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Abstract Background Drug resistant tuberculosis (DR-TB) continues to be a significant global public health concern despite the availability of effective TB medicines. Equally, delayed DR-TB treatment initiation is associated with increased morbidity, amplified resistance, transmission risk and poor treatment outcomes. This study aimed to investigate treatment delays and identify predictors of delayed treatment initiation among DR-TB patients in Uganda. Method A retrospective study was conducted using routine DR-TB national case registration data between January 2012 and December 2019. Stata version 15 was used to run uni-variate analysis to describe patient characteristics using frequencies and percentages; bivariate analysis to identify significant differences in median times to treatment initiation; and logistic regression model was fitted, and adjusted odds ratio (AOR) with 95% confidence interval was used to identify factors associated with DR-TB treatment delay. Results A total of 2,166 DR-TB patients were included in this study. The median treatment initiation delay was 10 days. Approximately 57% of DR-TB patients experienced delays in starting their treatment beyond the acceptable 7-day timeframe. Being diagnosed as RR-TB [AOR = 1.22; 95% CI: 1.08–1.37], and being a recurrent TB patient [AOR = 1.22; 95% CI: 1.01–1.47] were associated with treatment delays. Patients with previous history of ‘lost to follow-up’ (LTFU), failure and being diagnosed as Pre-XDR-TB were less inclined to delay DR-TB treatment. Conclusion Several DR-TB patients experienced treatment delay. The delay was significant among patients diagnosed as RR-TB and those with TB treatment history of recurrent TB. This highlights the need for heightened vigilance among healthcare workers when managing DR-TB patients with a history of past TB treatment and those diagnosed as RR-TB to minimize delays. Furthermore, future research should investigate a comprehensive list of variables influencing the timing of treatment initiation after diagnosis. An in-depth understanding of the effects of these factors can inform targeted interventions to optimize treatment strategies for improved DR-TB patient outcomes.

Background: Although mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknown, limiting the development of interventions to support this vulnerable population., Methods: We performed a secondary analysis of data from a large multi-country prospective cohort [Childhood Acute Illness and Nutrition (CHAIN) Network] study. Data from 5 sites in Uganda, Kenya, and Malawi were included. Hospitalized children aged 2-23 months were followed from an index admission for 6 months after discharge to determine acute and long-term outcomes. Using perinatal HIV exposure (HEU and HUU) as the primary exposure and adjusting for child, caregiver, and household characteristics, we compared inpatient and 30-day survival outcomes, nutritional status, hospital length of stay, illness severity, and utilization of inpatient resources., Results: We included 1486 children: 217 HEU and 1269 HUU. HEU children had an increased risk of mortality both during hospitalization [adjusted OR 1.96, 95% CI (1.14-3.37)] and in the 30 days following hospital admission [adjusted hazard ratio 2.20, 95% CI (1.10-4.42)]. Wasting and stunting were more frequent in HEU than HUU children, with adjusted OR 1.41, 95% CI (1.03-1.95) and adjusted OR 1.91, 95% CI (1.34-2.70), respectively. HEU children were also more likely to have a prolonged hospital stay compared to HUU children [adjusted OR 1.58, 95% CI (1.08-2.29)], although admission diagnoses, illness severity at admission, and use of inpatient resources (supplemental oxygen, nasogastric tube, and second-line antibiotics) did not differ significantly between groups., Conclusions: HEU children are more likely to die during hospitalization and within 30 days of admission, to be wasted and stunted upon hospital admission, and to require a prolonged hospital stay, as compared to HUU children. Hospitals in settings with a high prevalence of women-living-with-HIV should ensure that maternal HIV status is established among children requiring admission and build capacity to provide additional hospital monitoring and early post-discharge support for HEU children., Competing Interests: Declarations. Ethics approval and consent to participate: The ethical approval of the parent study was obtained from the Oxford Tropical Research Ethics Committee (OxTREC Ref:34-16) and ethics committees of all participating institutions. Written consent was obtained from caregivers of all study participants for current and future use of study data and samples. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: The burden of early sexual engagement among youth is enormous. It directly raises the risk of sexually transmitted infections(STIs) and indirectly contributes to unintended pregnancy, unsafe abortion, premature childbirth, and psychosocial issues. The aim of this paper was to estimate the timing of sexual debut and examine the factors influencing the timing of first sexual intercourse following menarche among female youth aged between 15 and 24 in Uganda., Method: Self-reported data were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a sub-sample of 7964 female youth from the individual woman file. Kaplan-Meier survival curves, decrement life-table analysis, and the discrete-time logit model were used to examine the timing of sexual debut and associated factors., Results: 67.4% of the female youth had experienced first sexual initiation. Overall, the meantime to sexual debut was 4.4 years and the median time was 4.3 years, and all the female youth had experienced first sexual initiation by the end of the twelfth year following menarche. Significant factors found to influence the timing of sexual initiation include having higher education level (OR = 0.724: 95% CI = 0.59-0.89; p = 0.003), residing in the Northern region (OR = 0.877:95% CI = 0.79-0.97, p = 0.012), being employed (OR = 1.085: 95% CI = 1.01-1.16; p = 0.021), and being literate (OR = 1.155; 95% CI = 1.07-1.25; p < 0.001)., Conclusions: These findings are expected to be central in the bid to delay first sexual intercourse. Also they shed light on some of the factors associated with the timing of sexual debut which may be addressed at community level for non-school going youth and in schools, as school based prevention sexual and reproductive health programs. The findings highlight the need for future studies to collect more data to explore further the linkage between time to first debut since menarche and, mass media, religion, type of residence, and wealth index., (© 2024. The Author(s).)

Background: Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries., Methods: We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates., Findings: We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (-0.27 [-0.36, -0.19]) and MW (-0.23 [-0.34, -0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<-2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions., Interpretation: Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support., Funding: Bill & Melinda Gates FoundationOPP1131320; National Institute for Health ResearchNIHR201813., Competing Interests: Members of the writing group declare having received support from the Bill and Melinda Gates Foundation (BMGF) for staff and research activities directly linked to this project which was paid to their universities or institutions (JAB, JLW, RHJB). Reimbursement for travel directly related to this project was also provided by BMGF and paid through the universities (JLW, JAB). JAB participated in a leadership role for the Commonwealth Association for Paediatic Gastroenterology & Nutrition (CAPGAN) and on a Data Safety Monitoring Board (DSMB) for a study regarding vitamin D., (© 2024 The Authors.)

Background: The World Health Organization (WHO) defines Preterm Birth (PTB) as "a live birth taking place before the expected 37 weeks of gestation". Annually, approximately 15 million infants are born prematurely, constituting significantly to infant mortality during the initial four weeks of life, responsible for 40% of deaths among children under the age of five. Evidently, preterm deliveries have contributed to 46% of admissions to the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital (LRRH) over the past three years. Paradoxically, while the prevalence of preterm births remains high, there is a lack of documented information regarding the underlying risk factors. Consequently, the primary objective of this study was to assess the potential risk factors associated with preterm birth at LRRH., Methods: An analytical cross-sectional research was undertaken at LRRH, employing a quantitative methodology. The study utilized secondary data obtained from a total of 590 comprehensive maternal medical records, of deliveries that occurred at the facility between April 2020 and July 2021. The collected data underwent analysis using STATA version 17 software. To identify predictors of preterm birth, a Logistic regression model was applied, yielding adjusted odds ratios (AOR) alongside 95% confidence intervals (CI). The significance level was set at p < 0.05 to establish statistical significance. Furthermore, assessments for multicollinearity and model fitness were conducted using the Variance Inflation Factor (VIF) and linktest, respectively., Results: The prevalence of preterm delivery among mothers who gave birth at LRRH stood at 35.8%. The outcomes of logistic regression analysis revealed that maternal employment status had a statistically significant association with preterm birth (AOR = 0.657, p = 0.037, 95%CI: 0.443-0.975); having a baby with low birth weight (AOR = 0.228, p < 0.001, 95% CI: 0.099-0.527) and experiencing preeclampsia (AOR = 0.142, p < 0.001, 95% CI: 0.088-0.229) were also identified as significant predictors of preterm birth in the study., Conclusions and Recommendations: The occurrence of preterm delivery is significantly higher (35.8%) among mothers who gave birth at LRRH when compared to the national average (13.6%). The prevalence of preterm birth among mothers was linked to factors such as employment status, delivery of low birth weight infants, and the presence of preeclampsia. Consequently, the research proposes a set of recommendations. Firstly, the Ministry of Health (MoH) should evaluate the present state of readiness within the healthcare system to effectively handle cases of preterm birth both within medical facilities and the community. Secondly, the Ministry of Gender, Labour, and Social Development should leverage Labor Officers to implement and uphold the regulations stipulated in the Employment Act and Labor Laws., (© 2023. The Author(s).)

