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Abstract: Annually, 30 million children are affected by newborn conditions, most in low-income countries, with long-term implications for survivors. We aimed to evaluate neonatal intracranial pathologies identifiable on cranial ultrasound (CUS) in sub-Saharan Africa (SSA). This systematic review and meta-analysis explored the spectrum of neonatal intracranial pathology, in nine databases, using the Joanna Briggs Institute Systematic Review Tools. The review was registered with PROSPERO (CRD42022309249). In total, 92 studies from 14 countries were identified, with South Africa (34%) and Nigeria (28%) most represented. Of these, 38 (42%) focused on intraventricular haemorrhage (IVH), 13 (14%) on congenital brain anomalies, 11 (12%) on intracranial infection, 9 (10%) on ventriculomegaly/hydrocephalus, and 7 (8%) on neonatal encephalopathy. IVH pooled prevalence was 29% (CI 23–35%), with a quarter high-grade (24%, CI 20–29%). Higher prevalence was seen at lower gestation (<32 weeks, 38% (CI 26–50%)) and birthweight (<1500 g, 32% (CI 24–40%)). Periventricular leukomalacia was less common than IVH (9% (CI 6–13%)). A spectrum of intracranial pathology has been reported on neonatal CUS from SSA. IVH affected close to one third of at-risk neonates, and PVL one in eleven, with potentially important implications for longer term outcomes for affected children. Impact:

Newborn conditions, like prematurity and neonatal encephalopathy, are leading causes of under-5 child mortality, with the greatest burden in sub-Saharan Africa.

Intracranial pathologies relating to newborn conditions, may have important long-term consequences, yet frequently go undetected in settings with limited access to imaging.

We examined the spectrum and prevalence of different neonatal intracranial pathologies detectable on cranial ultrasound imaging from the sub-Saharan Africa region.

A wide spectrum of intracranial pathology was reported, including a high prevalence of intraventricular haemorrhage and periventricular leukomalacia among small and preterm neonates, with potential important implications for childhood outcomes.

ABSTRACTSeptic shock treatment in sub-Saharan African hospitals is challenging due to limited availability of ICUs, central venous catheters, vasopressors, and trained staff. We designed this proof-of-concept study to determine efficacy, safety, and feasibility of norepinephrine (NE) use in a non-intensive setting in a low-resource country, consisting in a peripheral infusion via a mechanical drop counter. Septic shock patients accessing a rural hospital in Uganda were included: the 2020 group (N = 12) was prospectively enrolled (Jan–Mar 2020) when NE was available; the 2019 group (N = 11) was retrospectively enrolled (Oct–Dec 2019). Enrollment was continuous to reduce selection bias. Basic clinical endpoints (noninvasive blood pressure, tissue perfusion, diuresis) defined shock control and the prognostic endpoint was survival at hospital discharge. Shock control at 6 and 12 hours was higher in the 2020 group (p = 0.012 for both). Survival at hospital discharge was 75% and 27.3%, respectively (p = 0.039). NE infusion was associated with a Hazard Ratio of 0.23 (p = 0.041) in a multivariate Cox model. No NE-induced adverse effects were detected. These preliminary results suggest that implementing NE infusion in a low-resource setting without ICU could be a safe and effective strategy in managing septic shock and that this approach could lead to a lower mortality rate.

‘Bird, or How I Became an Acholi Poet’, is a poetic response that demonstrates wer, Luo for song, as a site for knowledge making and social memory as well as a method for resistance and decolonization. This poem features the voices of war veterans, Ugandan exiles who fought in the 1978–79 Liberation war between Tanzania and Uganda, who shared their stories with me during my doctoral fieldwork. One such is Capt. K, who joined the Ugandan exiles in Tanzania after a violent purge of ethnic Acholi and Lango officers and soldiers by Amin in 1972. As he shares his story, Capt. K describes the colonial British as filled with roro.This Luo term, denoting treachery, describes the colonial intent of the British: the creation of ‘the thing’ out from which Fanon’s notion of decolonization is the creation of the [hu]man. I reflect on how ‘bird’, ‘weather’, ‘map’, and ‘grammar’, concepts from Morrison, Brand, Sharpe and Spillers, form the foundation to think about the colonial spectre. I conclude that weris a decolonial space from which Ugandans can articulate their own humanity beyond the colonial narrative as part of a continuing anti-colonial struggle.

Population growth has increased climate impact and it is one of the reasons for the conception of sustainable management. Sustainability management has become an integral part of the business environment and decision-making processes. It is important to mention that construction sectors represent one of the main polluters. This article introduces the path for Costa Rica in the last five years in terms of development and the increasing number of companies with green building certification. Interviewing the professionals with vast experience in the sustainable sector is the tool used to compile the current situation of Costa Rica and the journey through this path as a pioneer in Latin America and the Caribbean. The study explores the situation lived by the companies in Costa Rica to set their projects according to the regulations established by the authorities in the sustainable management field and examines the position of the governmental authorities as a barrier or a facilitator. Therefore, this article aims to contribute to the discussion about the status of sustainability management in Costa Rica in the last five years as the scope of the investigation.

Biodiversity conservation has focused on large vertebrates and plants with pronounced economic value, compared with smaller organisms such as benthic macroinvertebrates that play a particular role in freshwater ecosystems. The increasing loss and degradation of freshwater habitats, coupled with low taxonomic and ecological knowledge and limited conservation efforts in the tropical regions, threaten macroinvertebrate biodiversity. This study investigated spatial and seasonal variability in benthic macroinvertebrate diversity and the underlying environmental variables within the Aturukuku River in Tororo, Uganda. Benthic macroinvertebrates were evaluated by comparing their composition at a reference site in the upstream rural area with two urban midstream sites and one rural downstream site during dry and wet seasons in 2018. Benthic macroinvertebrate diversity in the Aturukuku River was lower than that reported from least disturbed small rivers within the same region; with moderate to high pollution tolerant taxa, dominating. Chironomidae, Oligochaeta and Simuliumsp. predominated at the urban sites receiving sewage and abattoir effluent. The Shannon–Wiener diversity index, species richness and species evenness in the river were generally low. Prosobranch (Thiaridae) snails and bivalves (Sphaeridae) were among the taxa with low tolerance to changes in the river. Canonical Correspondence Analysis revealed that total nitrogen, dissolved oxygen, temperature and streambed substrate were predominant in structuring benthic macroinvertebrate assemblages. There was no potential species-rich area for macroinvertebrate conservation, given the poor environmental conditions and diversity in the entire river. However, specific mitigation measures against the declining quality of the river are recommended, to boost conservation of macroinvertebrates and the entire riverine ecosystem.

Abstract:"Conversations at the Crossroads" is an interlogue between Indigenous and Black writers and scholars who gathered at Simon Fraser University on the unceded, ancestral territories of the Musqueam, Squamish, and Tsleil Waututh Nations in Vancouver, British Columbia. The purpose of the gathering was to contest and revitalize those critical frameworks that best reflect the complex and longstanding alliances in Black and Indigenous histories, futures, literatures, and experiences. While dialogues across these diverse communities have been going on for a long time, they have not always been foregrounded adequately in public debates and academic discussions. These conversations demonstrate that the language for conceiving and mobilizing comparative studies has changed—to a large extent because Indigenous and Black scholars and writers have pushed to change it and to challenge the power relationships underpinning academic disciplines. Each of the participants reflects deeply on the limits and opportunities of the available theoretical frameworks to reignite conversations between scholarly fields in general, and across postcolonial studies, Indigenous studies, and Black studies in particular.

