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At 3 severe infection cohort sites in Uganda, Orientia seropositivity was common. We identified 4 seroconversion cases and 1 PCR-positive case. These results provide serologic and molecular support for Orientia spp. circulating in sub-Saharan Africa, possibly expanding its endemic range. Orientia infections could cause severe illness and hospitalizations in this region. [ABSTRACT FROM AUTHOR]

Background: Cryptococcal meningitis (CM) remains a major cause of death among people living with HIV in rural sub-Saharan Africa. We previously reported that a CM diagnosis and treatment program (CM-DTP) improved hospital survival for CM patients in rural, northern Uganda. This study aimed to evaluate the impact on long-term survival. Methods: We conducted a retrospective study at Lira Regional Referral Hospital in Uganda evaluating long-term survival (≥1 year) of CM patients diagnosed after CM-DTP initiation (February 2017-September 2021). We compared with a baseline historical group of CM patients before CM-DTP implementation (January 2015-February 2017). Using Cox proportional hazards models, we assessed time-to-death in these groups, adjusting for confounders. Results: We identified 318 CM patients, 105 in the Historical Group, and 213 in the CM-DTP Group. The Historical Group had a higher 30-day mortality of 78.5% compared to 42.2% in the CM-DTP Group. The overall survival rate for the CM-DTP group at three years was 25.6%. Attendance at follow-up visits (HR:0.13, 95% CI: [0.03–0.53], p <0.001), ART adherence (HR:0.27, 95% CI: [0.10–0.71], p = 0.008), and fluconazole adherence: (HR:0.03, 95% CI: [0.01–0.13], p <0.001), weight >50kg (HR:0.54, 95% CI: [0.35–0.84], p = 0.006), and performance of therapeutic lumbar punctures (HR:0.42, 95% CI: [0.24–0.71], p = 0.001), were associated with lower risk of death. Altered mentation was associated with increased death risk (HR: 1.63, 95% CI: 1.10–2.42, p = 0.016). Conclusion: Long-term survival of CM patients improved after the initiation of the CM-DTP. Despite this improved survival, long-term outcomes remained sub-optimal, suggesting that further work is needed to enhance long-term survival. [ABSTRACT FROM AUTHOR]

Enhancing the productivity of crops through the adoption and uptake of technologies improves farmers' socioeconomic status through increased market participation. However, smallholder farmers in Sub‐Saharan Africa (SSA) face a myriad of challenges that make it difficult for them to access and participate in the output markets. Like most SSA countries, the uptake of improved technologies is still low in Malawi. This study examines the relationship between the uptake of improved potato seed and donor‐funded training on market participation. Using secondary data from 393 potato farmers in Malawi, the study applied a triple‐hurdle model to examine the extent to which such interventions and other socioeconomic and institutional factors influence market participation. The results showed that male‐headed farm households, more experienced farmers, and those who participated in International Potato Center (CIP)‐led training were likely to market their potato output. Further, farmers closer to urban centers, those with off‐farm income, those who had participated in potato training, use of improved potato seed, and quantity of output positively influenced the decision to sell in high‐value markets such as supermarkets. On the other hand, land size, ownership of transport equipment, group membership, and access to credit had positive effects on the amount of potatoes sold, while the distance to the markets reduced the quantity sold. Based on these findings, there is a need to set up a seed system within the local communities where farmers can easily access the seeds. Additionally, there is a need for a collaborative effort between public and private sector stakeholders to invest in the production of improved potato seeds that would help to address the shortfall in supply. Finally, institutional support interventions that utilize farmer groups as a key entry point in sustaining training on improved potato seed, relaxing credit constraints, and promoting diversification into off‐farm enterprises would enhance potato production and marketing. Core Ideas: Better access to improved potato seed is essential for food security.Inadequate training and seed supply constrain potato production.Access to good seed and training are key to market participation. [ABSTRACT FROM AUTHOR]

The International Potato Center (CIP) has collaboratively implemented various demand‐pull and supply‐push interventions since 2006 to develop the seed system for biofortified orange‐fleshed sweet potato (OFSP) (Ipomoea batatas) varieties in Malawi. Consequently, the adoption of OFSP varieties has increased to 30%. Nevertheless, the actual adoption rates, the contribution of these interventions to the seed system development, and the extent to which the current policy and regulatory environment facilitated or impeded the availability and access to quality planting materials by smallholder farmers are not well understood. This study explored these critical issues using desk reviews and qualitative information with OFSP subsector stakeholders. The results reveal that most of the critical nodes of the OFSP seed system are underdeveloped. However, CIP backstopping interventions to the national research systems contributed significantly to building Malawi's capacity for producing clean early‐generation seed materials. In addition, CIP has played a critical role in developing the community‐level capacity to produce and disseminate clean vines through the introduction of decentralized vine multipliers and commercial vine multipliers. The study recommends integrating formal and informal seed systems for vegetatively propagated crops to improve access to quality planting materials by farmers. Second, government and development partners (CGIAR centers, Nongovernmental Organization) should progressively promote/create demand for OFSPs among consumers because of the strong association between the biofortified OFSP varieties and nutrition. Lastly, there is need for government and development partners to establish and increase OFSP interventions in the Northern and Central regions of Malawi. Core Ideas: Access to certified seed for vegetatively propagated crops is low in Sub‐Saharan Africa.Various interventions were implemented to develop the seed system for orange‐fleshed sweet potato.Seed system for orange‐fleshed sweet potato is still in infancy stages.Integrations of formal and informal seed systems are critical to ensuring availability and access to quality seeds.Demand creation for orange‐fleshed sweet potato as a nutritious food will trigger improvements in the seed system. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this paper is to establish whether trust plays a significant mediating role in the relationship between access to microcredit and survival of young women microenterprises in under-developed financial markets in sub-Saharan Africa. The main focus of this paper is to specifically test whether relational social capital built by young women from homogeneous and heterogeneous groups can be more effective in promoting economic exchange in under-developed financial markets since interpersonal trust has recently been found to harbor group collusion, especially among kins. Overall, the paper distinguishes trust among individuals based on their age, gender and ethnic diversity. Design/methodology/approach: This study used structural equation model to test whether trust significantly mediates the relationship between access to microcredit and survival of young women microenterprises using Analysis of Moments Structures (AMOS) based on recommendations by Hair et al. (2022) and Baron and Kenny (1986). Findings: The findings from this study revealed that trust significantly and positively mediate the relationship between access to microcredit and survival of young women microenterprises in under-developed financial markets in sub-Saharan Africa. Trust developed from relational social capital among young women from homogeneous and heterogeneous groups create a stronger basis for economic exchange in under-developed financial markets. Research limitations/implications: While this study generates a positive evidence on the impact of access to microcredit on survival of young women microenterprises, the results cannot be over emphasized and generalized because the data were collected from only a single developing country. Future research may extend the current study to include other developing countries to make a more justified comprehensive analysis. Practical implications: The findings from this study highlights the importance of using a blend of social policy guided by norms combined with formal regulations as an informal contract enforcement mechanism to achieve efficient economic exchange in under-developed financial markets. Relational social capital formed on the basis of informal norms among groups from diverse population can supplement formal laws to enforce contractual obligations in microcredit access, especially among youthful microentrepreneurs, who seems to have stronger relational behaviors than adults. Financial institutions such as banks should use informal contract enforcement system to increase the scope of financial inclusion of young microentrepreneurs, especially in unbanked rural communities in sub-Saharan Africa, Uganda inclusive where formal laws are weak and sometimes not functional. The findings also show that younger people have a stronger relationship behavior than adults. Therefore, policy should create structures that can promote social activities among youth. Governments in sub-Saharan Africa, Uganda inclusive through their respective Ministry of Gender, Labour and Youth Affairs should create youth clubs that can increase interaction and relational social capital among the younger population to derive economic empowerment. sub-Saharan African governments, Uganda inclusive should rely more on social policy based on relational social capital as a missing link to promote and achieve economic development. Originality/value: This paper provides an evidence on the unique role of age, gender and ethnicity in information sharing and exchange based on social policy in the financial market to limit group collusion. The authors indicate that diversity in relational social capital among young women microentrepreneurs prohibit strategic defaults, which promotes access to microcredit for survival of women micro small and medium enterprises (MSMEs) through socialization. High level of interaction among younger women microentrepreneurs from homogeneous and heterogeneous groups allow them to close the information gap to timely meet borrowing contractual obligations to derive economic benefits. The paper shows that younger women have more trust than older women while searching for economic value through socialization. In fact, social policy can wholly supplement formal policy to promote growth and survival of young women microenterprises, especially in sub-Saharan Africa, Uganda inclusive. [ABSTRACT FROM AUTHOR]

