Differential returns from globalization to women smallholder coffee and food producers in rural Uganda

Background: Globalization-related measures to liberalize trade and stimulate export production were applied in Uganda in the late 1980s, including in the coffee production sector, to revitalize agricultural production, increase incomes to farmers and improve rural food security.Objective: To explore the different effects of such measures on the health and dietary outcomes of female coffee and food small holder farmers in Uganda.Methods: We gathered evidence through a cross-sectional comparative interview survey of 190 female coffee producers and 191 female food producers in Ntungamo district. The study mostly employed quantitative methods of data collection, targeting the sampled households. We also utilized qualitative data; collected three months after the household survey data had been collected and their analysis had been accomplished. Using qualitative interviews based on an unstructured interview guide, extra qualitative information was collected from key informants at national, district and community levels. This was among other underlying principles to avoid relying on snapshot information earlier collected at household level in order to draw valid and compelling conclusions from the study. We used indicators of production, income, access to food and dietary patterns, women’s health and health care. Of the two groups selected from the same area, female coffee producers represented a higher level of integration into liberalised export markets.Results: Document review suggests that, although Uganda’s economy grew in the period, the household economic and social gains after the liberalization measures may have been less than expected. In the survey carried out, both food and coffee producers were similarly poor, involved in small-scale production, and of a similar age and education level. Coffeeproducers had greater land and livestock ownership, greater access to  inputs and higher levels of income and used a wider variety of markets than food producers, but they had to work longer hours to obtain these economic returns, and spent more cash on health care and food from commercial sources. Their health outcomes were similar to those of the food producers, but with poorer dietary outcomes and greater food stress.Conclusions: The small-scale women farmers who are producing food cannot rely on the economic infrastructure to give them support for meaningful levels of production. However, despite having higher incomes than their food producing counterparts, the evidence showed that women who are producing coffee in Uganda as an export commodity cannot rely on the income from their crops to guarantee their health and nutritional wellbeing, and that the income advantage gained in coffee-producing households has not translated into consistently better health or food security outcomes. Both groups have limited levels of autonomy and control to address these problems.Key words: Globalization, women’s health, gender, smallholder farmers, Uganda, nutrition, food security, coffee producers, food producer

Tobacco use and associated factors among Adults in Uganda: Findings from a nationwide survey

Introduction Tobacco use and the exposure to tobacco smoke is one of the most preventable causes of death and disability globally. The risk is even higher among daily tobacco users. The World Health Organization (WHO) has recommended that surveillance of major risk factors for Non Communicable Diseases (NCDs) such as tobacco use is imperative to predict the future burden of NCDs, identify interventions to reduce future burden and monitor emerging patterns and trends. In 2014 the first Uganda nation-wide NCD risk factor survey was carried out to estimate the prevalence of major NCD risk factors. We analyzed data from this survey to estimate the prevalence of daily tobacco use and associated risk factors. Material and Methods A nationally representative sample was drawn stratified by the four regions of the country. The WHO’s STEPwise tool was used to collect data on demographic and behavioral characteristics including tobacco use, physical and biochemical measurements. Tobacco use was divided into three categories; daily tobacco use, daily smoked tobacco use and daily smokeless tobacco use. Weighted logistic regression analysis was used to identify factors associated with daily tobacco use. Results Of the 3983 participants, 9.2 % (366) were daily tobacco users, 7.4 % (294) were daily smoked tobacco users and 2.9 % (115) were daily smokeless tobacco users. Male participants were more likely to be daily tobacco users compared with female participants AOR 5.51 [3.81–7.95]. Compared with participants aged 18–29 years, those aged 30–49 years were more likely to be daily tobacco users AOR 2.47 [1.54–3.94] as were those aged 50–69 years AOR 2.82 [1.68–4.74]. Compared with participants without any education, those with primary education were less likely to be daily tobacco users AOR 0.43 [0.29–0.65], as were those with secondary education AOR 0.21 [0.14–0.33] and those with university level of education AOR 0.23 [0.11–0.48]. Compared with participants in the central region, those in the eastern region were more likely to be daily tobacco users AOR 2.14 [1.33–3.45] as were those in the northern region AOR 4.31 [2.79–6.45] and those in the western region AOR 1.87 [1.18–2.97]. Participants who were underweight were more likely to be daily tobacco users compared with people with normal BMI AOR 2.19 [1.48–3.24]. Conclusions In agreement with previous surveys on tobacco use, there is a high prevalence of tobacco use in Uganda with almost 1 in every 10 Ugandans using tobacco products daily. Being older, male, having no formal education, residing in the east, north and western regions and having low BMI were significantly associated with daily tobacco use. This information provides a useful benchmark to the National Tobacco Control Program for the designing of public health interventions for the control and prevention of tobacco use in Uganda

