computer literacy MOOC through TEP indicate that irrespective of age, when teachers are adequately supported internally by their schools and externally by a university, can improve their digital literacy and subsequently engage in online life-long learning. In addition, the results both in terms of high percentage of teacher participants’ completions (89%) and high volume of educational e-content generated, confirm TEP as an effective, attractive, and self-sustainable MOOC platform for in-service teachers’ in resource constraint environments. The paper finishes with an analysis of the relevance of TEP to Africa. [ABSTRACT FROM AUTHOR]

Background: Timely access to evidence increases the prospects for evidence informed decision making. We evaluated user experiences of a Clearing House for Health Policy with the aim of increasing access to evidence about the Uganda health system and interventions. Methods: We conducted in‐depth interviews with 15 potential users including policymakers, health policy advisors, health managers and researchers to provide evidence on their experience with the clearinghouse. On average participants took 20 minutes to first navigate the site and 45 minutes to perform search tasks and complete the interview. Results: Most respondents successfully searched for information with accuracy and completeness in a short time. Participants commended the performance and expressed high regard for the credibility of the clearinghouse. The majority felt that using the resource was worth their effort. The clearinghouse provided appropriate functionalities for information searching. Navigating and finding information from the site was achievable. However, inadequate background information about the site and lack of current information were widely reported. Conclusion: Our paper provides insights on the issues that can be addressed to improve online resources for health policy and system information in a limited resource setting. Users' experience of such resources can be improved by regularly appraising and appropriately indexing the contents, and optimising the capacity to customise information. [ABSTRACT FROM AUTHOR]

Highlights • We find that solar PV adoption rates are persistently lower for credit constrained households in Uganda. • For a large number of the poor, credit constraints serve as a permanent barrier. • Presence of well-functioning second-hand markets for solar PVs enhance consumption and welfare. • Polices that relax access to credit and facilitate second-hand markets are needed to promote solar PV adoption. Abstract Access to electricity in rural Sub-Saharan Africa, where livelihoods are predominantly based on small scale farming, is significantly low. Extending centralised national electricity grids to these rural areas faces significant technical and financial constraints. As a result, many see household-financed decentralised technologies such as small standalone solar photovoltaic (PV) systems as being important for achieving greater electricity access. However, rural farm households typically face a range of market imperfections including lack of access to credit, investment irreversibility (or absence of second-hand markets) and farm production/income risk which act as barriers to their ability and/or willingness to invest. This paper examines how these market imperfections impact on the adoption of standalone solar PV systems for small scale farm households in Uganda. We consider how temporary or permanent these barriers to adoption are when farm production/income is uncertain. We do so by using a dynamic programming model which captures household investment in small scale solar PV systems where significant positive benefits arise through assumed improved farm productivity or income effects, while allowing for credit constraints, investment irreversibility and income risk. Although strong positive incentives exist in the model to adopt a solar PV system, the results show that adoption rates are substantially lower for credit constrained households, with only 40% of these households adopting immediately, compared with over 70% of credit unconstrained households. While these adoption rates do increase over time, only 60% of credit constrained households have adopted within 5 years compared with nearly all credit unconstrained households adopting within the same time period. In the longer term for almost 30% of households the credit constraints act as a permanent barrier to adoption. The presence of a well-functioning second-hand market does increase household consumption and welfare but the impacts on overall adoption rates are rather small. [ABSTRACT FROM AUTHOR]

Approximately 1.8 million people were displaced in northern Uganda as a result of the LRA conflict. This paper explores risk and protective factors as well as examples of resilience among women in northern Uganda resettling after armed conflict and internal displacement. The risk and resilience ecological framework is used to identify and understand these factors along the multiple levels of the ecological social system. Risk factors included poor health, loss of instrumental and emotional support networks, and land vulnerability. Protective factors included engagement in livelihood and sociocultural activities with others. Resilience was located in the women's coping and maintenance of family and social relationships. [ABSTRACT FROM AUTHOR]

