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Background The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. We argue that health care delivery has multiple intersections that are experientially complex, multi-layered and multi-dimensional to the disadvantage of vulnerable population segments of society in the study area. Methods We used a cross-sectional qualitative exploratory design. Qualitative methods facilitated an in-depth exploration and understanding of this island dispersed and peripheral setting. Data sources included a review of relevant literature and an ethnographic exploration of the lived experiences of community members while seeking and accessing health care. Data collection methods included in-depth interviews (IDI) from selected respondents, observation, focus group discussions (FGDs) and key informant interviews (KII). Results We report based on the health care systems model which posits that, health care activities are diverse but interconnected in a complex way. The identified themes are; the role of geography, access (geographical and financial) to health services, demand and utilization, Supplies, staffing and logistical barriers and a permissive and transient society. When and how to travel for care was beyond a matter of having a health need/ being sick and need arising. A motivated workforce is as critical as health facilities themselves in determining healthcare outcomes. Conclusion Geography doesn’t work and affect health outcomes in isolation. Measures that target only individuals will not be adequate to tackle health inequalities because aspects of the collective social group and physical environment may also need to be changed in order to reduce health variations.

Background Country-wide urbanization in Uganda has continued amidst institutional challenges. Previous interventions in the water and sanitation sector have not addressed the underlying issues of a poorly managed urbanization processes. Poor urbanisation is linked to low productivity, urban poverty, unemployment, limited capacity to plan and offer basic services as well as a failure to enforce urban standards. Methods This ethnographic study was carried out in three urban centres of Gulu, Mbarara and Kampala. We explored relationships between urban livelihoods and sustainable urban sanitation, using the economic sociology of urban sanitation framework. This framework locates the urbanization narrative within a complex system entailing demand, supply, access, use and sustainability of slum sanitation. We used both inductive and deductive thematic analysis. Results More than any other city in Uganda, Kampala was plagued with poor sanitation services characterized by a mismatch between demand and the available capacity for service provision. Poor slum sanitation was driven by; the need to escape rural poverty through urban migration, urban governance deficits, corruption and the survival imperative, poor service delivery and lack of capacity, pervasive (urban) informality, lack of standards: ‘to whom it may concern’ attitudes and the normalization of risk as a way of life. Amidst a general lack of affordability, there was a critical lack of public good conscience. Most urbanites were trapped in poverty, whereby economic survival trumped for the need for meeting desirable sanitation standards. Conclusions Providing sustainable urban livelihoods and meeting sanitation demands is nested within sustainable livelihoods. Previous interventions have labored to fix the sanitation problem in slums without considering the drivers of this problem. Sustainable urban livelihoods are critical in reducing slums, improving slum living and curtailing the onset of slumification . Urban authorities need to make urban centres economically vibrant as an integral strategy for attaining better sanitation standards.

Background Schools could play a vital role in mental health care, particularly in low-income countries such as Uganda. An understanding of the prevalence and associated factors of mental health symptoms among school-going adolescents is essential for designing effective school-based interventions in Uganda This is important given Uganda’s regional disparities, where adolescents in post-conflict areas may face higher exposure to trauma and limited access to mental health care compared to those in non-conflict regions. This study aimed to investigate the prevalence rates of depressive and anxiety symptoms among school-going adolescents aged 14 to 17 years in both post-conflict and non-conflict settings. It also examines factors associated with moderate depressive and anxiety symptoms in both settings. Methods In total, 2845 school-going adolescents (1,273 boys; 16.3 ± 1.0 years) were screened using the Patient Health Questionnaire-9 – adolescent version, Generalized Anxiety Disorder-7, and self-report items on food insecurity, health and wealth status, history of childhood abuse and neglect and level of physical activity. Logistic regression models were applied to examine predictors of moderate to severe levels of depression and anxiety symptoms. Results Findings indicate that 67.5% ( n  = 1905) reported at least mild, 34.1% ( n  = 962) at least moderate, 12.7% ( n  = 359) at least moderate-severe and 4.9% ( n  = 138) severe symptoms of depression, while 65.6% ( n  = 1860) at least mild, 27.5% ( n  = 777) at least moderate and 7.8% ( n  = 219) severe symptoms of anxiety. In the multivariable analyses, female sex, food insecurity, poor self-reported health, co-morbid anxiety symptoms, and a history of abuse and neglect were all significantly associated with a higher odds of moderate symptoms of depression, while female sex, living in a post-conflict setting, food insecurity, poor self-reported health, co-morbid depressive symptoms, and a history of abuse were all significantly associated with a higher odds of moderate anxiety symptoms. Conclusions A substantial proportion of school-going adolescents in Uganda report at least moderate symptoms of depression and anxiety. Government and public sector agencies should re-evaluate their strategies at both family and school levels, particularly in underserved settings. Schools can serve as platforms for screening-and-referral pathways and group-based psychosocial programs, while the health system should strengthen capacity for co-occurring conditions.