Risk factors for hematemesis in Hoima and Buliisa Districts, Western Uganda, September-October 2015

Introduction: On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors.Methods: We defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed casepatients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design.Results: We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (ORM-H = ∞; 95%CI = 3.7-∞); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (ORM-H = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs.Conclusion: This reported cluster of hematemesis illness was due to predisposing conditions and use of Non- Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with predisposing conditions.Keywords: Hematemesis, outbreak, case-control, Ugand

Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016

Introduction: the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates. Methods: we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates. Results: among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health facility. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation. Conclusion: almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination

Widening the Understanding of Risk Approaches by Comparing Definitions from Different Disciplines

The aim of this chapter is to critically reflect definitions of hazard, risk, and risk perception and their assessments used in different scientific disciplines and give examples of the potential implications for scientific discussions, knowledge management, and risk communication. Scientists with backgrounds in public health, psychology, environmental health, occupational health, engineering, sociology, and medicine were asked for a definition of hazard, risk, risk assessment, and risk perception seen from their specific scientific disciplines. Hazard is generally seen as an adverse event or condition. For most risk definitions, probability and severity are important aspects. Often a quantification of risk is desired, whereas risk perception is seen as a subjective appraisal and a cognitive construct. As risk perceptions are based on a combination of knowledge and individual values and affects, it may not provide a reliable guidance for risk management decisions on a societal level. Discipline differences are mainly connected to terminology and interpretation of key concepts, but the differences are based on different tasks and perspectives. For dealing with controversies in science across disciplines, an acceptance and appreciation of terminology and perspectives from different scientific disciplines are needed to ensure a transparent risk assessment process

Canning quality of popular common bean germplasm in Eastern and Central Africa

Common bean (Phaseolus vulgaris L.) genotypes popular in eastern and central Africa were evaluated to determine their suitability for the canning industry. The genotypes were planted at the National Agricultural Research Laboratories (NARL), Kawanda-Uganda in the second rainy seasons (July-September) of 2015, 2016 and off season of 2017 (November- February). Two samples per genotype were evaluated at the canning facilities at Kawanda and Michigan State University (MSU) using a protocol based on home canning. One sample per genotype from the 2017 harvest was evaluated at Agriculture and Agri-Food Canada, Lethbridge Research and Development Centre (AAFC-LRDC) using the industry canning protocol. Data (n=134) was collected on seed moisture content, dry and soaked bean weight, hydration coefficient (HC) and visual quality, including colour retention, appearance, brine clarity, bean splitting and freedom starch/clumps on replicated samples. Additional data on unreplicated samples were collected on 100-seed weight, seed solids for canning, hydration coefficient after soaking (HCS), hydration coefficient after blanching (HCB), drain weight (%), matting, appearance, seed color, texture, and cooking quality traits including hard seed and partially hydrated seed (%) and HC after cooking. Analysis of variance of data from MSU and Kawanda showed significant (P≤0.01) differences among genotypes for the assessed parameters. Majority of the genotypes expressed good soaking ability considering that their HC were above the 1.8 recommended for canning and 28% combined the two mentioned traits with good overall canning quality visual rating. Apart from 26, all other varieties had good HC based on data from Canada. About 24% of genotypes belonging to various market classes consistently combined this trait with good visual quality. The most outstanding genotypes based on these traits included SAB659 (red mottled), MAC44 (red mottled), NABE21 (cream), NABE12C (cream) and VAX5 (cream), KK8 (red mottled), Bihogo (yellow) and VAX4 (black). These genotypes were superior to the white beans: MEXICO 142, Awash1, and Awash Melka, that were considered as high-quality controls. Results indicated that genotypes of diverse backgrounds, with good canning quality traits exist among the currently utilised varieties and breeding lines. This diversity could be exploited for breeding and varietal promotion in the canning industry

