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Samuel Omara,1 Musa Kasujja,1 Geoffrey Okot,1 Peter Okello,1 Maxwell Okello,1 Richard Mulumba,1 Justus Kafunjo Barageine2 1Department of Obstetrics and Gynecology, Kampala International University Western Campus, Bushenyi, Uganda; 2Department of Obstetrics and Gynecology, Makerere University/Mulago Hospital, Kampala, UgandaCorrespondence: Samuel Omara, Email samuelomara06@gmail.comBackground: Post-caesarean surgical site infections (PCSSIs) significantly impact maternal morbidity, mortality, and healthcare costs in low- and middle-income countries, particularly in sub-Saharan Africa, where preventive measures are often inadequate. Despite this burden, data on PCSSIs in this context are limited. This study aimed to evaluate the incidence and factors associated with PCSSIs at Mubende Regional Referral Hospital.Methods: This prospective cohort study included 204 women who underwent caesarean sections from July to September 2023. Data was collected and participants were monitored for up to 28 days post-delivery to identify occurrences of surgical site infections (SSIs). Statistical analysis was conducted using STATA, with significance defined as a p-value of < 0.05.Results: Most participants (63.2%) were aged 18– 35 years, with over 67% having a parity of ≤ 4. Preoperative antibiotics were administered to 77.5% of participants. Most surgeries (64.2%) lasted 1– 2 hours, and the overall incidence of surgical site infections (SSIs) was 16.18%. Significant risk factors associated with more than a twofold increase in SSI risk included unstable referral status (aRR = 2.02), obstructed labor (aRR = 2.97), chorioamnionitis (aRR = 2.73), and prolonged premature rupture of membranes (PROM) (aRR = 2.05). Prolonged labor increased SSI risk by 1.37-fold (aRR = 1.37), while receipt of preoperative antibiotics was linked to a reduced SSI risk (aRR = 0.77).Conclusion: The post-caesarean SSI rate at Mubende Regional Referral Hospital is notably high, with key risk factors including unstable referral status, obstructed labor, prolonged labor, chorioamnionitis, and prolonged premature rupture of membranes (PROM). Administering preoperative antibiotics 30 minutes to 1 hour prior to surgery is linked to a reduced risk of SSI.Keywords: caesarean section, surgical site infection, Uganda

Scrub typhus is a leading cause of nonmalarial febrile illness in Southeast Asia (1). Scrub typhus is caused by miteborne Orentia tsutsugamushi infections, which until recently were thought to be [...]

A crop rotation study was conducted in the Agoro Rice scheme from mid-2015 to 2017 to determine the effect of sweetpotato–rice rotation in the lowlands on financial returns and sweetpotato root, sweetpotato vine, and rice yields compared to monocropping. Treatments included crop rotations of sweetpotato–rice–sweetpotato, rice–sweetpotato–rice, rice–rice–rice (control), and sweetpotato–sweetpotato–sweetpotato (control). The study used the sweetpotato varieties NASPOT 11 (cream-fleshed), NASPOT 10 O, and Ejumula (both orange-fleshed) and the rice varieties Wita 9, Agoro, and Komboka. The results showed that mean sweetpotato root yields in the rotation treatment were significantly higher (28 t ha−1) than the control (19.8 t ha−1), representing a 47% gain in yield. Generally, the percentage gain in yield across years due to rotation ranged from 3 to 132%, depending on the variety. The total number of vine cuttings was significantly different between treatments and seasons (P < 0.001). Mean rice paddy yields in rotation were 8–35% higher than the control. The higher yields of sweetpotato in the rotation can be attributed to the rotation crop benefitting from residual fertilizers applied in rice in the previous season, while rice in the rotation crop could have benefited from the land preparation and establishment of the sweetpotato fields. The benefit of rotation for both crops varied by variety while the revenue-to-cost ratio varied by season and crop variety. Revenue-to-cost ratios for rotation and control treatments were greater than 1, indicating net profits were positive for both. The rotation generated 0.43 times more revenue than rice monocropping. Both rotation and monocropping systems generated profits, but rotation was 43% more profitable. In other words, if monocropping generates 1 dollar, rotation generates 1.43 dollars. The study concludes that rotation of sweetpotato with rice led to (1) increased yields of both rice and sweetpotatoes, (2) more profitable utilization of land, (3) enhanced availability of sweetpotato planting material at the beginning of the upland growing season, and (4) reduced the cost of land preparation for the main rice crop. Findings from this study show that there is great potential for diversification of rice-based cropping systems in Uganda, which will contribute to building sustainable food systems.

Abstract Background Postnatal growth failure (PGF), a multifactorial condition is common in preterm infants and infants born weighing

Abstract Background Utilization of oral health services is a global public health challenge. Low- and middle-income countries are disproportionately affected. Uganda is one of the low- and middle-income countries where only 4% of the population has access to oral health services. Northern Uganda is one of the regions in the country with limited information about oral health utilization. Objective To assess factors associated with utilization of oral health services among adults aged 18–70 years in Lira district, Northern Uganda. Methods This was a quantitative cross-sectional study conducted in Lira District. Multistage sampling was used to select 576 respondents. Data was collected using a researcher-administered structured questionnaire that was adopted, modified, and pretested. Data was analyzed at three levels, including univariate, bivariate, and multivariate at 0.05 significance level. Results Of the 634 respondents, 576 responded, giving a 90.9% response rate. Results show that utilization of oral health services was 20.5% (118) among adults aged 18–70 years in 6 months. Predictors of utilization of oral services among this age group are: having not attended any formal education (AOR = 0.2, 95%CI 0.06–0.62), having poor attitudes towards oral health services (AOR = 0.55, 95%CI 0.34–0.89), having cultural influence on the utilization of the oral health services (AOR = 4.84, 95% CI 2.77–8.43), accessing the services from private not-for-profit facilities (AOR = 4.67, 95% CI 1.79–12.16), being un sure of the availability of the equipment used (AOR = 0.42, 95% CI 0.18–0.9), and availability of friendly services (AOR = 2.53, 95% CI 1.12–5.50). Conclusions and recommendations Utilization of oral health services is low in Lira district, with only 2 in 10 of the adults aged 18-70years of age utilizing oral health services in 6 months. To improve utilization, targeted health education campaigns should address cultural barriers and attitudes, while ensuring that public health facilities are better equipped and provide more user-friendly services.

Abstract Background Globally, teenage pregnancy is a public health problem. Low- and middle-income countries in the Sub-Saharan region are more affected with teenage pregnancy. It is worse with teenage girls who have other vulnerabilities like living in refugee camps. However, there is little information about teenage pregnancy in refugee camps especially in resource limited areas like Northern Uganda. Objective To determine the prevalence and the factors associated with teenage pregnancy among refugees in Palabek refugee settlement, Northern Uganda. Methods This was a cross-sectional study conducted among teenage girls in Palabek refugee settlement in Northern Uganda. The study estimated a total sample size of 316 teenage girls and they were sampled using systematic random sampling. Data was collected using researcher administered questionnaire. Conditional logistics regression was employed to identify the associated factors for teenage pregnancy. Results A total of 306 teenagers participated in the study with a response rate of 98.6%. The study showed that the prevalence of teenage pregnancy among teenage girls in Palabek refugee settlement, Northern Uganda was 41.2%. The factors associated with teenage pregnancy among teenage girls in Palabek refugee settlement included: being in the 15–19 years age group (AOR = 6.3, 95%CI: 1.8–22.8), not being in school (AOR = 5, 95%CI: 2.3–10.9), not being married (AOR = 0.2, 95%CI: 0.1–0.5), delayed sexual debut (AOR = 2.4, 95%CI: 1.1–5.5), having multiple sexual partners (AOR = 0.3, 95% CI: 0.1–0.7), alcohol use (AOR = 6.7, 95%CI: 2.2–18.4), being aware of sexual reproductive health services (AOR = 0.4, 95%CI: 0.2–0.9), and having divorced families (AOR = 2.4, 95% CI: 1.2–4.9). Conclusion Study results reveal that 4 in 10 teenage girls in Palabek, Northern Uganda, are pregnant, influenced by individual, community, and health system factors. This highlights vulnerabilities in refugee camps, urging prioritization of sexual and reproductive health for adolescent girls in refugee camps.

