FR1.2: Understanding Community Perceptions of Women Empowerment for Agricultural and Rural development

The concept of women empowerment has been widely embraced in development efforts aimed at achieving gender equality outcomes. However, intended outcomes are not always achieved due to a disconnect between how the concept of women empowerment is perceived by target communities and development actors. An understanding of how targeted communities perceive women empowerment helps development actors design context specific women empowerment approaches suited to prevailing social cultural norms and perceptions of men and women. This study therefore aims at understanding perceptions of women empowerment by local communities in rural farming villages of Kiboga district in central Uganda. A qualitative case study design was used to collect data on community perceptions about women empowerment through key informants and sex-disaggregated focus group discussions. The data were coded using Atlas Ti and analyzed to identify themes. We found that men perceived an empowered woman as un-submissive, and a competitor to men's household head position. To women, an empowered woman was perceived as un-submissive, hardworking and taking over culturally assigned men's household responsibilities. As women get empowered, what do men become and at what cost to women? Findings indicate that an empowered woman takes over the responsibilities of an "ideal man" and this adds work burden to women and a backlash from men. In order to counter this, development agencies should target men and women and invest in interventions and approaches that transform local gender norms that dis-empower women. The study is ongoing and further data collection will be completed in August 2022

TH2.1: Understanding femininities: Implications for women's Participation in Agricultural interventions in central Uganda

Research has documented how men's behaviors in patriarchal settings affect women's economic empowerment outcomes, while less attention has been paid to how gender identity constructions around femininities influence these outcomes. We define femininities as gender based roles and expected behaviors of women in a given community and economic empowerment as women's decision-making regarding access and control of productive resources and management of income. This paper presents research on how female and male farmers in rural communities of central Uganda define what it means to be a woman and how those identity constructions influence women's economic empowerment. This qualitative case study is based on focus group discussions conducted with Sasakawa Africa Association intervention farmers (28 women and 25 men) of Kiboga District. Six focus group discussions were conducted, two with men only, women only, and both men and women respectively. Findings reveal co-existence of traditional and progressive femininities, dubbed "unruly" by men and some women. Traditional femininities were depicted as women complying to community values which deter them from financial decision making and owning productive resources. Progressive femininities on the other hand are noncompliant to these community values, and enjoy more economic empowerment. Men valued economically empowered women because they relieve men of financial responsibilities. Incorporating gender transformative approaches in women's economic empowerment interventions could decode traditional femininities and increase women's intrinsic agency within the context of economic empowerment

TH2.1: Who is a man? Understanding the local normative climate for transformative interventions in rural farming communities of Central Uganda

Local gender normative climate refers to how norms in a community interact with men and women agency- their ability to make strategic life choices. Understanding the normative climate includes unpacking the community's expectations of what it means to be a man "masculinity norms". Such normative factors interact with and constrain opportunities for women's equitable participation in agriculture, yet most women empowerment literature focuses on individual women level factors. This ongoing study aims to determine masculinity norms that affect women's ability to make strategic choices within the Sasakawa Africa's Nutrition sensitive agricultural extension project intervention areas in Kiboga District, Central Uganda. The study utilized an interpretive qualitative case study with data collected from sex disagreggated focus group discussions with intervention beneficiaries. Findings indicate that the community expectation of who a man should be are along family formation and provisioning; dominance in household decision making and leadership; and community level participation. The normative structures also exempted men from participating in domestic chores and negative sanctions were experienced by men that did so. Gender roles espousing notions like "vegetable growing is a woman's domain" dissuaded men's engagement in this activity. Consequently, domestic chores on top of additional activities from vegetables growing under the project present an increased labor burden for women. Inability to make strategic life choices like attending training that would build their capacities in areas important for their development curtails their economic investments. This calls for development agents' deliberate efforts to engage both women and men to reframe norms and new behaviors that will foster gender equality and a harmoniously transformed community

TH2.1: Empowerment without Transformation? A Scoping Review on Women Empowerment, Masculinities and Social norms in Agricultural Research