The increased mortality rate among the Acoli people of northern Uganda is anecdotally blamed on excessive consumption of cheap and widely available sachet-packaged alcohol in the region. In this paper, we quantify this perceived association by determining statistically the health risks associated with ingesting 20 heavy metals in 17 popular spirits products consumed in Acoli. Thirteen of these products were industrially packaged in sachets (locally known as ‘sachet,’ waragi, arege or moo lyec) and four were locally produced Lira-Lira spirits from Bolo, Awere and Teso Bar in the region and Nsambya in southern Uganda. A Scottish whisky purchased in San Diego (USA) was our reference. Risk assessment was performed according to standardized protocols developed by the United States Environmental Protection Agency (US EPA). Our results show that a strong correlation indeed exists between health risks and ingestion of spirits in Acoli. At >2.5 sachets/day for 240 day/year over a lifetime for example, the risk of developing cancer due to exposure to As, Pb and Cr alone is 1 in 102,041. This estimate excludes ethanol, a known carcinogen, and 17 heavy metals also studied due to lack of their cancer slope factors. The primary non-cancer related health risk factor in all samples tested is ethanol with unacceptably high health index of four. The Lira-Lira spirits, with 100–6000% copper above the US EPA limit for intake by oral ingestion in water, would be the ‘cleanest’ without copper and at par with the Scottish whisky. Collectively, we find that no amount of alcohol consumed in Acoli is safe. Preventive measures are therefore recommended to reduce mortality in Acoli in particular, and in Uganda in general. These measures should include public education, better public policies, creating productive economic activities other than brewing alcohol, and social activities that engage people away from drinking. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the ways in which "mental health" difficulties are approached in low-income countries, using a case study of Uganda focus down upon the issues. Design/methodology/approach – The study involved two phases. The first was the collection and analysis of documentary evidence and interviews with policy makers in Uganda. The second involved interviews with health staff, traditional healers and the public in the Buganda Kingdom of Uganda. Interviews were conducted in English or Luganda and translated as necessary. No external sources of funding to declare. Findings – There are differing perceptions of mental health and illness in Uganda and there exists culturally accepted sources of support for distress. This highlights the important role of traditional healers and the paper argues that they should be recognised for their work in mental health care. Research limitations/implications – The paper is a small-scale study of one area of Uganda (Buganda Kingdom), the extent to which it can be generalised is therefore very limited. However, the research is sufficient to indicate the benefits of traditional healers in mental health care and supports an argument towards a public mental health model. Practical implications – The paper argues for a move in priority away from a focus upon a biomedical model of mental health support towards a public health model and the meaningful engagement of traditional healers. This would also necessitate a refocus of spending in the wider society. Originality/value – The paper poses a challenge to the Global Public Health movement and questions the relevance of expanding biomedical psychiatry in low-income countries. The paper also adds weight to emerging literature on the value of a public health approach to mental health and illness, especially in the developing world. [ABSTRACT FROM AUTHOR]

This paper investigates the benefits of Chinese companies to the Ugandan economy using data gathered during fieldwork in Kampala. Potential contributions to the Ugandan economy are analysed through a number of economic and managerial factors, and their determinants. This paper shows that potential benefits vary on the basis of sector, investment size and ECCO registration. The potential harm caused by one sector in particular is indicated. The paper presents recommendations regarding how potential benefits can be maximised and harm reduced. Given the increased presence of Chinese enterprises in Africa, these findings are relevant to African policymakers and academics. [ABSTRACT FROM AUTHOR]

Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41–0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18–1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda’s AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities. [ABSTRACT FROM AUTHOR]

Older adults’ vulnerability and resilience are a result of processes constructed throughout the lifecycle. In Uganda, older people almost always rely exclusively on their social networks for care and economic support when in need. These support systems are mainly family based, and play a role of safety net for their older members. However, localised in-depth studies have pointed out the limitations of family-based support systems, especially in the context of the HIV/AIDS epidemic. This paper uses 83 in-depth interviews conducted in various settings across Uganda with older people and their family members on the subject of their support systems. Over and above the lack of immediate/personal resources characterising most older people, our results highlight the importance of the extent of support systems and resource diversity. Most of the people in our case studies had lost descendants due to the civil war, the HIV/AIDS epidemic, or simply family break-ups, events which often create large breaches and gaps in support systems. Few older people can be resilient in this situation, primarily because there are often not enough resources available in their support networks to cover the needs of all, especially education for the young and health-care access for the old. [ABSTRACT FROM AUTHOR]