Gain and performance in yield and micronutrient concentration in common bean improvement

Common bean (Phaseolus vulgaris L.) is a staple and nutritious leguminous food crop for all income categories in Africa. Efforts to improve its yield performance and nutritional components, especially Iron and zinc have resulted in the release of several varieties in the sub-Saharan African region. The objective of this study was to assess genetic progress in varieties released in 12 African countries through the Pan African Bean Research Alliance (PABRA) from 1973 to 2017, to inform current breeding decisions. A total of 214 released varieties, land races and breeding lines, of bush and climbing beans were evaluated for yield, micronutrient (Fe and Zn) concentration, and phenology in three locations (Kawanda and Kachwekano in Uganda, and Kitengule in Tanzania) in 2017–2018. There were significant differences (P 0.01) among genotypes for all traits except days to maturity (DPM). Genotype x environment interaction was also significant (P<0.05) for all assessed traits, except for iron in climbing beans. Across environments, repeatability (H2) was greater than 0.50 for all traits, except for DPM in climbing beans. Annual rates of genetic yield gains were 4.41 and 4.57 kg ha-1 for large and small seed bush beans, and -2.74 and 21.6 kg ha-1 for large and small seeded climbers. Similarly, gains in seed iron (FESEED) were 0.40 and 0.17 ppm for bush and climbing beans, respectively. These represented an annual relative gain over the oldest varieties of 0.6 and 0.7% kg ha-1 for yield of large and small seeded bush beans, -0.3 and 1.6% kg ha-1 for yield of large and small seeded climbers, 0.6 and 0.2% ppm for FESEED of bush and climbers. Overall, genetic progress was slow for both yield and FESEED

Development of white common beans for the processing industry in East Africa: Adaptability, resistance to selected diseases, cooking time and canning quality