There is an increasing focus on re-thinking women's "empowerment" strategic interventions in order to achieve meaningful transformation in gender norms. This move is increasingly characterized by initiatives that deliberately seek to engage women and men, highlighting not only how women's lives in agricultural communities are interwoven with men's lives but also calls for ‘involvement' of men in women's empowerment work to address the underlying social norms, attitudes and behaviours that perpetuate gender inequalities. How have social categories "women", "men" and notions of empowerment and masculinities been conceptualized in agricultural research on women's empowerment? How have these concepts been deployed in agricultural research and with what implications? This paper draws from a literature review. Search terms included "Women's empowerment", "masculinities", "gender norms", "agency" "Power relations", "Rural masculinities" "male involvement in agriculture". Drawing on literature within agri food system, seed systems, nutrition sensitive agriculture in different regions of Africa and Asia, the paper argues that conceptualization of categories women, men, masculinities and femininities and the approaches drawn therefrom (the assumptions we work with about women and men) have potential to transform and/or reproduce unequal gender power relations

Treatment decision algorithms for tuberculosis screening and diagnosis in children below 5 years hospitalised with severe acute malnutrition: a cost-effectiveness analysis

Background Children with severe acute malnutrition (SAM) are an important risk group for underdiagnosis and death from tuberculosis. In 2022, the World Health Organization (WHO) recommended use of treatment decision algorithms (TDAs) for tuberculosis diagnosis in children. There is currently no cost-effectiveness evidence for TDA-based approaches compared to routine practice. Methods The TB-Speed SAM study developed i) a one-step TDA including Xpert, clinical, radiological and echography features, and ii) a two-step TDA, which also included a screening phase, for children under 5 years hospitalised with SAM at three tertiary hospitals in Uganda and Zambia from 4th November 2019 to 20th June 2022. This study is registered with ClinicalTrials.gov, NCT04240990. We assessed the diagnostic accuracy and cost-effectiveness of deploying TB-Speed and WHO TDA-based approaches compared to the standard of care (SOC). Estimated outcomes included children started on tuberculosis treatment, false positive rates, disability-adjusted life years (DALYs) and incremental cost-effectiveness ratios (ICERs). Findings Per 100 children hospitalised with SAM, averaging 19 children with tuberculosis, the one-step TDA initiated 17 true positive children (95% uncertainty intervals [UI]: 12–23) on tuberculosis treatment, the two-step TDA 15 (95%UI: 10–22), the WHO TDA 14 (95%UI: 9–19), and SOC 4 (95%UI: 2–9). The WHO TDA generated the most false positives (35, 95%UI: 24–46), followed by the one-step TDA (18, 95%UI: 6–29), the two-step TDA (14, 95%UI: 1–25), and SOC (11, 95%UI: 3–17). All TDA-based approaches had ICERs below plausible country cost-effectiveness thresholds compared to SOC (one-step: $44–51/DALY averted, two-step:$34–39/DALY averted, WHO: $40–46/DALY averted). Interpretation Our findings show that these TDA-based approaches are highly cost-effective for the vulnerable group of children hospitalised with SAM, compared to current practice. Funding Unitaid Grant number: 2017-15-UBx-TB-SPEED

Using graduates as key stakeholders to inform training and policy in health professions: The hidden potential of tracer studies

Background. Tracer studies are alumni surveys that attempt to track  activities of graduates of an educational institution, which enable the contextualisation of these professionals through a dynamic and reliable system to determine their career progression. It also enables the gathering of information to feed back into training institutions and to inform policy bodies on key issues. The purpose of this study was to track career paths of radiography graduates in Uganda, examine their contribution to their profession, and establish their opinions on how to improve training and inform policy.Methods. A cross-sectional descriptive survey of radiography graduates who completed their training between 2001 and 2011 was conducted. Namesof graduates were obtained from university records and contact details were sought from the register of the Uganda Radiographers Association, Facebook, Twitter, and friends. Data were collected using a  self-administered questionnaire distributed electronically to the students. In a few instances, the survey was completed telephonically.Results. A total of 90 questionnaires were sent out; 72 (80%) were returned. The majority of the respondents (95.8%) were employed as radiographers at the time of the survey and were all satisfied with their work. A significant number were employed abroad, while those who  remained in the country worked for private health facilities and only a few worked in government health facilities. Key suggestions were identified to improve training and influence policy.Conclusion. Graduate radiographers were generally satisfied with their current work. Many trained radiographers, however, are leaving the country,thereby creating a skills shortage in the government healthcare system