Background: The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods: Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings: Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation: The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is projected to become the second most common cause of disability by 2020 calling for a better understanding its antecedents across the lifespan and in diverse socio-cultural settings. In this paper we describe the risk factors of MDD among older people (50 years +) living in HIV-endemic central and southwestern Uganda. A cross-sectional study was undertaken among 471 respondents (50 years +) participating in the Wellbeing of Older People’s Study cohort of the MRC/UVRI Uganda research Unit on AIDS in Uganda. Participants were from five strata: HIV negative, HIV positive on ART, HIV positive not on ART, having an adult child on ART, and having an adult child who died of HIV. Overall MDD prevalence was 9.2% (95% CI 6.7–12.2%) with a prevalence among males of 7.4% (95% CI 4.0–12.3%) and females of 10.3% (95% CI 7.0–14.3%). Factors significantly associated with MDD included: declining socio-economic status, increasing disability scores, decreasing mean grip strength, reported back pain, and not having hypertension. Marginally associated with MDD was being HIV infected and not on ART. [ABSTRACT FROM PUBLISHER]

Enhancing the private sector, and especially entrepreneurship, has become a key feature of development policy in recent years. In many African countries, entrepreneurship is promoted as a way to solve the youth unemployment crisis, but little is known about the experiences of young entrepreneurs. This paper examines the motivations and aspirations of young business owners in Uganda. Drawing on qualitative data collected in Kampala, the paper shows the diversity and complexity of factors underpinning the decision to set up a business and the variety of future aspirations. The paper questions the common representation of entrepreneurs as either necessity- or opportunity-driven and discusses the widespread assumption that necessity-driven entrepreneurs in developing countries are unlikely to have growth aspirations. Adopting the notion of social embeddedness, this paper shows how entrepreneurship motivations and aspirations are closely intertwined with changes in the socio-economic environment, social networks, family relations and position in the life course. [ABSTRACT FROM AUTHOR]

The West Nile region in northwestern Uganda is a focal point for human plague, which peaks in boreal autumn and is spread by fleas that travel on rodent hosts. The U.S. Centers for Disease Control and Prevention is collaborating with the National Center for Atmospheric Research to quantitatively address the linkages between climate and human plague in this region. The aim of this paper is to advance knowledge of the climatic conditions required to maintain enzootic cycles and to trigger epizootic cycles and ultimately to target limited surveillance, prevention, and control resources. A hybrid dynamical-statistical downscaling technique was applied to simulations from the Weather Research and Forecasting Model (WRF) to generate a multiyear 2-km climate dataset for modeling plague in the West Nile region. The resulting dataset resolves the spatial variability and annual cycle of temperature, humidity, and rainfall in West Nile relative to satellite-based and in situ records. Topography exerts a first-order influence on the climatic gradients in West Nile, which lies in a transition zone between the drier East African Plateau and the wetter Congo Basin, and between the unimodal rainfall regimes of the Sahel and the bimodal rainfall regimes characteristic of equatorial East Africa. The results of a companion paper in which the WRF-based climate fields were applied to develop an improved logistic regression model of human plague occurrence in West Nile are summarized, revealing robust positive associations with rainfall at the tails of the rainy season and negative associations with rainfall during a dry spell each summer. [ABSTRACT FROM AUTHOR]

With the expansion of access to HIV testing and antiretroviral therapy in sub-Saharan Africa, questions have emerged as to whether stigma remains a useful concept for understanding the effects of AIDS. There is, however, a paucity of research on how HIV-positive Africans - especially African men - experience living with AIDS. This paper addresses this gap and draws on findings from ethnographic fieldwork in 2004 and 2009 with a support group for HIV-positive men in Kampala, Uganda. The paper demonstrates that stigma is central to how men in this context coped with HIV and AIDS and it provides a conceptual framework that links men's experiences of AIDS stigma to conceptions of masculinity. In so doing, findings highlight both the possibilities and challenges of involving African men more fully in HIV prevention. [ABSTRACT FROM AUTHOR]

