Background: The burden of non-communicable diseases including cardiovascular diseases such as heart failure in Africa is rising rapidly, and they are now recognised as a significant cause of morbidity and mortality in the continent. Heart failure causes significant multidimensional impact (physical, social, psychological and spiritual), even with the advent of medicines that offer mortality benefit. Comprehensive care for heart failure must include palliative care that addresses multidimensional needs in line with patient-centered care. However, most research on heart failure in Africa has not explored these multidimensional needs from the patients’ perspective, and palliative care is still seen as being for those with cancer and HIV/AIDS. Aims: To understand the multidimensional experiences, needs, and use of services by patients with heart failure during their disease trajectory. To understand health care professionals’ perceptions of patients’ needs, the care required and the availability of services for patients with advanced heart failure in Uganda. Methods: A total of 48 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer, 8 with bereaved carers), were conducted with 21 patients with stage 3 or 4 heart failure being treated in Mulago Hospital and some of their family carers. Patient interviews were followed by the administration of the African Palliative Care Association African Palliative Outcome Scale supplemented with the broader symptom assessment tool the POS-S. Patients were interviewed during the time of hospitalisation when the researcher first made contact with them, and were followed up monthly by phone. Longitudinal interviews were conducted at 3 and 6 months after the first interview if their clinical condition remained stable, and earlier if there were major concerns or changes in their multidimensional experiences. Eight single interviews were conducted with health professionals (5 doctors, 2 nurses and 1 social worker) involved in the care of the patients. All interviews were audio recorded, and those of the health professionals transcribed verbatim, those of the patients were first translated to English and transcribed and all were exported into QSR Nvivo software version 10 for analysis. Principles from Charmaz’s grounded theory (line by line coding, focused coding, constant comparison and theoretical coding) were employed for analysis. Findings: The patients’ experience was that of learning to live with the unknown in a life dominated by symptoms despite, and because of, treatments. The impact of the various symptoms limited physical performance leading to multiple losses. Presence of a high level of health illiteracy, lack of information on their illness coupled with a high reliance on local cultural beliefs to make health decisions, led to the following: delayed recognition of illness and seeking of care; inappropriate self- care and poor adherence to medications; poor understanding of illness and its prognosis; unrealistic expectations of treatment; and inappropriate choices of where to seek care. Patients were often faced with health system challenges that contributed to late diagnosis and exacerbated the problem of poor adherence to treatment because of lack of medicines and lack of information. The illness impact was also observed in the social, psychological and spiritual domains of patients’ lives causing anxiety and worry, isolation, rejection and stigma, spiritual pain and spiritual growth. Patients expressed the need for normal functioning, information, to be in control and to be facilitated to cope and adapt to the unknown. Patients employed different mechanisms of coping and adaptation, with hope being central in coping as they tried to live with the unknown. Patients suggested changes to the health system and in the conduct of health professionals to improve future care. Health professionals were able to recognise the multidimensional impact of the illness on the patients, but the details of the concerns tended to differ for the patients and health professionals. Health professionals’ proposals on improving care tended to emphasise interventions that would improve physical care as opposed to the other dimensions. Conclusion: This is the first qualitative longitudinal research in Uganda that has explored the experiences of patients with advanced heart failure to gain an understanding of their needs and concerns from their perspective over the course of their illness. Many concerns such as a lack of information, challenges with coping, the symptom experience and its impact on function and the psychological, social and spiritual aspects of their lives are enduring in literature. However, this study also identified other concerns less common in the literature that could have led to a unique illness experience. These included: health system challenges; the impact of culture; beliefs and poverty; and a high level of health illiteracy.

