Building democracy from below : lessons from Western Uganda

How to achieve democratisation in the neopatrimonial and agrarian environments that predominate in sub-Saharan Africa continues to present a challenge for both development theory and practice. Drawing on intensive fieldwork in Western Uganda, this paper argues that Charles Tilly’s ‘democratisation as process’ provides us with the framework required to explain the ways in which particular kinds of association can advance democratisation from below. Moving beyond the current focus on how elite-bargaining and certain associational forms may contribute to liberal forms of democracy, this approach helps identify the intermediate mechanisms involved in building democracy from below, including the significance of challenging categorical inequalities, notably through the role of producer groups, and of building trust networks, cross-class alliances and synergistic relations between civil and political society. The evidence and mode of analysis deployed here help suggest alternative routes for supporting local efforts to build democracy from below in sub-Saharan Africa

Hyperglycemia in pregnancy diagnosed using glycated hemoglobin (HbA1c) in Uganda: a preliminary cross-sectional report

Background: Hyperglycemia in pregnancy (HIP) is a common medical complication during pregnancy and is associated with several short and long-term maternal-fetal consequences. We aimed to determine the prevalence and factors associated with HIP among Ugandan women. Methods: We consecutively enrolled eligible pregnant women attending antenatal care at Kawempe National Referral Hospital, Kampala, Uganda in September 2020. Mothers known to be living with diabetes mellitus or haemoglobinopathies and those with anemia (hemoglobin &lt;11g/dl) were excluded. Random blood sugar (RBS) and glycated hemoglobin A1c (HbA1c) were measured on peripheral venous blood samples. HIP was defined as an HbA1c ?5.7% with its subsets of diabetes in pregnancy (DIP) and prediabetes defined as HbA1c of ?6.5% and 5.7-6.4% respectively. ROC curve analysis was performed to determine the optimum cutoff of RBS to screen for HIP. Results: A total of 224 mothers with a mean (± SD) age 26±5 years were enrolled, most of whom were in the 2nd or 3rd trimester (94.6%, n=212) with a mean gestation age of 26.6±7.3 weeks. Prevalence of HIP was 11.2% (n=25) (95% CI: 7.7-16.0). Among the mothers with HIP, 2.2% (n=5) had DIP and 8.9% (n=20) prediabetes. Patients with HIP were older (28 years vs. 26 years, p=0.027), had previous tuberculosis (TB) contact (24% vs. 6.5%, p=0.003) and had a bigger hip circumference (107.8 (±10.4) vs. 103.3 (±9.7) cm, p = 0.032). However only previous TB contact was predictive of HIP (odds ratio: 4.4, 95% CI: 1.2-14.0; p=0.022). Using HbA1c as a reference variable, we derived an optimum RBS cutoff of 4.75 mmol/L as predictive of HIP with a sensitivity and specificity of 90.7% and 56.4% (area under the curve = 0.75 (95% CI: 0.70-0.80, p&lt;0.001)), respectively. Conclusions: HIP is common among young Ugandan women, the majority of whom are without identifiable risk factors.</ns4:p

High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>There is limited data on Methicillin resistant <it>Staphylococcus aureus </it>(MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA.</p> <p>Results</p> <p>One hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of <it>Staphylococcus aureus</it>. Forty one <it>S. aureus </it>isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and <it>mecA/femA/nuc</it>-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and <it>ica </it>genes. One isolate positive for all determinants possessed the <it>bhp </it>homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCC<it>mec </it>type I was the most common at 54% prevalence (22/41), followed by <it>SCCmec </it>type V (15%, 6/41) and <it>SCCmec </it>type IV (7%, 3/41). <it>SCCmec </it>types II and III were not detected and 10 isolates (24%) were non-typeable.</p> <p>Conclusions</p> <p>Hyper-virulent methicillin resistant <it>Staphylococcus aureus </it>is prevalent in the burns unit of Mulago hospital.</p

Kajian potensi ekstrak bilberi sebagai penunjuk pH untuk memantau kesegaran makanan secara kromametri

Penunjuk pH sebagai suatu pendekatan untuk memantau kualiti atau kesegaran makanan semasa telah mendapat perhatian industri pembungkusan makanan. Penggunaan sumber semula jadi pigmen tumbuhan terutamanya daripada buah-buahan dan sayur-sayuran menjadi pilihan para pengguna untuk menggantikan pewarna sintetik dalam memastikan keselamatan makanan yang diambil setiap hari. Dalam kajian ini, ekstrak daripada bilberi telah digunakan sebagai pewarna sensitif pH. Perubahan warna sampel dikaji secara terperinci melalui kaedah kromametri dan juga kaedah spektrofotometri ultra-lembayung nampak. Warna merah terang terhasil dalam pH berasid, merah pudar pada neutral dan magenta ke kuning dalam pH beralkali. Keputusan kajian kromametri menunjukkan bahawa ekstrak bilberi berupaya mempamerkan perubahan warna yang jelas terhadap perubahan pH, iaitu terdapat perubahan nilai warna a* yang menyumbang kepada perubahan yang bererti dalam perbezaan warna keseluruhan (ΔE*). Nilai ΔE* juga ditentukan wujud hubungan linear dan kuantitatif terhadap julat pH tertentu. Oleh yang demikian, ekstrak bilberi didapati berpotensi sebagai bahan sensor untuk pH dalam membangunkan satu sensor pH bagi memantau kesegaran makanan terutamanya hasilan laut berbungkus memandangkan tahap kerosakan produk tersebut berkait rapat dengan perubahan pH ke arah alkali

The effect of a group-based mindfulness and acceptance training on psychological flexibility and adherence to antiretroviral therapy among adolescents in Uganda: an open-label randomized trial

Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15-19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15-19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH.</p

The Effect of a Group-Based Mindfulness and Acceptance Training on Psychological Flexibility and Adherence to Antiretroviral Therapy Among Adolescents in Uganda: An Open-Label Randomized Trial

Adherence to antiretroviral therapy (ART) is lower in adolescents with HIV (AWH) than in any other age group, partly due to self-regulatory challenges during development. Mindfulness and acceptance training have been shown to support psychological flexibility, a self-regulatory skill that potentially improves adolescent adherence to medication. We assessed the effect of weekly group-based mindfulness and acceptance training sessions on ART adherence among older adolescents (15–19 years) in Kampala, Uganda. One hundred and twenty-two AWH (median age 17, range 15–19 years, 57% female) receiving care at a public health facility in Kampala were randomized 1:1 to receive 4 weekly 90-min group sessions facilitated by experienced trainers or standard-of-care ART services. The training involved (Session 1) clarifying values, (Session 2) skillfully relating to thoughts, (Session 3) allowing and becoming aware of experiences non-judgmentally, and (Session 4) exploring life through trial and error. At baseline, postintervention, and 3-month follow-up, psychological flexibility was measured using the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8), and self-reported ART adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8). At baseline, the intervention and standard-of-care arms had similar psychological flexibility (AFQ-Y8 score:15.45 ± 0.82; 15.74 ± 0.84) and ART adherence (MMAS-8 score: 5.32 ± 0.24; 5.13 ± 0.23). Retention through the study was moderate (71%). Completion of mindfulness and acceptance training was associated with a significant reduction in psychological inflexibility at the 3-month follow-up (AFQ-Y8 score: 12.63 ± 1.06; 14.05 ± 1.07, P  = .006). However, no significant differences were observed in self-reported adherence to ART at the 3-month follow-up (MMAS-8 score: 5.43 ± 0.23; 4.90 ± 0.33, P  = .522). Group-based mindfulness and acceptance training improved psychological flexibility in this population of adolescents on ART in Uganda but did not significantly improve ART adherence. Future research should explore integrated approaches that combine behavioral management training with other empowerment aspects to improve ART adherence among AWH