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For children to know how to fully participate in and most effectively lead the world they will inherit, they must learn how to critically engage with it and be knowledgeable about foundational rights and instruments that support such engagement. Together, critical literacy, which encourages the examination and interrogation of the underlying assumptions of dominant narratives and 'legitimate' knowledge, and children's rights education, which involves children in learning how to express their ideas and fully participate in society (as appropriate to their age and ability), offer a powerful approach--theoretical and pedagogical--to engage children in active engagement of the world, especially with respect to the promotion of social justice. However, the layers of complexity and risks associated with deep consideration of challenging topics require expert guidance and compassionate role modelling from teachers of young children. Our paper considers the intersections between critical literacy and global child rights with reference to a study conducted with young school children in Canada and Uganda to discuss how teachers can support meaningful learning experiences in the classroom that can promote children's agency and social justice commitments.

This paper demonstrates that the phenomenographic methodology -- the study of variations of lived experience -- has the capacity to manage cultural and paradigmatic differences between researchers and participants in cross-cultural research. The process of cross-cultural research presented herein makes a contribution to the existing body of knowledge about the efficacy of phenomenography. This process was developed from a phenomenographic research project in Northern Uganda and from due consideration of other cross-cultural phenomenographic studies. The study of experience in cross-cultural education projects provides an opportunity to understand participants' conceptions of inner (psychological) and outer (sociocultural) learning processes. A phenomenographic methodology necessitates the organization of categories of description into a holistic 'mental model', which may comprise metaphoric representation. The use of metaphor in phenomenography to depict the categories of description as a whole was found to be particularly powerful in this cross-cultural research study as metaphor helped to establish common understandings between researchers and participants. Furthermore, phenomenography also has the potential to help manage the influences of internationalization in local contexts as its methods give primacy to local participants' experiences.

In many low- and lower-middle-income countries, private schools are often considered to offer better quality of education than government schools. Yet, there is a lack of evidence to date on their role in reducing inequalities: namely, the extent to which private schooling improves learning among the most disadvantaged children. Our paper uses household survey data from Kenya, Tanzania, and Uganda to identify whether any observed impact of private schooling on core literacy and numeracy skills differs according to children's household wealth. We demonstrate wealth gaps in access to private schooling, and use inferential models to account for observable differences between those who do and do not enrol in private schools. In Kenya and Uganda, we find that private schooling appears to improve the chances of children learning relative to their peers in government schools, but the chances of the poorest children learning in private schools remains low and is at best equivalent to the richest learning in government schools. In Tanzania, private schooling does not seem to improve poorer children's learning, whereas it does for richer children. These findings raise a caution about the extent to which private provision can help narrow learning inequalities.

In the midst of the violence of the 21st century, many children fear that they or someone they know will lose a relative or friend through terrorism. Professionals in dance movement therapy, dance education, and physical education can help children to overcome their fears in order to feel safe and to build self-esteem. This article examines how several nations use dance education and therapy to help children manage the trauma of violence and loss. Unfortunately, dance programs alone cannot guarantee the end of conflict, but they can act as a catalyst for better understanding for future generations. Much can be learned from dance educators and movement therapists who have, by their own sense of humanity and extensive training, bravely explored the concept of healing for children traumatized by war. Dance movement therapists must fulfill the requirements of higher educational institutions and the standards of the American Dance Therapy Association in order to handle challenges that lie ahead. Well-trained dance and physical educators will continue to play a major role in providing an outlet for expression.

Since the end of the Second World War in 1945, the erection of camps within and across state borders has become the most common response to the influx of displaced persons. Based on empirical evidence from northern Uganda, this paper aims to provide answers to two main questions: (i) how does the camp influence and frame the upbringing of children?; and (ii) how do caregivers shape and adjust upbringing within this setting and when they return to their 'former homes' ? Interviews and focus‐group discussions were conducted with 48 caregivers living in Kitgum District, northern Uganda. Deductive thematic analysis was employed to structure participants' accounts of past and present interconnections between upbringing and (previous) encampment. By paying close attention to their (counter‐)narratives, people's agency and coping are emphasised through the simultaneous forging of new interconnections (that is, discontinuities) and holding on to old interconnections (that is, continuities) between upbringing, the camp, and the post‐war village. [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]

This paper draws on empirical evidence from a 3‐year research project in Northern Uganda examining the educational experiences of refugees with disabilities. The authors present the compounded and interrelated challenges children with disabilities and their families face as they navigate their educational experiences and seek out opportunities to live well. The authors seek to make a contribution towards improving educational experiences by first highlighting compounding challenges faced by refugee children living with disabilities and their families and related policy gaps that have ramifications for refugee children's access to education in particular, and second by expanding discourse about refugee children with disabilities agency in relation to these liminal gaps and the impact the gaps have for accessing education. The authors use Powell and McGrath's (in Skills for human development: Transforming vocational education and training, Routledge, 2019; Handbook of vocational education and training, Springer, 2019) concept of critical capabilities and relationality, to expand Klocker's (in Global perspectives on rural childhood and youth: Young rural lives, Routledge, 2007) notions of thick and thin agency and to interrogate refugee children living with disabilities' agency in relation to education opportunities and rights. [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]

As part of the 2030 Agenda, much effort has been exerted in comparing multidimensional child poverty measures both technically and conceptually. Yet, few countries have adopted and used any of these measures in policymaking. This paper explores the reasons for this absence from a political economy perspective. It develops an innovative political economy framework for poverty measurement and a hypothesis whereby a country will only produce and use reliable and sustainable multidimensional child poverty (MDCP) measures if and only if three conditions coalesce: consensus, capacity and polity. We explore this framework with two relevant case studies, Mexico and Uganda. Both countries satisfy the capacity condition required to measure MDCP but only Mexico satisfies the other two conditions. Our proposed political economy framework is normatively relevant because it identifies the conditions that need to change across multiple contexts before the effective adoption and use of an MDCP measure becomes more likely. [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]

