Search

Background: Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions., Methods: We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions., Results: We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged., Conclusion: The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings., (© 2024. The Author(s).)

Genome editing (GE) has emerged as a technology that could revolutionize food and agricultural production. While its advent has evoked enthusiasm for a more sustainable food system, there exists heterogeneity in regulations and public opinions regarding the technology. This review discusses evidence on the implications of government regulations on GE, and perceptions of genome-edited (GEd) food and related regulations. The review highlights consumers' positive attitude and preference for GEd foods when compared with genetically modified foods, despite the limited awareness and knowledge of GE technology. While policy changes might trigger debates, providing tailored benefits, information to consumers could further improve their attitude toward GE., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Intimate partner sexual violence (IPSV) during pregnancy is of key reproductive health concern as it is associated with various risks linked to severe intrapartum complications. This study assessed the prevalence and the correlates of intimate partner sexual violence among pregnant women in Napak district, Northeastern Uganda. This was an analytical cross-sectional study conducted among 284 pregnant women who were obtained by systematic sampling in Napak district between November and December 2020. A structured questionnaire was used to collect the data, and this was analyzed using STATA version 15. The correlates of IPSV were determined at a multivariable level using a Poisson regression model with robust variance at the individual, relationship, and societal levels of the socio-ecological model. The study enrolled 284 pregnant women of whom, 65.5% were aged between 18 and 28 years and 62.0% were not formally educated. Also, 56% of the pregnant women had experienced IPSV during their current pregnancies, the most prevalent form (35.6%) being unwanted sexual advances. Factors of women being in their third or subsequent pregnancies, primiparity, women who rated their communication with their partners as low, being in a relationship for less than five years, lower age of the spouse, and a lower level of education (primary) among women showed a statistical association with IPSV. This study reports a high prevalence of IPSV during pregnancy, and it was associated with individual, relationship, and societal factors. Based on this, concerted efforts through sensitization on the dangers of IPSV are required to avert the practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Amodoi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We implemented and assessed a comprehensive, antenatal care (ANC)-embedded strategy to prevent HIV seroconversions during pregnancy in Uganda. HIV-negative first-time ANC clients were administered an HIV risk assessment tool and received individual risk counseling. Those attending ANC without partners obtained formal partner invitation letters. After three months, repeat HIV testing was carried out; non-attending women were reminded via phone. We analyzed uptake and acceptance, HIV incidence rate, and risk behavior engagement. Among 1081 participants, 116 (10.7%) reported risk behavior engagement at first visit; 148 (13.7%) were accompanied by partners. At the repeat visit (n = 848), 42 (5%, p < 0.001) reported risk behavior engagement; 248 (29.4%, p < 0.001) women came with partners. Seroconversion occurred in two women. Increased odds for risk behavior engagement were found in rural clients (aOR 3.96; 95% CI 1.53-10.26), women with positive or unknown partner HIV-status (2.86; 1.18-6.91), and women whose partners abused alcohol (2.68; 1.15-6.26). Overall, the assessed HIV prevention strategy for pregnant women seemed highly feasible and effective. Risk behavior during pregnancy was reduced by half and partner participation rates in ANC doubled. The observed HIV incidence rate was almost four times lower compared to a pre-intervention cohort in the same study setting., (© 2023. The Author(s).)

Background: Soil fertility decline due to nutrient mining coupled with low inorganic fertilizer usage is a major cause of low crop yields across sub-Saharan Africa. Recently, biochar potential to improve soil fertility has gained significant attention but there are limited studies on the use of biochar as an alternative to inorganic fertilizers. In this study, we determined the effect of maize stover biochar without inorganic fertilizers on soil chemical properties, growth and yield of tomatoes (Solanum lycopersicum L.). A field experiment was conducted in 2022 for two consecutive seasons in Northern Uganda. The experiment included five treatments; inorganic fertilizer (control), biochar applied at rates of 3.5, 6.9, 13.8 and 27.6 t ha -1 ., Results: In this study, maize stover biochar improved all the soil chemical properties. Compared to the control, pH significantly increased by 27% in the 27.6 t ha -1 while total N increased by 35.6% in the 13.8 t ha -1 . Although P was significantly low in the 3.5 t ha -1 , 6.9 t ha -1 and 13.8 t ha -1 , it increased by 3.9% in the 27.6 t ha -1 . Exchangeable K was significantly increased by 42.7% and 56.7% in the 13.8 t ha -1 and 27.6 t ha -1 respectively. Exchangeable Ca and Mg were also higher in the biochar treatment than the control. Results also showed that plant height, shoot weight, and all yield parameters were significantly higher in the inorganic fertilizer treatment than in the 3.5, 6.9, and 13.8 t ha -1 treatments. Interestingly, maize stover biochar at 27. 6 t ha -1 increased fruit yield by 16.1% compared to the control suggesting it could be used as an alternative to inorganic fertilizer., Conclusions: Maize stover biochar applied at 27.6 t ha -1 improved soil chemical properties especially pH, N, P and K promoting growth and yield of tomatoes. Therefore, maize stover biochar could be recommended as an alternative to expensive inorganic fertilizers for tomato production in Northern Uganda., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: The adversities faced by youths living with HIV (YLWH) are manifold, resulting not only from the health impact but also from society's response to HIV and the people living with it. This study sought to explore these youths' perceptions and representations of what promotes resilience., Methods: Photovoice methodology was chosen to elicit first-person accounts that are grounded in lived experience and experiential knowledge. Eleven young people, boys and girls aged 14-21 living in western Uganda, participated in seven group sessions aimed at imagining, producing and discussing visual stories about what fosters resilience in the face of HIV-related adversity. The visual stories were subjected to inductive content analysis by the participants, and then thematically analyzed and interpreted by the researchers using the theoretical framework of social-ecological resilience., Results: We found that participants experience well-being amidst HIV-related adversity through managing tensions in material resources, sense of identity, power and control in their lives, cultural adherence, relationships, sense of cohesion and social justice., Discussion: The findings add to the body of knowledge on youth resilience in Sub-Saharan Africa by documenting multisystemic resources for YLWH in Ugandan communities. The findings further show that resources are highly incidental and situational, neither widely available nor structurally embedded in society. The study therefore informs the global HIV/AIDS agenda to spur ecologies of resilience around YLWH., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Vindevogel and Kimera.)