Sweetpotato is climate smart crop, grown with limited external inputs (fertilisers, pesticides, less labour) making it an attractive crop for resource-constrained smallholder farmers. It is also a major cash and food crop for many countries in sub-Saharan Africa. However, adoption of the high yielding and nutritious improved varieties has been disappointingly low. This study uses qualitative methods to explore the barriers and enablers of farmer varietal replacement and adoption. Unlike the extant quantitative studies that identify the determinants of adoption, we delve deeper into understanding the reasons for or against the preference for specific varieties. We used a rich set of information collected via focus group discussions which explore why farmers prefer certain varieties over others and how they perceive the new improved varieties from the national breeding programs. Doing so enabled us to unravel specific traits or trait combinations that farmers seek and identify those that they perceive needing improvement. We find that the most preferred traits were 'yield' and 'good taste'. Implying that the neglect of sensory attributes by breeders contributes to the low adoption of improved sweetpotato varieties. Moreover, we find that altruism among the respondents plays an important role in farmer use of, and sharing of information about improved sweetpotato varieties. Women and men farmers obtained most of their information from neighbours, NGOs and radios. For women, the most important source of planting materials doubled as their most important source of information. Thus, concerted efforts to minimise information constraints are essential for unravelling the adoption puzzle. [ABSTRACT FROM AUTHOR]

Non-communicable diseases (NCDs) are a growing health burden in Sub-Saharan Africa and especially Uganda, where they account for over one third of all deaths. During the COVID-19 pandemic, public health control measures such as societal "lockdowns" had a significant impact on longitudinal NCD care though no studies have looked at the lived experience around NCD care during the pandemic. Our objective was to understand the experience of NCD care for both patients and providers in southwestern Uganda during the COVID-19 pandemic. We conducted in-depth, in-person qualitative interviews with 20 patients living with hypertension, diabetes, and/or cardiac disease purposefully selected from the outpatient clinics at Mbarara Regional Referral Hospital and 11 healthcare providers from public health facilities in Mbarara, southwestern Uganda. We analyzed transcripts according to conventional content analysis. We identified four major themes that emerged from the interviews; (1) difficulty accessing medication; (2) food insecurity; (3) barriers to the delivery of NCD clinical care and (4) alternative forms of care. Pre-existing challenges with NCD care were exacerbated during COVID-19 lockdown periods and care was severely disrupted, leading to worsened patient health and even death. The barriers to care were exacerbations of underlying systemic problems with NCD care delivery that require targeted interventions. Future work should leverage digital health interventions, de-centralizing NCD care, improving follow-up, providing social supports to NCD patients, and rectifying supply chain issues. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) pandemic affected malaria control activities in sub-Saharan Africa (SSA) resulting in 690,000 excess deaths in the year 2021. The authors hypothesized that COVID-19 affected the World Health Organization (WHO) Test, Treat and Track (T3) strategy that has been implemented in Uganda since 2010. In this study, health worker's adherence to the T3 strategy during COVID-19 pandemic in Eastern Uganda was studied by assessing their knowledge, skills and practices. Methods: A cross-sectional study utilizing mixed quantitative and qualitative data collections methods was conducted at Mbale Regional Referral Hospital in Eastern Uganda between November and December in 2020. Data were captured on demographics, knowledge, skills and practices for both health workers (HWs) and patients. Quantitative data were analysed using STATA 15.0 and reported as descriptive statistics, proportions and statistical associations. Moreover, qualitative data were collected via key informant interviews (KII) among purposively sampled study participants and analysed thematically using NVIVO software. Ethical approval was obtained prior to the study. Results: A total of 436 study participants, of whom 103/436 (24%) and 333/436 (76%) were HWs and patients, respectively were studied. Among the HWs with mean age of 34 years (SD = 8.8 years), 81/103 (79%) had good practices, most 63/103 (61%) had good knowledge, and only 11/103 (10.7%) had good skills. Specifically, on the cadres, the laboratory personnel 19/103 (18%) had good knowledge 14/19 (74%) OR: 2.0 (95% CI 0.7–6) and were highly skilled OR: 4.6 (95% CI 1.2—18.1; P < 0.0150) compared to other cadres, respectively. Among the patients whose age ranged 3 months to 80 years (mean 17.8 years) and females 177/333 (53%); a majority 257/333 (77%) were tested, of whom 139/333 (42%) tested positive. Out of the positive cases, 115/333 (35%) were treated and tracked. About 75/333 (23%) were not tested but treated for malaria. Of the 168/239 (70.3%) patients tested, 115/168 (68.5%) were positive and treated, P = 0.0001. The KII revealed low level of In-service training, overwhelming number of patients and stock-out of supplies as a key factor for poor HW adherence to T3 strategy. Conclusions: During COVID-19 pandemic period HWs adherence to T3 initiative was low as 27% malaria patients did not receive treatment. [ABSTRACT FROM AUTHOR]

Study background: The use of dual protection methods among young women living with HIV (YWLHIV) aged 15–24 years in sub-Saharan Africa (SSA) is poorly researched despite the double risk of unintended pregnancy and HIV. Even more scanty is literature on the use of female-controlled dual protection methods. We propose to determine the female-controlled dual protection prevalence, and the predictors among YWLHIV in northern Uganda. The study will also explore the YWLHIV's experiences and perceptions regarding the female-controlled dual protection methods. Materials and methods: This study will employ a mixed-methods design. The study area will be Lira district and Lira city located in northern Uganda. The setting for recruitment of participants will be the public health facility–based anti-retroviral therapy (ART) clinics. These ART clinics serves a total of about 1,771 YWLHIV. A sample of 425 YWLHIV will be selected by stratified random sampling from the ART clinic registers. The three strata of interest will be the YWLHIV attending the ART clinic at referral hospitals, health centers level IV (primary healthcare centers), and health centers level III (dispensaries). The primary outcome will be the use of the female-controlled dual protection methods. The outcome will be measured by asking the YWLHIV 'what methods under their control as YWLHIV do they use to protect against both unintended pregnancy and HIV during sexual intercourse with their male partners.' The questionnaire also has measures for the unintended pregnancy, HIV status, and the potential predictors. Qualitative component of the study will be in-depth interviews of the participants about their experiences and perceptions regarding the female-controlled dual protection methods. Data collection was still ongoing at the time of first submission of this study protocol to the journal (14th March 2023). The Statistical Package for Social Sciences (SPSS) version 23.0 will be used for the statistical analyses. Descriptive statistics, bivariate and multivariate regression analyses will be used to establish the prevalence, associated factors and the predictors of the outcome respectively. The statistical significance level of 5% and 95% confidence interval will be considered. In-depth interviews will be manually analyzed using a thematic analysis approach for codes, themes, and categories. [ABSTRACT FROM AUTHOR]

Simple Summary: Maize is the staple food in Sub-Saharan Africa and a source of livelihood for millions of smallholder farmers. Constraints in production, which include pest damage, lead to loss of production and hunger. Since its arrival in Kenya in 2016, fall armyworm (FAW) has caused huge destruction. Chemical control is the preferred choice by farmers despite its negative effects. Baculoviruses offer a sustainable alternative to pesticides. However, their cost and special storage requirements make them unattractive to smallholder farmers, especially where repeat applications are required. The potential to use recycled virus inoculum from FAW larvae treated with a commercial baculovirus product has not been documented. This study evaluated the efficacy of recycled virus inoculum from larvae treated with Littovir, a commercial product, under laboratory and field conditions. Under laboratory conditions, the recycled virus inoculum caused varying mortality in different FAW instars, with the highest mortality recorded in the 1st–3rd instars. Under field conditions, the recycled virus inoculum produced maize yield comparable to that of commercial insecticides but similar to that of the control. This study has highlighted the potential of recycled virus inoculum from larvae treated with a commercial product. This approach offers affordable means of controlling FAW since farmers only need to purchase the commercial product once and can use recycled virus inoculum from treated larvae for repeat applications. Fall armyworm (FAW) is a major pest of maize and causes huge losses. Chemical pesticides are the commonly used control strategy among farmers. The efficacy of baculoviruses against FAW has been proven; however, farmers may not be able to afford the products. The use of farmer-produced baculovirus mixtures could provide an opportunity for a nature-based solution for FAW at a low cost. This study evaluated the potential of recycled virus inoculum from FAW larvae treated with a commercial baculovirus (Littovir) for the management of FAW under laboratory and field conditions. In the laboratory, the virus from 25, 50, 75 and 100 FAW larvae caused variable mortality among FAW instars. The highest mortality (45%) among 1st–3rd instars was caused by Littovir followed by recycled virus inoculum from 100 FAW larvae (36%). Under field conditions, even though recycled virus inoculum did not offer adequate protection against FAW damage, the maize yield was comparable to that of commercial insecticide-treated plots and similar to that of control plots. This study has shown the potential use of recycled virus inoculum from infected larvae for the management of FAW. This would offer the farmers a sustainable and affordable option for the management of FAW as it would require the farmers to purchase the commercial baculovirus once and collect larvae from treated plots for repeat applications. [ABSTRACT FROM AUTHOR]

