Implementation of Universal Primary Education Programme in Uganda and its Influence on Education Performance

This study was an assessment of implementation process of Universal Primary education (UPE) programme in Uganda and how it influences the performance of the programme. The principal whim for undertaking this study was the yearning to assess the quality of UPE in Uganda derived from the view that having reached the year 2015, the year that was set for achieving UPE Millennium Development Goal number 2, and the national commitment to improving quality primary education remains unclear. In order to attain this, a combination of research methods have been conducted particularly the interviews and documentary analysis; where 11interviews were carried out. Further analysis was done on content documents Annual Education Abstracts from the Ministry of education and sports and some reports from NAPE and UWEZO. From the findings, quality implementation framework was not followed, implementation process influences programme performance, and it’s not only implementation that influences performance but also other factors

Micro-credit and Women Empowerment: A Case of Female Headed Households in Uganda

Progress of any society especially the poor is based on government Interventions or any development partner. Micro-credit are mandated to empower women. This study aimed at finding out whether the outcomes of utilization of Micro-credit have led to empowerment of Female Headed Households (FHHs). Data collection was done from 209 respondents. Qualitative Research design guided the study. Research tools like questionnaires, interviews, focused group discussions and observation were mainly employed. Data was collaborated with the literature review during discussion. The Study reveals that Micro-credit  provided loans to start income generating projects, training and skills development, mobilisation of savings, money transfers and mobile money banking services, leading to improved incomes, household welfare and domestic purchases. Above all, female headed households continue to be poor and marginalised amidst such Interventions. The study recommends that Micro-credit be made more flexible, incorporate special relief non-financial intermediations and schemes in order to meet the deliberate gender needs within the household and at the community level

The Impact of Intra-Household Gender Relations in Accessing Agricultural Extension Services for Improved Livelihoods: The Case of NAADS Beneficiary Sub-Counties in Kabale District

This study explored the influence of intra-household gender relations in access to Agricultural Extension Services (AESs) for improved livelihoods as a pathway to long term poverty reduction. The study covered the four NAADS pioneer beneficiary Sub counties of Bubare, Bukiinda, Ikumba and Maziba in Kabale district. It analysed gender based relational differences prevailing between men and women in a household (HH) in the creation and recreation of secure livelihoods through AESs. A mixed method approach with cross sectional and exploratory research designs was used to collect data through documentary review, Focus Group Discussions (FGDs), HH surveys, Key Informant (KI) interviews and observation checklist. The study sample comprised of 181 farmers’ HHs and 14 KIs.The study results revealed that intra-HH gender relations among the Bakiga people of Kabale district are situated within a patriarchal setting which exhibit men’s dominance over women’s decisions in major spheres of life which affects equal access to AESs. Although AESs have been  operational in the district for over a decade, their existence has not transformed farmers’ livelihoods in  which is majorly attributed to unequal gender relations with regard to gender roles and division of labour, resource distribution, ownership and control as well as decision making which are reinforced by the Bakiga’s patriarchal system. Extension system is “gender blind” and NAADS agents/officials pay little attention to the gender relations which are skewed in favour of men, yet women are the key actors in agriculture production and reproduction. Micro, meso and macro level extension systems and structures were also anchored onto the patriarchal power setting thus obscure how women and men access production resources in their HHs in pursuit of livelihood streams. Thus, there is need for equitable technical advice to principle HHs members and examination of the composition of AESs structure as well as deconstructing HH power and control structure in pursuit of improved livelihood. This will empower women who are the linchpin of HH production and reproduction hence creating foundational pathways for improved livelihood

Challenges Facing Female Headed Households in Accessing and Utilizing Microfinance Lending among Selected Municipalities of South West Uganda