This paper investigates the links between social capital and household poverty in Uganda. It assumes a two-way causal relationship between poverty and access to social capital. This suggests an endogeneity problem, so the paper uses econometric techniques that control for endogeneity. Using two nationally representative datasets, the authors' analyses revealed that access to social capital defined in terms of membership of social organisations positively affects household income and reduces poverty. Education was the key determinant of income and increases the probability of joining social networks. Their results further show that household income and welfare are positively associated with access to social capital or group participation. This suggests that government strategies to increase household income that take into consideration existing social institutions will go a long way to encourage associational growth and performance and consequently reduce poverty. [ABSTRACT FROM AUTHOR]

Household consumption surveys suggest that the downward trend in rural poverty indicators recorded in Uganda during the 1990s has been reversed since 2000. This paper examines the Ugandan government's strategy to reduce rural poverty, the Plan for Modernization of Agriculture (PMA). It argues that, while there appear few better choices of "target" for the PMA than to improve incomes of the rural poor through increased agricultural productivity, emphasis on decentralization as a mechanism for poverty reduction is misplaced in the current political context of Uganda. The paper considers what alternative mechanisms might better deliver reductions in rural poverty. [ABSTRACT FROM AUTHOR]

• Commercial agriculture as a government policy is seen as key to nutrition. • Nutrient intake is largely through accrued income. • Women control over income is beneficial for nutrition. • Nutrition education is key for better nutritional outcomes. Agricultural commercialization is expected to enhance a wide array of household welfare indicators, notably, nutrition. Using LSMS-ISA survey data for Uganda, this paper examines the channels through which household nutrient intake is influenced under crop commercialization. A control function was employed to address issues of endogeneity, while the Generalized Propensity Score technique was used to estimate the continuous treatment effects. The results show that commercialization mainly affects nutrient intake through the resulting crop income. From a gender perspective, the findings show that female control of farm income positively and significantly affects the overall nutrient intake. The findings point to three important implications. First, interventions geared towards agricultural commercialization are beneficial to household nutrition via income generation. Given this income-nutrition linkage, proactive steps towards support for nutrition-sensitive commercial agriculture are needed to ensure that nutrient-rich foods are available on the market. Second, there is the need to improve knowledge and perception of what constitutes a good diet. This would provide a stronger linkage between agricultural production, income, and nutrition. Third, gender relations in a household are critical for nutrition outcomes. As such, measures which can empower women to own and control key agricultural production assets are needed to reinforce the link between commercialization and nutrition. [ABSTRACT FROM AUTHOR]

• In Uganda, proximity to aid-funded WASH projects is associated with increased household access to improved sources of water. • However, proximity to these projects is also associated with an increase in the time burden of water collection due to longer travel and wait times. • The supply of improved water sources financed by WASH aid in Uganda remains inadequate relative to the demand for these services. • Locating more water projects closer to households can help to increase access to water and reduce the time burden of water collection. Empirical evidence from cross-country studies on the effectiveness of aid to the water, sanitation and hygiene sector (WASH aid) points to significant heterogeneity across countries and highlights the need for further research at the sub-national level to assess and quantify the effectiveness of WASH aid within countries. This paper combines geocoded sub-national data on the location of WASH aid projects in Uganda with nationally representative household-level panel survey data to examine whether proximity to aid-funded WASH projects improves household access to water. Access to water is evaluated along three dimensions: access to an improved water source, travel time to an improved water source and waiting time at an improved water source. The results of a difference-in-difference regression analysis suggest that while aid-funded WASH projects increase household access to improved sources of water, households may also see the time burden of water collection increase, as they may need to travel longer distances and also experience longer wait times due to congestion at water service points. This is an indication that the supply of improved water sources financed by WASH aid in Uganda remains insufficient relative to demand as measured by the population density. [ABSTRACT FROM AUTHOR]