Background: It is widely acknowledged that Uganda was the first country in sub-Saharan Africa to experience a significant decline in HIV seroprevalence in the 1990s. Framed as the initial ‘success story’ in the history of the global HIV/AIDS pandemic, the behavioural mechanisms and policies accounting for the Ugandan HIV decline have been extensively debated over the past 25 years. With reference to broader debates about the role of evidence in policy, this thesis aims to examine contested explanations for the decline in HIV prevalence in Uganda and the role of evidence in the development of global HIV prevention policy in the 1990s. The thesis examines diverse explanations for Uganda’s HIV decline and how these came to be framed in the context of the emergence of Second Generation Surveillance (SGS), a global HIV/AIDS surveillance framework introduced by UNAIDS/WHO in 2000. Official accounts describe SGS as having been developed on the basis of Ugandan behavioural evidence presented during a key meeting of HIV/AIDS policymakers which took place in Nairobi in 1997. This meeting provides a focal point for examining the role of evidence in global HIV prevention policy and the relationship between evidence and policy pertaining to low income countries in the 1990s. Methods: A review of UNAIDS/WHO documents and 29 in-depth interviews with HIV/AIDS experts from Uganda and international organisations were analysed. Results: UNAIDS documents present SGS as a technocratic, problem-solving response to limitations in established HIV surveillance approaches, developed at a UNAIDS-sponsored workshop in Nairobi, Kenya, in 1997. These official accounts present the emergence of SGS as evidence-based and reflecting a clear consensus that developed during the Nairobi workshop. While interview data suggest agreement around the need for improved HIV surveillance systems, they indicate a more complex picture in terms of the extent to which SGS was evidence-based and highlight contested interpretations of this evidence among HIV experts. Findings from interviews suggest that the introduction of SGS by UNAIDS/WHO may be understood as serving both technical and broader strategic purposes. As indicated in UNAIDS/WHO policy documentation, SGS was intended to improve older global HIV surveillance methodologies via the triangulation of multiple data sources. The introduction of SGS also appears to have served two broader purposes, functioning as something akin to a marketing tool to help promote the institutional identity of UNAIDS, while also signalling a shift towards a ‘multisectoral’ approach that aimed to unify epidemiological and social scientific disciplinary approaches. While interviewees’ accounts coincide in describing a decline in HIV prevalence during the 1990s, they present divergent interpretations of this evidence which became significant in the development of SGS. One interpretation focused on a reduction in multiple partnerships within the Ugandan population as the key change driving the decline in HIV prevalence, while a contrasting explanation focused on increased use of condoms as the primary cause of this decline. Interviewees’ accounts suggest a process of competition, whereby different actors sought to secure the primacy of their interpretation in institutional understandings of Uganda’s HIV decline and in the development of SGS. Claims of disciplinary bias and institutional marginalisation appear to have contributed to the subordination of explanations focused on a decline in multiple sexual partners, while the policy entrepreneurship of one key actor appears influential in explaining the ascendency of explanations focused on increased condom use. Despite these contestations around the evidence used to inform the development of SGS, UNAIDS documents and peer-reviewed publications from this period emphasise one interpretation (that of increased condom uptake) which thus appears as the official explanation for the success of HIV control in Uganda. The transition from the WHO’s Global Programme on AIDS (GPA) to UNAIDS, and the initiation of a multisectoral HIV prevention approach, appear as important contextual and institutional influences in the interpretation of evidence for Uganda’s HIV decline. The failure of the partnership reduction explanation to align with the evolving institutional and political orthodoxy, and the potential for this explanation to challenge UNAIDS’ new focus on multisectoral HIV prevention, may help to explain why it did not inform subsequent HIV/AIDS policy and does not appear in official accounts of SGS’s development. In contrast, explanations focused on increased condom use were consistent with UNAIDS’ HIV prevention policy agenda (including its emphasis on multisectoral approaches) and appeared to reinforce the organisation’s need for increased financial resources to mitigate HIV/AIDS via the distribution and promotion of condoms. Discussion: This study demonstrates that the development of SGS, and the politics of evidence supporting its introduction, are more complex than existing UNAIDS/WHO accounts describe. Official explanations of the development of SGS provide a simplistic account of how evidence informed policy in a linear and rational way. In contrast, findings from this thesis suggest that SGS served multiple policy functions (i.e. marketing, promotion of institutional credibility, and a demonstration of disciplinary integration) in the context of the recently-formed UNAIDS, and that the role and interpretation of evidence in this context were highly contested. Consistent with the work of Kingdon (1995) and more recently Stevens (2007), this study suggests that personal, political and institutional factors play important roles in shaping how evidence is presented and linked with policy. These findings suggest that more nuanced understandings of the relationship between evidence and policy are needed to explain HIV/AIDS policy development within both sub-Saharan African and at a global level.