Introduction: Electrocardiographic (ECG) abnormalities are increasingly being reported among people living with HIV (PLWH). However, the exact prevalence of ECG abnormalities among PLWH in Sub-Saharan Africa (SSA), a region with one of the highest burdens of HIV, is not known. Through a systematic review, we determined the prevalence and patterns of ECG abnormalities among PLWH in SSA. Methods: We conducted a search in online databases including EMBASE, MEDLINE, CINAHL and Research for Life for studies published between 1st January 2000 and 31st December 2020. Studies reporting any form of ECG abnormalities published in English were screened and reviewed for eligibility. Retrieved studies were assessed for validity using the modified Newcastle-Ottawa Scale. Data was summarized qualitatively, and ECG abnormalities were further subcategorized into rate, conduction, and rhythm abnormalities as well as atrial and ventricular enlargements. Results: We retrieved seventeen of the 219 studies assessed for eligibility published between 2001 and 2020, with a total of 2,572 eligible participants. The mean age of the participants ranged between 6.8 years and 58.6 years. Of the 17 studies, 8 (47%) were case-control, 6 (35.3%) cross-sectional and 3 (17.6%) were cohort in design. Thirteen studies were conducted in the adult population while four were conducted in the pediatric population. The prevalence of ECG abnormalities ranged from 10% to 81% and 6.7% to 26.5% in the adult and pediatric population respectively. Among studies done in the adult population, conduction abnormalities were the most reported (9 studies) with a prevalence ranging from 3.4% to 53.5%. In the pediatric population, rate abnormalities were the most reported (4 studies) with a prevalence ranging from 3.9% to 20.9%. The heterogeneity in results could be attributed to the absence of uniform criteria to define ECG abnormalities. Conclusion: Our findings highlight a high prevalence of ECG abnormalities among PLWH in SSA. Consideration of ECG in the comprehensive evaluation of cardiac dysfunction among PLWH in SSA maybe warranted. [ABSTRACT FROM AUTHOR]

Purpose: African animal trypanosomiasis (AAT) is a disease affecting livestock in sub-Saharan Africa. The use of trypanocidal agents is common practice to control AAT. This study aimed to identify drug-resistant Trypanosoma congolense in Lambwe, Kenya, and assess if molecular test backed with mice tests is reliable in detecting drug sensitivity. Methods: Blood samples were collected from cattle, in Lambwe, subjected to buffy coat extraction and Trypanosoma spp. detected under a microscope. Field and archived isolates were subjected to molecular characterization. Species-specific T. congolense and TcoAde2 genes were amplified using PCR to detect polymorphisms. Phylogenetic analysis were performed. Four T. congolense isolates were evaluated individually in 24 test mice per isolate. Test mice were then grouped (n=6) per treatement with diminazene, homidium, isometamidium, and controls. Mice were subsequently assessed for packed cell volume (PCV) and relapses using microscopy. Results: Of 454 samples, microscopy detected 11 T. congolense spp, eight had TcoAde2 gene, six showed polymorphisms in molecular assay. Phylogenetic analysis grouped isolates into five. Two archived isolates were homidium resistant, one was also diminazene resistant in mice. Two additional isolates were sensitive to all the drugs. Interestingly, one sensitive isolate lacked polymorphisms, while the second lacked TcoAde2, indicating the gene is not involved in drug sensitivity. Decline in PCV was pronounced in relapsed isolates. Conclusion: T. congolense associated with homidium and diminazene resistance exist in Lambwe. The impact can be their spread and AAT increase. Polymorphisms are present in Lambwe strains. TcoAde2 is unlikely involved in drug sensitivity. Molecular combined with mice tests is reliable drug sensitivity test and can be applied to other genes. Decline in PCV in infected-treated host could suggest drug resistance. [ABSTRACT FROM AUTHOR]

The cost of chicken production in developing countries is 300% higher than in developed nations. Overreliance on the key protein feed ingredients especially soybean and fishmeal (SFM) that are characterized by rising food-feed competition and supply chain impediments exacerbate the situation. The use of insect protein as a sustainable alternative protein source has attracted global attention recently. However, there is a dearth of empirical insights on farmers' preferences for commercial insect-based feed for chicken production in Sub-Saharan Africa. This study evaluated farmers' willingness to pay for attributes of insect-based commercial chicken feed in Kenya using a choice experiment based on a survey of 314 predominantly chicken farmers. Results show that the farmers are willing to pay premium prices ranging between US$ 0.35 and US$ 3.45 for insect-based feed in the form of either pellets or mash, feed explicitly labelled as containing insects, insect protein feed mixed with SFM and dark-colored feed. These findings provide evidence for multi-stakeholder collaborations to facilitate the creation of an inclusive insect-based feed regulatory framework for sustainable feed and chicken production. [ABSTRACT FROM AUTHOR]

'Naronut 1R' (Reg. no. CV‐150, PI 693985) is a high‐yielding, Spanish‐type groundnut (Arachis hypogaea L. subsp. fastigiata var. vulgaris) cultivar with a red seed coat and two seeds per pod. The cultivar was selected from a cross between International Crops Research Institute for the Semi‐arid Tropics advanced lines 'ICGV‐SM 90704' and 'ICGV‐SM 86715'. Naronut 1R was developed for groundnut rosette disease resistance, late leafspot resistance, yield, red seed coat, and early maturity. Naronut 1R matures in 75–80 d after planting, compared with 90 d for the widely grown and popular landrace Erudu red (Spanish‐type groundnut). Naronut 1R has much higher yields (1,473 kg ha−1) than Erudu red (554 kg ha−1). The overall groundnut rosette disease rating was 44% lower in Naronut 1R (2.8 disease rating) compared with Erudu red (5.0 disease rating). Similarly, the overall late leafspot disease rating was 28% lower in Naronut 1R (3.6 disease rating) compared with Erudu red (5.0 disease rating). Similar to Erudu red, Naronut 1R seed testa is red, but the seed is larger. The sound mature kernel weight was 9.42% higher for Naronut 1R than for Erudu red. The shelling percentage for Naronut 1 was 49.3%, whereas Erudu red was 60%. Naronut 1R has lower protein (18.1 vs. 21.3%) and oil content (36.0 vs. 44.3%) than Erudu red. Naronut 1R will allow for broad adoption of a high yielding, early maturing, red seed coat cultivar that carries resistance to groundnut rosette disease and late leaf spot disease. Core Ideas: Naronut 1R is a high‐yielding, very early‐maturing peanut cultivar.Naronut 1R is resistant to groundnut rosette disease and late leaf spot disease.Naronut 1R is broadly adaptable across sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

A large body of research shows that mobile money through its agent networks can potentially increase financial inclusion, especially in the unbanked rural regions of the developing world. This study intends to establish whether agent liquidity has a significant moderating effect in the relationship between mobile money services and financial inclusion of the unbanked poor population in rural sub-Saharan Africa. The data were collected from mobile money users through a cross-sectional approach using a semi-structured quantitative questionnaire and Analysis of Moment Structures was used to test for the moderating effect of agent liquidity between mobile money services and financial inclusion. The results revealed a significant moderating effect of agent liquidity in the relationship between mobile money services and financial inclusion of the unbanked poor population in rural sub-Saharan Africa with data collected from rural Uganda. Agent liquidity enhances access to and usage of mobile money services by 27 percentage points to spur financial inclusion among the unbanked rural poor population. Similarly, agent liquidity has a direct significant effect on access to and usage of mobile money services among the unbanked rural poor population. Overall, the results showed that agent liquidity plays a significant and positive moderating role between mobile money services and financial inclusion. The findings from this study can help mobile money providers to increase cash float amounts to boost agent liquidity to meet instant cash-in and cash-out demands of customers. Besides, regulations on mobile money agents should be loosen to allow more village "dukas" (small village shops) to offer mobile money financial services to crowd-in more unbanked rural poor population. [ABSTRACT FROM AUTHOR]

Background: HIV-related stigma negatively impacts HIV prevention, treatment, and care, particularly among children and adolescents in sub-Saharan Africa. Interventions that are culturally grounded and relevant for addressing root causes may reduce the stigma experienced by HIV-positive and HIV-affected young people. This study, to be conducted in a post-conflict, rural setting in Omoro District, Uganda, will develop and evaluate a transformative arts-based HIV-related stigma intervention rooted in local cultural knowledge to reduce stigma and improve HIV prevention and care for young people living with HIV. The intervention will be delivered to young people attending school by community Elders, with the support of teachers, through the transfer of local cultural knowledge and practices with the aim of re-establishing the important cultural and social role of Elders within a community that has suffered the loss of intergenerational transfer of cultural knowledge throughout a 25-year civil war. Methods: A formative research phase consisting of interviews with students, teachers, and Elders will inform the intervention and provide data for study objectives. Workshops will be delivered to Elders and teachers in participating schools to build capacity for arts-based, educational workshops to be conducted with students in the classroom. The intervention will be evaluated using a stepped-wedge cluster-randomized trial. Government-funded schools in Omoro District will be randomized into three blocks, each comprised of two primary and two secondary schools (n=1800 students). Schools will be randomly assigned to a crossover sequence from control to intervention condition in 8-week intervals. A process evaluation will be implemented throughout the study to evaluate pathways between intervention development, implementation, and effects. Discussion: This study will generate comprehensive, in-depth participatory research and evaluation data to inform an effective and sustainable protocol for implementing arts-based HIV stigma interventions for young people in school settings. Findings will have widespread implications in post-conflict settings for HIV prevention, treatment, and care. Trial registration: ClinicalTrials.gov NCT04946071. Registered on 30 June 2021. [ABSTRACT FROM AUTHOR]

