Towards gender responsive policy formulation and budgeting in the agricultural sector: Opportunities and challenges in Uganda

Achieving economic growth while reducing poverty in an equitable manner demands that governments in Sub-Saharan Africa commit actions and resources to address gender inequalities, even more so under a changing climate which is expected to widen social inequalities (Dankelman, 2012). Internationally, the UN asserts that achieving gender equality, development and peace must be supported by explicit budgetary allocation to targeted activities to ensure gender equality at all scales (OSAGI, 2001). Over the past two decades, Uganda has advanced gender equality and empowerment of women. Uganda’s commitment to promote gender equality and equity was confirmed by enacting the National Gender Policy (1997, revised in 2007). Other components of the political and legal efforts to tackle gender inequality include (i) the 1995 Constitution of Uganda in articles 32 (3 & 4); (ii) the Equal Opportunities Act (2007); (iii) the Public Finance Management Act (2015); and (iv) the National Development Plan II (2015/16-2019/20). However, despite all these initiatives, effective gender mainstreaming as a strategy for addressing gender inequalities remains a big challenge, as manifested by Uganda’s Gender Inequality Index of 0.538, ranking 122 out of 155 countries in the 2014 index (UNDP, 2015)

Gender responsive policy formulation and budgeting in Tanzania: do plans and budgets match?

The Convention on the Elimination of All Forms of Discrimination against Women has been ratified by more countries than any other UN convention (Gabizon, 2016). The United Republic of Tanzania is one such country that hopes to fully utilize its human resources, both men and women, for socio-economic development. It is recognized that the continued marginalization of women constitutes a major obstacle to rapid socio-economic development of the country (MCDGC, 2005). The United Republic of Tanzania–through the Ministry of Community Development, Gender and Children–has prioritized gender equality through different instruments: the Constitution of the United Republic of Tanzania was amended in 2005 to increase women’s participation in the National Parliament and Local Authorities; the Women and Gender Development Policy of 2000 puts more emphasis on women in development, and the National Strategy for Gender Development was intended to promote gender equality and equity. Despite these developments, challenges still remain, as demonstrated by Tanzania’s low ranking (123rd out of 149 countries) on the 2013 Gender Inequality Index (UNDP, 2015)

Diagnostic performance of blood inflammatory markers for tuberculosis screening in people living with HIV.

BackgroundApproaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy.MethodsConsecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the top-ranked cytokines/chemokines individually and in combination with sensitivity constrained to ≥ 90% as recommended for TB screening.ResultsThe median plasma level of 5 biomarkers (IL-6, INF-γ, MIG, CRP, IL-18) was significantly different between patients with and without TB. With sensitivity constrained to 90%, all had low specificity with IL-6 showing the highest specificity (44%; 95% CI 37.4-49.5). Biomarker panels were found to be more valuable than any biomarker alone. A panel combining IFN-γ and IL-6 had the highest specificity (50%; 95% CI 46.7-53.3). Sensitivity remained high (>85%) for all panels among sputum smear-negative TB patients.ConclusionsDirect measurement of unstimulated plasma cytokines/chemokines in peripheral blood is a promising approach to TB screening. Cytokine/chemokine panels retained high sensitivity for smear-negative TB and achieved improved specificity compared to individual cytokines/chemokines. These markers should be further evaluated in outpatient settings where most TB screening occurs and where other illnesses associated with systematic inflammation are less common

Diagnostic performance of blood inflammatory markers for tuberculosis screening in people living with HIV.

BACKGROUND:Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy. METHODS:Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough ≥ 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the top-ranked cytokines/chemokines individually and in combination with sensitivity constrained to ≥ 90% as recommended for TB screening. RESULTS:The median plasma level of 5 biomarkers (IL-6, INF-γ, MIG, CRP, IL-18) was significantly different between patients with and without TB. With sensitivity constrained to 90%, all had low specificity with IL-6 showing the highest specificity (44%; 95% CI 37.4-49.5). Biomarker panels were found to be more valuable than any biomarker alone. A panel combining IFN-γ and IL-6 had the highest specificity (50%; 95% CI 46.7-53.3). Sensitivity remained high (>85%) for all panels among sputum smear-negative TB patients. CONCLUSIONS:Direct measurement of unstimulated plasma cytokines/chemokines in peripheral blood is a promising approach to TB screening. Cytokine/chemokine panels retained high sensitivity for smear-negative TB and achieved improved specificity compared to individual cytokines/chemokines. These markers should be further evaluated in outpatient settings where most TB screening occurs and where other illnesses associated with systematic inflammation are less common

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine