Contraceptive use among young women of pastoral communities of Karamoja sub-region in Uganda.

Sexual and reproductive health is an important part of general health globally recognised in Sustainable Development Goal (SDG) 3. Access to sexual and reproductive health services such as contraception provides young people with the opportunity to make informed choices regarding reproductive health. However, poor sexual and reproductive health is evident in numerous forms including sexually transmitted infections, unwanted pregnancies and unsafe abortion. In this paper, we examine the experiences of contraceptive use among young women living in pastoral communities. Findings derive from a qualitative contextual analysis of adolescent sexual and reproductive health conducted in the Karamoja sub-region of Uganda. Focus group discussions and in-depth interviews were conducted with married young women aged 15-19. Audio recordings and field notes were taken during interviews. Thematic data analysis was conducted aided by Atlas.ti software. Findings reveal that young women living in pastoralist communities experience challenges which deter their use of contraception. Contraceptive use experiences, socio-cultural values and practices, the attitudes of service providers, and livelihood necessities of pastoralism cause low uptake of contraception. Adequate understanding of the experiences and associated values encountered by such vulnerable and marginalised groups in the use of contraception is critical in addressing the challenge to achieving SDG targets.

Ugandan stakeholder hopes and concerns about gene drive mosquitoes for malaria control: new directions for gene drive risk governance.

BACKGROUND: The African Union's High-Level Panel on Emerging Technologies identified gene drive mosquitoes as a priority technology for malaria elimination. The first field trials are expected in 5-10 years in Uganda, Mali or Burkina Faso. In preparation, regional and international actors are developing risk governance guidelines which will delineate the framework for identifying and evaluating risks. Scientists and bioethicists have called for African stakeholder involvement in these developments, arguing the knowledge and perspectives of those people living in malaria-afflicted countries is currently missing. However, few African stakeholders have been involved to date, leaving a knowledge gap about the local social-cultural as well as ecological context in which gene drive mosquitoes will be tested and deployed. This study investigates and analyses Ugandan stakeholders' hopes and concerns about gene drive mosquitoes for malaria control and explores the new directions needed for risk governance. METHODS: This qualitative study draws on 19 in-depth semi-structured interviews with Ugandan stakeholders in 2019. It explores their hopes for the technology and the risks they believed pertinent. Coding began at a workshop and continued through thematic analysis. RESULTS: Participants' hopes and concerns for gene drive mosquitoes to address malaria fell into three themes: (1) ability of gene drive mosquitoes to prevent malaria infection; (2) impacts of gene drive testing and deployment; and, (3) governance. Stakeholder hopes fell almost exclusively into the first theme while concerns were spread across all three. The study demonstrates that local stakeholders are able and willing to contribute relevant and important knowledge to the development of risk frameworks. CONCLUSIONS: International processes can provide high-level guidelines, but risk decision-making must be grounded in the local context if it is to be robust, meaningful and legitimate. Decisions about whether or not to release gene drive mosquitoes as part of a malaria control programme will need to consider the assessment of both the risks and the benefits of gene drive mosquitoes within a particular social, political, ecological, and technological context. Just as with risks, benefits-and importantly, the conditions that are necessary to realize them-must be identified and debated in Uganda and its neighbouring countries.

Challenging the paradigm: anthropological perspectives on HIV as a chronic disease.

Recently HIV has been framed as a 'manageable' chronic disease in contexts in which access to effective care is reliable. The chronic disease paradigm emphasizes self-care, biomedical disease management, social normalization, and uncertainty. Data from a longitudinal study of patients (N = 949) in HIV care at two sites in Uganda, collected through semistructured interviews and ethnographic data, permit examination of the salience of this model in a high burden, low resource context struggling to achieve the promise of a manageable HIV epidemic. Our data highlight the complexity of the emerging social reality of long-term survival with HIV. Participants struggle to manage stigma as well as to meet the costs involved in care seeking. In these settings, economic vulnerability leads to daily struggles for food and basic services. Reconceptualizing the chronic disease model to accommodate a 'social space,' recognizing this new social reality will better capture the experience of long-term survival with HIV.

Primary school children's perspectives on common diseases and medicines used: implications for school healthcare programmes and priority setting in Uganda.

BACKGROUND: Existing school health programmes in Uganda target children above five years for de-worming, oral hygiene and frequent vaccination of girls of reproductive age. OBJECTIVE: To assess primary school children's perspectives on common diseases they experience and medicines used in order to suggest reforms for school healthcare programmes and priority setting. METHODS: Rapid appraisal approaches, triangulated with a survey, using a semi-structured questionnaire with 80 children aged 8-15 years, were used in data collection. This was done during a three months fieldwork in one primary boarding school in Kampala. An investigation was made into perspectives of children on their recent illness experiences and medicines they used to recover. Other techniques in data collection included participant observation and eliciting children's narratives of diseases they experienced in a two weeks recall. Key informants, who included school teachers, a nurse, 2 paediatricians, 4 matrons and private health service providers in the vicinity of the school, were approached to validate children's narratives. RESULTS: Children named and ranked malaria as the most severe and frequently experienced disease. Other diseases mentioned included diarrhoea, skin fungal infections, flu, and typhoid. The symptoms children recognised in case of illness were high body temperature, vomiting, headache, weakness, appetite loss and diarrhoea. Children were either given medicines by the school nurse or they self-medicated using pharmaceuticals including chloroquine, panadol, flagyl, fansidar, quinine injections, capsules (amoxicillin and ampicillin) obtained from the clinics, drug shops, pharmacies, and other unspecified indigenous medicines from their home and markets. CONCLUSION: The healthcare needs and priorities of children in primary school are infectious diseases which they could readily identify.