Background: Scientific evidence has revealed possible confounders in diet induced obesity models of Drosophila melanogaster . High Sugar Diet (HSD) induction of obesity in flies has been associated with fly hyperosmolarity and glucotoxicity, while High Fat Diet (HFD) induction has been associated with lipotoxicity. The objective of this study was to assess for a healthy obesity phenotype by comparison of fly survival, physio-chemical and biochemical changes associated with HSD, HFD and Protein Restricted Diet (PRD) obesity induction models of male Drosophila melanogaster . Here, we provide information on a PRD as the plausible option in obesity research not involving cancer, diabetes, glucotoxicity and lipotoxicity studies., Methods: Obesity was induced by exposing Drosophila melanogaster white mutant w to four experimental diets for four weeks. Group 1 was fed regular food (control), group 2 was fed a 0.5% less yeast than in regular feed (PRD), group 3 was fed a 30% w/v sucrose to regular cornmeal food (HSD) and group 4 was fed a 10% w/v food-grade coconut oil to regular cornmeal food (HFD). Peristaltic waves were measured on 3rd instar larvae of all experimental groups. Negative geotaxis, fly survival, body mass, catalase activity, triglycerides (TG/TP), sterol, and total protein were measured in adult 1118 to four experimental diets for four weeks. Group 1 was fed regular food (control), group 2 was fed a 0.5% less yeast than in regular feed (PRD), group 3 was fed a 30% w/v sucrose to regular cornmeal food (HSD) and group 4 was fed a 10% w/v food-grade coconut oil to regular cornmeal food (HFD). Peristaltic waves were measured on 3rd instar larvae of all experimental groups. Negative geotaxis, fly survival, body mass, catalase activity, triglycerides (TG/TP), sterol, and total protein were measured in adult Drosophila melanogaster after four weeks., Results: Triglycerides (TG/TP) and total protein levels were significantly higher in HSD phenotype. Sterols were higher in HFD phenotype. Though catalase enzyme activity was highest in PRD phenotype, this activity was not statistically significant when compared to that of HSD and HFD phenotypes. However, PRD phenotype had the lowest mass, highest survival rate and the highest negative geotaxis, thus demonstrating a balanced, stable and more viable metabolic status in the experimental model., Conclusion: A protein restricted diet induces a stable increased fat storage phenotype in Drosophila melanogaster ., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

The increasing popularity of gene editing in plants has prompted research on stakeholder views. Gene edited foods are often more accepted than genetically modified foods, though differences occur within target groups, regions, and products. Nevertheless, marketing challenges related to a lack of familiarity with the technology, labeling, and risk perception remain., Competing Interests: Declaration of interests No interests are declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Salt reduction in food has been employed to improve public health. The effects of salt coatings on sodium content, sensory properties, structural breakdown, microstructure, salt release properties, and shelf life of yellow alkaline noodles (YAN) were evaluated. 15 g/dL resistant starch HYLON™ VII (HC) or 5% (v/v) Semperfresh™ (SC) with 10, 20, and 30 g/dL sodium chloride (NaCl) were used. HC-Na30 and SC-Na30 had the highest sodium content and came closest to commercial YAN in taste and saltiness perception. Structural improvement was demonstrated with HC-Na10 and SC-Na10 as both noodles required maximum work to be broken down. Moreover, SEM micrographs of these noodles showed a more compact and dense appearance with increased continuity of the matrix and fewer voids and hollows. However, ruptured surfaces were observed in noodles coated with 20 and 30% salt. The enhanced salt release from the coatings was demonstrated in an in vivo analysis, with the released salt occurring rapidly from HC and SC coatings. HC-Na10 and SC-Na10 noodles had a shelf life of more than 8 days when stored at 4 °C, which is longer than HC-Na0 and SC-Na0 noodles. Storage at 4 °C decelerated the microbiological growth, changes in pH and CIE L* values in salt-coated noodles than storage at 25 °. Thus, HC-Na10 and SC-Na10 could be suitable formulations to replace commercial YAN., (© 2023. The Author(s).)

Aim: This study was conducted to determine the correctness and completeness of documentation of partographs., Design: This was a retrospective descriptive study., Methods: We included 365 partographs of deliveries conducted from January 1st to October 31st 2019. Data were collected using a checklist and analysed descriptively. The study based on 13 partograph parameters., Results: About 8-13 parameters were correctly documented in 71.5 % of the partographs. About 38.9%, 24.7%, 99.7%, 22.5% and 16 % of the partographs had no documentation of obstetric risk factors, foetal heart rate, colour of liquor, uterine contractions and cervical dilatation respectively. About 12.1% of the cervicographs crossed the action line and 61.4% of partographs where cervicographs crossed the action line had no documentation of action(s) taken., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Information on the basic changes associated with green tea small molecules in acute inflammation is deficient. The purpose of the study was to characterize and establish the effects of green tea silver nanoparticles (AgNPs) following inflammation in BALB/c male mice. In this study, green tea silver nitrate nanoparticles were characterized and the extract were made up to constitute high (100%), medium (10%), and low (1%) concentrations for administration. Acute inflammation was induced in groups I-V of the experimental rodents by injecting 0.5 ml/kg of fresh egg albumin on the subplantar surface of the right hind paw and animals were monitored for 36 h. Group I-III were administered 100%, 10%, 1% green tea nanoparticles extract while group IV was given diclofenac. Group V was the positive control while group VI was the negative control that received the vehicle. Paw edema was measured at a 2 h interval for 3 days, while the pain was assessed by measuring the locomotion activity using the voluntary wheel running and the anxiety-like behavior. Hypersensitivity was measured through the temperature sensation experiment and a non-linear regression analysis was done. Here, synthesized green tea AgNPs registered an absorbance band at 460 nm, phytochemicals due to presence of organic functional groups of O[bond, double bond]C[bond, double bond]O of oxycarbons, of C[bond, double bond]C of a conjugate alkene, C[bond, double bond]O of a stretching bond of a secondary alcohol. The silver green tea nanoparticles were spherical, covered by a slimy layer, capped and stable. Green tea AgNPs significantly decreased temperature hypersensitivity in BALB/c male mice and this demonstrated their protective effects. Low concentrations of green tea nanoparticles inhibited edema thus mimicking effects of diclofenac, however, the percentage of inhibition was highest in medium and high silver-tea nanoparticles concentrations demonstration the importance of concentration in therapeutics. Anxiety was lowest in BALB/c male mice treated with high concentrations of silver green tea nanoparticles, and this led to increased locomotory activity in mice. Green tea AgNPs have strong anti-inflammatory effects at high concentrations. Concentrations of green tea AgNPs modulated basic sensory and motor behaviors in BALB/c male mice demonstrating their importance in complementary and integrative medical practice., Competing Interests: The authors declare no competing interests, (© 2023 The Authors.)

Data on metabolic profiles of blood sampled at d 3, 6, 9, and 21 in lactation from 117 lactations (99 cows) were used for unsupervised k-means clustering. Blood metabolic parameters included β-hydroxybutyrate (BHB), nonesterified fatty acids, glucose, insulin-like growth factor-1 (IGF-1) and insulin. Clustering relied on the average and range of the 5 blood parameters of all 4 sampling days. The clusters were labeled as imbalanced (n = 42) and balanced (n = 72) metabolic status based on the values of the blood parameters. Various random forest models were built to predict the metabolic cluster of cows during early lactation from the milk composition. All the models were evaluated using a leave-group-out cross-validation, meaning data from a single cow were always present in either train or test data to avoid any data leakage. Features were either milk fatty acids (MFA) determined by gas chromatography (MFA [GC]) or features that could be determined during a routine dairy herd improvement (DHI) analysis, such as concentration of fat, protein, lactose, fat/protein ratio, urea, and somatic cell count (determined and reported routinely in DHI registrations), either or not in combination with MFA and BHB determined by mid-infrared (MIR), denoted as MFA [MIR] and BHB [MIR], respectively, which are routinely analyzed but not routinely reported in DHI registrations yet. Models solely based on fat, protein, lactose, fat/protein ratio, urea and somatic cell count (i.e., DHI model) were characterized by the lowest predictive performance [area under the receiver operating characteristic curve (AUC ROC ) = 0.69]. The combination of the features of the DHI model with BHB [MIR] and MFA [MIR] powerfully increased the predictive performance (AUC ROC = 0.81). The model based on the detailed MFA profile determined by GC analysis did not outperform (AUC ROC = 0.81) the model using the DHI-features in combination with BHB [MIR] and MFA [MIR]. Predictions solely based on samples at d 3 were characterized by lower performance (AUC ROC DHI + BHB [MIR] + MFA [MIR] model at d 3: 0.75; AUC ROC MFA [GC] model at d 3: 0.73). High predictive performance was found using samples from d 9 and 21. To conclude, overall, the DHI + BHB [MIR] + MFA [MIR] model allowed to predict metabolic status during early lactation. Accordingly, these parameters show potential for routine prediction of metabolic status., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