Sub-Saharan Africa is characterized by gender inequality in the form of income, health, education, employment and human rights; suggesting that efforts aimed at reducing extreme poverty benefit males relatively more than females. Access to microfinance is one single factor identified to contribute to reduction in gender inequality. However, female headed households continue to be excluded from utilizing microfinance services either due to their relatively low income levels and lack of assets as collateral.  The central question of this paper is whether increased access to microfinance leads to reduction of poverty among female headed households in selected municipalities of south west Uganda. This paper contributes to the existing literature by examining the local context faced by female headed households; in relation to ownership of household assets, health and education expenditures. The study was carried out in Mbarara and Bushenyi-Ishaka Municipalities. Data was collected from a total of 209 respondents by use of questionnaires, interviews and focused group discussions.The study reveals that female headed household face accessibility challenges like bureaucracy, limited collateral security, discrimination, loan delays and high cost of borrowing.  Challenges related to loan utilization included group tension over loan repayment, loan terms, grace period, interest rates, fines and penalties.There is need for government intervention so as to embrace flexible lending policies and accommodate the gender needs and challenges of FHH borrowers. The study findings will be used by policy and development planners to redesign microfinance strategies aimed at improving the plight of the marginalized groups like women in FHH.

From antiretroviral therapy access to provision of third line regimens: evidence of HIV Drug resistance mutations to first and second line regimens among Ugandan adults.

HIV care programs in resource-limited settings have hitherto concentrated on antiretroviral therapy (ART) access, but HIV drug resistance is emerging. In a cross-sectional study of HIV-positive adults on ART for ≥6 months enrolled into a prospective cohort in Uganda, plasma HIV RNA was measured and genotyped if ≥1000 copies/ml. Identified Drug resistance mutations (DRMs) were interpreted using the Stanford database, 2009 WHO list of DRMs and the IAS 2014 update on DRMs, and examined and tabulated by ART drug classes. Between July 2013 and August 2014, 953 individuals were enrolled, 119 (12.5%) had HIV-RNA ≥1000 copies/ml and 110 were successfully genotyped; 74 (67.3%) were on first-line and 36 (32.7%) on second-line ART regimens. The predominant HIV-1 subtypes were D (34.5%), A (33.6%) and Recombinant forms (21.8%). The commonest clinically significant major resistance mutations associated with the highest levels of reduced susceptibility or virological response to the relevant Nucleoside Reverse Transcriptase Inhibitor (NRTI) were; the Non-thymidine analogue mutations (Non-TAMS) M184V-20.7% and K65R-8.0%; and the TAMs M41L and K70R (both 8.0%). The major Non-NRTI (NNRTI) mutations were K103N-19.0%, G190A-7.0% and Y181C-6.0%. A relatively nonpolymorphic accessory mutation A98G-12.0% was also common. Seven of the 36 patients on second line ART had major Protease Inhibitor (PI) associated DRMS including; V82A-7.0%, I54V, M46I and L33I (all 5.0%). Also common were the accessory PI mutations L10I-27%, L10V-12.0% and L10F-5.0% that either reduce PI susceptibility or increase the replication of viruses containing PI-resistance mutations. Of the 7 patients with major PI DRMs, five had high level resistance to ritonavir boosted Lopinavir and Atazanavir, with Darunavir as the only susceptible PI tested. In resource-limited settings, HIV care programs that have previously concentrated on ART access, should now consider availing access to routine HIV viral load monitoring, targeted HIV drug resistance testing and availability of third-line ART regimens

Antiretroviral therapy uptake and coverage in four HIV community cohort studies in sub-Saharan Africa

OBJECTIVE: To compare socio-demographic patterns in access to antiretroviral therapy (ART) across four community HIV cohort studies in Africa. METHODS: Data on voluntary counselling and testing and ART use among HIV-infected persons were analysed from Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and Manicaland (Zimbabwe), where free ART provision started between 2004 and 2007. ART coverage was compared across sites by calculating the proportion on ART among those estimated to need treatment, by age, sex and educational attainment. Logistic regression was used to identify socio-demographic characteristics associated with undergoing eligibility screening at an ART clinic within 2 years of being diagnosed with HIV, for three sites with information on diagnosis and screening dates. RESULTS: Among adults known to be HIV-infected from serological surveys, the proportion who knew their HIV status was 93% in Karonga, 37% in Kisesa, 46% in Masaka and 25% in Manicaland. Estimated ART coverage was highest in Masaka (68%) and lowest in Kisesa (2%). The proportion of HIV-diagnosed persons who were screened for ART eligibility within 2 years of diagnosis ranged from 14% in Kisesa to 84% in Masaka, with the probability of screening uptake increasing with age at diagnosis in all sites. CONCLUSIONS: Higher HIV testing rates among HIV-infected persons in the community do not necessarily correspond with higher uptake of ART, nor more equitable treatment coverage among those in need of treatment. In all sites, young adults tend to be disadvantaged in terms of accessing and initiating ART, even after accounting for their less urgent need

