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There is an increasing trend toward regionalization as higher education adapts to openness and globalization. In response, East African countries formed networks and partnerships that strengthened business, higher education, student and staff mobility, and research. This is because regionalization is embedded in East Africa's economy, politics, culture, and social norms. In addition, regionalization is influenced by internationalization and globalization. It promises development opportunities, although challenges are inevitable. This paper examines the contributions of regional student mobility to East Africa's development. We use neoliberal and world systems theories to illuminate the advantages and disadvantages of regionalizing higher education and explain how partner states can maximize opportunities and minimize challenges. Data was collected through convenience sampling of two hundred international students and two staff members in international students' offices. Data analysis revealed that the regionalization of East African higher education reflects historical power relations; it has benefits though founded on inequalities.

Research ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no "gold standard" for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still "foreign" is challenging and necessitates supportive leadership at all institutional levels. [ABSTRACT FROM AUTHOR]

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]

A considerable body of literature suggests that immigration undermines voluntary contributions to public goods because it leads to ethnic diversity, which erodes social trust. This article posits that the effect of immigration outweighs that of ethnic diversity, so that immigration may explain why ethnic diversity is negatively associated with social trust and public goods provisioning. I also highlight a need to emphasize the moderating influence of transaction costs when analyzing provisioning problems associated with immigration and ethnic diversity. To examine my hypotheses, I use a mixed-method research design to study public goods management in randomly selected communities in rural Uganda whose rates of immigration and levels of ethnic diversity vary. I analyze community-level attempts at collective action that involve substantially different costs; that is, contributing to toilet construction and participating in litter pickup programs. The findings suggest that socio-political barriers to collective action for public goods provisioning may have less to do with the stock of demographic diversity than the flow rate of demographic change. The same findings suggest a more micro-level explanation that transcends the erosive effects (of immigration and ethnic diversity) on social trust to emphasize the moderating influence of transaction costs. [ABSTRACT FROM AUTHOR]

Background: Maternal undernutrition during pregnancy is currently estimated at 23.5% in Africa, which is worrying given the negative impacts of malnutrition on maternal and fetal birth outcomes. The current study aimed at characterizing the associations of maternal dietary intake and nutritional status with fetal growth at 14–26 weeks gestation. It was hypothesized that maternal dietary intake was positively associated with maternal nutritional status and fetal growth both in early and late pregnancy. Methods: This was a cross-sectional survey of 870 pregnant women in mid-western Uganda conducted in August 2013. Data were collected on women's dietary intake (indicated by women's dietary diversity and the diet quality score) and nutritional status (indicated by hemoglobin level and mid-upper arm circumference) at 14–26 weeks gestation. Fetal growth was determined by symphysis-fundal height Z-scores processed using the INTERGROWTH-21st calculator. Associations between maternal dietary intake and nutritional status with fetal growth were determined using correlations and chi-square tests. Results: Overall, only 25% had adequate dietary diversity and the most utilized food groups were White tubers, roots and starchy vegetables; Pulses, nuts and seeds; Cereals and grains, Dark green leafy vegetables, and Fats and oils. A larger proportion of younger women (15–29 y) were classified as anemic (20.4% versus 4.4%) and underweight (23.7% versus 5.0%) compared to older women (30–43 y). Additionally, women aged 15 to 24 years had significantly lower mean SFH-for-gestation age Z-scores than women 36–43 years (F4, 783 = 3.129; p = 0.014). Consumption of legumes nuts and seeds was associated with reduced risk of anemia while consumption of dairy products (mostly milk) was positively associated with better fetal growth. Surprisingly, low Hb level was positively associated with normal fetal growth (rP = -0.133; p = 0.016) after 20 weeks gestation, possibly indicating normal fetal growth paralleled with physiologically necessary hemodilution. Conclusions: Sub-optimal dietary patterns, characterized by limited dietary diversity and low protein intake, are likely to compromise maternal nutrition and fetal growth in limited resource settings. Improving pregnant women's access to cheaper but nutrient-dense protein sources such as pulses, nuts and dairy products (mostly milk) has potential to improve women's nutritional status and enhance fetal growth. [ABSTRACT FROM AUTHOR]

