The traditional history of the Buganda kingdom, with special reference to the historical writings of Sir Apolo Kaggwa.

In committing Buganda's oral traditions to writing, Kaggwa did not consciously set out to write a history of Buganda. Consequently, some of these traditions are mere legends, though they are being increasingly used by the historians as historical sources. Such interest, has demonstrated the need for a critical study of these traditions so as to disentangle history from mythology. And in order to make Kaggwa's work available to the world of learning, an English translation has been made with annotations. But although we have found the Kiganda traditions largely reliable some of the conclusions drawn from them are by no means definitive. One learns from these traditions, something about the settlement and the expansion of Buganda, and the growth of her political institutions. Buganda's early history is that of a struggling small kingdom surrounded by a powerful neighbour, Bunyoro. But the picture changes during the 17th century when Buganda begins to expand at Bunyoro's expense, and by the beginning of the 19th century, she had already become the dominant power. This expansion, created administrative and military problems. Hence new chieftainships were established and through them, Buganda developed an efficient system of local government dominated by the King. But originally the king was more or less equal to the Bataka. Buganda's isolation from the outside world, was broken during the reign of Suna II by the visits of the Arabs. They were followed by the European explorers and missionaries during the reign of Mutesa I. Their existence in Buganda, the introduction of firearms and other trade goods, the teachings of Christianity and Islam; combined to accelerate the political and social revolution which had begun two centuries before

Correlates of ever had sex among perinatally HIV-infected adolescents in Uganda

Background: The objective of this study was to explore the correlates of ever had sex among perinatally HIV-infected PHIV) adolescents. Methods: A cross-sectional survey of sexual behaviour was conducted with 624 PHIV adolescents living three regions 12 districts) of Uganda. Data was collected on socio demographic characteristics (age, sex, occupation, religion and education status), sexual practices and behaviours (Intimate relationships, sexual intercourse, age of sexual debut, condom use, multiple and concurrent sexual partners), consequences of sexual behaviours (pregnancy and STI’s) and life style factors (use of alcohol, psychoactive substances and peer influence). Multivariable logistic-regression was used to ascertain the determinants of sexual activity. Results: The majority of PHIV were female (59.3 %) and the mean age of the sample was 16.2 (±2.1) years. The mean age of sexual debut was 15.8 years; 16.2 % (101/624) reported symptoms for sexually transmitted infections (STI) and more than a third (213/624) reported ever had sex. Of these 76.5 % (165/213) used condoms inconsistently; and 49.3 % (105/213) had been pregnant or made someone pregnant. Of those in relationships, 56.3 % (223/396) did not disclose and were not aware of their partners’ HIV status. Adolescents aged 15–19 years were more likely to have ever been sexually active (Adjusted odds ratio (AOR) 6.28, 95 % Confidence interval (CI): 2.63-14.99) compared to those aged 10–14 years. Adolescents who were living alone were more likely to have ever been sexually active compared to those living with one or both parents (AOR 4.33, 95 % CI: 1.13-16.62). The odds of being sexually active were lower among adolescents in school compared to those out of school (AOR 0.2, 95 % CI:0.13-0.30), who had never been treated for STI (compared to those who had never been treated for STI) (AOR 0.19, 95 % 0.11-0.32) and adolescents who never drank alcohol (AOR 0.49, 95 % CI 0.28-0.87). Conclusion: PHIV adolescents have risky sexual behaviours charac terized by being sexually active, inconsistent condom use, and having partners of unknown status. Risk reduction interventions are required to minimize unplanned pregnancies, STI, and HIV transmission by PHIV adolescents

Adolescent Abstinence and Unprotected Sex in CyberSenga, an Internet-Based HIV Prevention Program: Randomized Clinical Trial of Efficacy