Introduction: In Uganda, adult men living with HIV are more likely to present late for care; with a CD4 cell count below 350 cells/μl compared to women. Understanding why adult men present late for HIV care is important in improving early linkage to care. Studies across countries in Sub-Saharan Africa emphasize the role of masculinity norms; defined as social expectations about appropriate roles and behavior for men, in men's health behaviours particularly, in HIV care engagement. This study therefore explored how masculinity norms influence men's late presentation for HIV care. Methods: This was a qualitative study undertaken in Jinja District, Eastern Uganda between October and November 2020. We conducted 20 In-Depth Interviews (IDIs) with men living with HIV who had presented late for care at Family Hope Centre. We also conducted four Focus Group Discussions (FGDs) with HIV negative men and women in selected communities of Katende and Walukuba. Conventional content analysis approach was used to identify themes across the collected data. Results: A total of 20 men participated in the In-depth Interviews (IDIs), with majority being married 15/20 (75%) and primary level holders 7/15 (46.7%). Nineteen (19) women participated in two FGDs, with a mean age of 29.5 years. Nineteen (19) men also participated in other two FGDs, with a mean age of 28.2 years. Conventional content analysis results indicated that men's late presentation for HIV care in Jinja district is greatly related to their concerns of loss of respect and the need to preserve their reputation and maintain a sense of normality in their families and society as proposed by Wilson's (1969) respectability-reputation theoretical model. Respectability was endorsed by 'the wider society', while reputation was endorsed almost entirely by men and some women. Conclusion: Findings show that the explanations for men's late presentation arise from the masculinity norms in Jinja District, Eastern Uganda. [ABSTRACT FROM AUTHOR]

The primary purpose of this study is to establish the moderating role of generational differences in the relationship between mobile money adoption and use and financial inclusion in developing countries. Three key findings emerged: first, there is a moderating role of generational differences on mobile money adoption and use; second, both mobile money adoption and use and generational differences have significant and positive effects on financial inclusion; third, the inclusion of generational differences, as a moderator, results in 6.7 per cent increase in financial inclusion in developing countries. [ABSTRACT FROM AUTHOR]

Air pollution is a major global public health issue causing considerable morbidity and mortality. Measuring levels of air pollutants and facilitating access to the data has been identified as a pathway to raise awareness and initiate dialogue between relevant stakeholders. Low-and middle-income countries (LMICs) urgently need simple, low-cost approaches to generate such data, especially in settings with no or unreliable data. We established a network of easy-to-use low-cost air quality sensors (PurpleAir-II-SD) to monitor fine particulate matter (PM2.5) concentrations at 15 sites, in 11 cities across eight sub-Saharan Africa (sSA) countries between February 2020 and January 2021. Annual PM2.5 concentrations, seasonal and temporal variability were determined. Time trends were modelled using harmonic regression. Annual PM2.5 concentrations ranged between 10 and 116 µg/m3 across study sites, exceeding the current WHO annual mean guideline level of 5 µg/m3. The largest degree of seasonal variation was seen in Nigeria, where seven sites showed higher PM2.5 levels during the dry than during the wet season. Other countries with less pronounced dry/wet season variations were Benin (20 µg/m3 versus 5 µg/m3), Uganda (50 µg/m3 versus 45 µg/m3), Sukuta (Gambia) (20 µg/m3 versus 15 µg/m3) and Kenya (30 µg/m3 versus 25 µg/m3). Diurnal variation was observed across all sites, with two daily PM2.5 peaks at about 06:00 and 18:00 local time. We identified high levels of air pollution in the 11 African cities included in this study. This calls for effective control measures to protect the health of African urban populations. The PM2.5 peaks around 'rush hour' suggest traffic-related emissions should be a particular area for attention. [ABSTRACT FROM AUTHOR]

Blood transfusion is life-saving but sometimes also associated with morbidity and mortality. There is limited data on mortality in patients transfused with whole blood in sub-Saharan Africa. We described the 30-day all-cause mortality and its associated factors in patients transfused with whole blood to inform appropriate clinical intervention and research priorities to mitigate potential risks. A retrospective study was performed on purposively sampled patients transfused with whole blood at the Uganda Cancer Institute (UCI) and Mulago hospital in the year 2018. Two thousand twelve patients with a median (IQR) age of 39 (28–54) years were enrolled over a four month period. There were 1,107 (55%) females. Isolated HIV related anaemia (228, 11.3%), gynaecological cancers (208, 10.3%), unexplained anaemia (186, 9.2%), gastrointestinal cancers (148, 7.4%), and kidney disease (141, 7.0%) were the commonest diagnoses. Most patients were transfused with only one unit of blood (n = 1232, 61.2%). The 30 day all-cause mortality rate was 25.2%. Factors associated with mortality were isolated HIV related anaemia (HR 3.2, 95% CI, 2.3–4.4), liver disease (HR 3.0, 95% CI, 2.0–4.5), kidney disease (HR 2.2, 95% CI, 1.5–3.3; p<0.01), cardiovascular disease (HR 2.9, 95% CI, 1.6–5.4; p<0.01), respiratory disease (HR 3.0, 95% CI 1.8–4.9; p<0.01), diabetes mellitus (HR 4.1, 95% CI, 2.3–7.4; p<0.01) and sepsis (HR 6.2, 95% CI 3.7–10.4; p<0.01). Transfusion with additional blood was associated with survival (HR 0.8, 95% CI 0.7–0.9, p<0.01). In conclusion, the 30-day all-cause mortality was higher than in the general inpatients. Factors associated with mortality were isolated HIV related anaemia, kidney disease, liver disease, respiratory disease, cardiovascular disease, diabetes mellitus and sepsis. Transfusion with additional blood was associated with survival. These findings require further prospective evaluation. [ABSTRACT FROM AUTHOR]

Introduction: With improved HIV treatment availability in sub‐Saharan Africa, the population of older people with HIV (PWH) is growing. In this qualitative study, we intended to understand (1) the lived experiences of ageing people in rural Uganda, with and without HIV, (2) their fears and health priorities as they grow older. Methods: We conducted 36 semi‐structured interviews with individuals with and without HIV in Mbarara, Uganda from October 2019 to February 2020. Interview guide topics included priorities in older age, physical functioning in daily activities, social functioning, HIV‐related stigma and the impact of multimorbidity on health and independence. Interviews were conducted in Runyankole, transcribed, translated and inductively coded thematically by two researchers with tests for inter‐coder reliability. Results: The respondents were purposively sampled to be evenly divided by sex and HIV serostatus. The median age of respondents was 57 (49–73). Two‐thirds were married or cohabitating, 94% had biological children and 75% cited farming as their primary livelihood. Overall, PWH considered themselves as healthy or healthier than people without HIV (PWOH). PWH rarely considered their HIV status a barrier to a healthy life, but some reported a constant sense of anxiety as it relates to their long‐term health. Irrespective of HIV status, nearly all respondents noted concerns about memory loss, physical pain, reductions in energy and the effect of these changes on their ability to complete physical tasks like small‐scale farming, and activities of daily living important to the quality of life, such as participating in community groups. Increasing reliance on others for social, physical and financial support was also a common theme. The most prevalent health concern among participants involved the threat of non‐communicable diseases and perceptions that physical functioning may diminish. Conclusions: In rural Uganda, we found that PWH consider themselves to be healthy and do not anticipate a different ageing experience from PWOH. Common priorities shared by both groups included the desire for physical and financial independence, health maintenance and social support for daily functioning and social needs. Entities supporting geriatric care in Uganda would benefit from attention to concerns about functional limitations and reported needs as people age with and without HIV. [ABSTRACT FROM AUTHOR]