Common bean ( Phaseolus vulgaris L.) provides dietary protein, energy, fiber, and micronutrients, especially iron and zinc to over 800 million people in Africa and Latin America. The crop has various seed types. White beans are very popular for the processing industry. This study aimed to investigate the agronomic performance, canning quality, cooking time (COOKT) and response to root rots ( Fusarium cuneirostrum and Pythium ultimum ) and angular leaf spot (ALS; Pseudocercospora griseola ) diseases among 151 drought tolerant small and large seeded white bean genotypes from trials conducted between 2013 to 2018 in East Africa. Significant (P&lt;0.001) differences existed among the genotypes for response to the three pathogens, COOKT and canning quality traits. Resistance to each of the pathogens was expressed in 24-75% of the genotypes, while dual resistance to any two pairs of the pathogens occurred in 10-44% of the genotypes. Four genotypes; ICNBunsixSxB405/4C-1C-1C-88, RAZ-11, ETSNAP18 and ETSNAP3 expressed resistance to the three pathogens but had COOKT of 46-56 minutes (based on a Matson cooker), and below average canning quality. They are recommended as sources of diseases resistance but could be further improved for COOKT and canning quality. Sixty-eight genotypes had COOKT &lt;50 minutes while 24 expressed good to excellent visual canning quality. Some phenotypes: RAZ-120, RAZ36-Caballero, NavyLine-60, NavyLine-25, ZABR16573-25F22, ZABR16575-60F22, ETSNAP33, Bifortsmallseeded-15 and ZABR16574-37F22, that were cooked in &lt;45 minutes, exhibited good to excellent canning quality and expressed resistant to intermediate diseases resistance responses. These may be used as parental lines and/or fast tracked for variety release through regional trials.Le haricot commun ( Phaseolus vulgaris L.) fournit des prot\ue9ines alimentaires, de l\u2019\ue9nergie, des fibres et des micronutriments, en particulier du fer et du zinc \ue0 plus de 800 millions de personnes en Afrique et en Am\ue9rique latine. La culture a divers types des graines, mais les haricots blancs sont tr\ue8s populaires dans l\u2019industrie de la transformation. Cette \ue9tude visait \ue0 \ue9tudier la qualit\ue9 agronomique et de mise en conserve, le temps de cuisson et la r\ue9ponse des haricots blancs aux pourritures des racines et \ue0 la tache angulaire (ALS, angular leaf spot) qui provoquent des pertes de rendement importantes dans la production des haricots en Afrique de l\u2019Est. Les haricots \ue0 petites et grandes graines am\ue9lior\ue9s pour la tol\ue9rance \ue0 la s\ue9cheresse ont \ue9t\ue9 \ue9valu\ue9s de 2013 \ue0 2018. Des diff\ue9rences significatives (P&lt;0,001) existaient entre les 151 g\ue9notypes pour la r\ue9ponse \ue0 trois agents pathog\ue8nes ( Fusarium cuneirostrum , Pythium ultimum and Pseudocercospora griseola ), le temps de cuisson et les caract\ue9ristiques de qualit\ue9 de mise en conserve. Il \ue9tait possible de s\ue9lectionner une r\ue9sistance \ue0 la maladie simple, double et triple. La r\ue9sistance \ue0 chacun des agents pathog\ue8nes a \ue9t\ue9 exprim\ue9e dans 24 \ue0 75 % des g\ue9notypes ; tandis qu\u2019une double r\ue9sistance \ue0 deux paires des agents pathog\ue8nes s\u2019est produite dans 10 \ue0 44 % des g\ue9notypes. Les quatre g\ue9notypes ; ICNBunsixSxB405/4C-1C-1C-88, RAZ-11, ETSNAP18 et ETSNAP3 qui ont exprim\ue9 une r\ue9sistance \ue0 trois agents pathog\ue8nes ont \ue9t\ue9 cuits en 46-56 minutes et sont recommand\ue9s comme sources de r\ue9sistance pour la reproduction, mais pourraient \ueatre encore am\ue9lior\ue9s pour une cuisson rapide et la qualit\ue9 de la mise en conserve \ue9tant donn\ue9 qu\u2019une qualit\ue9 g\ue9n\ue9rale de mise en conserve inf\ue9rieure \ue0 la moyenne a \ue9t\ue9 observ\ue9e. Les soixante-huit g\ue9notypes ont \ue9t\ue9 cuits en moins de 50 minutes tandis que 24 exprimaient une qualit\ue9 visuelle de mise en conserve bonne \ue0 excellente. Les g\ue9notypes comme RAZ-120, RAZ36-Caballero, NavyLine-60, NavyLine-25, ZABR16573-25F22, ZABR16575-60F22, ETSNAP33, Bifortsmallseed-15 et ZABR16574-37F22, cuits en moins de 45 minutes, pr\ue9sentaient une bonne \ue0 excellente mise en conserve la qualit\ue9 et la r\ue9sistance \ue0 une r\ue9ponse interm\ue9diaire aux maladies \ue9valu\ue9es ont \ue9t\ue9 recommand\ue9es \ue0 des fins de s\ue9lection et pour une \ue9valuation plus approfondie en vue d\u2019une promotion \ue9ventuelle

Screening, Diagnosis, and Management of Patients With Alcohol Use Disorders at Bwindi Community Hospital, Uganda.