Background: Childhood obesity is an emerging public health problem globally. Although previously a problem of high-income countries, overweight and obesity is on the rise in low- and middle-income countries. This paper explores the factors associated with childhood obesity and overweight in Uganda using data from the Uganda Demographic and Health Survey (UDHS) of 2016.Methods: We used Uganda Demographic and Health Survey (UDHS) 2016 data of 4338 children less than 5 years. Multistage stratified sampling was used to select study participants and data were collected using validated questionnaires. Overweight and obesity were combined as the primary outcome. Children whose BMI z score was over two were considered as overweight while those with a BMI z score greater than three were considered as obese. We used multivariable logistic regression to determine factors associated with obesity and overweight among children under 5 years of age in Uganda.Results: The prevalence of overweight and obesity was 5.0% (217/4338) (95% CI: 4.3-5.6), with overweight at 3.9% (168/4338: 95% CI: 3.2-4.3) and obesity at 1.1% (49/4338: 95% CI: 0.8-1.5). Mother's nutritional status, sex of the child, and child's age were associated with childhood obesity and overweight. Boys were more likely to be overweight or obese (aOR = 1.81; 95% CI 1.24 to 2.64) compared to girls. Children who were younger (36 months and below) and those with mothers who were overweight or obese were more likely to have obesity or overweight compared to those aged 49-59 months and those with underweight mothers respectively. Children from the western region were more likely to be overweight or obese compared to those that were from the North.Conclusion: The present study showed male sex, older age of the children, nutritional status of the mothers and region of residence were associated with obesity and overweight among children under 5 years of age. [ABSTRACT FROM AUTHOR]

Realistic planning for a nutrition intervention is a critical component of implementation, yet effective approaches have been poorly documented. Under the auspices of 'The Micronutrient Powders Consultation: Lessons Learned for Operational Guidance,' 3 working groups were formed to summarize experiences and lessons across countries regarding micronutrient powders (MNP) interventions for young children. This paper focuses on programmatic experiences in the planning stages of an MNP intervention, encompassing assessment, enabling environment and adaptation, as well as considerations for supply. Methods included a review of published and grey literature, key informant interviews, and deliberations throughout the consultation process. We found that assessments helped justify adopting an MNP intervention, but these assessments were often limited by their narrow scope and inadequate data. Establishing coordinating bodies and integrating MNP into existing policies and programmes have helped foster an enabling environment and support programme stability. Formative research and pilots have been used to adapt MNP interventions to specific contexts, but they have been insufficient to inform scale-up. In terms of supply, most countries have opted to procure MNP through international suppliers, but this still requires understanding and navigating the local regulatory environment at the earliest stages of an intervention. Overall, these findings indicate that although some key planning and supply activities are generally undertaken, improvements are needed to plan for effective scale-up. Much still needs to be learned on MNP planning, and we propose a set of research questions that require further investigation. [ABSTRACT FROM AUTHOR]

The impact of colonisation affects a number of formerly colonised societies. This paper addresses how therapeutic interventions in northern Uganda align with a colonial framework. It explores connections between the English invasion of northern Uganda in the mid‐1800s and therapeutic approaches to young people affected by armed conflict. Two case examples of treatment for young people at major reception centres are provided: (i) World Vision and (ii) Gulu Support the Children Organisation. Both draw on Western mental health interventions as the approach of choice rather than prioritising traditional Acholi values. This conceptual paper explores new directions for Western helping professional in the Global South. [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]

The Lord's Resistance Army (LRA) insurgency from 1986 to 2006 is one of the longest conflicts in Uganda. This paper examines the effect of the LRA insurgency on child nutrition using the 2011 Uganda Demographic and Health Survey. The distance from each village to the border of South Sudan is used as an instrument for identifying the intensity of the conflict. We find that each conflict event in a village lowers weight-for-age z-scores and weight-for-height z-scores for children born after the conflict. We further investigate a possible heterogeneous conflict effect on child nutrition in terms of gender, region, and maternal education. Low household wealth, limited access to healthcare, and poor maternal nutrition appear to be channels through which the conflict inhibits the growth and development of children 5 years after the end of the conflict. [ABSTRACT FROM AUTHOR]

The paper examines the use of four visual 'action' methods for eliciting information from street children about their interactions with the socio-spatial environment. These methods were adapted and used to encourage child-led activities and minimize researcher input. The advantages and constraints associated with the successful implementation of visual methods with children are examined, followed by a brief examination of the 'real' and ethical considerations surrounding their use. The paper concludes that visual methods allow a high level of child-led participation in research, as well as providing a stimulus for eliciting further oral material. [ABSTRACT FROM AUTHOR]

Background: Mental and neuropsychological disorders make up approximately 14% of the total health burden globally, with 80% of the affected living in low- and middle-income countries (LMICs) of whom 90% cannot access mental health services. The main objective of the TREAT INTERACT study is to adapt, implement, and evaluate the impact of a novel, intersectoral approach to prevent, identify, refer, and treat mental health problems in children through a user centred task-sharing implementation of the TREAT INTERACT intervention, inspired by the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) for primary school staff in Mbale, Uganda. Health care personell will be trained in the mhGAP-IG. Methods: This is a pragmatic mixed-methods hybrid Type II implementation-effectiveness study utilizing a co-design approach. The main study utilize a stepped-wedged trial design with six starting sequences, randomizing three schools to the intervention at each interval, while the remaining act as "controls". Other designs include a nested prospective cohort study, case control studies, cross-sectional studies, and qualitative research. Main participants' outcomes include teachers' mental health literacy, stigma, and violence towards the school children. Implementation outcomes include detection, reach, sustainability, and service delivery. Child and caregiver outcomes include mental health, mental health literacy, and help-seeking behaviour. Discussion: Based on the results, we will develop sustainable and scalable implementation advice on mental health promotion and draft implementation guidelines in line with current WHO guidelines. This project will generate new knowledge on the structure, organization, delivery, and costs of mental health services in a LMIC setting, as well as new knowledge on the implementation and delivery of new health services. Trial registration: ClinicalTrials, NCT06275672, 28.12.2023, retrospectively registered. [ABSTRACT FROM AUTHOR]

