Exploring how women negotiate pregnancy in respect to food behaviours and weight status : an interpretative phenomenological study

This study is a longitudinal exploration of women’s eating behaviours and weight status during motherhood starting from pre-conception, through pregnancy and into the early postpartum period.The study aimed to explore how women negotiate pregnancy in the context of food and weight status using IPA. The rationale was to capture from the diverse voices of different women what is important to them at these different time points and collectively how this informs behaviour in the motherhood journey. The participants consisted of three different, randomly selected sample sets of women 20- 40 years. Focus groups were carried out with 10 never pregnant women, followed by serial individual interviews with five currently pregnant women, and five women who had recently given birth, interviewed at 2 different time points.The findings highlight a change in women’s priorities described in superordinate themes along the motherhood cycle. Women’s priorities changed starting in pre-conception with a strong sense of self and realisation of limited time for childbearing, to focussing on the baby at the expense of the self, during and after pregnancy.The findings strongly show that women’s eating has emotional, biological and gendered meanings during the transition to motherhood. Socialisation, social events, expectations and peer support also strongly influenced how women negotiated conflict in this continuum. There are tensions in the postpartum period between the new focus on the baby (emerging during pregnancy), which prescribes healthful eating, and the stresses of a new motherhood lifestyle which reverts women to emotional eating (present preconceptually). In negotiating these tensions, women adopt the digital discourse as part of self-support behaviours in addition to trust and desire for the support of HCPs and significant others. The findings have implications for lifestyle interventions that acknowledge these tensions, women’s priorities and their coping strategies

Optimising stocking rates on livestock farms neighbouring wetlands for sustainable productivity and ecological stability

Uganda’s wetlands, especially in south-western Uganda are increasingly being invaded by cattle herders, particularly during droughts. Such uncontrolled grazing is accelerating wetland degradation. The objective of this study was to assess seasonal forage availability on farms neighbouring Ekigaaga wetland in south-western Uganda, and to determine their optimum stocking for sustainable productivity and ecological stability. The grazed area on each side of the virgin wetland was taken as a block, giving two blocks. In each block, three square metre sampling plots were demarcated along a transect line cutting across farms adjacent to the wetland. Some of these plots were fenced and others were left open to grazing by livestock. Two months after setting up the study, vegetation samples were collected from the fenced and unfenced plots in each block once every month, for a period of six months. Livestock classes and numbers grazing on each block were established and standardised into Tropical Livestock Units (TLU); where one TLU is equivalent to a cow weighing 250 kg. During wet and dry seasons, Cynodon dactylon was the most abundant forage species in the unfenced plots in both blocks. Fencing increased the prevalence of Chloris gayana and Themeda triandra in block 2. Sporobolus pyramidalis was the most abundant weed in both blocks. Fenced and unfenced plots in block 1 had higher grazeable forage yields (488.05 and 399.97 kg ha-1, respectively) than block 2 (432.08 and 371.97 kg ha-1, respectively). The TLU that could be safely grazed on blocks 1 and 2 were 121 and 107, respectively compared to the TLU being grazed on blocks 1 (279) and 2 (381). Therefore, to sustain the productivity and ecological stability of these grazing areas, there is need to control weeds/thickets, improve forage resources by oversowing with quality forages, and to adjust livestock numbers to match with forage quantities available for grazing. &nbsp

A digital assessment tool for monitoring and planning food security interventions in rural households of Uganda

In this paper, a digital assessment tool that is used to monitor food security in rural homesteads is presented. It provides instant results in the form of statistics that can help in planning for appropriate interventions. Food security is an essential and universal ingredient of any community’s well-being. The fact that food security is a complex and multidimensional concept, its measurement has been a challenge to both researchers and practitioners. The tool makes food security assessment and monitoring easier and can generate instant statistics that can inform appropriate interventions aimed at enhancing decisions of rural communities on food security. The tool is evaluated with the intended users and evaluation results indicate that it is a useful device for monitoring food security and for informing intervention program

Two decades of post-graduate training in Applied Public Health: The experience and challenges of the Uganda Public Health School Without Walls

The objective of this work is to describe the experience of the Uganda Public Health School Without Walls (PHSWOW) in training public health professionals at post-graduate level to offer leadership in planning, delivery of health services and research within a decentralized health system. As one of the constituents of the Makerere University College of Health Sciences, the Uganda PHSWOW has the vision of becoming a Centre of Excellence, providing leadership in public health and the mission of promoting the attainment of better health of the people in Uganda and beyond through public health training, research and community service. Key to the successes of the program are the 238 program graduates, most of whom have remained in-country to serve at district and national levels of service delivery. Collaborations have been established with government, private, non-governmental and international institutions leading to increased health service provision and research for the improvement of health status of populations and influence on public policy. There is still a lot to do in diversifying the skills mix of graduates and contributing to an ambitious increment from 0.4 to 4.7 public health professionals per 10,000 population; as is currently the case in high-middle income countries. Currently, the Uganda PHSWOW has exceeded the proposed output for FETPs of training 3 to 5 graduates per 1 million population suggested by some authors, however the output is still inadequate. More also needs to be done to promote a culture of publication in an effort to translate public health evidence into policy and practice

'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda

Objective: Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors’ internship experiences in Kenya and Uganda. Methods: Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data. Findings: Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being ‘treated like we are nobody’. Conclusion: We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors’ well-being and provide standardised supervision, support systems and conducive learning environments