The role of indigenous knowledge in increasing context specificity and exposing blind spots in scientific understanding is widely evidenced in disaster studies. This paper aims to structure the processes that shape indigenous knowledge production and its optimisation using the case of floods. An inductive analytical approach is applied among riparian indigenous communities (focus on the Bayira) of the Rwenzori region of Uganda where plenty of indigenous flood practices have been recorded. Indigenous knowledge of floods is found to be based on intimate comprehension of local hydrometeorological regularities. Insofar as these regularities follow natural dynamics, indigenous socio-epistemic processes are noted to be consistent with the laws of nature. Coupled with regular open sociocultural deliberations, the conceptualisation of hydrometeorological regularities induces an indigenous ontology and empiricist epistemology. This, together with the techniques used, is the driver of crucial epistemic virtues which enable indigenous knowledge to provide disaster solutions that are adapted, pragmatic, and holistic., (© 2021 The Authors Disasters © 2021 ODI.)

The measurement of pH in the reticulorumen in combination with a time-pH threshold has been widely applied in research to diagnose subacute ruminal acidosis. However, other pH metrics also have biological value. In this study, 44 animals were monitored during the transition period using reticuloruminal pH boluses. Traditional and more complex pH characteristics were calculated to characterize the reticuloruminal pH profile: time pH <6, slope of a logistic cumulative pH curve (β 0 ), and deviations [squared error (SqEr)] from pH predictions based on a harmonic static model. In this study, we aimed to examine the associations between those pH metrics and metabolic health parameters, feed intake, and activity. Finally, to describe the reticuloruminal pH dynamically, we also constructed a dynamic linear model. The results of this model were studied in relation to feed intake. All pH parameters were mutually correlated (particularly β 0 and SqEr; mean Pearson correlation of -0.52). pH patterns, rather than time pH <6, were associated with metabolic health and feed intake: high variation in daily pH (β 0 parameter) was reflected in higher blood concentrations of nonesterified fatty acids. Moreover, pH deviations of the harmonic model were negatively associated with feed intake and rumination behavior. This research confirms the biological importance of pH metrics focusing on pH variation and pH deviations and provides deeper insight into its associations with metabolic health status, feed intake, and activity during early lactation., (© 2022, The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Background: An in vitro assay on Sigmoidin A from Erythrina abyssinica stem bark revealed its potency to inhibit pancreatic lipase. However, studies indicate activity of extract bioactive compounds in combination far exceed the favorable effects of each individual compound due to synergy and additive effects. In this study, we provide information on the effect of E. abyssinica stem bark extract in Drosophila melanogaster . The objective of the study was to determine the safety and effects of E. abyssinica stem bark extract on fly survival, body weight, triglycerides, sterol, total protein, and catalase activity of obese male D. melanogaster., Methods: Obesity was induced by exposing D. melanogaster white mutant w 1118 stem bark extract at concentrations of 2.5 g/ml, 5.0 g/ml, and 7.5 g/ml. The positive control was exposed to only coconut food while the negative control was on regular food. Fly survival observations were done for 15 days, while acute and chronic effects were done at 30 min and after 48 h respectively following treatment. Body mass, negative geotaxis, reducing power of the extract, triglycerides (TG/TP), sterol, total protein levels, and catalase activity were measured after 10 days of exposure to the experimental diets.E. abyssinica stem bark extract at concentrations of 2.5 g/ml, 5.0 g/ml, and 7.5 g/ml. The positive control was exposed to only coconut food while the negative control was on regular food. Fly survival observations were done for 15 days, while acute and chronic effects were done at 30 min and after 48 h respectively following treatment. Body mass, negative geotaxis, reducing power of the extract, triglycerides (TG/TP), sterol, total protein levels, and catalase activity were measured after 10 days of exposure to the experimental diets., Results: Fly survival changes were observed after 10 days and E. abyssinica stem bark extract had the strongest reducing power at 7.5 g/ml extract concentration. E. abyssinica stem bark extract reduced body mass, triglyceride levels (TG/TP), sterol levels, and modulated catalase activity at 7.5 g/ml extract concentration. Though the standard drug fenofibrate had the highest fat accumulation reduction potential, the extract at 7.5 g/ml was much safer in reducing fat accumulation in obese male D. melanogaster than other concentration used ., Conclusion: Antioxidants in E. abyssinica stem bark extract are responsible for the observed anti-obesity activity., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km 2 resolution for 0-5 and 5-15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km 2 pixels (summarized from 8519 unique temperature sensors) across all the world's major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (-0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications., (© 2022 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Our aim was to identify sexual risk behavior among HIV-negative pregnant women in Kabarole District, Uganda, by conducting a cross-sectional study among 1610 women within three healthcare settings. One in six women engaged in HIV-specific risk behaviors including multiple sexual partners or alcohol abuse; 80% of the pregnant women reported to generally abstain from using condoms. In multivariate analysis, predictors of sexual risk behavior included being a client of the public health facilities as compared to the private facility (AOR 3.6 and 4.8, p < 0.001), being single, widowed or divorced or not cohabiting with the partner (AOR 4.7 and 2.3, p < 0.001), as well as higher household wealth (AOR 1.8, p < 0.001) and lack of partner status knowledge (AOR 1.6, p = 0.008). Self-estimated risk perception was linked with engagement in HIV-related risk behaviors except for alcohol abuse. Our findings indicate that reducing risky behaviors in pregnancy in order to prevent HIV should be a high-priority public health concern., (© 2021. The Author(s).)

We present an explanatory theory for HIV-related stigma from the perspectives of youth living with HIV/AIDS (YLWHA) in Western Uganda, on which the fight against this relentless stigma in this age group and locality can be founded. A constant comparative method was used to analyze textual data from in-depth interviews with 35 YLWHA, selected from three health facilities. A stigma process model for YLWHA was developed with the stigmatizing feelings and behaviors as the core category. Concepts delineating causes, consequences, and moderators of HIV-related stigma emerged from the data to complete the stigma process. The specific focus on YLWHA and contextual characteristics adds new dimensions to the understanding of HIV-related stigma that are scant in existing HIV-related stigma models. In light of our findings, research is necessary to identify context-specific strategies to overcome the deep-rooted causes of stigmatizing views and behaviors in all social spheres of YLWHA within Western Uganda.