When we compare human gestures to those of other apes, it looks at first like there is nothing much to compare at all. In adult humans, gestures are thought to be a window into the thought processes accompanying language, and sign languages are equal to spoken language with all of its features. Some research firmly emphasises the differences between human gestures and those of other apes; however, the question about whether there are any commonalities is rarely investigated, and has mostly been confined to pointing gestures. The gestural repertoires of nonhuman ape species have been carefully studied and described with regard to their form and function—but similar approaches are much rarer in the study of human gestures. This paper applies the methodology commonly used in the study of nonhuman ape gestures to the gestural communication of human children in their second year of life. We recorded (n = 13) children's gestures in a natural setting with peers and caregivers in Germany and Uganda. Children employed 52 distinct gestures, 46 (89%) of which are present in the chimpanzee repertoire. Like chimpanzees, they used them both singly, and in sequences, and employed individual gestures flexibly towards different goals. [ABSTRACT FROM AUTHOR]

Increasingly, research investigates how the imprisonment of those with child care responsibilities may affect children and their outcomes. However, this research is often conducted in high-income, developed countries, with little known about its impact in low-income, least developed countries. This study starts to address this gap by examining if the imprisonment of those with child care responsibilities in Uganda, a low-income least developed country, may affect child poverty, wellbeing, health, diet, and education. Drawing on 76 interviews conducted with 61 adults and 15 children, participants were asked to recount what affect, if any, imprisonment of the child's caregiver was believed to have on child poverty, health, wellbeing, diet, and education. The findings reveal that imprisonment was believed to have a largely negative effect on these aspects of children's lives for most children, hindering government efforts to improve child outcomes and tackle key development challenges. Based on these findings, it is argued that our theoretical understanding of imprisonment and its effects may need to be broadened to include how differing socio-economic policy contexts may moderate the impact of imprisonment on child outcomes. [ABSTRACT FROM AUTHOR]

This collaborative research study arose in response to the United Nations Sustainable Development Goals 2 and 3, which have amongst their targets an aim to eradicate preventable deaths in children under five years old. The research is founded on the aims of the Global Agenda for Social Work and Social Development which aims at strengthening the social work profession through linkages between global challenges and local responses. To address these issues through nutritious child feeding, it was essential to understand the views and experiences of SW and social development practitioners involved with child feeding practices. Through an online qualitative survey and reflexive thematic analysis, we explored the views and experiences of practitioners working with the Uganda Red Cross Society. Three themes were developed from analysis of the data: Lifestyle Choices & Restrictions; Limited Resources & Facilities; and Knowledge & Education. A reflection on the challenges encountered and advancing international social work through engagement with the Global Agenda are also presented. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of undernutrition among children below five years of age, in Uganda and the world over, remains very high. About 45% of all global deaths among children below five years of age are attributed to undernutrition. A number of studies using different statistical approaches affirm this effect, yet some factors indicate the influence of other factors within the system. This study, therefore, uses a method that demonstrates how different variables feed into each other. Aim: The aim of this study was to establish the major factors associated with an increased likelihood of undernutrition and the paths showing how these risk factors influence undernutrition. Methods: Data from the Uganda Demographic and Health Survey (UDHS, 2016) were used for this study. A sample of 4530 children, whose age, height, and weight measurements were recorded, was considered for this study. Additionally, the study used generalized structural equation models to identify the multifaceted natures and paths of the risk factors that influence undernutrition among children below five years of age. The study relied on the UNICEF 2020 conceptual framework to identify and analyze the direct and indirect effects of these risk factors of undernutrition. Results: From the perspective of a male child, having a perceived small size at birth, a low birth weight, being breastfed for less than 6 months, having no formal education from mothers, limited income-generating opportunities, a low wealth status, and notable episodes of diarrhea were among the key factors associated with an increased likelihood of undernutrition. The identified paths were as follows: (i) Having no education, as this was associated with limited working opportunities and a low income, which increases the likelihood of low household wealth status, hence increasing the chances of undernutrition. (ii) Exposure to a rural setting was associated with an increased likelihood of undernutrition through association with poor and or low employment levels within the rural areas. (iii) A shorter duration of breastfeeding was associated with children in urban areas, resulting in an increased likelihood of undernutrition. (iv) Children aged between 6 and 47 months had a higher likelihood of undernutrition. Conclusions: An approach that addresses and recognizes all these factors at different levels, along the established paths, should be implemented to effectively reduce undernutrition among children below five years of age. [ABSTRACT FROM AUTHOR]

Purpose – Health education that integrates community participation is essential for malaria control. However, children’s participation is not generally as active as that of adults, thus turning children into recipients, as opposed to partners in malaria control. The purpose of this paper is to develop a better understanding of how children can transform from mere recipients to active partners in malaria control efforts, by exploring the implementation of a school health education program in Uganda. Design/methodology/approach – A qualitative multi-case study involving six schools where the health education program was implemented was undertaken, using six focus group discussions with 72 school children and respondent interviews with 14 teachers and district health promotion staff. Findings – Children acted as health messengers, offered peer support and engaged in environmental management to minimize mosquito breeding. The benefits of the school malaria program included increasing access to malaria information, boosting malaria knowledge, improving children’s self-esteem and their skill as health educators. However, implementation was undermined by hostility from adults, inadequate time and tight school schedules, which should be addressed in future malaria programs. Practical implications – The findings suggest that children can play an important role in malaria programs. Therefore, programs should be sufficiently structured to facilitate children’s participation. Practitioners should be encouraged to be conscious of the applicability of the health promoting school approach to malaria control. Originality/value – This research facilitated a more comprehensive understanding of the role children can play in malaria control, thus providing a basis for their involvement in malaria programs. It also adds to a relatively scarce area of literature on the school health-malaria control nexus. [ABSTRACT FROM AUTHOR]

Parental involvement in their children's schooling is in recognition that establishing the context in which a child attends school is important. Reading to Learn (RtL)was implemented in two districts of Kwale and Kinango in Kenya and of Amolatar and Dokolo in Uganda. This paper looks at parental involvement and their experiences with RtL. Data are obtained from survey responses at baseline and focus group discussions with parents at endline. Findings indicate that parents are key actors in literacy and numeracy of their children. The study underscores the role of parents and context in literacy activities and policy implementation. [ABSTRACT FROM AUTHOR]

Objective: A qualitative study was conducted to gain insight into challenges reported by Butaleja households during a previous household survey. Specifically, this paper discusses heads of households' and caregivers' perceptions of challenges they face when seeking care for their very young children with fever presumed to be malaria. Methods: Eleven focus groups (FGs) were carried out with household members (five with heads of households and six with household caregivers) residing in five sub-counties located across the district. Purposive sampling was used to ensure the sample represented the religious diversity and geographical distance from the peri-urban center of the district. Each FG consisted of five to six participants. The FGs were conducted at a community centre by two pairs of researchers residing in the district and who were fluent in both English and the local dialect of Lunyole. The discussions were recorded, translated, and transcribed. Transcripts were reviewed and coded with the assistance of QDA Miner (version 4.0) qualitative data management software, and analyzed using thematic content analysis. Results: The FG discussions identified four major areas of challenges when managing acute febrile illness in their child under the age of five with presumed malaria: (1) difficulties with getting to public health facilities due to long geographical distances and lack of affordable transportation; (2) poor service once at a public health facility, including denial of care, delay in treatment, and negative experiences with the staff; (3) difficulties with managing the child's illness at home, including challenges with keeping home-stock medicines and administering medicines as prescribed; and (4) constrained to use private outlets despite their shortcomings. Conclusions: Future interventions may need to look beyond the public health system to improve case management of childhood malaria at the community level in rural districts such as Butaleja. Given the difficulties with accessing quality private health outlets, there is a need to partner with the private sector to explore feasible models of community-based health insurance programs and expand the role of informal private providers. [ABSTRACT FROM AUTHOR]

We investigated the psychometric properties of the Children's Hope Scale among a sample of 1,118 South Sudanese refugee children (570 girls, 548 boys) aged 9 to 14 years displaced in Uganda. We assessed the underlying factor structure and model fit through exploratory and confirmatory factor analyses and measurement invariance by sex and developmental stage. Confirmatory factor analysis revealed good fit for a one-factor model with the error terms of items 1 and 3 and items 4 and 6 allowed to covary. There was no evidence of differential item functioning by group. Evidence from this study supports the use of a unidimensional model of hopefulness across groups and signifies the importance of confirming these properties for measures used to evaluate humanitarian interventions. [ABSTRACT FROM AUTHOR]

Caleb Wakhungu and the Mt Elgon Self-Help Community Project use narrative ideas and practices to spark and sustain local economic 'development' projects in rural Uganda. Their innovative work links community work, therapy and development. This short paper describes the significance of moving away from a children's rights model (which had been imported from the West) to a model of empowering children and families in ways that are congruent with local cultural practices and understandings. [ABSTRACT FROM AUTHOR]

Advocacy represents an intervention into complex, dynamic and highly contextual socio-political systems, in which strategies and tactics must be adjusted on a continual basis in light of rapidly changing conditions, reactions from actors and feedback. For this reason, the practice of advocacy is often considered more art than science. However, capacities and practices for advocacy can be strengthened by sharing and analysing experiences in varying contexts, deriving general principles and learning to adapt these principles to new contexts. Nutrition is a particular context for advocacy, but to date, there has been little systematic analysis of experiences. The purpose of this paper is to illustrate and draw lessons from the practice of nutrition advocacy, especially in relation to stunting and complementary feeding, and suggest ways to strengthen capacities and practices in the future. The strategies and tactics, achievements and lessons learnt are described for three case studies: Uganda, Vietnam and Bangladesh. These cases, and experience from elsewhere, demonstrate that concerted, well-planned and well-implemented advocacy can bring significant achievements, even in short period of time. In light of the global and national attention being given to stunting reduction through the SUN ( Scaling Up Nutrition) movement and other initiatives, there is now a need for much stronger investments in strategic and operational capacities for advocacy, including the human, organisational and financial resources for the advocacy and strategic communication themselves, as well as for monitoring and evaluation, supportive research and institutional capacity-building. [ABSTRACT FROM AUTHOR]

Background: Child and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda. Objective: To determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda. Methods: Four districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3-19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents. Results: The prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14-19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education. Conclusion: The prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda. [ABSTRACT FROM AUTHOR]

Background HIV-related stigma, among other factors, has been shown to have an impact on the desire to have children among people living with HIV (PLHIV). Our objective was to explore the experiences of HIV-related stigma among PLHIV in post-conflict northern Uganda, a region of high HIV prevalence, high infant and child mortality and low contraception use, and to describe how stigma affected the desires of PLHIV to have children in the future. Methods Semi-structured interviews were conducted with 26 PLHIV in Gulu district, northern Uganda. The interviews, conducted in Luo, the local language, were audio recorded, transcribed and then translated into English. Thematic data analysis was undertaken using NVivo8 and was underpinned by the 'Conceptual Model of HIV/AIDS Stigma'. Results HIV-related stigma continues to affect the quality of life of PLHIV in Gulu district, northern Uganda, and also influences PLHIV's desire to have children. PLHIV in northern Uganda continue to experience stigma in various forms, including internal stigma and verbal abuse from community members. While many PLHIV desire to have children and are strongly influenced by several factors including societal and cultural obligations, stigma and discrimination also affect this desire. Several dimensions of stigma, such as types of stigma (received, internal and associated stigma), stigmatizing behaviours (abusing and desertion) and agents of stigmatization (families, communities and health systems), either directly, or indirectly, enhanced or reduced PLHIV's desire to have more children. Conclusion The social-cultural context within which PLHIV continue to desire to have children must be better understood by all health professionals who hope to improve the quality of PLHIV's lives. By delineating the stigma process, the paper proposes interventions for reducing stigmatization of PLHIV in northern Uganda in order to improve the quality of life and health outcomes for PLHIV and their children. [ABSTRACT FROM AUTHOR]