Context Cost-effective, scalable programs are urgently needed in countries deeply affected by HIV. Methods: This parallel-group RCT was conducted in four secondary schools in Mbarara, Uganda. Participants were 12 years and older, reported past-year computer or Internet use, and provided informed caregiver permission and youth assent. The intervention, CyberSenga, was a five-hour online healthy sexuality program. Half of the intervention group was further randomized to receive a booster at four-months post-intervention. The control arm received ‘treatment as usual’ (i.e., school-delivered sexuality programming). The main outcome measures were: 1) condom use and 2) abstinence in the past three months at six-months' post-intervention. Secondary outcomes were: 1) condom use and 2) abstinence at three-month's post-intervention; and 6-month outcomes by booster exposure. Analyses were intention to treat. Results: All 416 eligible youth were invited to participate, 88% (n = 366) of whom enrolled. Participants were randomized to the intervention (n = 183) or control (n = 183) arm; 91 intervention participants were further randomized to the booster. No statistically significant results were noted among the main outcomes. Among the secondary outcomes: At three-month follow-up, trends suggested that intervention participants (81%) were more likely to be abstinent than control participants (74%; p = 0.08), and this was particularly true among youth who were abstinent at baseline (88% vs. 77%; p = 0.02). At six-month follow-up, those in the booster group (80%) reported higher rates of abstinence than youth in the intervention, no booster (57%) and control (55%) groups (p = 0.15); they also reported lower rates of unprotected sex (5%) compared to youth in the intervention, no booster (24%) and control (21%) groups (p = 0.21) among youth sexually active at baseline. Conclusions: The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and, with the booster, may also promote HIV preventive behavior among sexually active youth in the longer term. Trial Registration NCT00906178

Young people, inequality and violence during the COVID-19 lockdown in Uganda

This working paper reports findings from a qualitative study on how response measures during the early stages of the COVID-19 pandemic in Uganda have affected the lives of adolescent young people. The study was conducted as part of a broader research project: Contexts of Violence in Adolescence Cohort Study (CoVAC), with data collected through mobile phone interviews in May-June 2020 with 18 girls and 16 boys (mainly aged 16-19 years) who have been participants in our longitudinal study. The data are contextualized within longitudinal biographical narratives of these young people that have been developed since 2018 and which helped us to illuminate the significance of the crisis in their everyday lives. The analysis shows how effects on young people of the lockdown varied according to gender, location, mobility and socio-economic background, amplifying inequalities and creating the conditions for multiple forms of violence

Working with Community Health Workers to Improve Maternal and Newborn Health Outcomes: Implementation and Scale-Up Lessons from Eastern Uganda

Background: Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation. Objectives: This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy. Methods: The CHWs were trained to conduct four home visits: two during pregnancy and two after delivery. The aim of the visits was to promote birth preparedness and utilization of maternal and newborn health (MNH) services. Mixed methods of data collection were employed. Quantitative data were analyzed using Stata version 13.0 to determine the level and predictors of CHW knowledge of MNH. Qualitative data from 10 key informants and 15 CHW interviews were thematically analyzed to assess the implementation experiences. Results: CHWs’ knowledge of MNH improved from 41.3% to 77.4% after training, and to 79.9% 1 year post-training. However, knowledge of newborn danger signs declined from 85.5% after training to 58.9% 1 year later. The main predictors of CHW knowledge were age (≥ 35 years) and post-primary level of education. The level of coverage of at least one CHW visit to pregnant and newly delivered mothers was 57.3%. Notably, CHW reports complemented the facility-based health information. CHWs formed associations, which improved teamwork, reporting, and general performance, and thus maintained low dropout rates at 3.6%. Challenges included dissatisfaction with the quarterly transport refund of 6 USD and lack of means of transportation such as bicycles. Conclusions: CHWs are an important resource in community-based health information and improving demand for MNH services. However, the CHW training and supervision models require strengthening for improved performance. Local solutions regarding CHW motivation are necessary for sustainability.DFI

Recruitment and retention of women in fishing communities in HIV prevention research

Introduction: Women in fishing communities in Uganda are more at risk and have higher rates of HIV infection. Socio-cultural gender norms, limited access to health information and services, economic disempowerment, sexual abuse and their biological susceptibility make women more at risk of infection. There is need to design interventions that cater for women’s vulnerability. We explore factors affecting recruitment and retention of women from fishing communities in HIV prevention research. Methods: An HIV incidence cohort screened 2074 volunteers (1057 men and 1017 women) aged 13-49 years from 5 fishing communities along Lake Victoria using demographic, medical history, risk behaviour assessment questionnaires.1000 HIV negative high risk volunteers were enrolled and followed every 6 months for 18 months. Factors associated with completion of study visits among women were analyzed using multivariable logistic regression. Results: Women constituted 1,017(49%) of those screened, and 449(45%) of those enrolled with a median (IQR) age of 27 (22-33) years. Main reasons for non-enrolment were HIV infection (33.9%) and reported low risk behaviour (37.5%). A total of 382 (74%) women and 332 (69%) men completed all follow up visits. Older women (>24 yrs) and those unemployed, who had lived in the community for 5 years or more, were more likely to complete all study visits. Conclusion: Women had better retention rates than men at 18 months. Strategies for recruiting and retaining younger women and those who have stayed for less than 5 years need to be developed for improved retention of women in fishing communities in HIV prevention and research Programs

Phylogenetic Networks and Parameters Inferred from HIV Nucleotide Sequences of High-Risk and General Population Groups in Uganda:Implications for Epidemic Control

Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in evaluating determinants of HIV spread. We analyzed 2017 HIV pol sequences (728 Lake Victoria fisherfolk communities (FFCs), 592 female sex workers (FSWs) and 697 general population (GP)) to identify transmission networks on Maximum Likelihood (ML) phylogenetic trees and refined them using time-resolved phylogenies. Network generative models were fitted to the observed degree distributions and network parameters, and corrected Akaike Information Criteria and Bayesian Information Criteria values were estimated. 347 (17.2%) HIV sequences were linked on ML trees (maximum genetic distance ≤4.5%, ≥95% bootstrap support) and, of these, 303 (86.7%) that consisted of pure A1 (n = 168) and D (n = 135) subtypes were analyzed in BEAST v1.8.4. The majority of networks (at least 40%) were found at a time depth of ≤5 years. The waring and yule models fitted best networks of FFCs and FSWs respectively while the negative binomial model fitted best networks in the GP. The network structure in the HIV-hyperendemic FFCs is likely to be scale-free and shaped by preferential attachment, in contrast to the GP. The findings support the targeting of interventions for FFCs in a timely manner for effective epidemic control. Interventions ought to be tailored according to the dynamics of the HIV epidemic in the target population and understanding the network structure is critical in ensuring the success of HIV prevention programs

Evaluation of a large-scale donation of Lifebox pulse oximeters to non-physician anaesthetists in Uganda

Summary Pulse oximetry is widely accepted as essential monitoring for safe anaesthesia, yet is frequently unavailable in resource-limited settings. The Lifebox pulse oximeter, and associated management training programme, was delivered to 79 non-physician anaesthetists attending the 2011 Uganda Society of Anaesthesia Annual Conference. Using a standardised assessment, recipients were tested for their knowledge of oximetry use and hypoxia management before, immediately following and 3–5 months after the training. Before the course, the median (IQR [range]) test score for the anaesthetists was 36 (34–39 [26–44]) out of a maximum of 50 points. Immediately following the course, the test score increased to 41 (38–43 [25–47]); p < 0.0001 and at the follow-up visit at 3–5 months it was 41 (39–44 [33–49]); p = 0.001 compared with immediate post-training test scores, and 75/79 (95%) oximeters were in routine clinical use. This method of introduction resulted in a high rate of uptake of oximeters into clinical practice and a demonstrable retention of knowledge in a resource-limited setting

A qualitative analysis of migrant social workers’ work experiences and perceived prejudice from an empowering acculturative integration approach

An increasing number of migrant social workers are employed in the UK social work sector. This article explores the acculturative integration experiences of a small group of migrant social workers. We critically observe that research on migrant professionals’ trajectories should adopt theories that emphasise people’s empowerment and potential for agency. We use a framework drawing on liberation psychology for analysing the autobiographical narratives of a sample of migrant social workers employed in England. Findings indicate that the participants perceived prejudice on a number of occasions and circumstances. Even though in their narrative of survival they talked about activating several psychosocial resources, they were sceptical about their professional development and dissatisfied at work. The paper discusses the emerging findings while highlighting the framework’s relevance for understanding these experiences from an empowering acculturation perspective and suggesting ways of improving migrant social workers’ acculturative integration by addressing systemic barriers