Introduction: Safe drinking water practice is a key public health promotion strategy for reducing the spread of waterborne diseases. The purpose of this study was to investigate the factors that influence boiling water practice among older persons in informal settlements of Kampala., Methods: We collected primary data on "Access to safe water and health services among older persons in informal settlements of Kampala in October 2022. The study interviewed 593 men and women aged 60 years and older. The Complementary log-log multivariable technique was used to establish the association between boiling water practice and selected independent variables., Results: The results show that nearly 8% of the respondents did not boil their water for drinking. The findings show that the female older persons had increased odds of boiling water to make it safe for drinking compared to their male counterparts (OR = 1.859, 95% CI = 1.384-2.495). Other factors associated with boiling water practice among older persons in the informal settlements of Kampala were; living alone, quality of house, and type of water source., Conclusion: Basing on our findings, we find that older women are more likely to use safe drinking water practice (boiling) compared to the male older persons. Health education majorly targeting older men about the importance and health benefits associated with safe water drinking practices should be prioritized by policy makers. There is need to improve housing conditions of older persons to minimize typhoid, diarrhea and other health risks associated with drinking unsafely managed water., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Maniragaba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The aim of this paper was to assess the association between non-clinical factors and Caesarean delivery in Uganda. Self-reported data from the individual recode file were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a sub sample of 9929 women aged 15-49 with a recent birth in the last 5 years preceding the survey. Chi-square tests and multivariate comlementary log-log regression models were used to examine the relationship between non-clinical factors and Caesarean section delivery. About one in ten (7%) of the women aged 15-49 had Caesarean deliveries. Non-clinical factors which were significantly associated with Caesarean section delivery include advanced maternal age, having the first birth compared to subsequent births, having 1-3 children compared to 4 or more children, higher level of women's education relative to no education, being in the middle, richer, and richest wealth quintile compared to the poorest quintile. In conclusion, evidence suggests that the trend in Caesarean delivery can be attributed partially to non-clinical factors including advanced maternal age, birth order, parity, women's education level, and wealth quintile. Thus, efforts to address the trend in Caesarean section delivery, need to take account of non-clinical factors.

Understanding urban travel behaviour is crucial for planning healthy and sustainable cities. Africa is urbanising at one of the fastest rates in the world and urgently needs this knowledge. However, the data and literature on urban travel behaviour, their correlates, and their variation across African cities are limited. We aimed to describe and compare travel behaviour characteristics and correlates of two Kenyan cities (Nairobi and Kisumu). We analysed data from 16,793 participants (10,000 households) in a 2013 Japan International Cooperation Agency (JICA) household travel survey in Nairobi and 5790 participants (2760 households) in a 2016 Institute for Transportation and Development Policy (ITDP) household travel survey in Kisumu. We used the Heckman selection model to explore correlations of travel duration by trip mode. The proportion of individuals reporting no trips was far higher in Kisumu (47% vs 5%). For participants with trips, the mean number [lower - upper quartiles] of daily trips was similar (Kisumu (2.2 [2-2] versus 2.4 [2-2] trips), but total daily travel durations were lower in Kisumu (65 [30-80] versus 116 [60-150] minutes). Walking was the most common trip mode in both cities (61% in Kisumu and 42% in Nairobi), followed by motorcycles (17%), matatus (minibuses) (11%), and cars (5%) in Kisumu; and matatus (28%), cars (12%) and buses (12%) in Nairobi. In both cities, females were less likely to make trips, and when they did, they travelled for shorter durations; people living in households with higher incomes were more likely to travel and did so for longer durations. Gender, income, occupation, and household vehicle ownership were associated differently with trip making, use of transport modes and daily travel times in cities. These findings illustrate marked differences in reported travel behaviour characteristics and correlates within the same country, indicating setting-dependent influences on travel behaviour. More sub-national data collection and harmonisation are needed to build a more nuanced understanding of patterns and drivers of travel behaviour in African cities., (© 2023 The Authors. Published by Elsevier Ltd.)

Introduction: Socioeconomic inequalities contribute to poor health. Inequitable access to diverse and healthy foods can be a risk factor for non-communicable diseases, especially in individuals of low socioeconomic status. We examined the extent of socioeconomic inequalities in food purchasing practices, expenditure, and consumption in a resource-poor setting in Kenya., Methods: We conducted a secondary analysis of baseline cross-sectional data from a natural experimental study with a sample size of 512 individuals from 376 households in western Kenya. Data were collected on household food sources, expenditure and food consumption. Household socioeconomic status (SES) was assessed using the multiple correspondence analysis (MCA) model. Concentration indices (Ci) and multivariable linear regression models were used to establish socioeconomic inequalities., Results: About half (47.9%) of individuals achieved a minimum level of dietary diversity with the majority coming from wealthier households. The two most consumed food groups were grains and roots (97.5%, n = 499) and dark green leafy vegetables (73.8%, n = 378), but these did not vary by SES. The consumption of dark green leafy vegetables was similar across wealth quantiles (Ci = 0.014, p = 0.314). Overall, the wealthier households spent significantly more money on food purchases with a median of USD 50 (IQR = 60) in a month compared to the poorest who spent a median of USD 40 (IQR = 40). Of all the sources of food, the highest amount was spent at open-air markets median of USD 20 (IQR = 30) and the expenditure did not vary significantly by SES (Ci = 0.4, p = 0.684). The higher the socioeconomic status the higher the total amount spent on food purchases. In multivariable regression analysis, household SES was a significant determinant of food expenditure [Adjusted coefficient = 6.09 (95%confidence interval CI = 2.19, 9.99)]., Conclusion: Wealthier households spent more money on food compared to the poorest households, especially on buying food at supermarkets. Individuals from the poorest households were dominant in eating grains and roots and less likely to consume a variety of food groups, including pulses, dairy, eggs and fruits, and vegetables. Individuals from the poorest households were also less likely to achieve adequate dietary diversity. Deliberate policies on diet and nutrition are required to address socioeconomic inequalities in food purchasing practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Were, Foley, Musuva, Pearce, Wadende, Lwanga, Mogo, Turner-Moss and Obonyo.)

The study examined the argument that cohabitation as a form of union increases physical violence victimization among women. The study's aim was to assess the association between physical violence and other socio-demographic factors that influence physical violence among women. Self-reported data were extracted from the 2016 Uganda Demographic and Health Survey (UDHS), with a sample of 2479 couples, from the couple file. Chi-squared tests and multivariate Firth-logit regression models were used to examine the relationship between intimate partner violence (IPV) victimization and marital status controlling for other social-demographic factors. There was no significant evidence that women in cohabiting union have a higher risk of exposure to physical violence in the Ugandan context. The risk of experiencing physical violence perpetration varied by birth cohort, with the most recent cohorts exhibiting a slightly higher risk of experiencing partner violence than previous cohorts. Significant factors found to be associated with an increased risk of experiencing IPV included being in the poorer, middle and richer compared with the poorest wealth tertile of income, residing in Eastern or Northern regions compared with the Central region, being affiliated to the Catholic faith compared with Anglican and having five or more children compared with 4 or fewer children. In conclusion, there is no evidence that physical violence is more pronounced among women in cohabiting unions compared with married women in Uganda.

Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6−23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.

Introduction: Non-communicable diseases have risen markedly over the last decade. A phenomenon that was mainly endemic in high-income countries has now visibly encroached on low and middle-income settings. A major contributor to this is a shift towards unhealthy dietary behavior. This study aimed to examine the complex interplay between people's characteristics and the environment to understand how these influenced food choices and practices in Western Kenya., Methods: This study used semi-structured guides to conduct in-depth interviews and focus group discussions with both male and female members of the community, across various socioeconomic groups, from Kisumu and Homa Bay Counties to further understand their perspectives on the influences of dietary behavior. Voice data was captured using digital voice recorders, transcribed verbatim, and translated to English. Data analysis adopted an exploratory and inductive analysis approach. Coded responses were analyzed using NVIVO 12 PRO software., Results: Intrapersonal levels of influence included: Age, the nutritional value of food, occupation, perceived satiety of some foods as opposed to others, religion, and medical reasons. The majority of the participants mentioned location as the main source of influence at the community level reflected by the regional staple foodscape. Others include seasonality of produce, social pressure, and availability of food in the market. Pricing of food and distance to food markets was mentioned as the major macro-level influence. This was followed by an increase in population and road infrastructure., Conclusion: This study demonstrated that understanding dietary preferences are complex. Future interventions should not only consider intrapersonal and interpersonal influences when aiming to promote healthy eating among communities but also need to target the community and macro environments. This means that nutrition promotion strategies should focus on multiple levels of influence that broaden options for interventions. However, government interventions in addressing food access, affordability, and marketing remain essential to any significant change., (© 2022. The Author(s).)

Severely ill children in low- and middle-income countries (LMICs) experience high rates of mortality from a broad range of infectious diseases, with the risk of infection-related death compounded by co-existing undernutrition. How undernutrition and acute illness impact immune responses in young children in LMICs remains understudied, and it is unclear what aspects of immunity are compromised in this highly vulnerable population. To address this knowledge gap, we profiled longitudinal whole blood cytokine responses to Toll-like receptor (TLR) ligands among severely ill children (n=63; 2-23 months old) with varied nutritional backgrounds, enrolled in the CHAIN Network cohort from Kampala, Uganda, and Kilifi, Kenya, and compared these responses to similar-aged well children in local communities (n=41). Cytokine responses to ligands for TLR-4 and TLR-7/8, as well as Staphylococcus enterotoxin B (SEB), demonstrated transient impairment in T cell function among acutely ill children, whereas innate cytokine responses were exaggerated during both acute illness and following clinical recovery. Nutritional status was associated with the magnitude of cytokine responses in all stimulated conditions. Among children who died following hospital discharge or required hospital re-admission, exaggerated production of interleukin-7 (IL-7) to all stimulation conditions, as well as leukopenia with reduced lymphocyte and monocyte counts, were observed. Overall, our findings demonstrate exaggerated innate immune responses to pathogen-associated molecules among acutely ill young children that persist during recovery. Heightened innate immune responses to TLR ligands may contribute to chronic systemic inflammation and dysregulated responses to subsequent infectious challenges. Further delineating mechanisms of innate immune dysregulation in this population should be prioritized to identify novel interventions that promote immune homeostasis and improve outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Uebelhoer, Gwela, Thiel, Nalukwago, Mukisa, Lwanga, Getonto, Nyatichi, Dena, Makazi, Mwaringa, Mupere, Berkley and Lancioni.)