Background: Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use. Methods: The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina Faso, Ghana, Malawi, and Uganda. Logistic regression models were employed to identify correlates of self-reported past-year drunkenness. Exposure to four adverse childhood experiences comprised the primary independent variables: living in a food-insecure household, living with a problem drinker, having been physically abused, and having been coerced into having sex. We controlled for age, religiosity, current schooling status, the household head's sex, living arrangements, place of residence, marital status, and country of survey. All analyses were conducted separately for males and females. Results: At the bivariate level, all independent variables (except for coerced sex among males) were associated with the outcome variable. Overall, 9% of adolescents reported that they had been drunk in the 12 months preceding the survey. In general, respondents who had experienced an adverse event during childhood were more likely to report drunkenness. In the multivariate analysis, only two adverse childhood events emerged as significant predictors of selfreported past-year drunkenness among males: living in a household with a problem drinker before age 10, and being physically abused before age 10. For females, exposure to family-alcoholism, experience of physical abuse, and coerced sex increased the likelihood of reporting drunkenness in the last 12 months. The association between adverse events and reported drunkenness was more pronounced for females. For both males and females there was a graded relationship between the number of adverse events experienced and the proportion reporting drunkenness. Conclusions: We find an association between experience of adverse childhood events and drunkenness among adolescents in four sub-Saharan African countries. The complex impacts of adverse childhood experiences on young people's development and behavior may have an important bearing on the effectiveness of interventions geared at reducing alcohol dependence among the youth. [ABSTRACT FROM AUTHOR]

Children under the age of 18 years represent 62 percent of the poor in Uganda. To date, their perspective has not been incorporated in the many poverty analyses that have been conducted. The survey reported in this paper asked children between the ages of 10 and 14 years about their perceptions of poverty, and also about the effectiveness of local government in addressing issues of concern to them. The survey found that children have a different perspective on poverty from that of the adult key informants consulted in our sample; they have a positive view of their own potential role in mitigating poverty, and are highly critical of the current performance of local government. [ABSTRACT FROM AUTHOR]

Background Despite major efforts to increase the uptake of preventive measures and timely use of the first line antimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors’ (1) training related to malaria case management for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options. Methods A qualitative study using semi-structured interviews was conducted in the rural district of Butaleja, Uganda in 2011. All 88 unlicensed drug outlets enumerated in the study area were visited by six locally recruited research assistants, with one vendor from each outlet invited to participate. The transcripts were analyzed using acceptable qualitative research protocols. Results About half of the 75 vendors interviewed had received some sort of formal training on malaria at a post-secondary institution, although only 6.7% had qualifications which met licensure requirements. The study found widespread misconceptions relating to the cause, as well as prevention and treatment of malaria. A large majority of the vendors relied primarily on non-specific symptoms and limited physical exams for diagnoses, with less than one-tenth of the vendors recognizing that rapid or microscopic blood testing was necessary to confirm a clinical diagnosis of malaria. While most recognized mosquitoes as the primary vector for malaria, over two-fifths of the vendors held misconceptions about the factors that could increase the risk of malaria, and nearly a third believed that malaria could not be prevented. With respect to acute case management, three-quarters viewed as the best option a medicine other than the government’s first-line antimalarial, artemisinin-based combination therapies (ACT). Almost three-fifths specified quinine as their preferred option, with about one-fifth recommending quinine injection. Conclusion Findings from this study confirm significant gaps in unlicensed vendors’ knowledge related to malaria. With increased utilization of unlicensed drug outlets in rural and remote settings such as Butaleja, findings from this study strongly supports the need to implement strategies to improve the quality of care delivered at these outlet. [ABSTRACT FROM AUTHOR]

Introduction: psychiatric comorbidities of epilepsy are common. In order to improve the overall quality of life of the affected individuals it is imperative for clinicians to screen and treat these conditions early. We aimed at determining prevalence of psychiatric comorbidities of epilepsy and treatment gap among children and adolescents (6-17) at Butabika Hospital. Methods: we conducted a cross sectional study; psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview for Children (MINI-kid 7.0.2 version) and clinical data abstraction was used to collect data from patient file. Quantitative data was analyzed using SPSS v25 software while qualitative data was analyzed using thematic analysis. The study followed the Consolidated criteria for Reporting Qualitative research (COREQ) and statement on guidelines for Strengthening the Reporting of Observational studies in epidemiology (STROBE). Results: a total of 157 participants were enrolled and, 38.9% (95%CI: 31.5-46.6%) had at least one psychiatric disorder whereas 12.1% had two or more psychiatric disorders. Attention Deficit Hyperactivity Disorder (11.5%), Autism Spectrum Disorder (7.0%) and Major Depressive Disorder (5.1%) were the most common psychiatric disorders. The treatment gap was 33.1% (95%CI: 26.1-40.7%). The barriers to screening were challenging psychiatric disorders, exhausting to screen; and inadequate diagnostic information. The barriers to treatment were poor compliance to treatment, poorly controlled seizures and inadequate human resources. Conclusion: psychiatric disorders are highly prevalent among children and adolescents with epilepsy but there is substantial screening and treatment gap. To close the gap, there is need to address institutional, caregiver and patient barriers to screening and treatment of the psychiatric comorbidities. Improving human resources, capacity building and provision of basic requirements for screening, could reduce the assessment and treatment gap. [ABSTRACT FROM AUTHOR]

Background: While 5% of 247 million global malaria cases are reported in Uganda, it is also a top refugee hosting country in Africa, with over 1.36 million refugees. Despite malaria being an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. This study aimed to investigate the risk factors for malaria infections among children under 5 years of age in refugee settlements in Uganda. Methods: We utilized data from Uganda's Malaria Indicator Survey which was conducted between December 2018 and February 2019 at the peak of malaria season. In this national survey, household level information was obtained using standardized questionnaires and a total of 7787 children under 5 years of age were tested for malaria using mainly the rapid diagnostic test. We focused on 675 malaria tested children under five in refugee settlements located in Yumbe, Arua, Adjumani, Moyo, Lamwo, Kiryadongo, Kyegegwa, Kamwenge and Isingiro districts. The extracted variables included prevalence of malaria, demographic, social-economic and environmental information. Multivariable logistic regression was used to identify and define the malaria associated risk factors. Results: Overall, malaria prevalence in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. Several risk factors were significantly associated with acquisition of malaria including fetching water from open water sources [adjusted odds ratio (aOR) = 1.22, 95% CI: 0.08–0.59, P = 0.002], boreholes (aOR = 2.11, 95% CI: 0.91–4.89, P = 0.018) and water tanks (aOR = 4.47, 95% CI: 1.67–11.9, P = 0.002). Other factors included pit-latrines (aOR = 1.48, 95% CI: 1.03–2.13, P = 0.033), open defecation (aOR = 3.29, 95% CI: 1.54–7.05, P = 0.002), lack of insecticide treated bed nets (aOR = 1.15, 95% CI: 0.43–3.13, P = 0.003) and knowledge on the causes of malaria (aOR = 1.09, 95% CI: 0.79–1.51, P = 0.005). Conclusions: The persistence of the malaria infections were mainly due to open water sources, poor hygiene, and lack of preventive measures that enhanced mosquito survival and infection. Malaria elimination in refugee settlements requires an integrated control approach that combines environmental management with other complementary measures like insecticide treated bed nets, indoor residual spraying and awareness. [ABSTRACT FROM AUTHOR]

Background: Most studies assessing pathophysiological heterogeneity in asthma have been conducted in high-income countries (HICs), with little known about the prevalence and characteristics of different asthma inflammatory phenotypes in low-and middle-income countries (LMICs). This study assessed sputum inflammatory phenotypes in five centres, in Brazil, Ecuador, Uganda, New Zealand (NZ) and the United Kingdom (UK).Methods: We conducted a cross-sectional study of 998 asthmatics and 356 non-asthmatics in 2016-20. All centres studied children and adolescents (age range 8-20 years), except the UK centre which involved 26-27 year-olds. Information was collected using questionnaires, clinical characterization, blood and induced sputum.Results: Of 623 asthmatics with sputum results, 39% (243) were classified as eosinophilic or mixed granulocytic, i.e. eosinophilic asthma (EA). Adjusted for age and sex, with NZ as baseline, the UK showed similar odds of EA (odds ratio 1.04, 95% confidence interval 0.37-2.94) with lower odds in the LMICs: Brazil (0.73, 0.42-1.27), Ecuador (0.40, 0.24-0.66) and Uganda (0.62, 0.37-1.04). Despite the low prevalence of neutrophilic asthma in most centres, sputum neutrophilia was increased in asthmatics and non-asthmatics in Uganda.Conclusions: This is the first time that sputum induction has been used to compare asthma inflammatory phenotypes in HICs and LMICs. Most cases were non-eosinophilic, including in settings where corticosteroid use was low. A lower prevalence of EA was observed in the LMICs than in the HICs. This has major implications for asthma prevention and management, and suggests that novel prevention strategies and therapies specifically targeting non-eosinophilic asthma are required globally. [ABSTRACT FROM AUTHOR]

Introduction: Perinatally acquired HIV infection (PHIV) occurs during a critical window of immune development. We investigated changes in systemic inflammation and immune activation in adolescents with PHIV and those without HIV (HIV-) in Uganda.. Methods: A prospective observational cohort study was performed in 2017-2021 in Uganda. All participants were between 10-18 years of age and without active co-infections. PHIVs were on ART with HIV-1 RNA level ≤400 copies/mL. We measured plasma and cellular markers of monocyte activation, T-cell activation (expression of CD38 and HLA-DR on CD4+ and CD8+), oxidized LDL, markers of gut integrity and fungal translocation. Groups were compared using Wilcoxon rank sum tests. Changes from baseline were examined with 97.5% confidence intervals on relative fold change. P values were adjusted for false discovery rate.. Results: We enrolled 101 PHIV and 96 HIV-; among these, 89 PHIV and 79 HIV- also had measurements at 96 weeks. At baseline, median (Q1, Q3) age was 13 yrs (11,15), and 52% were females. In PHIV, median CD4+ cell counts were 988 cells/µL (638, 1308), ART duration was 10 yrs (8, 11), and 85% had viral load <50 copies/mL throughout the study, 53% of participants had a regimen switch between visits, 85% of whom switched to 3TC, TDF and DTG. Over 96 weeks, while hsCRP decreased by 40% in PHIV (p=0.12), I-FABP and BDG both increased by 19 and 38% respectively (p=0.08 and ≤0.01) and did not change in HIV- (p≥0.33). At baseline, PHIVs had higher monocyte activation (sCD14) (p=0.01) and elevated frequencies of non-classical monocytes (p<0.01) compared to HIV- which remained stable over time in PHIV but increased by 34% and 80% respectively in HIV-. At both time points, PHIVs had higher T cell activation (p ≤ 0.03: CD4+/CD8+ T cells expressing HLA-DR and CD38). Only in PHIV, at both timepoints, oxidized LDL was inversely associated with activated T cells(p<0.01). Switching to dolutegravir at week 96 was significantly associated an elevated level of sCD163 (β=0.4, 95% CI=0.14,0.57, p<0.01), without changes in other markers.. Conclusion: Ugandan PHIV with viral suppression have some improvement in markers of inflammation over time, however T-cell activation remains elevated. Gut integrity and translocation worsened only in PHIV over time. A deeper understanding of the mechanisms causing immune activation in ART treated African PHIV is crucial. [ABSTRACT FROM AUTHOR]