Background: Malaria during pregnancy contributes to significant perinatal morbidity and mortality, accounting for almost 25% of global maternal mortality. However, the epidemiology and risk factors for subclinical malaria among pregnant women living in refugee settlements is poorly understood.Objective: To determine the prevalence and predictors of subclinical malaria among pregnant women in refugee settlements in Northern Uganda.Design: We conducted a multi-center, cross-sectional study.Methods: The study was conducted between April and June 2023 and involved pregnant women aged 18–45 years attending routine antenatal care (ANC) at three health facilities serving refugee communities in Adjumani district, Uganda. We collected sociodemographic, environmental, maternal, and obstetric factors using a structured questionnaire. Both CareStart Malaria HRP-2/pLDH (Pf/Pan) combo rapid diagnostic test (RDT) and blood smear microscopy with 3% Giemsa staining were simultaneously performed on samples from each patient. Logistic regression analysis identified factors independently associated with subclinical malaria, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).Results: We enrolled 304 pregnant women, with a mean age of 25 years. In total, 68.8% (n= 209) had lived in the settlement for over 12 months, 25.7% (n= 78) were primigravida, and 1.0% (n= 3) were living with HIV. Malaria prevalence was 5.3% (n= 16) by RDT and 3.2% (n= 10; seven Plasmodium falciparumand three P. malariae) by microscopy. Only 4 (25.0%) of the RDT-positive cases were also positive by microscopy (Cohen’s kappa: 0.278—Fair agreement). All participants were asymptomatic. Factors associated with higher odds of subclinical malaria included primiparity (aOR: 2.79, 95% CI: 1.25–6.25, p= 0.013), ⩾4 ANC visits (aOR: 2.41, 95% CI: 1.34–4.34, p= 0.003), and residence in the settlement for less than 12 months (aOR: 2.54, 95% CI: 2.0–3.22, p< 0.001). Living in the settlement for over 3 years, being primigravida, and being married were associated with 68%, 50%, and 68% lower odds of subclinical malaria, respectively (aOR: 0.32, 95% CI: 0.13–0.79, p= 0.014; aOR: 0.50, 95% CI: 1.22–5.52, p= 0.016; aOR: 0.32, 95% CI: 0.13–0.78, p= 0.012).Conclusion: Our study reveals the high prevalence of subclinical malaria among pregnant women in refugee settlements, particularly among primiparous women and recent arrivals. The poor agreement between RDT and microscopy suggests the need for dual screening in asymptomatic pregnant women.

Background: Malaria is a leading cause of death among children under 5 years of age in sub-Saharan Africa. The malaria vaccine is an important preventive measure introduced by the World Health Organization to reduce malaria and its associated mortality and morbidity. We aimed to assess the acceptance of the malaria vaccine among next of kin of children under 5 years of age in Gulu City, Northern Uganda.Methods: Between October and December 2023, we conducted a cross-sectional study in Pece–Laroo division, Gulu City, Uganda. Socio-demographic, vaccine profile and health system factors were collected. Multivariable logistic regression was performed using STATA 16 to determine factors associated with acceptance of the malaria vaccine among next of kin of children under 5 years.Results: A total of 432 participants were enrolled. Of these, the majority were female (72.5%, n= 313) with most aged 30 years and above (51.2%, n= 221). Overall, 430 (99.5%) participants had good knowledge about malaria. The majority (91.4%, n= 395) had good acceptance of the malaria vaccine. Factors independently associated with acceptance of the malaria vaccine were knowing a child who died of malaria [adjusted prevalence ratio (aPR): 1.07, 95% confidence interval (CI): 1.01–1.13, p= 0.022] and preferring the injection route for a malaria vaccine (aPR: 1.1, 95% CI: 1.06–1.22, p< 0.001). All 395 participants with good knowledge of malaria had good acceptance of the malaria vaccine (p= 0.007).Conclusion: There was a high acceptance of the malaria vaccine in Laroo–Pece division, Gulu, Uganda. However, there is a need for further health education to achieve universal acceptability of the malaria vaccine in preparation for the malaria vaccine implementation program in Uganda.

This study was conducted to assess the drivers of commercialization and profitability among the smallholder farmers of indigenous chickens (IC) in northern Uganda. A market index was constructed to measure the proportion of IC marketed as a proxy for commercialization. A Tobit regression model was fitted using maximum likelihood estimation to determine the drivers of commercialization level of IC. Gross margin analysis was conducted to measure annual profits from IC production and a multiple linear regression was estimated using ordinary least squares to ascertain the determinants of profitability. Overall, the level of commercialization of IC was found to be as low as 31.2%. This level was affected by: IC flock size, number of cattle owned, group membership and access to poultry specific extension services. Commercial IC production was found to be profitable with average gross margins of UGX 118,704 (equivalent to US$34 per annum). Our results revealed that profitability in IC production and marketing was affected by bicycle access, number of extension visits, family ownership of chickens, sex, and age of household head. Our findings point to the need for implementation of strategies to increase flock size like disease management, provision of targeted extension services and increased group marketing of chickens.

•Mobile short messaging; calls; ultrasound and TV services were the Information and Communication Technologies (ICTs) used in the maternal healthcare facility for Gulu Referral Hospital.•ICT skills, knowledge, trust and awareness were the key factors affecting ICT usage in the maternal healthcare.•Barriers to ICT usage were limited to: knowledge on technical and privacy data; staff involvement in the budget process, access, support; electricity and ICT design.