Psychological distress is common among adolescents living with HIV (ALHIV) worldwide, and has been associated with non-adherence to anti-retroviral therapy (ART), leading to poor virologic suppression, drug resistance, and increased risk for AIDS morbidity and mortality. However, only a few studies have explored the relationship between psychological distress and ART adherence among adolescents in sub-Saharan Africa. The paper examines the relationship between psychological distress and ART adherence, and effect of psychosocial resources on ART adherence. We conducted a cross-sectional survey of 464 ALHIV (aged 12–19; 53% female) seeking HIV care at a large HIV treatment center in Kampala, Uganda. ALHIV were recruited during routine clinic visits. Three self-reported binary adherence measures were utilized: missed pills in the past three days, non-adherence to the prescribed medical regimen, and self-rated adherence assessed using a visual analog scale. Psychological distress was measured as a continuous variable, and computed as the mean score on a locally developed and validated 25-item symptom checklist for Ugandan ALHIV. Psychosocial resources included spirituality, religiosity, optimism, social support, and coping strategies. After adjusting for respondents’ socio-demographic characteristics and psychosocial resources, a unit increase in psychological distress was associated with increased odds of missing pills in past 3 days (Odds Ratio(OR) = 1.75; Confidence Interval (CI): 1.04–2.95), not following the prescribed regimen (OR = 1.63; CI: 1.08–2.46), and lower self-rated adherence (OR = 1.79; CI: 1.19–2.69). Psychosocial resources were associated with lower odds for non-adherence on all three self-report measures. There is a need to strengthen the psychosocial aspects of adolescent HIV care by developing interventions to identify and prevent psychological distress among Ugandan ALHIV. [ABSTRACT FROM AUTHOR]

Microcredit transactions in developing countries create risks for borrowers that are routinely overlooked in the literature. This paper argues that common microfinance-lending methodologies that allow lenders to collateralize loans and unilaterally collect this security create opportunities for malicious lenders to steal from clients in good standing. In places where any lender can simply call itself a 'microfinance institution' (MFI), opportunistic lenders can use the halo effect associated with microfinance to encourage borrowers to make themselves unusually vulnerable to theft. Evidence of these abuses can be seen in a case study of Uganda, where theft and fraud by a small number of microfinance institutions created a large-scale crisis and contributed to a precipitous decline in trust in the financial sector as a whole. Even when it occurs only on the margins of the sector, I conclude, this type of opportunism may have problematic implications for all MFIs and undermine efforts to increase financial inclusion. This possibility provides a new impetus to consider innovative regulatory approaches for microfinance. [ABSTRACT FROM AUTHOR]

Background: Conflict and post-conflict communities in sub-Saharan Africa have a high under recognised problem of intimate partner violence (IPV). Part of the reason for this has been the limited data on IPV from conflict affected sub-Saharan Africa. This paper reports on the prevalence, risk factors and mental health consequences of IPV victimisation in both gender as seen in post-conflict eastern Uganda. Methods: A cross-sectional survey was carried out in two districts of eastern Uganda. The primary outcome of IPV victimisation was assessed using a modified Intimate Partner Violence assessment questionnaire of the American Congress of Obstetricians and Gynaecologists. Results: The prevalence of any form of IPV victimisation (physical and/or sexual and/or psychological IPV) in this study was 43.7 % [95 % CI, 40.1-47.4 %], with no statistically significant difference between the two gender. The factors significantly associated with IPV victimisation were: sub-county (representing ecological factors), poverty, use of alcohol, and physical and sexual war torture experiences. The mental health problems associated with IPV victimisation were probable problem alcohol drinking, attempted suicide and probable major depressive disorder. Conclusion: In post-conflict eastern Uganda, in both gender, war torture was a risk factor for IPV victimisation and IPV victimisation was associated with mental health problems. [ABSTRACT FROM AUTHOR]

The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH’s motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH’s self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH’s self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH’s self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new ‘self’: they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART programmes might explore further and encourage. [ABSTRACT FROM AUTHOR]