Cardiometabolic risk among HIV-POSITIVE Ugandan adults: prevalence, predictors and effect of long-term antiretroviral therapy.

INTRODUCTION: We investigated the prevalence, predictors of and effect of Antiretroviral Therapy (ART) regimen on cardiometabolic risk among HIV-positive Ugandan adults at enrolment into a prospective cohort to study the Complications of Long-Term ART (CoLTART). METHODS: We collected data on cardiometabolic risk factors including dyslipidemia, hypertension, hyperglycemia, obesity and calculated the mean atherogenic index for Plasma (AIP) and 10 year Framingham risk score (FHS). Exposures were: ART regimen, duration on ART, demographic, socio-economic, behavioral, and life-style factors including smoking, physical activity and diet (including fruit and vegetables consumption). RESULTS: We enrolled 1024 participants, 65% female, mean age was 44.8 years (SD 8.0) and median duration on ART was 9.4 years (IQR 6.1-9.8). The prevalence of abdominal obesity was 52.6%, BMI?25 kg/m2 -26.1%, hypertension-22.6%, high AIP-31.3% and FHS above 10% was 16.6%. The prevalence of low High Density Lipoprotein (HDL) was 37.5%, high Total cholesterol (Tc)-30.2%, high Low Density Lipoprotein (LDL) -23.6%, high Triglycerides (TG)-21.2%, low physical activity-46.4% and alcohol consumption-26.4%. In multivariate linear regression analyses, increasing age was associated with higher mean Tc, HDL, LDL, FHS (P10% compared to the non PI regimen. CONCLUSION: ART increases cardiometabolic risk. Integration of routine assessment for cardiometabolic risk factors and preventive interventions into HIV care programs in resource-limited settings is recommended

The effect of Tenofovir on renal function among Ugandan adults on long-term antiretroviral therapy: a cross-sectional enrolment analysis.

BACKGROUND: WHO recommends using Tenofovir containing first line antiretroviral therapy (ART), however, Tenofovir has been reported to be associated with renal impairment and dysfunction. We compared renal function among individuals on Tenofovir and those on non-Tenofovir containing ART. METHODS: In a cross-sectional study of HIV-Positive adults on ART, at enrolment into a prospective cohort to study the long-term complications of ART in Uganda, information on biophysical measurements, medical history, clinical examination and renal function tests (RFTs) was collected. Fractional Tubular phosphate reabsorption and estimated glomerular filtration rate (eGFR) were calculated. Mean values of RFTs and proportions with abnormal RFTs were compared between non-Tenofovir containing (Non-TDF) and Tenofovir containing (TDF-ART) ART regimen groups using a general linear regression model. Durations of TDF exposure were also compared. RESULTS: Between July 2013 and October 2014, we enrolled 953 individuals on ART for 6 or more months, median duration on ART was 9.3 years, 385 (40.4 %) were on non-TDF and 568 (59.6 %) on TDF-ART regimens. The proportion of participants with Proteinuria (>30 mg/dl) was higher among the TDF-ART group than the non-TDF ART group. However, in multivariable analysis, there were no significant differences in the adjusted mean differences of eGFR, serum urea, serum creatinine, fractional tubular reabsorption of phosphate and serum phosphates when patients on TDF-ART were compared with those on non-TDF containing ART. There were no differences in renal function even when different durations on Tenofovir were compared. CONCLUSIONS: We found no differences in renal function among patients on Tenofovir and non-Tenofovir containing ART for almost a decade. Tenofovir based first line ART can therefore safely be initiated even in settings without routine renal function monitoring