Tropical forests store 40-50 per cent of terrestrial vegetation carbon 1 . However, spatial variations in aboveground live tree biomass carbon (AGC) stocks remain poorly understood, in particular in tropical montane forests 2 . Owing to climatic and soil changes with increasing elevation 3 , AGC stocks are lower in tropical montane forests compared with lowland forests 2 . Here we assemble and analyse a dataset of structurally intact old-growth forests (AfriMont) spanning 44 montane sites in 12 African countries. We find that montane sites in the AfriMont plot network have a mean AGC stock of 149.4 megagrams of carbon per hectare (95% confidence interval 137.1-164.2), which is comparable to lowland forests in the African Tropical Rainforest Observation Network 4 and about 70 per cent and 32 per cent higher than averages from plot networks in montane 2,5,6 and lowland 7 forests in the Neotropics, respectively. Notably, our results are two-thirds higher than the Intergovernmental Panel on Climate Change default values for these forests in Africa 8 . We find that the low stem density and high abundance of large trees of African lowland forests 4 is mirrored in the montane forests sampled. This carbon store is endangered: we estimate that 0.8 million hectares of old-growth African montane forest have been lost since 2000. We provide country-specific montane forest AGC stock estimates modelled from our plot network to help to guide forest conservation and reforestation interventions. Our findings highlight the need for conserving these biodiverse 9,10 and carbon-rich ecosystems., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Animal communication has long been thought to be subject to pressures and constraints associated with social relationships. However, our understanding of how the nature and quality of social relationships relates to the use and evolution of communication is limited by a lack of directly comparable methods across multiple levels of analysis. Here, we analysed observational data from 111 wild groups belonging to 26 non-human primate species, to test how vocal communication relates to dominance style (the strictness with which a dominance hierarchy is enforced, ranging from 'despotic' to 'tolerant'). At the individual-level, we found that dominant individuals who were more tolerant vocalized at a higher rate than their despotic counterparts. This indicates that tolerance within a relationship may place pressure on the dominant partner to communicate more during social interactions. At the species-level, however, despotic species exhibited a larger repertoire of hierarchy-related vocalizations than their tolerant counterparts. Findings suggest primate signals are used and evolve in tandem with the nature of interactions that characterize individuals' social relationships., (© 2021 The Authors.)

Limited research exists on pregnant women's knowledge, attitudes, and behavior concerning COVID-19 in sub-Saharan Africa. We performed a cross-sectional study among 648 pregnant women in Fort Portal, Uganda, after the first lockdown starting in June 2020. Structured interviews were conducted at three different facilities during routine antenatal care, assessing sociodemographic background, knowledge of COVID-19, prevention behavior adherence, and psycho-emotional stress levels. We performed descriptive analyses and examined associated factors using multivariable logistic regression. In Fort Portal Region, 32.8% of pregnant women had a higher knowledge regarding the COVID-19 pandemic, while all women at least heard of COVID-19. 88.6% of the women showed low self-reported prevention behavior adherence. More than one third of the pregnant women experienced high psycho-emotional stress related to the pandemic (39.8%). The odds for psycho-emotional stress were increased among the age group 21-30 years (AOR 1.97; 95% CI 1.18-3.35) compared to women under the age of 21, and decreased in single or divorced women compared to women in partnerships (AOR 0.42; 0.22-0.77) and in women having less COVID-19-related knowledge (AOR 0.40; 0.27-0.58). In conclusion, prevention behavior adherence seemed challenging, and psycho-emotional stress was ubiquitous among our cohort. To avoid adverse consequences in maternal and neonatal health, campaigns for hygiene but also women's emotional state should be a major focus of community healthcare in exceptional times such as the SARS-CoV-2 pandemic.

Community Engagement (CE) is an accredited path for Higher Education Institutions (HEIs) to address development challenges facing communities. However, establishing practical CE approaches is difficult due to a lack of information on stakeholders' perceptions and needs for CE. This paper intends to fill this gap by examining engaged stakeholders' perceptions and needs for CE. We conducted a survey among 450 stakeholders, categorised as dairy farmers, students, and faculty members of a case study HEI in Africa. One-way ANOVA findings showed that the three categories perceived CE differently and had multiple needs. To harness reciprocal engagement, HEIs should create more CE opportunities and address stakeholders' needs such as establishing structures, allocating time for engagement elements, financial support, and communication., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: Although schools have been identified as significant settings in the response to the HIV/AIDS pandemic, limited research is available on how they can accommodate Youth Living with HIV/AIDS (YLWHA), especially in resource limited countries. In this study, we explored strategies by school stakeholders (school staff, parents/caretakers, and students) in western Uganda to care for and support YLWHA in their schools., Methods: The article utilizes data collected between May and October, 2019 from a qualitative inquiry based on focus group discussions and interviews with 88 school stakeholders purposively selected from 3 secondary schools in western Uganda. Textual data was analyzed thematically involving both inductive and deductive coding., Results: We identified 7 overarching interrelated themes in which participants reported strategies to care for and support YLWHA: counselling and guidance; social support networks and linkages; knowledge and skills; anti-stigma and anti-discrimination measures; disclosure of HIV status; treatment and management of HIV/AIDS; and affirmative actions for YLWHA. Stakeholders' strategies often differed regarding what was considered appropriate, the approach and who to take lead in supporting YLWHA., Conclusions: Despite the limited care and support strategies specific for YLWHA currently available in schools, our study points to optimism and high potential given stakeholders' identified avenues for improvement. We posit that promoting HIV/AIDS-care and support in schools is a gradual process requiring each school to develop a strong knowledge base about HIV/AIDS and support needs of YLWHA, develop a coherent and school-wide approach, and collaborate extensively with external stakeholders who are significant in supporting YLWHA.

Current analyses and predictions of spatially explicit patterns and processes in ecology most often rely on climate data interpolated from standardized weather stations. This interpolated climate data represents long-term average thermal conditions at coarse spatial resolutions only. Hence, many climate-forcing factors that operate at fine spatiotemporal resolutions are overlooked. This is particularly important in relation to effects of observation height (e.g. vegetation, snow and soil characteristics) and in habitats varying in their exposure to radiation, moisture and wind (e.g. topography, radiative forcing or cold-air pooling). Since organisms living close to the ground relate more strongly to these microclimatic conditions than to free-air temperatures, microclimatic ground and near-surface data are needed to provide realistic forecasts of the fate of such organisms under anthropogenic climate change, as well as of the functioning of the ecosystems they live in. To fill this critical gap, we highlight a call for temperature time series submissions to SoilTemp, a geospatial database initiative compiling soil and near-surface temperature data from all over the world. Currently, this database contains time series from 7,538 temperature sensors from 51 countries across all key biomes. The database will pave the way toward an improved global understanding of microclimate and bridge the gap between the available climate data and the climate at fine spatiotemporal resolutions relevant to most organisms and ecosystem processes., (© 2020 John Wiley & Sons Ltd.)