Background: Globally, the majority of people with HIV/AIDS live in sub-Saharan Africa. While the increasing availability of antiretroviral therapy is improving the outlook for many, its effects are yet to reach all of those in need and patients still present with advanced disease. This paper reports findings from qualitative interviews with patients living with AIDS and their caregivers who were receiving palliative care from Hospice Africa Uganda (HAU). We aimed to understand what motivated patients and their families to seek formal healthcare, whether there were any barriers to help- seeking and how the help and support provided to them by HAU was perceived. Methods: We invited patients with AIDS and their relatives who were newly referred to HAU to participate in qualitative interviews. Patients and carers were interviewed in their homes approximately four weeks after the patient's enrolment at HAU. Interviews were translated, transcribed and analysed using narrative and thematic approaches. Results: Interviews were completed with 22 patients (10 women and 12 men) and 20 family caregivers, nominated by patients. Interviews revealed the extent of suffering patients endured and the strain that family caregivers experienced before help was sought or accessed. Patients reported a wide range of severe physical symptoms. Patients and their relatives reported worries about the disclosure of the AIDS diagnosis and fear of stigma. Profound poverty framed all accounts. Poverty and stigma were, depending on the patient and family situation, both motivators and barriers to help seeking behaviour. Hospice services were perceived to provide essential relief of pain and symptoms, as well as providing rehabilitative support and a sense of caring. The hospice was perceived relieve utter destitution, although it was unable to meet all the expectations that patients had. Conclusion: Hospice care was highly valued and perceived to effectively manage problems such as pain and other symptoms and to provide rehabilitation. Participants noted a strong sense of being "cared for". However, poverty and a sense of stigma were widespread. Further research is needed to understand how poverty and stigma can be effectively managed in hospice care for patients for advanced AIDS and their families. [ABSTRACT FROM AUTHOR]

Background: In spite of the investments made by the Ugandan Government, the utilisation of maternal health services has remained low, resulting in a high maternal mortality (438 maternal deaths per 100,000 live births). Aiming to reduce poor women's constraints to the utilisation of services, an intervention consisting of a voucher scheme and health system strengthening was implemented. This paper presents the lessons learnt during the setup and implementation of the intervention in Eastern Uganda, in order to inform the design and scale up of similar future interventions.Methods: The key lessons were synthesised from a variety of project reports, as well as qualitative data drawn from six focus group discussions and four in-depth interviews conducted in the Buyende and Pallisa districts during the implementation phase of the voucher scheme.Results and Conclusions: To promote the successful implementation of interventions with demand and supply side initiatives, such as voucher schemes, the health system should be able to respond to the demand created by providing the additional required resources such as health workers, essential supplies and equipment. Involving a diverse, multi-sectoral group of stakeholders is important for addressing the different barriers experienced by women when seeking maternal health services. Voucher schemes should have a mechanism of detecting unintended consequences and mitigating them. Sustainability plans should be built into such interventions to maintain the gains achieved. Lastly, health policy planners can use this information to develop follow-up programmes to test modified versions that are more sustainable. Such programmes could use locally existing community structures for management and resource mobilisation for self-sustainment. [ABSTRACT FROM AUTHOR]

Background: Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons' healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons' healthcare access in Uganda, using a nationally representative sample. Methods: We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. Results: More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1-7 days (RR =1.19, 95% CI: 1.10-1.30); and 8-14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR= 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days. Conclusion: In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility imitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons. [ABSTRACT FROM AUTHOR]

Background Increasing interest is concentrating in the investigation of whether socioeconomic interventions yield results for children in the area of protection. AVSI Foundation, in Uganda, leads a consortium implementing the “Sustainable, Comprehensive Responses for Vulnerable Children and their Families” (SCORE) Project. The project targets 25,000 moderately and critically vulnerable households in Uganda and addresses them through a multisectoral intervention package encompassing socio-economic, food security, protection and family strengthening. Data from SCORE's monitoring and evaluation system and the mid-term assessment has become available and is used to investigate the topic. Objective This paper contributes original data and analysis to the discussion of socioeconomic strategies for vulnerability reduction and protection of children. Methods Statistical analysis of Village Savings and Loan Association Management Information System (VSLA MIS) data from 741 VSLAs was supported by the SCORE Project between 2012 and 2013. Statistical analysis of SCORE Vulnerability Assessment Tool (VAT) data covering 13,327 beneficiary households enrolled by SCORE in its first phase (last quarter 2011–first quarter 2012) and corresponding second assessment (second quarter 2013). Data analysis was carried out using Statistical Package for Social Sciences (SPSS). Results Between 2011 and 2012, SCORE supported the establishment of 743 Village Savings and Loan Associations (VSLAs), with a total membership of 20,818. Total saving stands at 1,113,185,960 Uganda Shillings. Saving and loans per capita are at 53,754 and 50,093 Uganda Shillings respectively, with regional variation (ranging 33,008–83,073 for savings, and 24,005–93,280 for lending). The overall loan to saving ratio is at 84.45%, with regional variation and range 60.83%–97.97%. Vulnerability data concerning the protection for 13,326 households supported by SCORE shows a reduction by 52%, with regional variation (range 42%–71%). Conclusion Results show that the VSLA approach can be used, besides community development, for direct vulnerability reduction strategies. VSLA approach can be made more inclusive of the most disenfranchised members of the community without losing in efficiency or effectiveness. SCORE Project data is highly suggestive of a positive linkage between socioeconomic interventions and protection outcomes, thereby reinforcing the current literature. More detailed analysis of SCORE databases may allow further understanding of the pathways linking the two result dimensions. [ABSTRACT FROM AUTHOR]