The triple burden of malnutrition in many low- and middle-income countries (LMICs) is partly a result of changing food environments and a shift from traditional diets to high-calorie Western-style diets. Exploring the relationship between food sources and food- and nutrition-related outcomes is important to understanding how changes in food environments may affect nutrition in LMICs. This study examined associations of household food source with household food insecurity, individual dietary diversity and individual body mass index in Western Kenya. Interview-administered questionnaire and anthropometric data from 493 adults living in 376 randomly-selected households were collected in 2019. Adjusted regression analyses were used to assess the association of food source with measures of food insecurity, dietary diversity and body mass index. Notably, participants that reported rearing domesticated animals for consumption ('own livestock') had lower odds of moderate or severe household food insecurity (odds ratio (OR) = 0.29 (95% CI: 0.09, 0.96)) and those that reported buying food from supermarkets had lower odds of moderate or severe household food insecurity (borderline significant, OR = 0.37 (95% CI: 0.14, 1.00)), increased dietary diversity scores (Poisson coefficient = 0.17 (95% CI: 0.10, 0.24)) and higher odds of achieving minimum dietary diversity (OR = 2.84 (95% CI: 1.79, 4.49)). Our findings provide insight into the relationship between food environments, dietary patterns and nutrition in Kenya, and suggest that interventions that influence household food source may impact the malnutrition burden in this context.

Objective: Obesity is a risk factor for both cognitive and physical impairment in late adulthood. Though the rates of obesity are high in many groups, older African Americans are disproportionately affected. A randomized pilot intervention of African Dance was conducted with 28 African American older adults with obesity (mean age = 68.4 ± 5.1 years; mean BMI = 33.4 ± 6.2). The goal of the study was to evaluate the physiological outcomes of a culturally sensitive exercise intervention and specifically changes in weight., Methods: Participants were randomly assigned to an African Dance (experimental) or Culture Education (control) group. They attended their assigned class for 1 hour per session, 3 days per week, for 6 months., Results: There was a significant group × time interaction on weight (P  = 0.005) such that the African Dance group lost weight (mean = 4.0 ± 6.0 lb) while the Culture Education group gained weight (mean = 2.6 ± 3.9 lb)., Conclusions: These results suggest that a culturally sensitive form of physical activity, African Dance, may be effective for promoting weight loss in a population at increased risk for obesity and cognitive decline., (© 2018 The Obesity Society.)

The aim of this paper was to establish whether the differences in the risks of union dissolution between cohabitors and non-cohabitors in Uganda have converged over time using event history data. Data were collected in 2013 from 1200 women in central Uganda using retrospective methods. Of these, 839 provided information on three types of first union: women who married directly (without first cohabiting), those who married following cohabitation and those who were still cohabiting. The data were analysed using decrement lifetable analysis. Though the analysis indicated a small difference in the timing of first union dissolution for women who married directly, no evidence was found that the difference in the risk of union dissolution between cohabitors and non-cohabitors had converged over the 9-year period following first union. Women's union/marriage status, number of living children in a union, parental union status and birth cohort were found to significantly influence the timing of union dissolution. Overall, the rate of union dissolution was fairly high, regardless of type of union.

Competing Interests: None of the authors have conflicts of interest and all authors participated in the study and have seen and approved this manuscript prior to submission.

This study aims at identifying factors that affect unmet need for contraception in Zambia. In particular, the studies seeks to estimate the magnitude of unmet need for spacing and limiting by selected socio-economic, socio-cultural and demographic background characteristics of the women, and to identify factors that have significant effects on unmet need for contraception in Zambia. Data are drawn from the 1996 Zambia Demographic and Health Survey. The results obtained show 27% of the currently married women had unmet need for contraception with 19% of them having unmet need for spacing and 8% for limiting. The study also found significant socio-economic and demographic differentials in the levels of unmet need for contraception among the study population. The correlates of unmet need for spacing were found to be the current age of the woman, region of residence, number of living children and type of place of residence. The correlates of total unmet need for contraception were found to be the age of the woman, region of residence, the number of living children, and the woman's approval of family planning. The study recommends that concerted efforts be made to eliminate unmet need for contraception by increasing the number of health facilities providing family services, and making existing ones to function better and to be more sensitive to women's culture and socio-economic circumstances. In addition, there is also need to increase the number of health personnel.