Water governance occurs at multiple levels, from the local to the supra-national, which are often highly fragmented. The interconnected nature of water requires interactions among these multiple governance levels. Public participation may foster such interactions. Thus, many water management reforms involved decentralization and public participation worldwide over the last decades. Yet, it is not demonstrated how these reforms may improve water resources sustainability. Their analysis in the literature does not show concretely how interactions among multiple levels materialize and are influenced by participation. As such, the question addressed is how interactions among multiple levels of water governance manifest over time in a participatory intervention. Using a case study in the Rwenzori region in Uganda, this article compares the multi-level interactions before and during a participatory process. The latter has been purposely implemented to bridge gaps between local and provincial levels through a participatory planning process centred on the provincial level. Four types of flows were analyzed: information and knowledge, hydrosocial, financial and human. Our analysis shows that using artefacts like the role-playing game and planning matrix fostered bi-directional information and knowledge flows. Hydrosocial flows did not change in depth but the legitimacy of the two organizations implementing the participatory process was reinforced. Project financial flows were injected through a provincial academic institution, who is not a regular budget recipient. They were therefore superimposed on existing budgeting process. We conclude by providing suggestions for the engineering of participatory processes in order to foster more collaborative and effective multi-level water governance.

While nutrition-sensitive value-chain approaches are strongly advocated, studies on consumer preferences for such interventions are lacking. This study aims to fill this gap by examining a nutrition-sensitive chain labeling scheme, using the Ugandan dairy sector as a case. A survey was conducted among 250 consumers, primarily eliciting perceptions of the importance of a nutrition-sensitive chain label compared to nutrition claims/facts. In addition, a choice-based conjoint experiment was designed with nutrition label, brand, fat content, and price as attributes. Findings show that nutrition-sensitive chain labeling was more positively perceived by consumers than by nutrition claims/facts. Ordered logistic regression analysis indicated that BMI, nutrition knowledge, and label use influenced consumers' perceived importance of a nutrition-sensitive chain label relative to sex, age, children, and milk purchase frequency for nutrition claims/facts. This is confirmed by the higher utilities for the nutrition-sensitive chain label in our conjoint experiment. Future research should focus on the integration of nutrition-sensitive chain labeling with existing labels in a way that promotes candid interpretation by consumers. Industrial and policy actors in the agri-food sector can use these findings to innovate and regulate appropriate labeling schemes in the context of nutrition-sensitive value chains., (Copyright © 2020 Wesana, Gellynck, Dora, Muyama, Mutenyo, Elizabeth, Kagambe and De Steur.)

Objectives: The study attempted to determine the incidence of HIV among pregnant women in Kabarole District, Uganda, and to identify socio-demographic and behavioral risk factors for seroconversion during pregnancy., Methods: We carried out a retrospective cohort study among women for whom a documented HIV-negative test result from the first pregnancy trimester could be confirmed using available records, and who were HIV-retested in the third trimester or during delivery. In total, 1610 pregnant women from three different healthcare settings took part in the study. We captured the results of repeated HIV tests and conducted semi-structured interviews to explore participants' socio-demographic characteristics and sexual risk behavior. For HIV incidence rates, we calculated the number of seroconversions per 100 person-years. We used Fisher's exact test to test for potential associations. Penalized maximum likelihood logistic regression and Poisson regression were applied to adjust for potential confounders., Results: The overall HIV incidence rate among participants was 2.9/100 women-years. Among socio-demographic characteristics, the multivariable analysis showed a significant association of marital status with HIV incidence in pregnancy (IRR 8.78, 95%CI [1.13-68.33]). Risky sexual behaviors including higher number of sexual partners in pregnancy (IRR 2.78 [1.30-5.94]), unprotected sex with unknown persons (IRR 14.25 [4.52-44.93]), alcohol abuse (IRR 12.08 [4.18-34.90]) and sex under the influence of drugs or alcohol (IRR 6.33 [1.36-29.49]) were significantly associated with seroconversion in pregnancy (similar results in logistic regression)., Conclusions: HIV incidence was three times higher among our pregnant study population compared to the general female population in Uganda. This underlines the importance of HIV prevention and repeat testing during pregnancy. Identified risk groups should be considered for pre-exposure prophylaxis., Competing Interests: The authors have declared that no competing interests exist.

Aim: To determine the health facility-based perinatal mortality rate, its causes and avoidable factors using the perinatal mortality surveillance and response guidelines., Design: This was an action study conducted in one of the districts in Western Uganda from 1 January-31 December 2019., Methods: A total of 20 perinatal death cases were recruited consecutively. Data were collected using a Ministry of Health Perinatal Death Surveillance and Response (PDSR) questionnaire containing questions on pregnancy, delivery and immediate postnatal care. We used descriptive statistics to describe key data elements., Results: We found a health facility-based perinatal mortality rate of 17.3 deaths per 1,000 live births. Birth asphyxia was the most common cause of perinatal deaths. Seven, three and ten mothers delayed seeking, reaching and receiving appropriate health care, respectively., Competing Interests: The authors declare no competing interests in this study., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

HIV-related stigma has been identified as a significant stressor affecting Quality of Life of Youth Living With HIV/AIDS (YLWHA). Gaining a contextualized understanding of how this stigma is experienced by YLWHA in Western Uganda is crucial in addressing it in this group and setting. In this study, we explored the lived experiences of YLWHA with HIV-related stigma. Photovoice was used to gain insight into the lived experiences of HIV-related stigma in 11 YLWHA (15-19 years), purposively selected from a hospital-based peer support group. Group interview transcripts, notes and photographs were subjected to phenomenological hermeneutic analysis. Encounters with enacted, anticipated and internalized stigmas and their myriad sequels were prevalent in the photos and narratives of participants. Our findings were categorized and presented in 5 main themes that were identified through the analysis: being devalued, experiencing fear, experiencing injustices, feeling lonely, and lacking future perspectives. HIV-related stigmas were experienced in various socio-ecological domains but predominantly in homes and schools that ought to be supportive surroundings for youths. A multilevel approach, targeting the entire society where the root causes of stigma can be found and specific contexts like schools and homes where youth are confronted with stigma on a daily basis is proposed for a wholistic intervention., Competing Interests: The authors have declared that no competing interests exist.

Background: Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients., Methods: A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors., Results: The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 - 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition., Discussion: In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities., Conclusions: Malnutrition is a threat in HIV adult patients in rural communities of Uganda., (© 2020 Odwee A et al.)