Diseases are the most important factors reducing groundnut yields worldwide. In East Africa, late leaf spot (LLS) and groundnut rosette disease (GRD) are the most destructive diseases of groundnut. Limited resistance is available in pure pedigree cultivated groundnut lines and novel sources of resistance are required to produce resistant new varieties. In this work, 376 interspecific lines from 3 different populations derived from crosses with the wild species A. duranensis, A. ipaënsis, A. batizocoi and A. valida were phenotyped for 2 seasons and across 2 locations, Serere and Nakabango, in Uganda. Several genotypes showed a higher yield, a larger seed, an earlier flowering, and similar resistance to the local cultivar checks. Genotypic data was used to construct a linkage map for the AB-QTL population involving the cross between Fleur11 and [A. batizocoi x A. duranensis]4x. This linkage map, together with the phenotypic data was used to identify quantitative trait loci controlling disease resistance. These lines will be useful in combining good agronomic traits and stacking disease resistance to improve the groundnut crop in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent data about condom use at the last sexual intercourse (LSI) among university students in sub-Saharan Africa (SSA) and its association with sex, age, and condom negotiation efficacy. The primary objective of this study was to summarize the proportion of condom use at the LSI among university students in SSA. The secondary objective was to determine the association between condom use at the LSI with sex, age, and condom negotiation efficacy among university students in SSA. Methods: In this systematic review and meta-analysis, two reviewers independently searched electronic databases and grey literature for eligible studies published until July 30, 2020, extracted data, and assessed the risk of bias in the included studies. We used the Dersimonian-Liard random-effects model to pool the proportion of condom use at the LSI and the association between condom use at the LSI with sex, age, and condom negotiation efficacy, reported using risk ratio (RR). We assessed publication bias using funnel plot and Egger's test, and explored sources of heterogeneity using sub-group and meta-regression analyses. Results: We meta-analyzed 44 studies with a combined sample size of 27,948 participants.Of 14,778 sexually active participants, 8,744 (pooled proportion, 52.9%; 95% CI, 45.0–60.7; 95% prediction interval, 2.8–98.9; I-squared = 99.0%, p< 0.0001) reported condom use at the LSI and the proportion of condom use at the LSI remained stagnant between 2000 and 2019 (p = 0.512). Condom use at the LSI was not associated with being a female compared to a male (pooled RR, 1.08; 95% CI, 0.68–1.71), being of a younger age (≤24 years old) compared to older age (25 years and more) (pooled RR, 1.16; 95% CI, 0-85-1.57), and having a higher condom negotiation efficacy compared to a lower condom negotiation efficacy (pooled RR, 1.54; 95% CI, 0-81-2.94). Conclusions: We found a low and heterogenous use of a condom at the LSI among university students in SSA which was not associated with sex, age, or condom negotiation efficacy. Accordingly, context-relevant interventions are needed to improve condom use at the LSI among university students in SSA. [ABSTRACT FROM AUTHOR]

• Cardiometabolic diseases increasingly prominent in HIV in low and middle-income countries (LMICs) such as South Africa. • Unclear if this reflects absolute risk increase or unmasking by improved survival. • Long-term implications for national health resource needs and patient survival are unknown. • Evidence is required to formulate interventions including targeted primary prevention. • Dearth of large, well-phenotyped, representative datasets is a major challenge within LMICs. Cardiovascular disease (CVD) burden is increasing among persons living with HIV (PLWH) in sub-Saharan Africa. It is unclear whether this reflects absolute increase in HIV-related CVD risk or unmasking by improved survival. Therefore, we examined whether HIV is associated with adverse cardiometabolic profiles among South African adults. We analyzed a nationally representative dataset (n=6420), estimating the weighted prevalence of hypertension, diabetes, and 10-year predicted risk of incident fatal/nonfatal CVD (if aged ≥40 years). Associations between HIV and cardiometabolic indices were assessed using log-binomial regression models adjusted for sociodemographic factors. HIV population prevalence was 18.9%, with a median age of 36 years. Hypertension (44.2% vs 45.4%), diabetes (18.6% vs 20.4%), and overweight/obesity (body mass index ≥25 kg/m2: 54.9% vs 52.0%) prevalence did not substantially differ by HIV status, although PLWH had a lower 10-year predicted CVD risk (median: 5.1% vs 13.5%). In adjusted models, females who are HIV-negative had a 5 mm Hg higher median systolic blood pressure (128 vs 123 mmHg) than female PLWH. PLWH in South Africa have better cardiometabolic disease profiles than the general population, and social determinants, rather than HIV, may have a greater influence on cardiometabolic risk. Designating PLWH a CVD high-risk group in South Africa is likely unwarranted. [ABSTRACT FROM AUTHOR]

Background. African animal trypanosomiasis (AAT) affects livestock productivity in sub-Saharan Africa. This study aimed to determine cattle AAT's prevalence and associated risk factors in Lambwe Valley, Kenya. Methods. In a cross-sectional survey, livestock owners were recruited from four villages of Lambwe in Homa Bay, Kenya. Blood samples were collected from the jugular veins of cattle, and buffy coat smears were examined under a microscope. Parasites were further detected using polymerase chain reaction (PCR). Using a semistructured questionnaire, livestock owners were interviewed on their knowledge of AAT and control practices. Chi-square and multilevel models were used for the analysis. Results. The overall prevalence was 15.63% (71/454). Trypanosoma vivax 10.31% and T. congolense Savannah 6.01% were the common species and subspecies. A total of 61 livestock keepers were involved in the study. Of these, 91.80% (56/61) knew AAT, and 90.16% (55/61) could describe the symptoms well and knew tsetse fly bite as transmission mode. Self-treatment (54.09%; 33/61) was common, with up to 50.00% of the farmers using drugs frequently. Isometamidium (72.13%; 44/61) and diminazene (54.09%; 33/61) were drugs frequently used. Although 16.39% (10/61) of the farmers claimed to use chemoprophylactic treatment, 6/10 did not use the right drugs. Animals (92.1%; 58/63) with clinical signs had positive infections. Villages closer to the national park recorded a higher prevalence. Infections were higher in cattle owned by those self-treating (27.23%; 58/213), those using drug treatment without vector control (27.62%; 50/181), those using single-drug therapy, and those practicing communal grazing (20.00%; 59/295). Clinical signs strongly associate with positive infections under multilevel modeling. Conclusion. Cattle trypanosomiasis is prevalent in the Lambwe region of Kenya. This is influenced by inappropriate control practices, communal grazing, and the proximity of farms to the national park. In addition, clinical signs of the disease have a strong association with infections. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure.Methods: We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status.Results: Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT.Conclusions: Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Warfarin remains the most widely prescribed oral anticoagulant in sub‐Saharan Africa. However, because of its narrow therapeutic index, dosing can be challenging. We have therefore (a) evaluated and compared the performance of 21 machine‐learning techniques in predicting stable warfarin dose in sub‐Saharan Black‐African patients and (b) externally validated a previously developed Warfarin Anticoagulation in Patients in Sub‐Saharan Africa (War‐PATH) clinical dose–initiation algorithm. The development cohort included 364 patients recruited from eight outpatient clinics and hospital departments in Uganda and South Africa (June 2018–July 2019). Validation was conducted using an external validation cohort (270 patients recruited from August 2019 to March 2020 in 12 outpatient clinics and hospital departments). Based on the mean absolute error (MAE; mean of absolute differences between the actual and predicted doses), random forest regression (12.07 mg/week; 95% confidence interval [CI], 10.39–13.76) was the best performing machine‐learning technique in the external validation cohort, whereas the worst performing technique was model trees (17.59 mg/week; 95% CI, 15.75–19.43). By comparison, the simple, commonly used regression technique (ordinary least squares) performed similarly to more complex supervised machine‐learning techniques and achieved an MAE of 13.01 mg/week (95% CI, 11.45–14.58). In summary, we have demonstrated that simpler regression techniques perform similarly to more complex supervised machine‐learning techniques. We have also externally validated our previously developed clinical dose–initiation algorithm, which is being prospectively tested for clinical utility. [ABSTRACT FROM AUTHOR]

Background: The extent to which the risk of atherosclerotic cardiovascular disease (ACVD) is increased among people living with HIV (PLWH) in sub-Saharan Africa remains unknown.Setting: Cross-sectional analysis nested within the Ugandan Noncommunicable Diseases and Aging Cohort, including PLWH in rural Uganda > 40 years taking antiretroviral therapy (ART) for at least 3 years, and a population-based control group of HIV-uninfected age- and sex-matched persons.Methods: We conducted carotid ultrasonography and collected ACVD risk factor data. Our outcome of interest was carotid plaque, defined as > 1.5 mm thickness from the intima-lumen interface to the media-adventitia interface. We fit multivariable logistic regression models to estimate correlates of carotid plaque including HIV-specific and traditional cardiovascular risk factors.Results: We enrolled 155 (50.2%) PLWH and 154 (49.8%) HIV-uninfected comparators, with a mean age of  51.4 years. Among PLWH, the median CD4 count was 433 cells/mm3 and 97.4% were virologically suppressed. Carotid plaque prevalence was higher among PLWH (8.4% vs 3.3%). HIV infection (aOR 3.90; 95% CI 1.12-13.60) and current smokers (aOR 6.60; 95% CI 1.22-35.80) had higher odds of carotid plaque, whereas moderate (aOR 0.13, 95% CI 0.01-1.55) and vigorous intensity of physical activity (aOR 0.34, 95% CI 0.07-1.52) were associated with decreased odds of carotid plaque.Conclusion: In rural Uganda, PLWH have higher prevalence of carotid plaque compared to age- and sex-matched HIV-uninfected comparators. Future work should explore how biomedical and lifestyle modifications might reduce atherosclerotic burden among PLWH in the region. [ABSTRACT FROM AUTHOR]

