Explore the vast range of titles available.

Pig production has a short history in Uganda. The majority of pigs are kept by smallholder farmers in rural areas where access to veterinary services is limited, and pig keeping has been suggested as a potential pathway out of poverty for smallholders. Previous research has identified the disease of African swine fever (ASF) as a major threat, causing high mortalities in pigs. With no available cure or vaccine, the only option is to implement biosecurity measures, i.e. strategies that prevent the spread of ASF. This paper draws on data from four months of ethnographic fieldwork in rural northern Uganda. Combining methods of participant observation, semi-structured interviews, focus group discussions and a survey, the aim was to improve understanding of smallholders’ perceptions and responses to pig health issues such as ASF. Applying the concept of practical knowledge, this paper analyses the potential and limitations of smallholders’ practice-based knowledge as a means of dealing with pig health issues. The results show that while pigs were appreciated locally for providing an income, many informants found it difficult to deal with pig diseases effectively. Consequently, informants commonly expressed a need for other kinds of knowledge in their pig production, indicating that veterinary advice can play an important role in reducing the negative impact of pig health issues. For animal health provision to have relevance in this context, however, veterinary practitioners must pay close attention to smallholders’ priorities and ways of knowing in their livestock keeping. Results further show that pig health issues made some informants abandon pig production altogether. To enhance the potential of pig production as a poverty mitigation strategy in Uganda, research and policy need to focus on ways of bettering general conditions for smallholder pig keeping, including improving the quality of and access to veterinary services in rural areas.

Background Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda. Methods A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0. Results A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother’s milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child. Conclusion In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk.

Background An epidemic of Hepatitis E infection occurred in Kitgum district, northern Uganda in 2009. In that epidemic, more than 10,422 people were infected, and over 166 deaths were registered. Kitgum District Health Management Information Systems (HMIS) showed that Hepatitis E cases continued to occur in Mucwini more than in Kitgum Matidi sub-county despite instituting similar epidemic control measures in the two communities. The tenacity of the virus in Mucwini sub-county had remained unclear. This study aimed to assess communities’ views and perspectives on the differential prevalence of Hepatitis E in the two sub-counties of Kitgum Matidi and Mucwini in northern Uganda. Methods A mixed study using qualitative and quantitative methods was used. Four Focus group discussions and six key informant interviews were conducted with the village health teams, local council chairpersons, health workers, and community members. These participants were chosen purposively because of their expertise and experience in community health services. Face-to-face interview guides were administered to obtain detailed information on factors associated with the differential occurrence of Hepatitis E in the two sub-counties. This study was approved by a local IRB and the Uganda National Council of Science and Technology (UNCS&T). Results The most substantial findings were the differences in prevention and control practices in the two communities. Residents of Mucwini were less compliant with infection, prevention, and control guidelines, and disagreements between local councilors and village health teams in Mucwini over allowances led to poor implementation and non-adherence to guidelines on community control of the epidemic. Conclusion A differentially higher prevalence of Hepatitis E in Mucwini than in Kitgum Matidi resulted from poor personal and community hygiene and non-adherence to behavior change communication among residents of Mucwini than their counterparts in Kitgum Matidi. The authors recommend a more proactive approach to managing an epidemic by securing the willingness of the affected community to adopt appropriate infection prevention and control guidelines. In addition, disagreements among stakeholders should be resolved quickly so that all community members adhere to control measures.