As Youth Living With HIV/AIDS (YLWHA) continue to survive and live with HIV chronically due to effective Antiretroviral Therapy (ART), it is paramount to work toward maximising their psychosocial wellbeing. The school where these YLWHA are expected to spend most of their time is an excellent environment to investigate this. In this study, we explore perspectives of Peer Educators (PEs) in secondary schools of one district in Western Uganda on how YLWHA are perceived in school, on their daily stressors and their way of coping with their HIV-positive serostatus given the support of the schools. We conducted eight focus groups with a total of 59 students who were members of Peer Educators Clubs (PECs) as well as 8 in-depth interviews with patron teachers of PECs in eight secondary schools of Kabarole district, selected through a stratified random sampling method. Focus groups and interviews were tape-recorded, transcribed and analysed thematically both inductively and deductively. Stressors and support in schools, as identified by the PEs were categorised into three interrelated thematic domains; psychological wellbeing of YLWHA, disclosure of HIV status by YLWHA, and health and treatment adherence. Stigma was found to be a key stressor and an intermediary in all the three thematic domains Stressors affecting psychological wellbeing were fear of death and uncertainty of the future compounded by financial and academic challenges. Stressors affecting disclosure centred around lack of privacy, confidentiality and fear of loss of friends. Stressors affecting treatment adherence included lack of privacy while taking drugs, unintended disclosure while obtaining drugs or seeking permission to attend clinic appointments and fear of drug adverse effects due to poor nutrition. A supportive school environment involved the availability of a school nurse, counselling services and PECs. We conclude that the school environment brings more stressors than supports for YLWHA. The daily stressors related to HIV stigma, uncertainty, disclosure, privacy and confidentiality render schooling a hassle for YLWHA. Interventions that promote resilient school communities are necessary to foster disclosure in a non-discriminatory and stigma-free environment. This calls for concerted efforts from all school stakeholders.

Background: Despite advancement in Prevention of Mother to Child Transmission (PMTCT) services, the rate of MTCT of HIV in sub-Saharan Africa is still high. This is partly due to low retention of HIV positive mothers in HIV care. We sought to determine the level of retention and the factors associated with retention among HIV positive pregnant and breastfeeding mothers following accreditation of an antiretroviral therapy (ART) clinic to offer full time ART services in one of the lower health facilities in rural Western Uganda., Methods: This study was a mixed methods study conducted in 5 health centres in rural Western Uganda from 10th April to 10th May 2017. A total of 132 retained and non-retained HIV positive pregnant and breastfeeding mothers were recruited. A Mother was categorized as retained if she had not missed her ART appointments at antenatal or postnatal clinic for ≥3 consecutive months. Questionnaires were administered and four focus group discussions were held. We used descriptive statistics to understand characteristics of mothers and their levels of retention. Thematic analysis was used to analyze qualitative data., Results: About a third (35.6%) of the mothers were aged 18-24 with a median age of 26 (IQR 23, minimum age of 16 and maximum age of 39). More than half, 73 (55.3%) of all mothers were in HIV care for 3-24 months and about 116(87.9%) of all mothers were retained in HIV care. This was an improvement from 53% reported in 2015. We found lack of formal education, lack of disclosure of HIV status to the spouse, perceived lack of confidentiality and self stigmatization as factors hindering retention. The desire to have an HIV free baby, fear of death and opportunistic infections, support from significant others and community groups were factors associated with retention., Conclusions: We observed improved retention in lower health centres and to achieve 100% retention, we recommend interventions such as sensitizing HIV positive mothers on disclosure of HIV status to spouse, maintaining confidentiality of client information at the clinic, support to girl child education and formation of community support groups., Trial Registration: This study was retrospectively registered with the Uganda National Council for Science and Technology (UNCST), registration receipt number 10961 on the 9th March, 2018.

Effective disaster risk reduction is often hampered by a general scarcity of reliable data collected on disastrous events, particularly in the Global South. Novel approaches are therefore necessary to alleviate this constraint, particularly with regard to reducing extensive risks. A geo-observer network, consisting of 21 reporters, was established in the Rwenzori region (Uganda) in February 2017 to collect data on eight different disasters using smartphone technology. Within the first 15 months of operation, a total of 319 disaster reports were submitted. A large majority of the reported disasters were reached by the geo-observers within 2 days after their occurrence. The analysis of reporting activity shows a large divergence, with one third of the most active geo-observers accounting for nearly 75% of all reports. By using an existing landslide susceptibility map as a proxy of expected landslide prevalence, this reporting divergence is demonstrated to be at least partially driven by a difference in disaster occurrences. This is confirmed by the results of a survey held among the geo-observers. Survey results also showed that the participants are more driven by non-pecuniary benefits rather than financial compensation. The data collected during the first 15 months of operation indicates that extensive risks in the region are underestimated and demonstrates the added value of participatory sensing to compensate for the current lack of well-functioning official data collection mechanisms. This pilot project is a proof of concept for participatory sensing to collect high quality data even in remote contexts where smartphone technology is not generally adopted. It can serve as a precedent or example for other regions where extensive risks are poorly understood but pose significant threat to the population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

New food technologies, such as genetic modification, food fortification, and processing technologies, are of growing interest for future food security and safety. For ensuring successful implementation of such technologies, consumers and other food supply chain actors should embrace them. We present a systematic review to identify and compare key factors of supply chain actors' evaluation of new food technologies. Evaluation encompasses indicators such as likelihood or intention to perform a behavior, perceived benefits/risks, willingness to pay, acceptance/adoption, and attitudes. Results from 183 studies showed several imbalances in research. Although studies mainly focused on (1) genetically modified foods, (2) by consumers, (3) in developed countries, only very few studies have targeted other food technologies, other supply chain actors such as farmers (13 studies) or processors (two studies), or developing countries (43 studies). With respect to consumers' evaluation, key determinants were trust in institutions, information assessment, perceived risks and benefits, attitudes toward the product or technology, perceived behavioral control, quality perception of the product, and impact on health. Farmers' evaluation of new food technologies was explained by the factors of perceived risk and benefits and of actual source of information. For the few processor evaluation studies, no convergence of factors could be reached. This systematic review contributes to a better understanding of consumers' and farmers' evaluation behavior and opens up avenues for future research on supply chain actors' food technology evaluations. The differences in the conceptualization and measurement of extracted factors demonstrate the need for standardized approaches in future studies., (© 2019 Institute of Food Technologists®.)

Background: In 2010, Uganda Malaria Control Programme distributed cost-free mosquito bed nets to households with children under-five years and pregnant women in selected sub-counties. We assessed the factors associated with sleeping under costfree mosquito nets among children under-five years in Nyakayojo sub-county, Mbarara District, Uganda., Methods: 381 households with at least a child under-five years and benefited from cost-free bed nets in Nyakayojo were randomly selected. Caregivers of children were interviewed using a questionnaire., Results: 74% children slept under bed nets a night before the study. Children from households with ≥2 nets [aOR=1.75; 95% CI: 1.09-2.81, p=0.02], female caregiver [aOR=2.11; 95% CI: 1.16-3.79, p=0.01] and children from households that did not face problems (skin irritation, torn nets, suffocation, night sweating, nasal congestion and candle fire) when sleeping under bed nets [aOR=1.81; 95% CI: 1.10-2.98, p=0.02] were more likely to use nets. Main reason for not sleeping under a net was damage to the net (47.1%)., Conclusion: The proportion of children sleeping under nets was comparable to MDG target. Improvements in use of mosquito nets by children can be achieved through increasing number of nets in a household.