Background: Seizure control among children with epilepsy (CWE) receiving anti-seizure medications (ASMs) remains a challenge in low-resource settings. Uncontrolled seizures are significantly associated with increased morbidity and mortality among CWE. This negatively impacts their quality of life and increases stigma. Aim: This study determined seizure control status and described the factors associated among CWE receiving ASMs at Mbarara Regional Referral Hospital (MRRH). Methods: In a retrospective chart review study, socio-demographic and clinical data were obtained from 112 medical records. CWE receiving ASMs for at least six months and regularly attending the clinic were included in the study. Physical or telephone interviews were conducted with the immediate caregivers of the CWE to establish the current seizure control status of the participants. Results: A total of 112 participants were enrolled. Of these, three-quarters had generalized onset seizures, 23% had focal onset seizures, while 2% had unknown onset motor seizures. About 60.4% of the study participants had poor seizure control. Having a comorbidity (p-value 0.048, AOR 3.2 (95% CI 1.0– 9.9)), history suggestive of birth asphyxia (p-value 0.014, AOR 17.8 (95% CI 1.8– 176.8)), and being an adolescent (p-value 0.006, AOR 6.8 (95% CI 1.8– 26.6)) were significantly associated with poor seizure control. Conclusion: Seizure control among CWE receiving ASMs at MRRH remains poor. Efforts geared to addressing seizure control and optimizing drugs are needed, especially among children with comorbidities, those with history of birth asphyxia, and adolescents. [ABSTRACT FROM AUTHOR]

Our study contextualized empirical factors influencing adolescent behaviors. An assessment using focus group discussion (FGD) was done with randomly selected adolescents in primary schools in Northern Uganda to explore the influence of child poverty and parenting among other factors on adolescents' behaviors. A semi‐structured interview guide and in‐depth interviews were also conducted for parents/guardians and teachers, respectively. Adolescents expressed desirable developmental outcomes contrary to teachers' concerns regarding achieving them. Parenting and places of residence had a significant positive impact on adolescent behaviors, with the village residence having a much earlier influence compared to parenting. Our findings revealed a scanty understanding of child poverty, parenting, and adolescent development among parents/guardians. Any action‐oriented toward awareness would promote adolescent behavioral development. [ABSTRACT FROM AUTHOR]

Background: Cerebral palsy (CP) is a non-progressive neuromuscular condition diagnosed in childhood. CP as a form of disability, does not cause any specific oral disease. However, some oral conditions are more commonly associated with people with CP compared to the general population. The overarching aim of the current study was to determine the oral hygiene status, gingival status, and the prevalence of dental caries in children with CP attending a leading hospital institution for children with disabilities in Kampala, Uganda. Additionally, we determined the barriers faced by children with CP in accessing oral healthcare. Methods: This cross-sectional study was carried out at the Comprehensive Rehabilitation Services Uganda hospital in Kampala, Uganda. Our study population consisted of a convenient sample of 90 children diagnosed with CP aged 3–17 years and their caregivers. A validated and interviewer administered structured questionnaire was used to collect socio-demographic data of the participants. A modified World Health Organization oral health assessment form for those aged 3–17 years was used to gather data on oral health status (plaque score, gingival bleeding and dental caries.) The data was subjected to statistical tests with critical value set up at 5%. Results: Only 32.2% of the children evaluated had adequate oral hygiene, while 44.4% of the children experienced gingival bleeding. The prevalence of dental caries for both deciduous and permanent dentition was 63.3%, with DMFT values of 3.8 ± 4.5. The most common barrier reported by the caregivers was the challenge in modality of transportation availability from the children's homes to the health facilities (34.4%). Conclusions: Children with CP in the study population have a significant prevalence of oral diseases and face several barriers to oral healthcare. Results from this study aim to provide relevant support to advocate for a nationwide change in policy to improve access to dental care to decrease the burden of oral diseases in children with special healthcare needs. [ABSTRACT FROM AUTHOR]

Background: Hunger and malnutrition are rampant among refugees and displaced populations, many of whom are infants and children. We sought to determine the prevalence and factors associated with thinness among children aged 5–17 years living in Nakivale refugee settlement, Isingiro district, southwestern Uganda. Methods: This was a cross sectional study that enrolled 420 children aged 5 to 17 years. The World Health Organization cluster sampling was used to select 30 villages from which 14 households were selected by consecutive sampling and participants were then chosen per household by simple random sampling. Data were collected on the participant socio-demographic, family, dietary, medical, hygiene and refugee status factors. Thinness was defined as having a z-score < -2 standard deviations of Body Mass Index-for-age from the median WHO growth standards. The prevalence of thinness was determined by ascertaining the total number of children with thinness over the total number of children studied. Multivariable logistic regression model was used to determine the factors independently associated with thinness with p < 0.05 level of significance. Results: A total of 420 children aged 5–17 years were enrolled into the study. The median age (IQR) was 8.6 (6.8–11.8) and majority 248 (59.1%) were female. The prevalence of thinness was 5.5% (95% CI: 3.7-8.1%). The factors independently associated with thinness were; living with a chronic disease (aOR 6.47, 95%CI; 1.63–24.64, p = 0.008), use of water from natural sources (aOR 3.32, 95%CI; 1.27–8.71, p = 0.015), and duration of stay in the settlement of less or equal to 10 years (aOR 3.19, 95%CI; 1.15–8.83, p = 0.025). Conclusion: Five in every 100 children aged 5–17 years in Nakivale refugee settlement have thinness. Thinness was more likely among children who are living with a chronic disease, used water from natural sources and those whose families had stayed shorter in the settlement. Our findings suggest that children with chronic disease should receive extra food supplementation and have routine growth monitoring as part of their chronic care. The study reiterates a need to have clean and safe water supply and close nutrition assessment and monitoring, especially for newly registered refugee children. [ABSTRACT FROM AUTHOR]