Background Piggery production is a main income source for the rural poor in Uganda, where 1.3 million households own about 4.47 million pigs. Nonetheless, health challenges and lack of knowledge by the farmers affect the productivity and profits of the pig enterprises. Thus, this study determined the knowledge and practices among smallholder pig farmers and the associated risk factors for pig gastrointestinal disorders in Masindi district, Uganda. Methods A cross-sectional survey was conducted using a closed-end questionnaire interview of 170 smallholder pig farmers in the rural district of Masindi, from March to July 2020. The qualitative data was analyzed and presented as frequencies, percentages, and their 95% confidence intervals. Bivariate and multi-variate analysis were used to determine factors associated with GIT disorders. Results Of the 170 farmers, males and females were equal (50%), mostly as pig owners (91.2%), rural folks (88.8%), who raised other animal species (72.9%) and with 5–10 years (72.4%) of experience. Of these, 67.6% were married, mainly in age ranges of groups 19–50 (90.6%) and 47.6% had attained primary school level. Pig rearing was for income generation (95.5%) and 79.4% reported GIT disorders on their farms, affecting local breeds (57.0%) of all age groups and throughout the year. Similarly, most of the farmers understood transmission routes of GIT disorders and adhered to biosecurity practices. However, 62.9% treated the sick pigs, 40.6% sold the sick pigs and only 25.9% consulted a veterinarian. At multivariable logistic regression analysis, being a female farmer ( p  = 0.018, OR = 3.163, CI: 1.213, 8.244); mixing of different herds of pigs ( p  = 0.003, aOR = 4.141, 95%CI (1.317,13.013); feeding pigs on raw tubers ( p  = 0.017, aOR = 2.703, 95% CI (1.198,6.099) and scavenging ( p  < 0.001, aOR = 9.605, 95% CI (2.131,43.289) were significantly associated with GIT disorders. Conclusion Poor husbandry practices especially feeding on raw tubers, scavenging and mixing of different herds of pigs were associated with widespread pig GIT disorders. Involving women in strategies to improve pig GIT health as equal partners is suggested. Farmers are encouraged to adopt confinement and housing of pigs as the minimum good husbandry practices for sustainable pig production.

Globally, rabies claims about 59,000 human lives annually, and 99% of human transmission is by dogs. The disease is entirely preventable through mass dog vaccination. Despite this, only an estimated 10% of dogs in Uganda are vaccinated, and the reasons for this low uptake are not fully understood. This study investigated barriers to mass dog vaccination for rabies control in Kyegegwa, a rural Ugandan district. This qualitative study was conducted with eight key informants (KIs) and twelve focus groups (FGs) with participants from twelve randomly selected parishes. Audio recordings were transcribed in English and transcripts were managed using Atlas ti version 6.0 data management software. Thematic analysis was conducted to produce the results. This study identified three major themes affecting mass dog vaccination in Kyegegwa District: (1) community dynamics, including misconceptions about vaccines, limited awareness, and difficulties in handling aggressive dogs; (2) Resource and service constraints such as vaccine shortages, limited veterinary personnel, and high costs; and (3) Systemic and operational challenges, including delayed campaign announcements, poor communication, and lack of vaccination certificates. These barriers collectively explain the persistently low coverage of mass dog vaccination in rural Uganda. Limited awareness, logistical challenges, and inadequate veterinary resources were reported to be barriers to rabies control in Kyegegwa District. Addressing these issues may require timely communication, workforce strengthening, animal mobile clinics, and cost mitigation. Accurate dog population assessments and tailored community strategies may improve vaccination coverage, offering a foundation for effective rabies prevention in Kyegegwa District and similar resource-limited settings.

Background Women living with HIV (WLHIV) require more frequent cervical cancer screening than HIV negative women. However, uptake of cervical cancer screening services integrated into HIV care at most rural public health facilities in Eastern Uganda is low, below 50%. This is attributed to low cervical cancer screening literacy among rural WLHIV: limited ability to access, understand, and apply cervical cancer screening information. There is a need for evidence-based, context-specific, theory-informed strategies that target multi-level barriers and facilitators of cervical cancer literacy among these women. This study used research evidence, theory, and stakeholder engagement in selecting strategies for improving cervical cancer screening literacy among rural WLHIV. Methods This qualitative study applied research evidence to the Behavior Change Wheel (BCW) and co-design approach. The eight steps of the BCW included: 1) defining the problem in behavioral terms, 2) selecting the target behavior, 3) specifying the target behavior, 4) identifying what needs to change, 5) identifying intervention functions, 6) identifying policy categories, 7) identifying Behavior Change Techniques (BCT), and 8) identifying the mode of delivery. We conducted four parallel co-design sessions with 12 health care providers and 16 rural women at steps 3 and 4 of the BCW. Results We formulated eighteen behavioral targets that were linked to all Capability, Opportunity, and Motivation-Behavior (COM-B) behavioral determinants. Nine behavioral targets were selected under the education, persuasion, enablement, and training intervention functions, as well as the communication/marketing and service provision policy categories. We identified ten most appropriate BCTs and four modes of delivery, which translated into four strategies, namely: 1) trained cervical cancer screening peer educators, 2) cervical cancer screening education video, 3) improved cervical cancer screening IEC charts, and 4) train midwives to prepare small portions of acetic acid for individual patient screening. Conclusions The BCW provided a comprehensive framework that integrated a co-design approach and applied research evidence in selecting context-specific and feasible strategies for improving cervical cancer screening literacy among rural WLHIV. Future research is needed to design and evaluate these strategies.

Background HIV prevalence among female sex workers (FSWs) in high burden countries in sub-Saharan Africa varies between 24 and 72%, however their access to HIV services remains limited. This study explored FSWs’ perspectives of the barriers and opportunities to HIV service access in Uganda. Methods The cross-sectional qualitative study was conducted between October and December 2013. Twenty-four focus group discussions were conducted with 190 FSWs in 12 districts. Data were analysed using manifest content analysis, using Atlas.ti software, based on the socio-ecological model. Results FSWs indicated that HIV services were available and these included condoms, HIV testing and treatment, and management of sexually transmitted infections. However, access to HIV services was affected by several individual, societal, structural, and policy related barriers. Individual level factors included limited awareness of some prevention services, fears, and misconceptions while societal stigma was prominent. Structural and policy level barriers included inconvenient hours of operation of the clinics, inflexible facility based distribution of condoms, interuptions in the supply of condoms and other commodities, and limited package of services with virtually no access to lubricants, HIV pre- and post-exposure prophylaxis, and support following client perpetrated violence. Policies such as partner testing and involvement at antenatal care, and using only one facility for antiretroviral drug refills hindered HIV service uptake and retention in care. FSWs had major concerns with the quality of services especially discrimination and rude remarks from providers, denial or delay of services, and potential for breach of confidentiality. However, some FSWs reported positive experiences including interface with friendly providers and participated in formal and informal FSW groups, which supported them to access health services. Conclusion Despite availability of services, FSWs faced major challenges in access to services. Comprehensive multilevel interventions targeting individual, societal, structural and policy level barriers are required to increase access to HIVservices among FSWs in Uganda. Policy and institutional adjustments should emphasize quality friendly services and expanding the package of services to meet the needs of FSWs.

Background Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators. Conclusions HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.

Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda. Eligible participants were patients aged 35-70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients' symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35-68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter's model of Pathways to Treatment to identify the factors influencing diagnostic delay. We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care. Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.

IntroductionCoronovirus disease 2019 (COVID-19) misinformation has been reported globally and locally. This has the potential to influence public risk perception and reduce the acceptance of the COVID-19 vaccine. This study aims to determine the prevalence of COVID-19 misinformation and vaccine hesitancy in Buikwe district. The study will also pilot a social mobilisation intervention using community influencers and determine its effect on COVID-19 misinformation and vaccine hesitancy.Methods and analysisThe study will be conducted using a quasi-experimental study design, in which two villages will be assigned to the intervention arm and two villages assigned controls. A mixed-methods technique employing both quantitative and qualitative methods will be employed. Data will be collected from healthy men and women aged 18 years and older who reside in the selected villages. The study will be implemented in three phases. First, a baseline study of 12 in-depth interviews with key informants and 6 focus group discussions and a household survey among 632 participants will be done. Second, an intervention employing dialogue-based social mobilisation approach using 10-man community groups per village will be developed and implemented. These will be trained and facilitated to educate and sensitise their communities about COVID-19. Third, an end-line household survey done after 6-months of intervention implementation in the four villages to assess the effect of the intervention on COVID-19 misinformation and vaccine hesitancy. Post-intervention qualitative evaluation will be done after the endline quantitative assessment. Preliminary analysis of the endline quantitative analysis will inform any revisions of the discussion guides. Qualitative data collected will be analysed using thematic content analysis while quantitative data will be analysed using χ2 tests or logistic regression, by intention-to-treat analysis.Ethics and disseminationThe study was reviewed for ethics and approved by the Makerere University School of Health Sciences Research Ethics Committee, reference number MakSHSREC-2020-45 and the Uganda National Council of Science and Technology, reference number HS1140ES. Study finding shall be presented to the district and national COVID-19 task force and at scientific gatherings and published in a peer-reviewed journal.Trial registration numberPACTR202102846261362.