Background: Stigma is a determinant of social and health inequalities. In addition, some notions of masculinity can disadvantage men in terms of health outcomes. However, few studies have explored the extent to which these two axes of social inequality intersect to influence men's health outcomes. This paper investigates the intersection of HIV stigma and masculinity, and its perceived impact on men's participation in and utilisation of HIV services in Uganda. Methods: Interviews and focus group discussions were conducted in Mbale and Jinja districts of Uganda between June and October 2010. Participants were men and women living with HIV (n = 40), their family members (n = 10) and health providers (n = 15). Inductive analysis was used to identify mechanisms through which stigma and masculinity were linked. Results: Our findings showed that HIV stigma and masculinity did not exist as isolated variables, but as intersecting phenomena that influenced men's participation in HIV services. Specifically, HIV stigma threatened masculine notions of respectability, independence and emotional control, while it amplified men's risk-taking. As a result, the intersection of masculinity and HIV stigma prevented some men from i) seeking health care and accepting a 'sick role'; ii) fulfilling their economic family responsibilities; iii) safeguarding their reputation and respectability; iv) disclosing their HIV status; and v) participating in peer support groups. Participation in some peer support activities was considered a female trait and it also exacerbated HIV stigma as it implicitly singled out those with HIV. In contrast, inclusion of income-generating activities in peer support groups encouraged men's involvement as it enabled them to provide for their families, cushioned them from HIV stigma, and in the process, provided them with an opportunity to redeem their reputation and respectability. Conclusion: To improve men's involvement in HIV services, the intersection between HIV stigma and masculinity should be considered. In particular, better integration of and linkage between gender transformative interventions that support men to reconstruct their male identities and reject signifiers of masculinity that prevent their access to HIV services, and stigma-reduction interventions that target social and structural drivers of stigma is required within HIV programmes. [ABSTRACT FROM AUTHOR]

Introduction: Global scale up of antiretroviral therapy is changing the context of HIV-related stigma. However, stigma remains an ongoing concern in many countries. Groups of people living with HIV can contribute to the reduction of stigma. However, the pathways through which they do so are not well understood. Methods: This paper utilizes data from a qualitative study exploring the impact of networked groups of people living with HIV in Jinja and Mbale districts of Uganda. Participants were people living with HIV (n=40), members of their households (n=10) and their health service providers (n=15). Data were collected via interviews and focus group discussions in 2010, and analyzed inductively to extract key themes related to the approaches and outcomes of the groups' anti-stigma activities. Results: Study participants reported that HIV stigma in their communities had declined as a result of the collective activities of groups of people living with HIV. However, they believed that stigma remained an ongoing challenge. Gender, family relationships, social and economic factors emerged as important drivers of stigma. Challenging stigma collectively transcended individual experiences and united people living with HIV in a process of social renegotiation to achieve change. Groups of people living with HIV provided peer support and improved the confidence of their members, which ultimately reduced self-stigma and improved their ability to deal with external stigma when it was encountered. Conclusions: Antiretroviral therapy and group-based approaches in the delivery of HIV services are opening up new avenues for the collective participation of people living with HIV to challenge HIV stigma and act as agents of social change. Interventions for reducing HIV stigma should be expanded beyond those that aim to increase the resilience and coping mechanisms of individuals, to those that build the capacity of groups to collectively cope with and challenge HIV stigma. Such interventions should be gender sensitive and should respond to contextual social, economic and structural factors that drive stigma. [ABSTRACT FROM AUTHOR]