Background Hypertension is a growing public health emergency in rural sub-Saharan Africa. Based on the known influence of religious leaders in rural sub-Saharan Africa and our prior research, we explored perspectives of religious leaders on hypertension and potential strategies to improve hypertension control in their communities. Methods We conducted 31 in-depth interviews with Christian (n = 17) and Muslim (n = 14) religious leaders in rural Tanzania. Interviews focused on religious leaders' perceptions of hypertension and how they could play a role in promoting blood pressure reduction. We used interpretative phenomenological analysis, a qualitative research method, to understand religious leaders' perspectives on, and experiences with, hypertension. Results Three main themes emerged during analysis. First, we found that perceptions about causes, treatment, and complications of hypertension are influenced by religious beliefs. Second, religious beliefs can enable engagement with hypertension care through religious texts that support the use of biomedical care. Third, religious leaders are enthusiastic potential partners for promoting hypertension control in their communities. These themes were consistent between religion and gender of the religious leaders. Conclusions Religious leaders are eager to learn about hypertension, to share this knowledge with others and to contribute to improved health in their communities. [ABSTRACT FROM AUTHOR]

Objectives: Universal Test and Treat (UTT) strategies are being adopted across sub‐Saharan Africa based on clinical benefits to morbidity and mortality and to attain targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Universal Test and Treat is expected to change the client population at clinics, due to more asymptomatic HIV clients initiating antiretroviral therapy (ART). We assessed the impact of UTT on client appointment adherence at 14 government‐managed health facilities in Eswatini's public sector health system. Methods: We assessed the impact of UTT on client adherence to appointment schedules from 2014 to 2017 in a stepped‐wedge trial. Repeated measures analysis was used to assess adherence to each scheduled appointment (primary definition: presenting for care within 7 days after the scheduled appointment), adjusting for time, age, sex, stage, marital status, ART status and facility. Results: Among 3354 clients (62.1% female; 57.4% < 35 years), a median (interquartile range) of 10 (6–15) appointments were scheduled during follow‐up. In a multivariable‐adjusted model, appointment adherence was significantly greater in clients who were female [odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.25–1.52], older (e.g. 40 to < 50 years vs. < 20 years; OR = 1.45, 95% CI: 1.00–2.09), married (OR = 1.31, 95% CI: 1.19–1.44), had lower WHO stage at study enrolment (1–2 vs. 3–4: OR = 1.26, 95% CI: 1.13–1.41), and were currently on ART (OR = 3.55, 95% CI: 2.62–4.82). However, UTT strategy was not significantly associated with client adherence to scheduled appointments (OR = 1.02, 95% CI: 0.72–1.45). Conclusions: Despite transitioning to UTT, there was no change in visit adherence, a reassuring finding given the large volume of clients currently being initiated at earlier stages of HIV. [ABSTRACT FROM AUTHOR]

Background: Biofortified staples have been promoted widely in sub-Saharan Africa to combat micronutrient deficiencies. Contemporary projects are increasingly using elementary schools to target households with these foods. Objective: This study assessed the effects of integrated nutrition education approaches, targeting preschoolers and their caregivers, on retention of orange-fleshed sweet potato (OFSP) on farms in the second season after lapse of free vine dissemination initiatives. Methods: Rural farming households, with preschoolers and no prior engagement with OFSP, were targeted. A multistage sample of 431 preschooler–caregiver pairs was recruited for a cluster-randomized controlled trial. After issuing routine OFSP promotion activities, 15 village-level clusters of the pairs were randomized into 1 control group (3 villages) and 3 treatment arms (4 villages each) for the interventions. Baseline and follow-up household-level survey data were collected from the caregivers. The interventions included: (1) OFSP-branded exercise books, posters, and a poem to preschoolers only; (2) OFSP-oriented mobile phone mediated text messages to caregivers only; and (3) both 1 and 2 provided to individual households concurrently. Interventions 1 and 2 were single-channeled, while 3 was multichanneled. We estimated the intention-to-treat (ITT) and treatment-on-the-treated (TOT) effects using a binary logit model and a special regressor method, respectively. Results: Only the multi-channeled nutrition education approach had significant effects (ITT = 0.167, P =.001; TOT =.243, P =.007) on the caregivers' likelihood to retain OFSP on their farms. Conclusions: The finding implies that multi-channeled agriculture nutrition education interventions through Early Childhood Development institutions can be effective in ensuring sustainable adoption of OFSP. [ABSTRACT FROM AUTHOR]

Achieving zero hunger by 2030 often raises the issue of environmental protection or sustainable social development among policy makers due to the environmental footprint of intensifying agricultural production across the continent. Sub-Saharan Africa (SSA) has one of the fastgrowing populations with more than half of the global growth between now and 2050. The challenge now lies in feeding the ever-growing population that is exerting pressure on the limited available resources. Doubling the agricultural productivity of small-scale farmers by 2030 (SDG 2.3) remains a daunting task for researcher and policy makers to address on the continent that now relies much on imports of food. Exploitation of the untapped massive land resources for agricultural production poses threats to sustainability. However, the challenges of global warming cannot be left out of this discussion since it has direct impact on future productivity on the continent. Climate change that has been projected to mostly affect the poorer countries also present trials to the food system through increased diseases and weather extremes of floods and droughts. Questions are yet to be answered on which tradeoffs and synergies if any need to be made to achieve zero hunger in Africa by 2030. This synopsis critically breaks down the conflicts, tradeoffs and synergies of how a continent with such massive agricultural production potential can navigate sustainably to achieve zero hunger, self-sufficiency and exports prospects while conserving the environment and natural resources. Evident deployment of new and improved technologies especially advanced biotechnology tools will be critical in achieving zero hunger by 2030. The adaptation needs of the continent are broad including institutional, social, physical and infrastructural needs, ecosystem services and environmental needs, and financial and capacity uncertain impacts. [ABSTRACT FROM AUTHOR]

Warfarin remains the oral anticoagulant of choice in sub‐Saharan Africa. However, dosing is challenging due to a highly variable clinical response for a given dose. This study aimed to develop and validate a clinical warfarin dose‐initiation model in sub‐Saharan Black‐African patients. For the development cohort, we used data from 364 patients who were recruited from 8 outpatient clinics and hospital departments in Uganda and South Africa (June 2018–July 2019). Validation was undertaken using the International Warfarin Pharmacogenetics Consortium (IWPC) dataset (690 black patients). Four predictors (age, weight, target International Normalized Ratio range, and HIV status) were included in the final model, which achieved mean absolute errors (MAEs; mean of absolute differences between true dose and dose predicted by the model) of 11.6 (95% confidence interval (CI) 10.4–12.8) and 12.5 (95% CI 11.6–13.4) mg/week in the development and validation cohorts, respectively. Two other clinical models, IWPC and Gage, respectively, obtained MAEs of 12.5 (95% CI 11.3–13.7) and 12.7 (95% CI 11.5–13.8) mg/week in the development cohort, and 12.1 (95% CI 11.2–13.0) and 12.2 (95% CI 11.4–13.1) mg/week in the validation cohort. Compared with fixed dose‐initiation, our model decreased the percentage of patients at high risk of suboptimal anticoagulation by 7.5% (1.5–13.7%) and 11.9% (7.1–16.8%) in the development and validation cohorts, respectively. The clinical utility of this model will be tested in a prospective study. Study HighlightsWHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?☑ Warfarin dosing remains challenging due to a highly variable clinical response for a given dose. WHAT QUESTION DID THIS STUDY ADDRESS?☑ Can a clinical dose‐initiation model be developed and validated for sub‐Saharan Black‐African patients? WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?☑ We have developed the first warfarin dose‐initiation clinical model for Black‐African patients in Uganda and South Africa. HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?☑ We will be implementing and validating this model in a prospective cohort to inform future large‐scale implementation. More optimized dosing should improve the quality of warfarin anticoagulation in these two developing countries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Little information is available on male breast cancer (MBC) incidence from sub-Saharan Africa. OBJECTIVE: This is a retrospective study on MBC in rural North Uganda, based on the pathology records of a private, non-profit, missionary hospital. METHODS: All male patients that had histological diagnosis of breast carcinoma from January 2009 to December 2016 were included in this study. RESULTS: In time span of 8 years, there were 337 consecutive breast cancer presentations, including 21 MBC (6.2%). The latter patients showed advanced disease (mean symptom duration: 20.3 months; mean tumour size: 5 cm) skin ulceration and ipsilateral lymph node metastasis: 60%). The mean age was 60.52 years (from 30 to 85 yrs). Ductal infiltrating carcinoma was the prevalent histological type in our series (65%), followed by an unusually high rate of papillary carcinomas (15%). There appeared to be a prevalence for left breasts (11 LT versus 6 RT; 64.7%), a finding also observed in the majority of MBC. CONCLUSIONS: This study is representative of the scenario in Northern Uganda, where MBC accounts for 6.2% of breast cancers, More information on the occurrence and risk factors of this unusual neoplasm in African countries may prompt prevention of chronic liver disease and early recognition and treatment of MBC. [ABSTRACT FROM AUTHOR]