The shift from flood protection to flood risk management, together with recent arguments on incorporating culture in managing risk, underscores the application of traditional ecological knowledge (TEK) in managing disasters from flood hazards. Yet, documentation and incorporation of TEK into practice remains a challenge. This article contributes to addressing this challenge by exploring the existence of TEK to flooding in the Rwenzori Mountains, Uganda. Using semi-structured interviews, data were collected from residents of the Nyamwamba watershed where intense flash floods caused deadly impacts in May 2013. Collected data were analysed using content, thematic and interpretive analysis techniques. Results indicate that TEK is exhibited through various traditional ecological approaches (TEAs). Although endangered, TEAs (conducted through collective action for a communally accepted end) are framed in three main activities: (1) assessment and prediction of rainfall and flood by the traditional hydro-meteorologist ( diviner ) and the traditional rain forecaster ( rainmaker ); (2) the mountain cleansing ritual (which act as flood risk awareness platform); and (3) immunising riverine communities through planting certain indigenous plants, which improve hydrological systems through their high conservation value for native ecological diversity. As most TEAs are conducted through collective action, they represent a platform to understand local capacities and enhance adoption of measures, and/or a source of knowledge for new measures to address flood risk. Therefore, full-scale investigations of these TEAs, determining how relevant TEAs are fine-tuned, and (scientific) measures enculturated based on fine-tuned TEAs could result in effective flood risk management in various flood hotspots where TEAs influence action., Competing Interests: The authors declare that there are no financial or personal relationship(s) that have inappropriately influenced the writing of this article.

Agronomic biofortification (i.e., the application of fertilizer to elevate micronutrient concentrations in staple crops) is a recent strategy recommended for controlling Iodine Deficiency Disorders (IDDs). However, its success inevitably depends on stakeholders' appreciation and acceptance of it. By taking Northern Uganda as a case, this study aimed to capture and compare the perceptions of seven key stakeholder groups with respect to agronomic iodine biofortification. Therefore, we employed a SWOT (Strength, Weaknesses, Opportunities & Threats) analysis in combination with an Analytical Hierarchy Process (AHP). Findings show that stakeholders ( n = 56) are generally positive about agronomic iodine biofortification in Uganda, as its strengths and opportunities outweighed weaknesses and threats. Cultural acceptance and effectiveness are considered the most important strengths while the high IDD prevalence rate and the availability of iodine deficient soils are key opportunities for further developing agronomic iodine biofortification. Environmental concerns about synthetic fertilizers as well as the time needed to supply iodine were considered crucial weaknesses. The limited use of fertilizer in Uganda was the main threat. While this study provides insight into important issues and priorities for iodine biofortification technology in Uganda, including differences in stakeholder views, the application of the SWOT-AHP method will guide future researchers and health planners conducting stakeholder analysis in similar domains., Competing Interests: The authors declare no conflict of interest.

Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (p<0.01), lower travel costs (p = 0.02), and lower number of previous deliveries (p = 0.04). Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation.

Background: Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm)., Methods and Findings: 124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm., Conclusion: Our findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.

Background: While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda., Methods: A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters., Results: Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria., Conclusion: In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes.

Building upon the growing interest and research on genetically modified (GM) biofortification, its socioeconomic potential has been increasingly examined. We conducted two systematic reviews and meta-analyses to provide comprehensive evidence of consumers' willingness to pay (11 economic valuation studies, 64 estimates) and cost-effectiveness/benefits (five economic evaluation studies, 30 estimates). Worldwide, consumers were willing to pay 23.9% more for GM biofortified food crops. Aside from crop and design-related differences, information provision was deemed crucial. Positive information (nutrition and GM benefits) is associated with the highest consumer willingness to pay, compared with negative, objective, and conflicting GM information, especially when negative information was mentioned last. This health intervention would reduce the aggregated micronutrient deficiency burden in Asia (15.6 million disability-adjusted life years (DALYs)) by 12.5-51.4%, at a low cost of USD 7.9-27.8 per DALY in a pessimistic and optimistic scenario, respectively. Given that GM biofortified crops could tackle hidden hunger in a cost-effective and well-accepted way, its implementation is worth pursuing. A case study on folate biofortification further elaborates on the importance of socioeconomic research and the determinants of their market potential., (© 2016 New York Academy of Sciences.)

Following the growing evidence on biofortification as a cost-effective micronutrient strategy, various researchers have elicited consumers' willingness to pay (WTP) for biofortified crops in an effort to justify and determine their adoption. This review presents a meta-analysis of WTP studies on biofortified foods, either developed through conventional breeding or using genetic modification technology. On the basis of 122 estimates from 23 studies (9507 respondents), consumers are generally willing to pay 21.3% more for biofortified crops. Because WTP estimates are often determined through different valuation methods and procedures, a meta-regression was carried out to examine the role of potential determinants. Aside from contextual factors, such as type of food crop, target nutrient, and region (but not breeding technique), various methodological factors significantly influence premiums, including the type of respondent, nature of the study, study environment, participation fee, and provided information. The findings allow researchers to better anticipate potential methodological biases when examining WTP for (biofortified) foods, while it gives policy makers a broad understanding of the potential demand for different biofortified crops in various settings., (© 2016 New York Academy of Sciences.)

Background: We conducted a study to assess the frequency and distribution patterns of selected opportunistic infections (OIs) and opportunistic cancers (OCs) in different geographical areas before and after HAART in Uganda., Methods: This was a cross-sectional serial review of observation data for adult HIV positive patients (≥15 years) enrolled with the AIDS support organization (TASO) in Uganda covering the period from January 2001 to December 2013. Both AIDS defining OIs/OCs and non-AIDS defining OIs were analyzed. The study period was structured into three time periods: "pre- HAART" (2001-2003), "early-HAART" (2004-2008) and "late-HAART" (2009-2013). Descriptive statistics were used to summarize the data by time period, age, gender and geographical location. Chi squared test used to test the significance of the differences in proportions., Results: A total of 108,619 HIV positive patients were included in the analysis. 64% (64,240) were female with median age of 33 years (IQR 27-40). The most frequent OIs before HAART were oral candida (34.6%) diarrhoeal infection (<1 month) (30.6%), geohelminths (26.5%), Mycobacterium tuberculosis (TB) (17.7%), malaria (15.1%) and bacterial pneumonia (11.2%). In early HAART (2004-2008), the most frequent OIs were geohelminths (32.4%), diarrhoeal infection (25.6%), TB (18.2%) and oral candida (18.1%). In late HAART (2009-2013), the most frequent OIs were geohelminths (23.5%) and diarrhoeal infection (14.3%). By gender, prevalence was consistently higher in women (p < 0.05) before and after HAART for geohelminths, candidiasis, diarrhoeal infection, bacterial pneumonia and genital ulcer disease but consistently higher in men for TB and Kaposi's sarcoma (p < 0.05). By age, prevalence was consistently higher in older age groups (>30 years) before and after HAART for oral candida and TB (p < 0.05) and higher in young age groups (<30 years) for malaria and genital ulcers (p < 0.05). By geographical location, prevalence was consistently higher in Eastern and Northern Uganda before and after HAART for diarrheal infection and geohelminths (p < 0.0001)., Conclusions: The frequency and pattern of OIs before and after HAART differs by gender, age and geographical location. Prevalence of geohelminths and diarrhea infection(<1 month) remains high especially in Northern and Eastern Uganda even after HAART and should therefore be given special attention in HIV/AIDS care programmes in these settings.

The interest to reduce food losses and wastes has grown considerably in order to guarantee adequate food for the fast growing population. A systematic review was used to show the potential of Value Stream Mapping (VSM) not only to identify and reduce food losses and wastes, but also as a way to establish links with nutrient retention in supply chains. The review compiled literature from 24 studies that applied VSM in the agri-food industry. Primary production, processing, storage, food service and/or consumption were identified as susceptible hotspots for losses and wastes. Results further revealed discarding and nutrient loss, most especially at the processing level, as the main forms of loss/waste in food, which were adapted to four out of seven lean manufacturing wastes (i.e. defect, unnecessary inventory, overproduction and inappropriate processing). This paper presents the state of the art of applying lean manufacturing practices in the agri-food industry by identifying lead time as the most applicable performance indicator. VSM was also found to be compatible with other lean tools such as Just-In-Time and 5S which are continuous improvement strategies, as well as simulation modelling that enhances adoption. In order to ensure successful application of lean practices aimed at minimizing food or nutrient losses and wastes, multi-stakeholder collaboration along the entire food supply chain is indispensable., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Predicting future prevalence of any opportunistic infection (OI) among persons infected with the human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) in resource poor settings is important for proper planning, advocacy and resource allocation. We conducted a study to forecast 5-years prevalence of any OI among HIV-infected individuals on HAART in Uganda., Methods: Monthly observational data collected over a 10-years period (2004-2013) by the AIDS support organization (TASO) in Uganda were used to forecast 5-years annual prevalence of any OI covering the period 2014-2018. The OIs considered include 14 AIDS-defining OIs, two non-AIDS defining OIs (malaria & geohelminths) and HIV-associated Kaposi's sarcoma. Box-Jenkins autoregressive integrated moving average (ARIMA) forecasting methodology was used., Results: Between 2004 and 2013, a total of 36,133 HIV patients were enrolled on HAART of which two thirds (66 %) were female. Mean annual prevalence for any OI in 2004 was 57.6 % and in 2013 was 27.5 % (X(2) trend = 122, b = -0.0283, p <0.0001). ARIMA (1, 1, 1) model was the most parsimonious and best fit for the data. The forecasted mean annual prevalence of any OI was 26.1 % (95 % CI 21.1-31.0 %) in 2014 and 15.3 % (95 % CI 10.4-20.3 %) in 2018., Conclusions: While the prevalence of any OI among HIV positive individuals on HAART in Uganda is expected to decrease overall, it's unlikely that OIs will be completely eliminated in the foreseeable future. There is therefore need for continued efforts in prevention and control of opportunistic infections in all HIV/AIDS care programmes in these settings.

Landslides affect millions of people worldwide, but theoretical and empirical studies on the impact of landslides remain scarce, especially in Sub-Saharan Africa. This study proposes and applies a method to estimate the direct impact of landslides on household income and to investigate the presence of specific risk sharing and mitigation strategies towards landslides in a tropical and rural environment. An original cross-sectional household survey is used in combination with geographical data to acquire detailed information on livelihoods and on hazards in the Rwenzori mountains, Uganda. Ordinary least square regressions and probit estimations with village fixed effects are used to estimate the impact of landslides and the presence of mitigation strategies. Geographical information at household level allows to disentangle the direct impact from the indirect effects of landslides. We show that the income of affected households is substantially reduced during the first years after a landslide has occurred. We find that members of recently affected households participate more in wage-employment or in self-employed activities, presumably to address income losses following a landslide. Yet, we see that these jobs do not provide sufficient revenue to compensate for the loss of income from agriculture. Given that landslides cause localized shocks, finding a significant direct impact in our study indicates that no adequate risk sharing mechanisms are in place in the Rwenzori sub-region. These insights are used to derive policy recommendations for alleviating the impact of landslides in the region. By quantifying the direct impact of landslides on household income in an agricultural context in Africa this study draws the attention towards a problem that has been broadly underestimated so far and provides a sound scientific base for disaster risk reduction in the region. Both the methodology and the findings of this research are applicable to other tropical regions with high landslide densities., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Since 2012, lifelong antiretroviral therapy for all HIV-positive pregnant women ("Option B+") is recommended by WHO for the prevention of mother-to-child transmission of HIV (PMTCT). Many sub-Saharan African countries have since introduced this regimen, but to date, longer-term outcome evaluations are scarce. We conducted an observational study in Fort Portal Municipality, Uganda, to describe uptake and adherence of Option B+ during pregnancy. HIV-positive women approaching antenatal care (ANC) services in two hospitals were enrolled and followed-up at monthly routine ANC visits until delivery. At each visit, next to sociodemographic and clinical data, we assessed drug adherence through pill counts. In total, 124 HIV-positive pregnant women were enrolled in our study; from these, 80.8% had not been aware of their positive serostatus before. Forty-five PMTCT clients (36.3%) never returned to ANC after their first visit. Protective factors (p < 0.05) for immediate loss to care included previous HIV status knowledge, status disclosure before or at first ANC visit, and tertiary education. Among those clients starting Option B+, the median adherence during pregnancy was 95.7% pill intake. Rather low adherence (<80%) was observed in 21.1% of clients, while more than half achieved an adherence level of ≥95%, with 40.8% of all clients being 100% adherent. The cohort's median adherence remained stable throughout the course of pregnancy. Healthcare providers should place high emphasis on individual PMTCT counseling at first ANC encounter, and pay special attention to those women previously unaware of their HIV status. However, after initial uptake, high adherence seems to be feasible for Option B+.

Knowledge of mortality trends and predictors among HIV-positive patients in the era of highly active antiretroviral therapy (HAART) in resource poor settings is still limited. The aim of this study was to describe trends and predictors of mortality among HIV-positive patients in the era of HAART in Uganda. Data from 2004 to 2013 for adult HIV-positive patients (≥15 years) obtaining care and treatment from the AIDS Support Organization in Uganda were reviewed for mortality. Descriptive statistics were analyzed by frequencies and cross tabulations. Calendar period was used as a proxy measure for HAART exposure and a time plot of the proportion of HIV-positive patients reporting dead per year was used to describe the trends. Logistic regression was used to determine the predictors of mortality at bivariate and multivariate levels, respectively. We included in the analysis 95,857 HIV positive patients; 64% were female with median age of 33 years (interquartile range 27-40). Of these 36,133 (38%) were initiated on ART and a total of 4279 (4.5%) died; 19.5% (835/4279) of those who died had an opportunistic infection. Overall, mortality first increased between 2004 and 2006 and thereafter substantially declined (X(2) trend=211.9, P<0.001). Mortality was relatively higher in Eastern Uganda compared to other geographical areas. Male gender, older age (>45 years), being from Eastern or Northern Uganda, having none or primary education, being unemployed, advanced immunodeficiency (CD4 count <100 cell/µL or WHO stage III or IV) and underweight (<45 kg weight) at HAART initiation and calendar period 2004-2008 were significant predictors of mortality (P<0.001). Overall, the expanding coverage of HAART is associated with a declining trend in mortality among HIV positive patients in Uganda. However, mortality trends differed significantly by geographical area and men remain potentially at higher risk of death probably because of delayed initiation on ART. There is urgent need for men targeted interventions for improved ART performance.