Introduction Though social networks which are deemed vehicles of community development exist in slum areas, underdevelopment still persists in these areas. We explored the nature and role of social networks in facilitating community development in the slums of Kampala through a sanitation lens. Methods Qualitative Social Network Analysis (SNA) was done to understand the nature of slum social networks primarily through the analysis of sanitation behavior. Data were collected through six Focus Group Discussions (FGD), six In-depth Interviews (IDIs), and 18 Key Informant Interviews (KII) with Government, civil society and private stakeholders. We used both inductive and deductive thematic analysis. Results Four themes emerged in our analysis; i); Unsupportive environments, uncooperative neighbours and uncertainty of tenure : participants reported slums as unsupportive of community development due to a shortage of space, poverty and unplanned services. Tenants perceived landlords as exploitative and predatory and wished the tables are turned. This notion of cyclic exploitation did not encourage collective action for community good. Short-term economic survival trumped long-term community interests ii) Patronage and poor service delivery : varying degrees of patronage led to multiple forms of illegalities and violations such as tax evasion. Due to vested interests and corruption among public officials, the slum population was lethargic. iii) Intersecting realities of poverty and unemployment : slum dwellers lived on the margins daily. Hence, poor living conditions were a secondary concern. iv)  Social relations for personal development : Slum social networks were driven by individual interests rather than community good. Slum dwellers prioritized connections with people of common socio-economic interests. As such social networks were instrumental only if they ‘added value’. Conclusion Social networks in slums are only concerned about survival needs. Slums require responses that address the complexity of slum formation and broader livelihood challenges, as well as re-assessing the meaning of community. We posit that more needs to be done in understanding the meaning and workings of a sociology beyond physical societies. Poverty is a modifier of social systems and processes and should be a concern for all stakeholders involved in slum development.

Despite the United Nations 2030 agenda, large number of both urban and rural dwellers in low-income countries continue to lack access to improved water. Thus, increased effort is required towards enhancing low-cost drinking water treatment technologies especially for developing countries. Slow sand filter (SSF) is one of the most commonly used low-cost and efficient technologies for treating household drinking water. However, effectiveness of SSF is substantially affected by very high turbidity and relatively large amounts of dissolved heavy metals. To enhance removal of both turbidity and heavy metals, this study optimized sand bed depth (SBD) of SSF and investigated the potential of natural zeolite from Uganda for removal of lead, arsenite (As(III)) and fluoride ions from water. To remove lead ions, the zeolite was used in its natural form. However, to remove As(III) and fluoride, the natural zeolite was modified using hexadecyltrimethylammonium bromide solution. Removal of high turbidity was found to require a large optimal SBD. Furthermore, efficiency of treating synthetic turbid water increased with increasing initial turbidity. Variation of final turbidity with SBD was found to be best described by an exponential function. Optimal SBDs on top of an underdrain gravel layer of 0.2 m were 453, 522, 561, and 580 mm for turbidity of 60, 80, 100, and 120 NTU, respectively. Optimized SBD used achieve at least 95% efficiency in removing suspended particles from water with turbidity 120 NTU was found to save up to 35% of the total cost for acquiring sand volume required by a conventional SSF. For a particular zeolite mass, removal efficiencies of lead, As(III) and fluoride generally increased with increasing contact time. Removal efficiencies of lead, As(III), and fluorides were also shown to increase with increasing zeolite mass. Lead removal efficiencies using natural zeolite were 75 and 98% under 20 and 40 min, respectively. Removal of As(III) using modified zeolite mass was 91% within contact time of 10 min. Adsorption of fluoride on modified zeolite was 80% within 5 min. Adsorption of lead, As(III), and fluorides indicated promising potential of natural zeolites from Uganda for treating polluted water.

In refugee generating situations, flight conditions and actual refugee circumstances, Gender Based Violence take different forms like rape, female genital mutilation, physical, psychological and emotional abuse, defilement and bride kidnapping in the name of 'early marriage' and sexual harassment among others. These forms are heightened by the adverse conditions of lack of basic needs, unequal power relations, breakdown of institutions of social control and order, exposure to the dangers of group violence and low capacity of protection agencies both local and international, and the host governments. This study intended to detail refugee experiences of Gender Based Violence among refugees in Uganda as well as the associated factors. We conducted a qualitative study and used content-thematic approach analysis. While there was high GBV awareness; this did not translate into reduced susceptibility. Detection, prevention and response to GBV were curtailed by an intersectionality of unequal power relations, poverty, and a multiplicity of cultures that concealed the nature, extent and reality of GBV. Effective GBV prevention requires an array of interventions and 'capacities' especially access to basic needs for individuals and households. Our findings aver that, gender based violence is endemic in peripheral hard to reach, conflict and post-conflict settings than in more stable communities due to underreporting and concealment that are associated with numerous capacity challenges in access and utilisation of the available services. The extreme conditions that refugees go through during displacement, flight and resettlement tend to exacerbate and sustain GBV.