Expansion of Antiretroviral Therapy (ART) programs in sub-Saharan Africa (SSA) has increased the number of people accessing treatment. However, the number of males accessing and being retained along the human immunodeficiency virus (HIV) care cascade is significantly below the UNAIDS target. Male gender has been associated with poor retention in HIV care programs, and little is known about strategies that reduce attrition of men in ART programs. This review aimed to summarize any studies on strategies to improve retention of heterosexual males in HIV care in SSA. An electronic search was conducted through Ovid® for three databases (MEDLINE®, Embase and Global Health). Studies reporting interventions aimed at improving retention among heterosexual men along the HIV care cascade were reviewed. The inclusion criteria included randomized-controlled trials (RCTs), prospective or retrospective cohort studies that studied adult males (≥15years of age), conducted in SSA and published between January 2005 and April 2019 with an update from 2019 to 2020. The search returned 1958 articles, and 14 studies from eight countries met the inclusion criteria were presented using the PRISMA guidelines. A narrative synthesis was conducted. Six studies explored community-based adherence support groups while three compared use of facility versus community-based delivery models. Three studies measured the effect of national identity cards, disclosure of HIV status, six-monthly clinic visits and distance from the health center. Four studies measured risk of attrition from care using hazard ratios ranging from 1.2–1.8, four studies documented attrition proportions at an average of 40.0% and two studies an average rate of attrition of 43.4/1000PYs. Most (62%) included studies were retrospective cohorts, subject to risk of allocation and outcome assessment bias. A pooled analysis was not performed because of heterogeneity of studies and outcome definitions. No studies have explored heterosexual male- centered interventions in HIV care. However, in included studies that explored retention in both males and females, there were high rates of attrition in males. More male-centered interventions need to be studied preferably in RCTs. Registry number: PROSPERO2020 CRD42020142923 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142923. [ABSTRACT FROM AUTHOR]

Background: Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda.Methods: This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival.Results: Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1-2) and 15% had high grade (Papile grades 3-4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH.Conclusion: In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration. [ABSTRACT FROM AUTHOR]

Background: Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa. Methods: Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment. Results: We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%. Conclusion: In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Agricultural projects that use information and communication technologies (ICT) to provide market information have increased considerably in developing countries in the last decade. These projects aim to strengthen smallholder farmers' linkage to input and output markets. This article examines the impact of such projects on smallholder farmers' input and output commercialisation, and household income, using propensity score matching technique and data collected from farmers in Kenya. The study finds that participation in ICT-based projects increases farmers' participation in input and output markets, and their household income. The article highlights the implications of these findings for ICT policy and practice. [ABSTRACT FROM AUTHOR]

Introduction: The WHO recommends antiretroviral treatment (ART) for all HIV‐positive patients regardless of CD4 count or disease stage, referred to as "Early Access to ART for All" (EAAA). The health systems effects of EAAA implementation are unknown. This trial was implemented in a government‐managed public health system with the aim to examine the "real world" impact of EAAA on care retention and viral suppression. Methods: In this stepped‐wedge randomized controlled trial, 14 public sector health facilities in Eswatini were paired and randomly assigned to stepwise transition from standard of care (SoC) to EAAA. ART‐naïve participants ≥18 years who were not pregnant or breastfeeding were eligible for enrolment. We used Cox proportional hazard models with censoring at clinic transition to estimate the effects of EAAA on retention in care and retention and viral suppression combined. Results: Between September 2014 and August 2017, 3405 participants were enrolled. In SoC and EAAA respectively, 12‐month HIV care retention rates were 80% (95% CI: 77 to 83) and 86% (95% CI: 83 to 88). The 12‐month combined retention and viral suppression endpoint rates were 44% (95% CI: 40 to 48) under SoC compared to 80% (95% CI: 77 to 83) under EAAA. EAAA increased both retention (HR: 1·60, 95% CI: 1·15 to 2·21, p = 0.005) and retention and viral suppression combined (HR: 4.88, 95% CI: 2.96 to 8.05, p < 0.001). We also identified significant gaps in current health systems ability to provide viral load (VL) monitoring with 80% participants in SoC and 66% in EAAA having a missing VL at last contact. Conclusions: The observed improvement in retention in care and on the combined retention and viral suppression provides an important co‐benefit of EAAA to HIV‐positive adults themselves, at least in the short term. Our results from this "real world" health systems trial strongly support EAAA for Eswatini and countries with similar HIV epidemics and health systems. VL monitoring needs to be scaled up for appropriate care management. [ABSTRACT FROM AUTHOR]

Introduction: There is great interest for integrating care for non‐communicable diseases (NCDs) into routine HIV services in sub‐Saharan Africa (SSA) due to the steady rise of the number of people who are ageing with HIV. Suggested health system approaches for intervening on these comorbidities have mostly been normative, with little actionable guidance on implementation, and on the practical, economic and ethical considerations of favouring people living with HIV (PLHIV) versus targeting the general population. We summarize opportunities and challenges related to leveraging HIV treatment platforms to address NCDs among PLHIV. We emphasize key considerations that can guide integrated care in SSA and point to possible interventions for implementation. Discussion: Integrating care offers an opportunity for effective delivery of NCD services to PLHIV, but may be viewed to unfairly ignore the larger number of NCD cases in the general population. Integration can also help maintain the substantial health and economic benefits that have been achieved by the global HIV/AIDS response. Implementing interventions for integrated care will require assessing the prevalence of common NCDs among PLHIV, which can be achieved via increased screening during routine HIV care. Successful integration will also necessitate earmarking funds for NCD interventions in national budgets. Conclusions: An expanded agenda for addressing HIV‐NCD comorbidities in SSA may require adding selected NCDs to conditions that are routinely monitored in PLHIV. Attention should be given to mitigating potential tradeoffs in the quality of HIV services that may result from the extra responsibilities borne by HIV health workers. Integrated care will more likely be effective in the context of concurrent health system reforms that address NCDs in the general population, and with synergies with other HIV investments that have been used to strengthen health systems. [ABSTRACT FROM AUTHOR]

Introduction: Despite growing enthusiasm for integrating treatment of non‐communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub‐Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost‐effectiveness of basic NCD‐HIV integration in a Ugandan setting. Methods: We developed an epidemiologic‐cost model to analyze, from the provider perspective, the cost‐effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization's STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability‐adjusted life years were estimated over 10 subsequent years along with incremental cost‐effectiveness of the integration. Results: Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10‐year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability‐adjusted life year averted among older ART patients. Conclusions: Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost‐effectiveness comparable to other standalone interventions to address NCDs in low‐ and middle‐income country settings. [ABSTRACT FROM AUTHOR]

Background: About 20-40% of patients with diabetes mellitus (DM) suffer from depressive disorders (DD) during the course of their illness. Despite the high burden of DD among patients with DM, it is rarely identified and adequately treated at the majority of primary health care clinics in sub-Saharan Africa (SSA). The use of peer support to deliver components of mental health care have been suggested in resource constrained SSA, even though its acceptability have not been fully examined.Methods: We conducted qualitative interviews (QI) to assess the perceptions of DM patients with an experience of suffering from a DD about the acceptability of delivering peer support to patients with comorbid DM and DD. We then trained them to deliver peer support to DM patients who were newly diagnosed with DD. We identified challenges and potential barriers to a successful implementation of peer support, and generated solutions to these barriers.Results: Participants reported that for one to be a peer, they need to be mature in age, consistently attend the clinics/keep appointments, and not to be suffering from any active physical or co-morbid mental or substance abuse disorder. Participants anticipated that the major barrier to the delivery of peer support would be high attrition rates as a result of the difficulty by DM patients in accessing the health care facility due to financial constraints. A potential solution to this barrier was having peer support sessions coinciding with the return date to hospital. Peers reported that the content of the intervention should mainly be about the fact that DM was a chronic medical condition for which there was need to adhere to lifelong treatment. There was consensus that peer support would be acceptable to the patients.Conclusion: Our study indicates that a peer support program is an acceptable means of delivering adjunct care to support treatment adherence and management, especially in settings where there are severe staff shortages and psycho-education may not be routinely delivered. [ABSTRACT FROM AUTHOR]