Background: Increasingly researchers are recognising the importance of including the perspectives of children and young people in research and in the development of interventions and innovations, in order to understand children's lives on their own terms. Purpose: This article reflects on the potential risks posed to children and young people in research and the role of gatekeepers in granting access and, in direct field activities, especially where the research could be deemed as 'sensitive'. Research Design: Using a combined descriptive and autoethnographic research design, questionnaires and reflections were gathered from the field experiences of researchers in four countries (India, Jamaica, Uganda and the UK) conducting research on children's experiences of violence victimisation as part of a gender-based violence prevention project. Data was collected retrospectively and analysed thematically with the aid of QSR NVivo. Results: Based on the five themes that emerged: accessing schools; approach to access; accessing participants; lessons learnt; and advice for other researchers, the overall findings indicate that researching sensitive topics with children and young people is necessarily problematic in order to safeguard them. This is especially the case in contexts where discrimination and stigma relating to certain topics may be a significant barrier to children's participation. Conclusion: Research planning requires attention to gatekeeper power, safeguarding children and young people, and understanding how processes and attitudes concerning the status and rights of children at national and institutional levels might influence the research process. [ABSTRACT FROM AUTHOR]

In Uganda, almost half of children under 5 years old suffer from undernutrition. Undernutrition, a common form of malnutrition in children, encompasses stunting, wasting and underweight. The causes of child undernutrition are complex, suggesting that interventions to tackle malnutrition must be multifaceted. Furthermore, limited access to healthcare for vulnerable populations restricts the potential of hospital‐based strategies. Community‐based management of acute malnutrition (CMAM), which includes nutritional counselling, ready‐to‐use therapeutic foods and the outpatient management of malnutrition by caregivers, is recognised as an effective approach for children's recovery. However, evaluations of CMAM programs are largely based on biomedical and behavioural health models, failing to incorporate structural factors that influence malnutrition management. The objective of this evaluation was to understand the factors influencing malnutrition management in a CMAM program in rural Uganda, using the socioecological model to assess the multilevel determinants of outpatient malnutrition management. This evaluation used qualitative methods to identify factors related to caregivers, healthcare providers and societal structures that influence children's outpatient care. Data were collected at a community health clinic in 2019 through observations and interviews with caregivers of malnourished children. We observed 14 caregiver‐provider encounters and interviewed 15 caregivers to examine factors hindering outpatient malnutrition management. Data were thematically analysed informed by the socioecological model. Findings showed that caregivers had a limited understanding of malnutrition. Counselling offered to caregivers was inconsistent and insufficient. Poverty and gender inequality limited caregivers' access to healthcare and their ability to care for their children. Factors at the caregiver and healthcare levels interacted with societal factors to shape malnutrition management. Results suggest that CMAM programs would benefit from providing holistic interventions to tackle the structural barriers to children's care. Using a socioecological approach to program evaluation could help move beyond individual determinants to address the social dynamics shaping malnutrition management in low‐ and middle‐income countries. [ABSTRACT FROM AUTHOR]

Youth living with HIV (YLWHIV) have an increased cancer risk. Our objective is to describe the prevalence of medical record (MR) reported suspected cancers in a contemporary cohort of YLWHIV in Uganda that was assembled through MR reviews of patients 10 to 24 years old across 35 Ugandan HIV care health facilities. Clinical data were abstracted to identify suspected cancer cases and information about HIV care. Among 3728 YLWHIV, we identified eight suspected cancer cases. The most common suspected types were Kaposi sarcoma (n=4) followed by lymphoma (n=3). Challenges encountered in data abstraction were missing data for several variables and confirmatory cancer diagnostic information. In follow-up of suspected cases referred for diagnosis at the Uganda Cancer Institute (UCI), none had diagnosis records in UCI files. In addition, ∼18% of patients (n=686) were lost-to-follow-up (LTF) defined as not having returned to the clinic in ≥183 days and three patients died from presumed Kaposi sarcoma. Although our results suggest that cancer is rare in YLWHIV, the possibility that the cancer burden is higher cannot be excluded due to incomplete information in MRs and high LTF rates. Further, our study raises concern that patients referred for diagnosis are not accessing potential life-saving care. [ABSTRACT FROM AUTHOR]

Background C-reactive protein (CRP) has shown promise as a triage tool for pulmonary tuberculosis (TB) in adults living with the human immunodeficiency virus. We performed the first assessment of CRP for TB triage in children. Methods Symptomatic children less than 15 years old were prospectively enrolled in Kampala, Uganda. We completed a standard TB evaluation and measured CRP using a point-of-care assay. We determined the sensitivity and specificity of CRP to identify pulmonary TB in children using 10 mg/L and 5 mg/L cut-off points and generated a receiver operating characteristic (ROC) curve to determine alternative cut-offs that could approach the target accuracy for a triage test (≥90% sensitivity and ≥70% specificity). Results We included 332 children (median age 3 years old, interquartile range [IQR]: 1–6). The median CRP level was low at 3.0 mg/L (IQR: 2.5–26.6) but was higher in children with Confirmed TB than in children with Unlikely TB (9.5 mg/L vs. 2.9 mg/L, P -value =.03). At a 10 mg/L cut-off, CRP sensitivity was 50.0% (95% confidence interval [CI], 37.0–63.0) among Confirmed TB cases and specificity was 63.3% (95% CI, 54.7–71.3) among children with Unlikely TB. Sensitivity increased to 56.5% (95% CI, 43.3–69.0) at the 5 mg/L cut-off, but specificity decreased to 54.0% (95% CI, 45.3–62.4). The area under the ROC curve was 0.59 (95% CI, 0.51–0.67), and the highest sensitivity achieved was 66.1% at a specificity of 46.8%. Conclusions CRP levels were low in children with pulmonary TB, and CRP was unable to achieve the accuracy targets for a TB triage test. [ABSTRACT FROM AUTHOR]