Strict enforcement of copyright in least developed countries like Uganda would negatively affect realisation of the right to education which is both intrinsic and instrumental to realisation of economic development goals including the Millennium Development Goals. The right to education is recognised internationally, regionally and by the Constitution of the Republic of Uganda 1995. Universal access to copyrighted educational materials is needed if education in less developed countries is to serve its purposes. However, to stimulate creation of materials for the future, copyright restricts both access and use of copyrighted materials which negatively affects realisation of the right to education in less developed countries. Unfortunately, exceptions as copyright’s tool for enabling access and use are unclear and narrowly construed. For TRIPS compliance, Uganda enacted the Copyright and Neighbouring Rights Act, 2006 without optimally transposing exceptions. Moreover, under the current international framework, even the most maximalist approach to exceptions would not serve less developed country needs. Accordingly, the Berne Appendix for developing countries, though procedurally complex, should be used. This thesis undertakes a critical comparative analysis of relevant international and national copyright provisions. While referencing legislation from selected countries, Uganda’s commendable fair use provisions are nevertheless not optimal for supporting education for economic development. Various doctrinal issues arise from the exceptions and Uganda’s Berne Union ‘absentee’ status. Pending international reforms, maximally transposing and utilising available exceptions is imperative. Key recommendations include: incorporating the human right to education among fair use factors and joining the Berne Union. Classical utilitarianism is used to justify maximising exceptions within the current international copyright framework to promote quality education. Arguably, maximally transposing and using exceptions to support education is the way to facilitate economic development as the ‘greatest good’ for the world’s greatest number living in poverty in less developed countries in an era of globalisation.

Microfinance has grown from a niche development intervention in the 1990s to one that commands global influence and donor support. By 2006 microfinance had become part of financial sector development policy through the concept of financial inclusion. At the same time theoretical analysis of economic development increasingly focused on the role of institutions and getting institutions right - including for the financial sector – which has given rise to attempts to theorize gradual institutional change. This convergence of policy, and theoretical emphasis on institutions, raises the central question as to what institutions and institutional changes are necessary for the financial sector to effectively serve poor people. The experience of microfinance sector growth over a decade in two countries has been investigated using a ‘micro-ethnographic’ methodology to respond to this question. The research finds that a focus on institutional functions rather than institutional forms aids definitional precision and allows comparability across markets. Social norms underpinned the development of institutional functions, as theories of social embeddedness suggest. These norms also became integrated into institutional functions through the process of change, adding to critiques of externally imposed ‘best practice’ institutional blueprints. Further, beyond the widely accepted institutional functions which the rest of the financial market needs to operate efficiently, this research highlights the importance of a constitutional function (or law) to include poor people in the formal financial system, appropriate supervision for microfinance providers and support for the development of microfinance. Recent theories of institutional change offer insights beyond path dependency in identifying spaces for change and how changes will ‘stick’. However, to better analyse change at the level of particular institutional arenas, greater elaboration is needed of: how to incorporate multiple sets of agents (including external development agents) and multiple institutional functions; appropriate time-frames for analysis and processes of actor engagement.