Information on major depressive disorder (MDD) in primary care settings in sub-Saharan Africa is limited, yet this is required to improve service development. We explored prevalence and factors associated with MDD among adolescents attending a primary care facility in urban Uganda. At Naguru Teenage Information and Health Centre, 281 adolescents were assessed for MDD using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid). Prevalence and risk factors were determined using frequencies and regressions, respectively. The prevalence of adolescent MDD was 18.2 %. Vulnerability factors were orphanhood, childhood trauma (particularly emotional abuse and physical neglect) while social support was protective. Considerable burden of clinically significant depression exists in primary care settings in Uganda; this may well contribute to a poor quality of life. [ABSTRACT FROM AUTHOR]

There are several hurdles to ensure sustainable seed production and consistent flow of improved legume varieties in sub‐Saharan Africa (SSA) and South Asia (SA). The unreliable demand, autogamous nature of most of the grain legumes, and slow variety replacement rate by smallholder farmers do not provide strong incentive for private seed companies to invest in legume seed business. Unless a well thought‐out and comprehensive approach to legume seed delivery is developed, current seed shortages will continue, eroding emerging market opportunities. The experiences reported here are collated through a 10‐year partnership project, the Tropical Legumes in SSA and SA. It fostered innovative public–private partnerships in joint testing of innovative market‐led seed systems, skills and knowledge enhancement, de‐risking private sector initiatives that introduced in new approaches and previously overlooked entities in technology delivery. As new public and private seed companies, individual seed entrepreneurs and farmer organizations emerged, the existing ones enhanced their capacities. This resulted in significant rise in production, availability and accessibility of various seed grades of newly improved and farmer demanded legume varieties in the target countries. [ABSTRACT FROM AUTHOR]

Background: Women account for 56% of new HIV infections in sub-Saharan Africa. Multipurpose Prevention Technologies (MPTs) are promising interventions because they combine HIV prevention with a less stigmatizing indication, such as pregnancy. We conducted a study with three placebo-only MPT products in Kisumu, Kenya and Soshanguve, South Africa, to assess preferences for attributes of tablets, vaginal rings and injectable products for dual prevention of HIV and pregnancy (TRIO Study). Here, we present former TRIO participants' views on the study results. Methods: After study completion in 2017, we held five dissemination sessions (two in Kisumu and three in Soshanguve) and five one-on-one sharing sessions in Soshanguve. Key results were discussed, with a focus on why some study products were more popular than others, which findings were surprising and why some women changed products over time. A thematic approach was used for analysis. Results: All 277 TRIO participants were telephoned, 168 (60.6%) were reached and 117 (42.2%) attended the dissemination sessions: 71 in Kisumu and 46 in Soshanguve. Participants were engaged and interested in the TRIO findings and willingly shared their perspectives and views candidly. Ease of use, discretion and familiarity were highlighted as drivers of product choice whereas novelty presented a challenge. In explaining the discrepancy between preference ratings and choices, participants cited features such as tablets being easy to explain to a partner or to discontinue. In explaining why 20% of participants switched products after practical experience, issues related to relationships with partners and product attributes perceived as unfavorable were paramount. Conclusion: The dissemination sessions provided an important forum for study participants to interrogate and explain the results to minimize possible misinterpretation. This exercise helped give context to the results, ensured correct lessons were derived from those results and increased credibility of the findings reported by the investigators. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa (SSA) is facing a growing co-epidemic of chronic HIV infection and diabetes. Hemoglobin A1c (A1c) may underestimate glycemia among people living with HIV (PLWH). We estimated the validity of A1c to diagnose diabetes among PLWH and HIV-uninfected persons in rural Uganda. Data were derived from a cohort of PLWH and age- and gender-matched HIV-uninfected comparators. We compared A1c to fasting blood glucose (FBG) using Pearson correlations, regression models, and estimated the sensitivity and specificity of A1c for detecting diabetes with FBG ≥126 mg/dL as reference standard. Approximately half (48%) of the 212 participants were female, mean age of 51.7 years (SD = 7.0) at enrollment. All PLWH (n = 118) were on antiretroviral therapy for a median of 7.5 years with mean CD4 cell count of 442 cells/µL. Mean FBG (89.7 mg/dL) and A1c (5.6%) were not different between PLWH and HIV-uninfected ( P > 0.50) groups, but the HIV-uninfected group had a higher prevalence of A1c >5.7% (33% vs. 20%, P = 0.024). We found a relatively strong correlation between A1c and FBG (r = 0.67). An A1c ≥6.5% had a poor sensitivity (46%, 95% CI 26-67%) but high specificity (98%, 95% CI 96-99%) for detecting diabetes. More work is needed to define an optimal A1c for screening diabetes in SSA. [ABSTRACT FROM AUTHOR]

Background Wilms tumour (WT) is the commonest malignant renal tumour in children and most common solid tumour in Africa. In Sub-Saharan Africa it is the commonest intra-abdominal tumour. WT is the commonest abdominal solid tumour in children in Mbarara Regional Referral Hospital (MRRH). Survival is determined by tumour histology, tumour biology, stage at diagnosis and surgery. In our settings other factors that may determine treatment outcome include; availability of chemotherapy and radiotherapy, co-morbidity, blood transfusion and anaesthesia. There is however no information regarding the clinico-pathological characteristics and treatment outcome of WT in MRRH. This study therefore set out to determine clinico-pathological characteristics of WT and end of treatment outcome among children attending this hospital. Methods A retrospective medical record review of all children diagnosed with WT at MRRH between January 2014 and March 2016 was done. Ten patients who had been diagnosed with WT between April 2016 and December 2016 and also receiving treatment at MRRH were recruited prospectively into the study. Data on various sociodemographics, clinical findings, histological characteristics and treatment outcome were collected. For data collected retrospectively patients were called in for follow up. Results Records of 14 patients were reviewed retrospectively, and 10 patients were recruited (prospectively). Of these two, were lost to follow up. Male to female ratio was 1:1. Mean age at diagnosis was 46 months. All the patients presented with an abdominal mass. Sixty seven percent presented in the pathological stage I and II of WT. Sixty seven percent of the patients had unfavourable histology, and of these, 63% had diffuse anaplasia. Only 59% were alive at the end of treatment. Conclusions Our patients are similar with regard to gender ratio, mean age at diagnosis, age distribution as described in literature. However, our patients differ in histological characteristics with a big proportion having anaplasia compared to WT studies done elsewhere. Majority of the patients were alive at the end of treatment. [ABSTRACT FROM AUTHOR]

• We examine effect of social incentives on social learning and quality seed technology adoption. • A field experiment involved training of model farmers, goal setting, and provision of public recognition. • Model farmers were less likely to contact co-villagers when incentivized with public recognition. • Farmers' knowledge and uptake of quality seeds were unaffected by social incentives. • Findings suggest social incentive crowded-out diffusion effort. A transition from low-input subsistence farming in Sub-Saharan Africa will require the use of yield-increasing agricultural technologies. However, in developing countries, most farmers continue to rely heavily on pest-infested and disease-infected recycled seed from own or local sources leading to low yields. This study used a field experiment to examine the effect of a social incentive combined with goal setting on the diffusion of agricultural knowledge and uptake of quality certified seed by farmers. We relaxed the seed access and information/knowledge constraints by introducing improved varieties of sweetpotato in the study villages and providing training to carefully selected progressive farmers who were then linked to co-villagers. We find that social incentives combined with goal setting reduced the likelihood of the trained progressive farmers reaching out to co-villagers to share information and discuss farming. Further, social incentive combined with goal setting had no significant effect on knowledge and experimentation by progressive farmers, and on willingness to pay for improved seed – as elicited through auctions, our proxy for experimentation, by co-villagers. These findings suggest that the combination of goal setting and public recognition acted to crowd-out diffusion effort. We conclude that social incentive combined with goal setting by established progressive farmers already enjoying a certain degree of public recognition is not sufficient to induce effort in learning and experimentation with agricultural innovations. These results have implications for design of policy and extension services to promote adoption of agricultural technologies with proven food and nutrition security benefits in developing countries. [ABSTRACT FROM AUTHOR]

The purpose of this article is to test the moderating effect of social networks in the relationship between mobile money usage and financial inclusion in rural Uganda. The results revealed that there is a significant and positive moderating effect of social networks in the relationship between mobile money usage and financial inclusion in rural Uganda. Besides, mobile money usage and social networks have direct and significant effects on financial inclusion in rural Uganda. Thus, the findings suggest that existence of social networks of strong and weak ties among mobile money users promote financial inclusion in rural Uganda. Previous studies have concentrated only on investigating the impact of mobile money in promoting financial inclusion in developing economies, especially in Sub-Saharan Africa. However, this particular study introduces the moderating effect of social networks in the relationship between mobile money usage and financial inclusion in rural Uganda, which seems to be sparse and lacking in literature. [ABSTRACT FROM AUTHOR]