Introduction: Adherence counselling with point‐of‐care (POC) drug‐level feedback using a novel tenofovir assay may support pre‐exposure prophylaxis (PrEP) adherence; however, perceptions of urine testing and its impact on adherence are not well studied. We qualitatively examined how POC tenofovir testing was experienced by transgender women (TGW) in Uganda. Methods: Within a cluster randomized trial of peer‐delivered HIV self‐testing, self‐sampling for sexually transmitted infections and PrEP among HIV‐negative TGW showing overall low PrEP prevention‐effective adherence (NCT04328025), we conducted a nested qualitative sub‐study of the urine POC assay among a random sample of 30 TGW (August 2021−February 2022). TGW interviews explored: (1) experiences with POC urine tenofovir testing and (2) perceptions of PrEP adherence counselling with drug‐level feedback. We used an inductive content analytic approach for analysis. Results: Median age was 21 years (interquartile range 20–24), and 70% engaged in sex work. Four content categories describe how TGW experienced POC urine tenofovir testing: (1) Urine tenofovir testing was initially met with scepticism: Testing urine to detect PrEP initially induced anxiety, with some perceptions of being intrusive and unwarranted. With counselling, however, participants found POC testing acceptable and beneficial. (2) Alignment of urine test results and adherence behaviours: Drug‐level feedback aligned with what TGW knew about their adherence. Concurrence between pill taking and tenofovir detection in urine reinforced confidence in test accuracy. (3) Interpretation of urine tenofovir results: TGW familiar with the interpretation of oral‐fluid HIV self‐tests knew that two lines on the test device signified positivity (presence of HIV). However, two lines on the urine test strip indicated a positive result for non‐adherence (absence of tenofovir), causing confusion. Research nurses explained the difference in test interpretation to participants' satisfaction. (4) White coat dosing: Some TGW deliberately chose not to attend scheduled clinic appointments to avoid detecting their PrEP non‐adherence during urine testing. They restarted PrEP before returning to clinic, a behaviour called "white coat dosing." Conclusions: Incorporating POC urine testing into routine PrEP adherence counselling was acceptable and potentially beneficial for TGW but required attention to context. Additional research is needed to identify effective strategies for optimizing adherence monitoring and counselling for this population. [ABSTRACT FROM AUTHOR]

This study examines how journalists in Rwanda, Uganda and Kenya perceive their journalistic role orientations in light of the countries' differing political systems, Rwanda representing the nation with the most restrictive political system, Uganda sitting in the middle and Kenya illustrating the nation that is home to the least restrictive political system. Data were analyzed from a comparative, quantitative online survey completed by 424 journalists from the three East African nations. Overall, the journalistic role orientations that emerged in each country align with the freedoms afforded by the political system in each country, revealing a trend that journalists in non-Western countries lean toward more interventionist roles (at times to the point of actively supporting their government), and journalists in countries with less restrictive political systems lean toward more adversarial roles (keeping their government in check). [ABSTRACT FROM AUTHOR]

Introduction: Many organizations are developing new contraceptive products and approaches that promote self-care including a microarray patch (MAP) that has the potential for self-administration with appropriate training. We studied women's perceptions of the MAP technology with the primary goal of providing feedback on product attributes to inform early technical design decisions regarding various MAP contraceptive products in development by MAP developers. Methods: Our study consisted of a qualitative phase with in-person In-Depth Interviews (IDIs) with a total of 60 women of reproductive age (WRA) and quantitative surveys, via face-to-face computer-assisted interviews of a total of 927 women in Ghana, Kenya and Uganda. Women's perceptions on 12 attributes of the MAP were assessed through written descriptions, a profile, and visual stimuli such as graphics and images. Results: Overall, the most widely preferred attribute set included: a hand-applied MAP, utilizing one circular patch, with a sticky backing, no larger than 2 cm diameter in size, applied by self, to the arm, offering sensory feedback (clicking sound and/or color change signals) to confirm enough pressure, successful application and removal, lasting 6 months with up to 12 months return to natural state of fertility. There is space to allow for variation in MAP designs (including the use of an applicator or provider administered MAP) if the design promotes and reflects the needs and expectations of users and providers. Discussion: The contraceptive MAP had a high and broad level of appeal amongst all groups of women who participated in the study and has a strong value proposition around important contraceptive needs such as ease of use, convenience, and discretion. [ABSTRACT FROM AUTHOR]

Objective: Providing country-level estimates for prevalence rates of Generalized Anxiety Disorder (GAD), COVID-19 exposure and food insecurity (FI) and assessing the role of persistent threats to survival--exemplified by exposure to COVID-19 and FI--for the mental health crisis in Africa. Methods: Original phone-based survey data from Mozambique, Sierra Leone, Tanzania and Uganda (12 consecutive cross-sections in 2021; n = 23,943) were analyzed to estimate prevalence rates of GAD. Logistic regression models and mediation analysis using structural equation models identify risk and protective factors. Results: The overall prevalence of GAD in 2021 was 23.3%; 40.2% in Mozambique, 17.0% in Sierra Leone, 18.0% in Tanzania, and 19.1% in Uganda. Both COVID-19 exposure (ORadj. 1.4; CI 1.3-1.6) and FI (ORadj 3.2; CI 2.7-3.8) are independent and significant predictors of GAD. Thus, the impact of FI on GAD was considerably stronger than that of COVID-19 exposure. Conclusion: Persistent threats to survival play a substantial role for mental health, specifically GAD. High anxiety prevalence in the population requires programs to reduce violence and enhance social support. Even during a pandemic, addressing FI as a key driver of GAD should be prioritized by policymakers. [ABSTRACT FROM AUTHOR]