This is a socio-cultural ethnography in five chapters about motorcycles and lifecycles in post-civil war northern Uganda. People of the Acholi sub-region endured civil war between 1986 and 2006. Many of them anticipate another violent, politically motivated upheaval in Uganda. Drawing on 23 months of field research between 2014 and early 2017, the author focused on ethnic Acholi motorcycle-taxi drivers known as bodabodas to explore how men raised during wartime make a life as internal migrants on their own, contested territory. The bodabodas’ experience as men attempting to fulfill moral responsibilities that preceded them and will also outlast them allowed the author to interrogate movement philosophically and ethnographically and with deeply historical dimensions. Results show the bodabodas’ and their passengers’ multiple uses and ideas of movement and memory as they navigate opportunities and constraints linking rural and urban aspirations and livelihoods in this setting. Specifically, results reveal how, for both men and women, cultural understanding of and claiming a rightful place in a region recovering from war is paradoxically forged not through settlement or rootedness but through continuous transportation as provided by the motorcycle taxis. Moving around is what keeps aspirations of place and destination (literally and figuratively: a home, an education, an office job) in play as both vital and meaningful. It keeps afloat stories of both responsibility fulfillment and personal freedom. The study thus contributes to the anthropology of youth, of internal migration, and of rural and urban transformation in East-Central Africa. The author’s method involved more than 1,000 trips as a passenger. The author interviewed 126 individuals (105 males, 21 females), gathered oral life histories, conducted mapping exercises, and drew on archival materials in the Uganda National Archives and Gulu District Archives. With native speakers of the Acholi language, the author translated poems, songs, proverbs, and folktales of relevance to migration, livelihoods, and cultural understandings of “home and away” in this tumultuous region. A key source for historical change comparisons were the 1950s-era ethnographic fieldnotes of anthropologist Paula Hirsch Foster at Boston University’s African Studies Library. / 2021-02-05T00:00:00Z

Poverty and disease are bound together in rural communities of sub-Saharan Africa (SSA) exacerbated by weak social services and conflict. The infectious disease burden in SSA combines the neglected tropical diseases (NTDs) and the 'big three' (malaria, HIV/AIDS and tuberculosis), so-called because they attract more global attention and hence funding. NTDs include human African trypanosomiasis (HAT or sleeping sickness), first noticed by the outside world during the slave trade era and later in the 2-th century by widespread epidemics of disease across the tsetse fly belt. HAT describes two diseases: i) Gambian HAT caused by Trypanosoma brucei gambiense is characteristically chronic with an infectious period lasting up to three years and ii) Rhodesian HAT caused by T.b. rhodesiense is an acute disease, killing its victim within weeks of infection. The two diseases are frequently considered together as both are transmitted by tsetse flies, the parasites are morphologically indistinguishable and the associated diseases are both fatal if left untreated. However, the two diseases are clinical, epidemiologically and geographical distinct, each requiring different control strategies. Under field conditions, where microscopy is the basic diagnostic tool, differentiation is simply by geographical location of the patient; the Great Rift Valley separates the Gambian disease present in West and Central Africa, from East and southern Africa's Rhodesian disease. Control strategies are also distinct; while the Belgian and French colonial strategies to control the disease were patient-centred, the British colonial powers in East Africa were motivated by the effect of tsetse borne diseases on animal health. Towards the end of the colonial ear, both types of disease were heading for elimination but during the immediate post-colonial era in the 1960s, political instability compromised the rigid HAT control programs that had been put in place. For zoonotic Rhodesian sleeping sickness, complex tsetse control programmes proved difficult to maintain and to justify economically; for Gambian sleeping sickness the generalised breakdown of medical services allowed the disease to