Abstract Background In Africa, dispensing oral HIV pre-exposure prophylaxis (PrEP) within already strained public health facilities has led to prolonged waiting periods and suboptimal experiences for clients. We sought to explore the acceptability of dispensing PrEP semiannually with interim HIV self-testing (HIVST) versus quarterly PrEP dispensing with clinic-based HIV testing to optimize clinic-delivered PrEP services. Methods We conducted a qualitative study within a non-inferiority individual-level randomized controlled trial testing the effect of six-monthly PrEP dispensing with HIVST compared to the standard-of-care three-monthly PrEP dispensing on PrEP clinical outcomes in Kenya (ClinicalTrials.gov: NCT03593629). Eligible participants were ≥ 18 years, refilling PrEP for the first time, and either in an HIV serodifferent relationship (men and women) or singly enrolled (women only). A subset of participants in the intervention group completed serial in-depth interviews (IDIs) at enrollment, six months, and 12 months. We utilized stratified purposive sampling to ensure representation across participant groups. We analyzed our qualitative data thematically using a combination of inductive and deductive approaches, the latter guided by the Theoretical Framework of Acceptability (TFA). Results Between May 2018 and June 2021, we conducted 120 serial IDIs with 55 participants; 64% (35/55) were in a serodifferent relationship, 64% (35/55) were women, and the median age was 32 years (IQR 27–40). Overall, participants found this novel PrEP delivery model highly acceptable; it was well-liked, private (TFA construct: affective attitude), and less burdensome (TFA construct: burden) compared to standard PrEP delivery. Additionally, participants were confident in their ability to participate in the intervention (TFA construct: self-efficacy). Some participants, however, highlighted model disadvantages, including fewer opportunities for in-person counseling and potentially less accurate HIV testing (TFA construct: opportunity costs). Ultimately, most participants reported that the intervention allowed them to achieve their HIV prevention goals (TFA construct: perceived effectiveness) and that their confidence in at-home HIVST and PrEP continuation increased following each semiannual clinic visit. Conclusions Semiannual PrEP clinic visits supported with six-monthly drug dispensing and interim HIVST was acceptable among PrEP users who experienced the intervention in Kenya. More comprehensive pre-intervention counseling and training on HIVST may help alleviate the client concerns presented, which were often resolved over time with intervention experience.

Abstract Background HIV prevalence among female sex workers (FSW) is significantly higher than among women in the general population. Studies have shown that FSW engage in unprotected sex which provides higher compensation when they face emergency situations. We co-created a savings intervention – Jitegemee (rely on yourself) – with FSW to encourage them to save part of their earnings to withdraw in emergency situations in order to reduce risk. Methods We undertook a five-phase intervention development process between February 2021 and July 2023: 1) qualitative interviews with FSW to identify essential intervention features; 2) pilot trial to assess intervention feasibility; 3) literature review of studies on economic empowerment of FSW; 4) scoring of key components of Phases 1–3 on a scale of 1–5 (1 = definitely exclude, 5 = definitely include), for inclusion in the intervention package; 5) workshops with FSW and other key stakeholders to co-design the intervention. Results In phase 1, nearly all participants (99%) found the intervention acceptable to them and 95% believed it would be acceptable to other FSW. Participants suggested inclusion of financial literacy (75%), savings groups (38%) and goal-setting (24%). In the feasibility assessment, 41% saved, of whom 46% withdrew some savings. Condom use was higher among FSW who withdrew their savings compared to those who did not (χ 2 7.52; p = 0.006). In Phase 3, we identified 14 intervention components. In phase 4, all suggested intervention components scored 4.5 on average. In phase 5, we held 3 workshops with FSW to co-design the intervention, which included instructions for how to save and make withdrawals, financial literacy training, and formation of savings groups. Conclusions A savings intervention for and by FSW was highly acceptable and feasible. Involving end-users in the design process is likely to result in greater economic security among FSW and lower engagement in higher risk transactional sex.

Abstract Background Preterm birth is the leading cause of childhood mortality, and respiratory distress syndrome is the predominant cause of these deaths. Early continuous positive airway pressure is effective in high-resource settings, reducing the rate of continuous positive airway pressure failure, and the need for mechanical ventilation and surfactant. However, most deaths in preterm infants occur in low-resource settings without access to mechanical ventilation or surfactant. We hypothesize that in such settings, early continuous positive airway pressure will reduce the rate of failure and therefore preterm mortality. Methods This is a mixed methods feasibility and acceptability, single-center pilot randomized control trial of early continuous positive airway pressure among infants with birthweight 800–1500 g. There are two parallel arms: (i) application of continuous positive airway pressure; with optional oxygen when indicated; applied in the delivery room within 15 min of birth; transitioning to bubble continuous positive airway pressure after admission to the neonatal unit if Downes Score ≥ 4 (intervention), (ii) supplementary oxygen at delivery when indicated; transitioning to bubble continuous positive airways pressure after admission to the neonatal unit if Downes Score ≥ 4 (control). A two-stage consent process (verbal consent during labor, followed by full written consent within 24 h of birth) and a low-cost third-party allocation process for randomization will be piloted. We will use focus group discussions and key informant interviews to explore the acceptability of the intervention, two-stage consent process, and trial design. We will interview healthcare workers, mothers, and caregivers of preterm infants. Feasibility will be assessed by the proportion of infants randomized within 15 min of delivery; the proportion of infants in the intervention arm receiving CPAP within 15 min of delivery; and the proportion of infants with primary and secondary outcomes measured successfully. Discussion This pilot trial will enhance our understanding of methods and techniques that can enable emergency neonatal research to be carried out effectively, affordably, and acceptably in low-resource settings. This mixed-methods approach will allow a comprehensive exploration of parental and healthcare worker perceptions, experiences, and acceptance of the intervention and trial design. Trial registration The study is registered on the Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Registered 08 August 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23888 .

As scholars, teachers, and researchers within academe we have, at times, felt the gravity, nuance, and depth of Black feminist theories and epistemologies have resulted in articulations and manifestations so flat they are rendered illegible and almost always universally synonymous. While there are certainly deep and rich connections among and between Black feminist theories, and while their proliferation has been often mutually facilitative, they are worthy of distinction. Our paper explores how the genealogy of Black women's theorizing has survived through its varying conceptualizations through explicating Womanism; Black Feminist Thought; and Endarkened Feminisms. We illustrate the genealogy of Black women's theorizing and suggest moving away from the singular meanings that, ultimately, reduce their public force and utility in higher education research and practice.

In this manuscript, I lift Black feminisms as a methodological intervention on a holistic meaning-making theory and its relationship to anti-Blackness. Specifically, I employed a Black feminist literary criticism, which presumes that Black people have cultivated living and survival practices throughout their history in the United States. I analyzed 7 full-length books and essays written by James Baldwin and Audre Lorde. Additionally, in attending to Black feminist theorizing, I used creative prose to situate myself in the text by locating the curated findings from the literary analysis in my mother's rearing practices. Pointing to the historical ways Black people have lived in the wake of anti-Black structures, I depart from the meaning-making pathways articulated by self-authorship and point to the possibilities of self-defining praxis for Black people.

This study focused on mapping agripreneurship curriculum and lecturers' competencies in 8 African Higher Education Institutions (HEIs), participating in the Strengthening Agri-Entrepreneurship and Community Engagement Training in East, West and North Africa (AgriENGAGE) joint Project. A sample of 194 lecturers from East, West, and North Africa participated in the study. The study employed a mixed method approach with concurrent nested research design methodology to collect information. Among the main results found in this study, the key aspects that were implemented in curricula were; business plan development ([mu] = 3.57), business opportunities identification ([mu] = 3.56), and communicating with value chain actors (= 3.51). Concerning the forms of entrepreneurship taught, most institutions focused on subsistence agripreneurship ([mu] = 3.23) with growth-oriented agripreneurship ([mu] = 2.50) and innovative-oriented agripreneurship ([mu] = 2.50) having the lowest rating. Regarding teaching methods within the provision of entrepreneurship education, most of the institutions were using traditional teaching methodologies with the common ones being formal lectures, field trips, in-class group discussions, and group project-based learning. Most lecturers had low teaching competencies concerning instructional quality and a moderate/average level of entrepreneurial competencies. The study recommends that universities should implement more professional development and pedagogical training over and above the subject competency to improve lecturers' entrepreneurial competency.

Black matters, according to Black feminist geographer Katherine McKittrick (2006), are always already spatial matters. As Black academics, we are intimately familiar with hostile environments and unwelcoming spaces (Dade et al., 2015; Griffin, 2013; Misawa, 2015). Embracing the sacred principle of nommo, which is to conjure images of biological and spiritual existence (Walker & Kuykendall, 2005), we envision poetry as a contestation of Black absenting and a platform to speak our imaginings into existence. This duoethnography, by a Black woman postdoctoral scholar and a Black man navigating academia as a current faculty member, draws on endarkened feminist epistemology as a conceptual framework to guide articulations of self in and against academic spaces that attempt to marginalize, silence, and erase Black personhood.

BackgroundPoint of care hemoglobin meters play key roles in increasing access to anemia screening in antenatal care especially in settings with limited access to laboratories. We aimed to determine the diagnostic accuracy of a non-invasive spot-check hemoglobin (SpHb) meter, Masimo Rad-67® Pulse CO-Oximeter®, in the diagnosis of anemia in pregnant women attending antenatal care clinics in Kilifi, Kenya.MethodsThis was a diagnostic accuracy study that retrospectively evaluated SpHb against a validated reference standard of laboratory assessed hemoglobin (Lab Hb) by a SYSMEX XN-330 automated hematology analyzer. The study was nested within a prospective pregnancy cohort study that recruited unselected pregnant women from antenatal care clinics in two public hospitals in Kilifi County, coastal Kenya. Records with both SpHb and Lab Hb were selected from pregnancy visits between May 2021 and December 2022. Linear regression and Bland-Altman analysis were performed to compare the two tests and diagnostic accuracy parameters obtained for the diagnosis of anemia.ResultsA total of 2,975 records (from 2,203 unique participants), with paired SpHb and Lab Hb were analyzed. Linear regression showed a significant but weak positive correlation, a proportional bias of 0.44 (95% CI 0.41–0.47) and a constant of 7.59 (95% CI 7.30–7.87, p