From Europe PMC via Jisc Publications Router.Publication status: PublishedIntroduction: The harmful use of alcohol is a growing global public health concern, with Sub-Saharan Africa at particular risk. A large proportion of adults in Uganda consume alcohol and the country has a high prevalence of alcohol use disorders (AUD), almost double that for the African region as a whole. Bwindi Community Hospital, in rural western Uganda, recently introduced a program of screening, diagnosis and management of AUD and we assessed how this worked. Methods: This was a cross-sectional study in three departments (out-patients, adult in-patients and sexual & reproductive health) of Bwindi Community Hospital assessing numbers of patients screened, diagnosed and treated with AUD between January 2014 and June 2017. Data sources included the hospital electronic data base and departmental case files. Frequencies and proportions are reported and odds ratios used to compare specific factors associated with medical interventions. Results: Altogether, 82,819 patients attended or were admitted to hospital, of whom 8,627 (10.4%) were screened and 273 (3.2%) diagnosed with AUD. The adult in-patient department recorded the largest number with AUD (n = 206) as well as a consistent increase in numbers in the last 18 months of the study. Of those with AUD, there were 230 (84%) males, 130 (48%) aged 36-60 years, and 131 (48%) with medical non-alcohol related diagnostic categories. Medical/supportive interventions included guidance and counselling to 168 (62%), community social support to 90 (33%), mental health service referrals for 75 (27%), detoxification for 60 (22%) and referral to Alcoholics Anonymous for 41 (15%). There were 36 (15%) patients who received no medical/supportive interventions, with significantly higher proportions in patients with surgical alcohol-related disease and pregnancy-related conditions (P < 0.05). Conclusion: Bwindi Community Hospital has implemented a program for AUD in three departments, with most individuals screened and managed in the adult in-patient department. While a variety of interventions were given to those with AUD, 15% received no intervention and this deficiency must be addressed. Program performance could improve through better screening processes, ensuring that 100% of those with AUD receive a medical/supportive intervention and raising public awareness

A large and persistent outbreak of typhoid fever caused by consuming contaminated water and street-vended beverages: Kampala, Uganda, January - June 2015.

BACKGROUND: On 6 February 2015, Kampala city authorities alerted the Ugandan Ministry of Health of a "strange disease" that killed one person and sickened dozens. We conducted an epidemiologic investigation to identify the nature of the disease, mode of transmission, and risk factors to inform timely and effective control measures. METHODS: We defined a suspected case as onset of fever (≥37.5 °C) for more than 3 days with abdominal pain, headache, negative malaria test or failed anti-malaria treatment, and at least 2 of the following: diarrhea, nausea or vomiting, constipation, fatigue. A probable case was defined as a suspected case with a positive TUBEX® TF test. A confirmed case had blood culture yielding Salmonella Typhi. We conducted a case-control study to compare exposures of 33 suspected case-patients and 78 controls, and tested water and juice samples. RESULTS: From 17 February-12 June, we identified 10,230 suspected, 1038 probable, and 51 confirmed cases. Approximately 22.58% (7/31) of case-patients and 2.56% (2/78) of controls drank water sold in small plastic bags (ORM-H = 8.90; 95%CI = 1.60-49.00); 54.54% (18/33) of case-patients and 19.23% (15/78) of controls consumed locally-made drinks (ORM-H = 4.60; 95%CI: 1.90-11.00). All isolates were susceptible to ciprofloxacin and ceftriaxone. Water and juice samples exhibited evidence of fecal contamination. CONCLUSION: Contaminated water and street-vended beverages were likely vehicles of this outbreak. At our recommendation authorities closed unsafe water sources and supplied safe water to affected areas