return, sometimes to devastating levels. The millennium development goals (MDGs) set out in 2000, highlighted specific challenges and opportunities for national and global development. HAT impacts national health goals of national development plans and MDGs and impedes rural development of SSA. NTDs were not addressed directly by MDGs but the World Health Organization (WHO) has reaffirmed its commitment not only to control of HAT but also to eliminate it as a public health problem by 2020. Currently there are 25 countries reporting HAT to WHO, and while the overall prevalence of HAT across Africa continues to fall, epidemics have been recorded, particularly from central Africa, South Sudan and Uganda. Uganda is uniquely, the only country affected by both T.b. gambiense and T.b. rhodesiense and until the present study, there was no evidence to suggest that the two parasite species co-existed in Uganda. The development of a new control paradigm for T.b. rhodesiese in South East Uganda has lowered the incidence of human infections and, more importantly, halted the northerly spread of this parasite. However, recurring epidemics in several established and new disease foci in central Uganda highlight the difficulties involved in eliminating this disease. The present study assesses past and present HAT control strategies centred on Dokolo, Kaberamaido and Soroti Districts located at the centre of Uganda. These districts are highly endemic for T.b. rodesiense, they represent the region of concern for overlap with T.b. gambiense foci in central Uganda, and are the current focus of the Stamp out Sleeping sickness control initiative. The point prevalence of T. brucei s.1 in cattle reservoir from villages with (out) reported human disease located at specific distances to Otuboi, Chagwere and Ochero cattle markets, was evaluated before and six months after trypanocidal treatment, to assess the transferrable impact of zoonotic T.b. rhodesiense to the human population. Overall, the proportion of T. brucei s.1 in cattle dropped significantly from 22% at baseline to 9% six months after trypanocide treatment (P < 0.05, Chi-square + 17.92, 95% C.I. + 1.71 to 4.49). All villages located in sub-counties that received at least 80% treatment coverage had a drop in T. brucei s.1 prevalence from 30.4% (95%, C.I + 22.8 to 38.0) before treatment was done, to 12.9% (95%, C.I. + 7.4 to 18.4) six months after treatment. More specifically, impact on human infective T.b. rhodesiense was also halved. In fact only three cattle were detected with the parasite six months after treatment compared with six from those sampled as baseline. This study also utilises documented cases between 2009 and 2012 to assess the current HAT reporting system for monitoring and evaluating transmission dynamics of the disease. Using a questionnaire, capacity and preparedness of healthcare professionals to respond to disease epidemics was assessed. The point prevalence of sleeping sickness in the three districts in 2009 was determined by screening volunteers. Microscopic examinations detected trypanosomes in four volunteers (4/5311 or 0.075 %) while PCR detected significantly more infections (24, p < 0.001). Multiplex PCR showed that ten of the Trypanozoon infections were T.b. rhodesiense while nested PCR identified four infections as T.b. gamiense, indicating that the distribution of the two forms of sleeping sickness overlaps in Uganda. Second phase investigations followed up the PCR positive cases; these people were screened again, together with members of their homestead and the inhabitants of three neighbouring homes. Besides microscopy and PCR, study subjects were examined clinically for sleeping sickness and completed a questionnaire to assess community recognition of the disease. This extended screen revealed no new cases underlining the importance of stringent early screening that PCR techniques can provide. At local healthcare centres, 54% of reported sleeping sickness cases were diagnosed only at the late stage, indicating a weakness in early diagnosis and hence early reporting. Interviews with local health workers also revealed weaknesses in recognition of clinical signs and a gap in diagnostic capacity. While records at treating hospitals remain a useful indicator for targeting active foci of infection, improvement in capacity to diagnose HAT at an early stage should contribute both to rural health and disease control strategies and also towards WHO's 2020 target of elimination of HAT.

No description available.

<p>Handels- och biståndsförhållandet mellan Uganda och Sverige har undersökts i syfte att tareda på hur utvecklingen har sett ut under frihandelsavtalet Everything But Arms. Avtalet harvarit aktivt sedan 2001 och resulterat i tullfrihet av alla varor förutom vapen och ammunitionför Ugandas handel med EU. Innan avtalets sattes igång var Ugandas handel med Sverigeojämn, det är den även idag efter ca åtta år av en global frihandel. Handelsstatistiken dessaländer emellan tyder på en stor export vinst för Sveriges del. Genom Everything But Armsavtaletstullfrihet anser EU och FN att ett MUL-land som Uganda kommer att kunnakonkurrera på världsmarknaden. EBA-avtalets målsättning är tydlig och menar att frihandelnkommer leda till att Uganda ökar sin export och därmed ta större plats på världsmarknaden. Igranskandet av förhållandet Uganda-Sverige utgjorde slutsatsen att EBA-avtalet inte har nåttupp till sin målsättning.EBA-avtalet har varit aktivt i snart åtta år och det svenska biståndet som ges till Uganda ärungefär 30 gånger större än Ugandas svenska exportintäkter. Ugandas sociala ochdemokratiska förhållanden i landet är den största faktorn som bromsar upp utvecklingen ochdärför är landet fortfarande beroende av utländskt bistånd. Det svenska biståndet går därförfrämst till demokratiska, humanitära och fattigdomsbekämpande insatser. Utan att kunnaförsäkra den sociala stabiliteten hos den ugandiska befolkningen kan inte handelsutvecklingenprioriteras. Uganda kan idag inte öka konkurrensen på världsmarknaden genom ett avtal omtullfrihet. De måste först uppnå acceptabla sociala, politiska och demokratiska nivåer i landetför att handeln ska kunna utvecklas och därmed i sin tur kunna konkurrera påvärldsmarknaden.</p>

<p>Recurrent crises of food insecurity and poverty are widespread in sub-Saharan Africa (SSA). There is an urgent need to increase food production so as to reduce bad nutrition and alleviate poverty. The availability and management of water contributes crucially to the variation in yields. Since the majority of farmers in SSA practice rain-fed agriculture under adverse climatic conditions, it is crucial to use water-conserving technologies systematically and make rainwater management an integral part of land use and crop management. While rainwater harvesting technologies (RHT) can increase productivity of rain-fed agriculture significantly at reasonable costs, successful adoption of RHT and accompanying high yields still remain primarily at family level and/or in geographical ‘pockets’. The big question is ‘why have farmers not widely adopted these apparently cheap and beneficial practices?’ An adequate understanding of the factors that lead some farmers to adopt RHT, characteristics of households that use RHT as well as technology transfer approaches offer valuable insights. Based on focus group discussions and a questionnaire survey covering adopters and non-adopters of RHT, and interviews with extension officers conducted in two banana growing districts in Uganda, this paper reveals circumstances, incentives, and support that would facilitate widespread adoption of RHT.</p>

<p><!--[if !mso]> <object classid="clsid:38481807-CA0E-42D2-BF39-B33AF135CC4D" id=ieooui></object><mce:style><! st1\:*{behavior:url(#ieooui) } --></p><p>Hydrological investigations were performed in the Lubigi papyrus wetland in suburban Kampala, Uganda, impacted by human encroachment for settlement and agriculture. The first aim was to investigate the water flow variations and the dampening effect of the wetland. A second aim was to estimate the effective wetland volume and area, and relate this to the wetland function for treatment of the suburban runoff. A study site with well defined inflows and outflows was chosen, and three transects were cut through the papyrus to be able to study the water movement beneath the floating papyrus mat. Water flow measurements showed a flow dampening effect of the wetland on peak flows after rains, and the water balance revealed that the precipitation on the wetland was only 4 % of the inflow during the study. The tracer added at the inlet was rapidly detected downstream in the canal in the middle of the wetland, indicating a strong short-circuiting effect of the human made canal. At the outlet the tracer concentration was lower than the detection limit, suggesting a good mixing in the downstream part of the wetland, which was also supported by other water quality measurements in the transects. Ammonium-N concentrations at the inflow and outflow indicated a net export of ammonium-N, but the observed flow variations suggest that intensive water sampling campaigns are necessary for a proper evaluation of the water treatment function. The calculated effective volume and area amounted to 74 and 46 %, respectively, of the theoretically estimated, with a corresponding loss in the flow dampening and water treatment function of the wetland.</p><p> </p> / Rapporten är ett resultat av ett Minor Field Study stipendium finansierad av Sida.